Diet Quality and Sarcopenia in Older Adults: A Systematic Review

Dietary characteristics of urban community-dwelling older adults with low muscle mass: the bunkyo health study: a cross-sectional study

BACKGROUND

With the aging of the population worldwide, extending healthy life expectancy is an urgent issue. Muscle mass has been reported to be associated with physical independence and longevity. This study aimed to investigate the characteristics of food intake in urban community-dwelling older adults with low muscle mass.

METHODS

This cross-sectional study used baseline data from the Bunkyo Health Study, which included 1618 urban community-dwelling older adults aged 65-84 years. All participants underwent measurement of body composition using bioelectrical impedance analysis and evaluation of nutrient and food intake using the brief-type self-administered diet history questionnaire. Participants were stratified by sex and divided into robust or low skeletal muscle mass index (SMI) groups according to the Asian Working Group for Sarcopenia criteria to compare differences in nutrient and food intake.

RESULTS

The mean age and body mass index were 73.1 ± 5.4 years and 22.6 ± 3.1 kg/m2, respectively. The prevalence of low SMI was 31.1% in men and 43.3% in women. In men, all food intake, including total energy intake, was similar between the low SMI group and the robust group. In women, the low SMI group had less total energy intake, and consumed lower amounts of energy-producing nutrients (protein, fat, and carbohydrates), but there were only small differences in the intake of specific foods.

CONCLUSIONS

There were sex differences in food intake characteristics between urban community-dwelling older adults with low SMI and those who were robust. Advising women to increase their energy intake may be important in preventing muscle loss, and further research is needed in men.

Exploring the complex associations among risks of malnutrition, sarcopenia, and frailty in community-dwelling older adults

BACKGROUND

Malnutrition, sarcopenia, and frailty are age-related conditions that are associated with multiple health-related negative outcomes. However, the complex associations between them remain to be elucidated. The aims of the study were to explore: (1) whether the risk of sarcopenia has a mediator effect on the association between risks of malnutrition and frailty; and (2) whether physical activity (PA) level modulates this mediator effect in community-dwelling older adults.

METHODS

This cross-sectional study involved 593 older adults (62.73% female; mean age = 71.35 ± 5.86 years). The Mini Nutritional Assessment-Short Form (MNA-SF), the SARC-F Questionnaire, and the FRAIL Questionnaire were used to assess the risks of malnutrition, sarcopenia, and frailty, respectively. The International Physical Activity Questionnaire Short Form (IPAQ-SF) was employed to assess PA level. Using the Hayes PROCESS macro (Models 4 and 7), mediation and moderated mediation analyses were performed.

RESULTS

The mediation analysis demonstrated that the MNA-SF had a significant effect on the SARC-F (B=-0.325; p < 0.001) and the SARC-F, in turn, had a significant effect on the FRAIL (B = 0.341; p < 0.001). The total (B=-0.171; p < 0.001), direct (B=-0.061; p = 0.001), and indirect (B=-0.111; bootstrap CI did not include zero, which indicates a significant effect) effects of MNA-SF on FRAIL were significant, showing that 65% of the association between the MNA-SF and FRAIL was explained by the SARC-F acting as a mediator. The moderated mediation analysis demonstrated that the association between MNA and SARC-F was moderated by the PA level (B = 0.253; p = 0.016). The SARC-F mediated and relatively enhanced the association between MNA-SF and FRAIL only in older adults with a moderate PA level (B=-0.120; CI: -0.154 to -0.085).

CONCLUSIONS

The SARC-F partially mediates the association between the MNA-SF and the FRAIL, indicating that malnutrition affects frailty through an indirect path via sarcopenia. Furthermore, the PA level moderates this mediator effect, with sarcopenia serving as a mediator in older adults with moderate a PA level but not in those with a low PA level. These findings reveal that it may be beneficial to consider PA level in combination with malnutrition and sarcopenia in the management and prevention of frailty in community-dwelling older adults.

CT-derived body composition and differential association with age, TNM stage and systemic inflammation in patients with colon cancer

Low skeletal muscle index/density (SMI/SMD) is prevalent in cancer, adversely prognostic and associated with tumour stage and the systemic inflammatory response (SIR). Age and SMI/SMD has not been widely studied. The present study analyses the association between age and SMI/SMD after adjustment for other clinicopathological factors. Patients undergoing resectional surgery for TNM Stage I-III disease within the West of Scotland between 2011 and 2014 were identified. A single CT slice was obtained from each patients staging CT scan. SMI and SMD were stratified normal/abnormal. The SIR was stratified using Systemic Inflammatory Grade (SIG). When stratified by age (< 50/50s/60s/70s/80+), 39%/38%/48%/62%/74% and 27%/48%/64%/82%/92% of patients had a low SMI and SMD respectively (both p < 0.001). Older age (OR 1.47, p < 0.001), female sex (OR 1.32, p = 0.032), lower socioeconomic deprivation (OR 1.15, p = 0.004), higher ASA (OR 1.30, p = 0.019), emergency presentation (OR 1.82, p = 0.003), lower BMI (OR 0.67, p < 0.002) and higher SIG (OR 1.23, p < 0.001) were independently associated with low SMI. Older age (OR 2.28, p < 0.001), female sex (OR 1.38, p = 0.038), higher ASA (OR 1.92, p < 0.001), emergency presentation (OR 1.71, p = 0.023), and higher SIG (OR 1.37, p < 0.001) were independently associated with lower SMD. Tumour factors were not independently associated with either SMI/SMD. Age was a major factor associated with low SMI/SMD in patients with colon cancer. Therefore, in these patients it is likely that this represents largely constitutional body composition as opposed to being a disease mediated effect. Adjustment for age is required when considering the cancer mediated effect on SMI/SMD in patients with colon cancer.

Dietary inflammatory index could increase the risk of sarcopenia in patients with chronic kidney disease

Using a system that incorporates a variety of food items rather than focusing on individual components can aid in assessing the inflammatory effects of a diet on disease outcomes such as chronic kidney disease (CKD). Therefore, we decided to investigate the association between dietary inflammatory index (DII) and the risk of protein-energy wasting (PEW) and sarcopenia in patients with CKD. In this cross-sectional study, 109 patients with CKD were selected from two clinics in Shiraz, Iran. The intake of individuals' diets was recorded using a validated 168-item food frequency questionnaire. Additionally, Asian Working Group for Sarcopenia (AWGS) guidelines were utilized to evaluate muscles' strength, mass, and function. Also, four International Society of Renal Nutrition and Metabolism (ISRNM) criteria (body mass index, intake of protein, albumin, and urine creatinine) were used  to diagnose PEW. Logistic regression was used to assess the association between DII and sarcopenia as well as PEW. The results showed that the intake of saturated fatty acids, trans fatty acids, niacin, beta-carotene, and vitamin C was significantly different between lower and higher DII groups. In the univariate model, higher odds of sarcopenia was observed by each unit increase in DII (odds ratio (OR) = 1.379, 95% confidence interval (CI): 1.042-1.824) and age (OR = 1.073, 95% CI: 1.017-1.132). Additionally, in the multivariate model, the association between DII and age with odds of sarcopenia remained significant (DII: OR = 1.379, 95% CI: 1.030-1.846 and age: OR = 1.063, 95% CI: 1.007-1.121). The current study suggests the possible role of pro-inflammatory foods in worsening muscle health, specifically sarcopenia, in CKD patients. Future longitudinal studies may reveal the causative nature of these correlations.

Omega-3 polyunsatured fatty acids and physical performance across the lifespan: a narrative review

Background and Aims

Physical performance is a major contributor of mobility and independence during older life. Despite a progressive decline in musculoskeletal function starts from middle age, several factors acting during the life-course can negatively influence musculoskeletal functional capacities. Lifestyle interventions incorporating nutrition and physical exercise can help maximizing the muscle functional capacities in early life as well as preserving them later in life. Among various dietary compounds, omega-3 polyunsaturated fatty acids (PUFAs) are gaining growing attention for their potential effects on muscle membrane composition and muscle function. Indeed, several pathways are enhanced, such as an attenuation of pro-inflammatory oxidative stress, mitochondrial function, activation of the mammalian target of rapamycin (mTOR) signaling and reduction of insulin resistance.

Methods

We performed a narrative review to explore the existing literature on the relationship between omega-3 PUFAs and physical performance across the life-course.

Results

Growing evidence from randomized controlled trials (RCTs) suggests beneficial effects of omega-3 PUFAs on muscle function, including physical performance parameters in mid to later life. On the other hand, despite a direct association in early life is not available in literature, some mechanisms by which omega-3 PUFAs may contribute to improved adult physical performance could be hypothesized.

Conclusion

Omega-3 PUFAs are gaining growing attention for their positive effect on muscle function parameters. The integration of physical function measures in future studies would be of great interest to explore whether omega-3 PUFAs could contribute to improved muscle function, starting from early life and extending throughout the lifespan. However, larger and high-quality RCTs are needed to fully elucidate the beneficial effects of omega-3 PUFAs supplementation on muscle mass and function.

Effects of a Yoga Program Combined with a Mediterranean Diet on Nutritional Status and Functional Capacity in Community-Dwelling Older Adults: A Randomized Controlled Clinical Trial

(1) Background: With the aging population, effective interventions are needed to enhance the health of older adults. This study investigated the combined effects of yoga and the Mediterranean diet on various health outcomes in community-dwelling older adults; (2) Methods: The study employed a randomized controlled trial design with a total of 116 older adults randomized to an experimental group (n = 57) that underwent a combined yoga and Mediterranean diet program and a control group (n = 59) that did not receive any intervention. Nutritional status was assessed using the Mini Nutritional Assessment, flexibility with the Back Scratch Test and the Chair Sit-and-Reach Test, balance, gait, and fall risk with the Tinetti Scale, and muscle strength with a dynamometer and the 30 s Chair Stand Test; (3) Results: Regarding nutritional status, there were significant differences between the experimental group and the control group (Cohen's d = 0.02). The participants in the experimental group showed greater balance (11.12 ± 3.01 vs. 10.03 ± 2.35, Cohen's d = 0.41 and gait (7.63 ± 1.96 vs. 6.69 ± 2.50, Cohen's d = 0.44) with respect to the control group. In terms of flexibility, the experimental group showed statistically significant improvements in the right arm (Cohen's d = 0.43), left arm (Cohen's d = 0.64), right perineum (Cohen's d = 0.42), and left leg (Cohen's d = 0.37) Finally, in terms of strength, participants in the experimental group experienced statistically significant improvements in grip strength and lower body strength (Cohen's d = 0.39 and 0.81, respectively); (4) Conclusions: The study highlights the potential benefits of a 12-week intervention combining yoga with a Mediterranean diet to improve the health and functional capacities of community-dwelling older adults.

E-PROOF: E-intervention for protein intake and resistance training to optimize function: A study protocol

BACKGROUND

Accounting for more than 60% of cancer survivors, older (≥65 years) cancer survivors have a 2- to 5-fold risk of physical function impairment, compared to cancer-free peers. One strategy to improve physical function is dietary and resistance training interventions, which improve muscle strength and mass by stimulating muscle protein synthesis. The E-PROOF (E-intervention for Protein Intake and Resistance Training to Optimize Function) study will examine the feasibility, acceptability, and preliminary efficacy of a 12-week randomized controlled trial of an online, tailored nutritional and resistance training education and counseling intervention to improve physical function and associated health outcomes (muscle strength, health-related quality of life (HRQoL), self-efficacy, and weight management).

METHODS

In this study, 70 older cancer survivors will be randomized to one of two groups: experimental (receiving remote behavioral counseling and evidence-based education and resources), and control (general survivorship education). We will examine the intervention effects on physical function, muscle strength, HRQoL, self-efficacy, weight, and waist circumference during a 12-week period between the experimental and control groups. Three months following the end of the intervention, we will conduct a follow-up assessment to measure physical function, muscle strength, and HRQoL.

SIGNIFICANCE AND IMPACT

This study is the first synchronous, online protein-focused diet and resistance training intervention among older cancer survivors. This novel study advances science by promoting independent health behaviors among older cancer survivors to improve health outcomes, and provide foundational knowledge to further address this growing problem on a wider scale through online platforms.

Effects of oral oligopeptide preparation and exercise intervention in older people with sarcopenia: a randomized controlled trial

BACKGROUND

Nutrition and exercise are important interventions for sarcopenia. There were few studies on oral oligopeptide nutrition preparations combined with exercise to intervene in the older people with sarcopenia. The aim of this study was to verify the effectiveness of oligopeptide nutrition preparation combined with exercise intervention on the older people with sarcopenia in community.

METHODS

A total of 219 subjects aged 65 years or older with sarcopenia were randomly divided into 4 groups. The nutrition group (n = 58) was given individualized nutrition education and oral oligopeptide nutrition preparation. The exercise group (n = 50) received exercise intervention. The combined group (n = 52) received both oral nutrition preparation and exercise interventions. The control group (n = 59) only received individualized nutrition education. The nutrition preparation can provide energy 185kcal and protein 24.2g per day. The exercise intervention including warm-up exercise, resistance exercise and aerobic exercise, the training time was 60min for 5 times every week. The intervention lasted for 16 weeks. Hand grip strength, gait speed, body composition and hematology parameters were measured before and after intervention.

RESULTS

A total of 159 subjects completed the study. Compared with baseline, the left grip strength and 6-m walking speed of the subjects in nutrition group increased significantly after the intervention, and the grip strength of both hands in exercise group and combined group increased significantly. The body weight of the subjects in nutrition group, exercise group and combined group increased significantly after intervention, but no increase in soft lean mass (SLM) and skeletal muscle mass (SMM) was observed in any of the four groups. The fat-free mass (FFM) of the legs of the control group, exercise group and nutrition group decreased after intervention, and only the FFM of the legs of the combined group maintained the level before the intervention.

CONCLUSION

Both oral peptide nutrition and exercise interventions can improve the muscle strength or function of the older people with sarcopenia. However, there were no increases in muscle mass observed.

TRIAL REGISTRATION

ChiCTR, ChiCTR2100052135. Registered 20 October 2021, https://www.chictr.org.cn/showproj.html?proj=135743.

The impact of income level on skeletal muscle health in rural Chinese older residents: a study of mediating effects based on dietary knowledge

China's rural residents have basically solved the problem of subsistence, but due to aging, the prevalence of sarcopenia (abbreviated as sarcopenia) has been increasing year by year, especially the skeletal muscle health of the rural older residents has not been sufficiently paid attention to, so analyses of the impact of income level on the skeletal muscle health of the older people in rural areas of China are of great practical significance. Based on the annual data of the China Health and Nutrition Survey (CHNS) in 2006, 2009, and 2011, we introduced the mediator variable of dietary knowledge and used the Probit model regression, mediation effect model, and instrumental variable regression to assess the skeletal muscle health status of the rural older people in China and explore the mechanism of the influence of the income level on the skeletal muscle health of the rural older residents in China. The primary objectives of this study were to evaluate the impact of income level on the skeletal muscle health status of older adults living in rural areas of China and to investigate the underlying mechanisms. By analyzing the findings of this study, our aim is to establish a correlation between the economic status and skeletal muscle health of older adults in rural communities, as well as elucidate the influence of income level and dietary knowledge on their skeletal muscle health. Through the attainment of these objectives, we hope to provide valuable insights and recommendations for enhancing skeletal muscle health among the rural older population in China. Based on our research findings, it can be inferred that there was a significant association between the financial status of rural older adults and their skeletal muscle health. Additionally, the prevalence of sarcopenia was lower among individuals with higher income levels, and there was a negative correlation between the prevalence of sarcopenia and the level of dietary knowledge among rural older individuals. The knowledge of dietary knowledge level of rural older people plays a mediating role in the income level and the prevalence of sarcopenia. Moreover, with the change in income level and the increase in age, the change in skeletal muscle health status showed obvious heterogeneity, in which the effect on the relatively younger (65-70 years old) samples was greater. Therefore, sustained income growth remains an effective way to improve the skeletal muscle health of older rural residents. At the same time, improving dietary knowledge and dietary quality among the older people is important in preventing a decline in muscle strength and physical function and in preventing the onset of sarcopenia.

Diet quality is associated with adipose tissue and muscle mass: the Coronary Artery Risk Development in Young Adults (CARDIA) study

BACKGROUND

Aging is associated with changes in body composition, and preventing loss of muscle mass and accumulation of excess adipose tissue in middle-aged adults may reduce age-related conditions at older ages. Dietary intake is one lifestyle factor shown to improve or maintain body composition. However, few studies have examined the Healthy Eating Index2015 (HEI2015), a measure of diet quality, and the association with body composition in adult men and women.

METHODS

Participant data (n = 3017) from the Coronary Artery Risk Development in Young Adults (CARDIA) study were used to examine the associations of the HEI2015 with body composition measures at Year 25 (Y25), including (1) 25 year-change in weight, body mass index (BMI), and waist circumference and (2) a computed tomography (CT) scan at Y25 measured muscle mass, muscle quality (better quality = less lipid within the muscle), and adipose tissue depots visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and adipose within skeletal muscle (intermuscular adipose tissue; IMAT). Dietary intake was assessed by a diet history three times over 20 years, at years 0, 7, and 20. HEI2015, averaged over three exams, was created and categorized into quintiles. Multiple regression analysis evaluated the associations of body composition stratified across quintiles of HEI2015 adjusted for demographic characteristics, energy intake, lifestyle factors, and baseline anthropometric measures as appropriate. Race-sex interaction was tested (Pinteraction  > 0.30).

RESULTS

Over 25 years of follow-up, averaged HEI2015 was significantly and inversely associated with weight gain (Quintile 1 (Q1) 37.3 lb vs. 32.9 in Q5; Ptrend  = 0.01), change in BMI (Q1 5.8 kg/m2 vs. 5.0 in Q5; Ptrend  = 0.005), and change in waist circumference (Q1 17.5 cm vs. 15.2 cm in Q5; Ptrend  < 0.001). By Y25, HEI2015 was inversely associated with VAT Q1 136.8 cm3 vs. 116.6 in Q5; Ptrend  < 0.001) and IMAT volumes (Q1 9.52 vs. 8.12 cm3 in Q5; Ptrend  < 0.001). Although total muscle volume declined (Ptrend  = 0.03), lean muscle mass volume was similar across quintiles (Ptrend  = 0.55). The IMAT/total muscle mass ratio declined across HEI2015 quintiles (Ptrend  < 0.001). Finally, higher HEI2015 was associated with better muscle quality at Y25 (higher value = less lipid within the muscle; Q1 41.1 vs. 42.2 HU in Q5; Ptrend  = 0.002). HEI2015 was nonlinearly, but inversely, associated with SAT (nonlinear P = 0.011).

CONCLUSIONS

Improving diet quality in young to middle-aged adults is a recommended strategy to promote better measures of body composition. Our study findings suggest that healthier food choices may influence body composition.

Imaging of Sarcopenia in Type 2 Diabetes Mellitus

Sarcopenia is an age-related condition characterized by the loss of skeletal muscle mass, muscular strength, and muscle function. In older adults, type 2 diabetes mellitus (T2DM) constitutes a significant health burden. Skeletal muscle damage and deterioration have emerged as novel chronic complications in patients with diabetes, often linked to their increased longevity. Diabetic sarcopenia has been associated with increased rates of hospitalization, cardiovascular events, and mortality. Nevertheless, effectively managing metabolic disorders in patients with T2DM through appropriate therapeutic interventions could potentially mitigate the risk of sarcopenia. Utilizing imaging technologies holds substantial clinical significance in the early detection of skeletal muscle mass alterations associated with sarcopenia. Such detection is pivotal for arresting disease progression and preserving patients' quality of life. These imaging modalities offer reproducible and consistent patterns over time, as they all provide varying degrees of quantitative data. This review primarily delves into the application of dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasound for both qualitative and quantitative assessments of muscle mass in patients with T2DM. It also juxtaposes the merits and limitations of these four techniques. By understanding the nuances of each method, clinicians can discern how best to apply them in diverse clinical scenarios.

Mango Consumption Was Associated with Higher Nutrient Intake and Diet Quality in Women of Childbearing Age and Older Adults

Nutritional equity has been recognized as a priority in nutrition research, as reiterated by the new life-stage approach utilized by the Dietary Guidelines for Americans. Two of the life stages focused on are pregnant and lactating females as well as older adults, due to their unique nutritional needs and unique chronic health conditions. Both groups have low intakes of several nutrients, including those of public health concern, and suboptimal diet quality, underlining the importance to improve their dietary intakes. Incorporating fruit into their diets could help alleviate these gaps. Thus, the objective of the current study is to expand upon our current knowledge of the benefits of fruit within these two subgroups that DGA guidelines focus on and determine nutrient and food group intake as well as diet quality in women of childbearing age (WCA; as a proxy for pregnant and/or lactating females, n = 16,774) and older adult (n = 18,784) mango consumers compared with non-consumers, using NHANES 1988-1994 and 1999-2018. Both WCA and older adult mango consumers had greater than 20% higher intakes of fiber and vitamin C and WCA consumers had upwards of 10% higher folate, magnesium, and potassium intakes compared with non-consumers. Both groups of consumers had lower intake of saturated fat and older adults had lower intakes of protein and vitamin B12. Diet quality was 16 and 13% higher in WCA and older adult consumers compared with non-consumers, respectively. Additionally, mango consumers had lower beef, poultry, fish, and solid fat intakes and WCA consumers had higher whole grain intakes compared with non-consumers. This study suggests incorporating mango into the diet could increase select nutrient intake as well as diet quality in specific life stages of adult Americans.

Association of dietary fat intake with skeletal muscle mass and muscle strength in adults aged 20-59: NHANES 2011-2014

Background

Sarcopenia, a progressive loss of skeletal muscle mass and strength, needs to initially prevent in the twenties. Meanwhile, there is a lack of research on the effects of fat consumption on skeletal muscle mass and strength in adults aged 20-59. We aimed to assess associations between dietary fat intake and skeletal muscle mass, as measured by appendicular lean mass adjusted for body mass index (ALMBMI), and muscle strength, as represented by handgrip strength adjusted for body mass index (GSMAXBMI), among adults aged 20-59.

Methods

Dietary fat intake per kilogram of actual body weight was assessed using two 24h recalls, while ALM and GSMAX were measured using DXA and a handgrip dynamometer, respectively. A weighted multiple linear regression model was employed to analyze the association between dietary fat intake and skeletal muscle mass, utilizing data from the National Health and Nutrition Examination Survey spanning from 2011 to 2014. To assess the non-linear relationship and saturation value between dietary fat intake and skeletal muscle mass, a smooth curve fitting approach and a saturation effect analysis model were utilized.

Results

The study comprised a total of 5356 subjects. After adjusting for confounding factors, there was a positive association observed between dietary fat intake and ALMBMI as well as GSMAXBMI. The relationship between dietary fat intake and ALMBMI showed an inverted U-shaped curve, as did the association with GSMAXBMI. Turning points were observed at 1.88 g/kg/d for total fat intake and ALMBMI, as well as at 1.64 g/kg/d for total fat intake and GSMAXBMI. Furthermore, turning points were still evident when stratifying by gender, age, protein intake, and physical activity. The turning points were lower in individuals with low protein intake(<0.8 g/kg/d) and high levels of physical activity.

Conclusion

The moderate dietary fat intake can be beneficial for muscle mass and strength in adults aged 20-59 under specific conditions. Special attention should be directed toward the consumption of fats in individuals with low protein intake and those engaged in high levels of physical activity.

Association Between Dietary Fiber Intake and Low Muscle Strength Among Korean Adults

The health benefits of dietary fiber are widely recognized, but its impact on muscle health remains unclear. Therefore, this study aimed to elucidate the relationship between dietary fiber intake and muscle strength through a cross-sectional analysis of data from the Korea National Health and Examination Survey (KNHANES). Data from a single 24-h dietary recall and handgrip strength tests of 10,883 younger adults aged 19 to 64 years and 3,961 older adults aged ≥ 65 years were analyzed. Low muscle strength was defined as handgrip strength < 28 kg for men and < 18 kg for women. Multivariable linear and logistic regression analyses were conducted to determine the association of dietary fiber intake with muscle strength. Approximately 43% of Korean adults met the recommended intake of dietary fiber, and those with higher dietary fiber consumption also had higher total energy and protein intake. After adjusting for confounding variables, dietary fiber intake was found to be positively associated with maximal handgrip strength in younger women aged 19 to 64 years (β = 0.015; standard error [SE] = 0.006) and older men aged ≥ 65 years (β = 0.035; SE = 0.014). For older women aged ≥ 65 years, those in the lowest quartile of dietary fiber intake had a higher risk of low muscle strength than those in the highest quartile after adjustment of confounders (odds ratio 1.709; 95% confidence interval 1.130-2.585). These results suggest that adequate dietary fiber intake may reduce the risk of sarcopenia in older Korean women.

Nutritional strategies to optimise musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein

Falls and osteoporotic fractures are a major public health problem, particularly among older adults. A third of individuals aged 65 years and over fall at least once each year, with up to 20 % of these resulting in serious injury, including fracture. In conjunction with regular exercise, the importance of diet for musculoskeletal health has largely focused upon calcium, vitamin D, and protein, particularly in the context of preventing falls and fractures. Whilst there is evidence for the benefits of these nutrients for musculoskeletal health, other aspects of the diet remain largely underexplored. For example, vegetables are rich sources of macro- and micronutrients that are essential for muscle function and bone health, which are key factors in the prevention of falls and fractures. Recent work has highlighted the importance of nutrients such as vegetable-derived nitrate and vitamin K1 in optimising muscle strength, physical function, and bone quality. In the context of dietary patterns, vegan/plant-based diets have recently gained popularity due to perceived health benefits, animal welfare, or to tackle climate change. The elimination and/or substitution of animal-based products for plant foods (without careful planning and/or expert dietary guidance) could, however, have long-term negative musculoskeletal consequences; a trend uncovered by recent evidence. Within the overarching theme of nutrition for fall and fracture prevention in older populations, the aim of this review is to (i) summarise the current evidence for calcium, vitamin D and protein; (ii) describe the importance of vegetables and selected nutrients, such as nitrate and vitamin K1, for muscle function and bone structural integrity; and (iii) highlight current evidence around different dietary patterns (e.g., plant-based, diet quality, data driven approaches) and their impact on musculoskeletal health.

Nutrition knowledge assessment tools for older adults and their carers: a scoping review

Poor nutritional intake is common among older adults. Given that nutrition knowledge is an important determinant of eating behaviour and nutritional status, understanding areas of inadequate knowledge can guide educational interventions to reduce risk of nutritional deficiencies and promote healthy ageing. This review investigated tools assessing general nutritional knowledge of older adults and their carers. Following the Joanna Briggs for Scoping Reviews guidelines, 4 databases (MEDLINE, CINAHL, Global Health and Embase) and grey literature were searched. Studies of any type containing general nutrition knowledge assessment tools for older adults or their carers were included. In total, 6934 articles were identified, of which 24 met the eligibility criteria, and 23 unique nutrition knowledge assessment tools were included. Of these tools, 14 were original, 6 were modified from other tools and 3 used dietary-related responses from national dietary survey questions. 6 tools were developed for carers (mostly nurses) and 17 tools for older adults. Tools had between 4 and 110 items. The most common topics for general nutrition knowledge questions were related to nutrients and roles, food sources of nutrients, and diet-disease relationships. 8 tools were developed prior to 2000. Most studies did not specify or assess psychometric properties of the tool, with only 9 (38 %) and 6 (26 %) studies testing for reliability and validity, respectively, and only 1 tool was considered reliable. Additional research for the development of reliable and validated tools or the validation of existing tools to assess nutrition knowledge of older adults and their carers is needed across different healthcare settings.

The role of nutrition in the prevention of sarcopenia

Sarcopenia is a common skeletal muscle disorder characterized by a loss of muscle mass and impaired muscle function that is associated with poor health outcomes. Although nutrition is considered an important factor in the etiology of sarcopenia, the preventive potential of diet, specifically the extent to which differences in habitual patterns of diet and/or nutrient intakes impact risk of its development, is poorly understood. This narrative review considered research evidence on dietary patterns and nutrient intakes in mid- (<60 y) and young-older (60-70 y) adulthood to evaluate how they relate to age-related changes in muscle mass and function. A key finding was that current evidence on adult diet and sarcopenia risk in older age is limited and fragmented, with different outcomes reported across studies (for example, lean mass, strength) and few reporting links to incident diagnosed sarcopenia. As these outcomes are not interchangeable, it challenges collation of the evidence, leaving many gaps in understanding. There is also limited information about adult (<70 y) diet and few longitudinal studies with repeated dietary assessments to enable definition of cumulative exposures across adulthood. However, despite these limitations, findings from studies of dietary patterns already provide reasonably consistent messages about the benefits of diets of higher quality in earlier adulthood for later physical performance, although whole-diet intervention trials are urgently needed to understand their potential. In comparison, there is little evidence of benefits of higher intakes of individual nutrients in earlier adulthood for later muscle mass and function. Although these gaps need to be addressed in future research, there may already be sufficient data to promote messages about diet quality more widely - that healthier diets of higher quality across adulthood, with known benefits for a range of health outcomes, are also linked to the effective preservation of muscle mass and function.

Association of diet quality with the risk of Sarcopenia based on the Chinese diet balance index 2016: a cross-sectional study among Chinese adults in Henan Province

BACKGROUND

Sarcopenia can lead to a series of unfavourable health outcomes. Diet is an important factor influencing sarcopenia. In this study, we aimed to evaluate the association of sarcopenia with diet quality assessed by the Chinese Diet Balance Index 2016 (DBI-16).

METHODS

A cross-sectional study was conducted to collect information on nutrition and health in Henan Province, China, and a total of 644 individuals were studied. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) criteria updated in 2019. Diet quality was assessed by using the Chinese Diet Balance Index 2016 (DBI-16), which includes three indicators: the lower bound score (LBS), higher bound score (HBS) and diet quality distance (DQD). Binary logistic regression analysis was used to estimate the risk of sarcopenia associated with diet quality.

RESULTS

A total of 49 of the 644 participants were diagnosed with sarcopenia. Excessive intake (score > 0) of cereals, meat, eggs and salt, inadequate intake (score < 0) of vegetables, fruits, dairy products, soybeans and low diet variety were commonly seen in both groups of participants. The participants with sarcopenia had a more serious inadequate intake of fruit than those without sarcopenia (p < 0.05). The overall LBS, HBS and DQD in both groups were in the interval of low-level problems. Compared with participants with a suitable LBS, those with an unsuitable LBS were more likely to have a low gait speed (OR: 2.58; 95%CI: 1.13-7.04) after multiple adjustments. However, the other two DBI-16 indicators, the HBS and DQD, were not associated with sarcopenia or its related diagnostic variables.

CONCLUSION

Unfavourable diet quality, mainly referring to inadequate dietary intake in this study, may be a risk factor for low gait speed.

The association of dietary patterns with muscle mass and strength in old age: The Hordaland Health Study

PURPOSE

The single nutrient approach in nutrition research lacks the ability to account for synergistic relationships between dietary components. Current evidence suggests that diet quality, reflecting overall dietary intake, may influence muscle health. In a community-based observational study in Western Norway, we examined dietary patterns in relation to muscle mass and strength at age 67-70.

METHODS

The current analysis was conducted in men and women of The Hordaland Health Study (HUSK), who participated in both the second (HUSK2) and third study wave (HUSK3). Dietary patterns were extracted by principal component analysis (PCA) on food frequency questionnaire (FFQ) data. Individual dietary pattern scores (DPS) for HUSK2 (age 46-49) and HUSK3 (age 67-70), and overall DPS (oDPS) were calculated. Outcome variables were appendicular skeletal muscle mass (ASMM) and handgrip strength (HGS) measured in HUSK3. The relationships of HUSK3 DPS and oDPS with ASMM and HGS were assessed by multivariate linear regression analysis adjusted for potential confounding factors.

RESULTS

We identified three distinct dietary patterns, labelled 'Western', 'Healthy', and 'Sweets-focused'. A significant positive association was observed between the oDPS for the 'Healthy' dietary pattern and ASMM in both men and women at age 67-70. No significant associations were found between HUSK3 DPS or oDPS for any of the identified dietary patterns and HGS in our population.

CONCLUSION

Higher oDPS on a dietary pattern predominantly rich in fish, vegetables, nuts and seeds, fruit and berries, and eggs was associated with better ASMM at age 67-70. To establish the influence of diet quality on muscle health, further long-term studies with repeated dietary assessments are warranted.

Association between dietary patterns and subjective and objective measures of physical activity among Japanese adults aged 85 years and older: a cross-sectional study

A healthy diet and regular physical activity (PA) are delineated as healthy behaviours. Their implementation is associated with better health outcomes and improved quality of life. There is less evidence of a relationship between dietary patterns (DP) and PA, especially in adults aged ≥ 85. Hence, this cross-sectional study investigates the association between DP and PA in people of this age group, using the data from The Kawasaki Aging and Well-Being Project. Brief-type self-administered diet history questionnaire was used to estimate the intake of fifty-eight types of food. After energy adjustment, principal component analysis was performed to identify DP. PA was measured objectively using an accelerometer and subjectively using a questionnaire validated for this age group. Thousand participants (median age: 86·9 years, men: 49·9 %) were included in the analysis. Three major DP (DP1 'various foods', DP2 'red meats and coffee', DP3 'bread and processed meats') were identified. DP1 'various foods' was similar to DP previously named 'healthy' or 'prudent' and showed a positive association with PA time (PAT) as measured by accelerometer (B, 6·25; 95 % CI 0·13, 12·37) and relatively shorter sedentary behaviour (SB) time. DP2 'red meats and coffee' and DP3 'bread and processed meats' were negatively associated with PAT and positively associated with SB time. This study observed the relationship between diet and PA behaviours in adults aged ≥ 85, with healthier and more food-diverse DP associated with longer PAT and relatively unhealthy DP with shorter PAT.

Service Awareness Among Older Adults Experiencing Barriers to Food and Eating

OBJECTIVE

To explore (1) the services older adults use to address the barriers to food access they face and (2) how they found out about these services.

DESIGN

Semistructured, basic descriptive qualitative in-person interviews.

SETTING

Senior center and participants' homes.

PARTICIPANTS

A convenience sample of 24 older adults recruited from suburban and urban settings. Primarily Black females, living alone, and able to leave home without help.

PHENOMENON OF INTEREST

Financial and nonfinancial barriers to food access, awareness of services available.

ANALYSIS

Codes were assigned to portions of the text in which participants described how they learned about a service. These codes were categorized into one of the 3 larger themes that emerged: (1) intentionally sought by the participant, (2) intentional outreach by the service, and (3) encounters in daily life and environment.

RESULTS

Most connections to services were made through encounters in participants' daily life and environment; for example, word of mouth from family, friends or neighbors; connection through other services; referral from health care professionals; and seeing the service in their neighborhood.

CONCLUSIONS AND IMPLICATIONS

Robust social networks, medical screening, and referral may promote awareness of food assistance services. Future research and outreach should target those who are most isolated.

Dietary diversity and possible sarcopenia among older people in China: a nationwide population-based study

Background

Sarcopenia is a common geriatric disease. Many dietary factors may contribute to the development of sarcopenia. Few studies have been conducted on dietary diversity and sarcopenia in Chinese older adults. Among a nationwide sample, the objective of this study is to assess the association between the dietary diversity score (DDS) and the prevalence of possible sarcopenia. We considered the different patterns of dietary diversity in relation to possible sarcopenia.

Methods

We conducted this analysis utilizing the cross-sectional data from the 2012, 2014, and 2018 waves of the Chinese longitudinal healthy longevity survey (CLHLS). A standard developed by the Asian Working Group for Sarcopenia 2019 (AWGS2019) was used to assess the possibility of sarcopenia. On the basis of the DDS generated by previous studies, we have constructed four new indicators as follows: total diet, animal-based diet, plant-based diet, and plant-based diet without the consumption of legume products and nuts. We used the generalized estimation equation (GEE) model to evaluate the associations between the DDS of the total diet, animal-based diet, plant-based diet, and plant-based diet without the intake of legume products and nuts and possible sarcopenia. These associations were statistically adjusted for a variety of potential confounders. Sensitivity analysis was performed by excluding some participants who were long-term bedridden, had Alzheimer's disease, or were terminally ill.

Results

The analysis included 6,624 participants (mean age 83.4 years at baseline). In our study, we found that participants with a higher DDS of the total diet (OR = 0.62; 95% CI: 0.51-0.77), animal-based diet (OR = 0.62; 95% CI: 0.49-0.79), and plant-based diet (OR = 0.64;95% CI: 0.51-0.80) were at a lower risk of developing sarcopenia. In sensitivity analyses, the associations remained unchanged.

Conclusion

Taking a diversified diet, including animal foods, may reduce the risk of developing sarcopenia. According to the findings of this study, adopting a diversified diet might reduce the risk of sarcopenia for older adults.

"Diet for the prevention and management of sarcopenia"

Sarcopenia is a geriatric condition characterized by a progressive loss of skeletal muscle mass and strength, with an increased risk of adverse health outcomes (e.g., falls, disability, institutionalization, reduced quality of life, mortality). Pharmacological remedies are currently unavailable for preventing the development of sarcopenia, halting its progression, or impeding its negative health outcomes. The most effective strategies to contrast sarcopenia rely on the adoption of healthier lifestyle behaviors, including adherence to high-quality diets and regular physical activity. In this review, the role of nutrition in the prevention and management of sarcopenia is summarized. Special attention is given to current "blockbuster" dietary regimes and agents used to counteract age-related muscle wasting, together with their putative mechanisms of action. Issues related to the design and implementation of effective nutritional strategies are discussed, with a focus on unanswered questions on the most appropriate timing of nutritional interventions to preserve muscle health and function into old age. A brief description is also provided on new technologies that can facilitate the development and implementation of personalized nutrition plans to contrast sarcopenia.

Nutritional Interventions: Dietary Protein Needs and Influences on Skeletal Muscle of Older Adults

BACKGROUND

This narrative review describes foundational and emerging evidence of how dietary protein intakes may influence muscle-related attributes of older adults.

METHODS

PubMed was used to identify pertinent research.

RESULTS

Among medically stable older adults, protein intakes below the recommended dietary allowance (RDA) (0.8 g/kg body weight [BW]/d) exacerbate age-related reductions in muscle size, quality, and function. Dietary patterns with total protein intakes at or moderately above the RDA, including one or preferably more meals containing sufficient dietary protein to maximize protein anabolism, promote muscle size and function. Some observational studies suggest protein intakes from 1.0 to 1.6 g/kg BW/d may promote greater muscle strength and function more so than muscle size. Experimental findings from randomized controlled feeding trials indicate protein intakes greater than the RDA (averaging ~1.3 g/kg BW/d) do not influence indices of lean body mass or muscle and physical functions with non-stressed conditions, but positively influence changes in lean body mass with purposeful catabolic (energy restriction) or anabolic (resistance exercise training) stressors. Among older adults with diagnosed medical conditions or acute illness, specialized protein or amino acid supplements that stimulate muscle protein synthesis and improve protein nutritional status may attenuate the loss of muscle mass and function and improve survival of malnourished patients. Observational studies favor animal versus plant protein sources for sarcopenia-related parameters.

CONCLUSIONS

Quantity, quality, and patterning of dietary protein consumed by older adults with varied metabolic states, and hormonal and health status influence the nutritional needs and therapeutic use of protein to support muscle size and function.

Relationship between dietary patterns and physical performance in the very old population: a cross-sectional study from the Kawasaki Aging and Wellbeing Project

OBJECTIVES

As the world's population is ageing, improving the physical performance (PP) of the older population is becoming important. Although diets are fundamental to maintaining and improving PP, few studies have addressed the role of these factors in adults aged ≥ 85 years, and none have been conducted in Asia. This study aimed to determine the dietary patterns (DP) and examine their relationship with PP in this population.

DESIGN

This cross-sectional study (Kawasaki Aging and Wellbeing Project) estimated food consumption using a brief-type self-administered diet history questionnaire. The results were adjusted for energy after aggregating into thirty-three groups, excluding possible over- or underestimation. Principal component analysis was used to identify DP, and outcomes included hand grip strength (HGS), timed up-and-go test, and usual walking speed.

SETTING

This study was set throughout several hospitals in Kawasaki city.

PARTICIPANTS

In total, 1026 community-dwelling older adults (85-89 years) were enrolled.

RESULTS

Data of 1000 participants (median age: 86·9 years, men: 49·9 %) were included in the analysis. Three major DP (DP1: various foods, DP2: red meats and coffee, DP3: bread and processed meats) were identified. The results of multiple regression analysis showed that the trend of DP2 was negatively associated with HGS (B, 95 % CI -0·35, -0·64, -0·06).

CONCLUSIONS

This study suggests a negative association between HGS and DP characterised by red meats and coffee in older adults aged ≥ 85 years in Japan.

Relationship between protein intake and grip strength in qualitative and quantitative aspects among the elderly in Korea: results from the Korea National Health and Nutrition Examination Survey

BACKGROUND

This study investigated the association between quantitative and qualitative protein intake and grip strength (GS) in the South Korean population to explore nutritional management for the prevention of sarcopenia.

METHODS

This cross-sectional study was based on data from a nationally representative sample of the South Korean elderly population, consisting of 1,531 men and 1,983 women aged 65 years and older who participated in the Korean National Health and Nutrition Examination Survey from 2016 to 2019. Low GS was defined as GS < 28 kg in men and GS < 18 kg in women. Protein intake was assessed using 1-day 24-h recall, and we analyzed absolute protein intake, protein intake by food source, and protein intake compared to dietary reference intake with per body weight or absolute daily recommended value.

RESULTS

The total and animal protein intake and protein intake from legumes, fish and shellfish were significantly lower in women with a low GS than in those with a normal GS. After adjusting for confounding factors, women who consumed more protein than the estimated average requirement (EAR, 40 g/day for women) were 0.528 times less likely to have low GS than women consuming less protein than the EAR (95% CI: 0.373-0.749), and consuming any amount of protein from legumes were 0.656 times less likely (95% CI: 0.500-0.860) to have low GS than women who did not consume any amount of legume protein.

CONCLUSIONS

This study provides epidemiological evidence that adequate protein intake above EAR and protein intake from legumes should be guided for preventing low GS, especially in elderly women.

The association of dietary inflammatory potential with skeletal muscle strength, mass, and sarcopenia: a meta-analysis

Aims

Evidence suggested that dietary inflammatory potential may be associated with age-related skeletal muscle decline, but the results remained controversial. To summarize the evidence for the relationships between dietary inflammatory potential and skeletal muscle strength, mass, and sarcopenia in adults we conducted this meta-analysis.

Methods

Embase, Pubmed, and Web of Science were searched from inception up to 12 March 2023 for studies that evaluated the associations of dietary inflammatory potential [estimated by the Dietary inflammatory index (DII)] with skeletal muscle strength, mass, and sarcopenia. A meta-analysis was then performed to calculate the pooled regression coefficient (β) and odds ratio (OR). The non-linear dose-response relation between DII and sarcopenia was assessed using random-effects dose-response meta-analysis.

Results

This meta-analysis included 24 studies involving 56,536 participants. It was found that high DII was associated with low skeletal muscle strength [OR 1.435, 95% confidence interval (CI) 1.247-1.651, P < 0.001, I² = 4.97%]. There was a negative association of DII with skeletal muscle strength (β-0.031, 95% CI -0.056 to -0.006, P = 0.017, I² = 72.69%). High DII was also associated with low skeletal muscle mass (OR 1.106, 95% CI 1.058-1.157, P < 0.001, I² = 0%). DII had a negative relationship with skeletal muscle mass with high heterogeneity (β-0.099, 95% CI -0.145 to -0.053, P < 0.001, I² = 88.67%); we downgraded the inconsistency in the subgroup analysis of overweight/obese participants (β-0.042, 95% CI -0.065 to -0.019, I² = 12.54%). Finally, the pooled results suggested that high DII was significantly associated with sarcopenia with significant heterogeneity (OR 1.530, 95% CI 1.245-1.880, P < 0.001, I² = 69.46%); age and BMI may contribute partially to the heterogeneity since heterogeneity was decreased in the subgroup of older age (OR 1.939, 95% CI 1.232-3.051, I² = 0%) and the group of overweight/obesity (OR 1.853, 95% CI 1.398-2.456, I² = 0%). There was a non-linear dose-response association between DII and sarcopenia (P = 0.012 for non-linearity).

Conclusion

This meta-analysis suggested that higher dietary inflammatory potential was significantly associated with lower skeletal muscle strength, mass, and risk of sarcopenia. Future studies with consistent assessment and standardized methodology are needed for further analysis.

The more you have, the more you lose: Muscle mass changes in trauma patients with prolonged hospitalizations

INTRODUCTION

Sarcopenia is a clinically relevant loss of muscle mass with implications of increased morbidity and mortality in adult trauma populations.  Our study aimed to evaluate loss of muscle mass change in adult trauma patients with prolonged hospital stays.

METHODS

Retrospective analysis using institutional trauma registry to identify all adult trauma patients with hospital length of stay >14 days admitted to our Level 1 center between 2010 and 2017. All CT images were reviewed, and cross-sectional area (cm²) of the left psoas muscle was measured at the level of the third lumbar vertebral body to determine total psoas area (TPA) and Total Psoas Index (TPI) normalized for patient stature.  Sarcopenia was defined as a TPI on admission below gender specific thresholds of 5.45(cm²/m²) in men and 3.85(cm²/m²) in women.  TPA, TPI, and rates of change in TPI were then evaluated and compared between sarcopenic and non-sarcopenic adult trauma patients.

RESULTS

There were 81 adult trauma patients who met inclusion criteria. The average change in TPA was -3.8 cm² and TPI was -1.3 cm². On admission, 23% (n = 19) of patients were sarcopenic while 77% (n = 62) were not. Non-sarcopenic patients had a significantly greater change in TPA (-4.9 vs. -0.31, p<0.0001), TPI (-1.7 vs. -0.13, p<0.0001), and rate of decrease in muscle mass (p = 0.0002). 37% of patients who were admitted with normal muscle mass developed sarcopenia during admission.  Older age was the only risk factor independently associated with developing sarcopenia (OR: 1.04, 95%CI 1.00-1.08, p = 0.045).

CONCLUSION

Over a third of patients with normal muscle mass at admission subsequently developed sarcopenia with older age as the primary risk factor. Patients with normal muscle mass at admission had greater decreases in TPA and TPI, and accelerated rates of muscle mass loss compared to sarcopenic patients.

A Sarcopenia Index Derived from Malnutrition Parameters in Elderly Haemodialysis Patients

(1) Background: Persons with chronic kidney disease may have sarcopenia characterized by the loss of muscle mass and loss of muscle strength. However, EWGSOP2 criteria to diagnose sarcopenia are technically challenging, especially in elderly persons on hemodialysis. Sarcopenia may be associated with malnutrition. We aimed at defining a sarcopenia index derived from malnutrition parameters for use in elderly haemodialysis patients. (2) Methods: A retrospective study of 60 patients aged 75 to 95 years treated with chronic hemodialysis was conducted. Anthropometric and analytical variables, EWGSOP2 sarcopenia criteria and other nutrition-related variables were collected. Binomial logistic regressions were used to define the combination of anthropometric and nutritional parameters that best predict moderate or severe sarcopenia according to EWGSOP2, and performance for moderate and severe sarcopenia was assessed by the area under the curve (AUC) of receiver operating characteristic (ROC) curves. (3) Results: The combination of loss of strength, loss of muscle mass and low physical performance correlated with malnutrition. We developed regression-equation-related nutrition criteria that predicted moderate sarcopenia (elderly hemodialysis sarcopenia index-moderate, EHSI-M) and severe sarcopenia (EHSI-S) diagnosed according to EWGSOP2 with an AUC of 0.80 and 0.866, respectively. (4) Conclusions: There is a close relationship between nutrition and sarcopenia. The EHSI may identify EWGSOP2-diagnosed sarcopenia from easily accessible anthropometric and nutritional parameters.

Mediterranean Diet and Sarcopenia Features in Apparently Healthy Adults over 65 Years: A Systematic Review

Low muscle mass combined with changes in physical function and muscle quality is defined as sarcopenia. In people > 60 years, sarcopenia reaches 10% and tends to increase with age. Individual nutrients, such as protein, may have a protective role against sarcopenia, but recent evidence suggests that protein alone has been ineffective in increasing muscle strength. Dietary patterns, instead, with a high "anti-inflammatory" potential, such as the Mediterranean dietary pattern, have been considered as an emerging dietary remedy against sarcopenia. The aim of this systematic review was to summarize the evidence of the role of Mediterranean diet in sarcopenia prevention and/or improvement, including recent data, in healthy elders. We searched published studies about sarcopenia and the Mediterranean diet until December 2022 in Pubmed, Cochrane, Scopus search engine and grey literature. In total, ten articles were identified as relevant: four cross-sectional studies and six prospective. No clinical trial was identified. Only three studies assessed sarcopenia presence and four measured muscle mass, which is an essential criterion in sarcopenia diagnosis. Mediterranean diet adherence had, in general, a positive role in muscle mass and muscle function, while the results were less clear with regard to muscle strength. Additionally, there was no evidence of a positive effect of the Mediterranean diet on sarcopenia. There is a need for conduction of clinical trials in order to reach cause-effects conclusions regarding the importance of the Mediterranean diet in sarcopenia prevention and management in Mediterranean and non-Mediterranean populations.

Satisfaction with Life and Nutritional Behaviour, Body Composition, and Functional Fitness of Women from the Kraków Population Participating in the "Healthy Active Senior" Programme

Pro-health behaviours are related to a person's personal resources. The aim of the study was to assess the relationship between satisfaction with life (SWL), nutritional behaviours, somatic indices, and functional efficiency of senior women. The research was conducted among 120 women aged 60-84 (Me = 65) participating in the "Healthy Active Senior" project at the University of Physical Education in Kraków. The Satisfaction with Life Scale (SWLS) and the proprietary validated questionnaire of nutritional behaviour were used. Body composition was assessed using the method of bioelectrical impedance (TANITA SC-330ST analyser), while physical fitness was evaluated via the Senior Fitness test (Fullerton Functional Fitness Test). Correlations between the variables were measured by implementing Spearman's R signed-rank correlation coefficients (with p < 0.05). Positive correlations between SWL and selected nutrition behaviours have been demonstrated, including eating 5-6 meals (p < 0.001) and drinking at least 2 litres of fluids a day (p = 0.023), consuming cereal products daily, including whole-grains (p = 0.001), avoiding alcoholic beverages (p = 0.030), and applying vitamin D supplementation (p = 0.010). At the same time, negative correlations between SWL and limiting the consumption of red as well as processed meats (p = 0.002), animal fats (p = 0.046), and the preference for vegetable oils in one's diet (p = 0.023) were shown. Significant correlations between satisfaction with life and two indicators of functional fitness were also confirmed: negative-with the variable '2.44-m Get-Up and Go' (p = 0.003); and positive-with the '2-Minute Step in Place' test (p = 0.034). The relationships between SWL and somatic indices did not reach the level of statistical significance. Among the women participating in the "Healthy Active Senior" programme, correlations between SWL and rational nutritional behaviours, as well as indices of functional fitness, were found (mostly positive), while the trends in these areas were not fully unambiguous, suggesting the validity of conducting further research.

Relationship between healthy eating index and sarcopenia in elderly people

BACKGROUND

Data on the association of Alternative Healthy Eating Index-2010 (AHEI-2010) with sarcopenia are scarce. We aimed to evaluate the association between adherence to AHEI-2010 and sarcopenia and its components including low muscle mass, low muscle strength, and low muscle performance among elderly people.

METHODS

In this cross-sectional study, which was conducted on 300 older people (150 men and 150 women) aged ≥55 years. Dietary information was done using a valid 117-item food frequency questionnaire (FFQ). To construct AHEI-2010 score, earlier studies were used. Sarcopenia and its components were described based on both former and new European Working Group on Sarcopenia in Older People (EWGSOP) guidelines.

RESULTS

We found no significant association between AHEI-2010 score and odds of EWGSOP2-sarcopenia, either before (OR for the highest vs. lowest tertiles: 0.55; 95% CI: 0.19, 1.55) or after (OR: 0.44; 95% CI: 0.14, 1.34) adjustment for confounders. In gender-stratified analyses, we found a significant protective association between adherence to the AHEI-2010 score and odds of EWGSOP2-sarcopenia among women after controlling for confounders (0.20; 95%CI: 0.04, 0.91).

CONCLUSIONS

In conclusion, healthy eating was inversely associated with odds of sarcopenia among women, but not in men. Further studies with a large sample size and prospective design are needed to examine this association.

Diet was less significant than physical activity in the prognosis of people with sarcopenia and metabolic dysfunction-associated fatty liver diseases: Analysis of the National Health and Nutrition Examination Survey III

BACKGROUND

Sarcopenia is prevalent in metabolic dysfunction-associated fatty liver diseases (MAFLD), and the primary treatment for both diseases is lifestyle modification. We studied how dietary components and physical activity affect individuals with sarcopenia and MAFLD.

MATERIALS AND METHODS

We conducted a study utilizing National Health and Nutrition Examination Survey (NHANES) III (1988-1994) data with Linked Mortality file (through 2019). The diagnosis of fatty liver disease (FLD) was based on ultrasound images revealing moderate and severe steatosis. Using bioelectrical measures, sarcopenia was assessed. Using self-report data, dietary intake and physical activity levels were evaluated.

RESULTS

Among 12,259 participants, 2,473 presented with MAFLD, and 290 of whom had sarcopenia. Higher levels of physical activity (odds ratio [OR] = 0.51 [0.36-0.95]) and calorie (OR = 0.58 [0.41-0.83]) intake reduced the likelihood of sarcopenia in MAFLD patients. During a median follow-up period of 15.3 years, 1,164 MAFLD and 181 MAFLD patients with sarcopenia perished. Increased activity levels improved the prognosis of patients with sarcopenia (Insufficiently active, HR = 0.75 [0.58-0.97]; Active, HR = 0.64 [0.48-0.86]), which was particularly pronounced in older patients.

CONCLUSION

In the general population, hyperglycemia was highly related to MAFLD prognosis. Physical inactivity and a protein-restricted diet corresponded to sarcopenia, with physical inactivity being connected to poor outcomes. Adding protein supplements would be beneficial for older people with sarcopenia who are unable to exercise due to frailty, while the survival benefits were negligible.

[Physical activity in sarcopenia: rehabilitation approaches in prevention and treatment of age-related muscle disorders]

Sarcopenia is a widespread condition in the elderly people, that occurs as a result of impaired muscle structure and function and is significantly associated with reduced quality and time of life. This review represents current approaches to the diagnosis of sarcopenia with reference to recent European and Asian consensus. They include rules for the evaluation of the main muscle strength and function tests (hand dynamometry, sit-to-stand test, 6-minute walk test, physical performance battery tests, etc.), physical and instrumental methods of muscle mass analysis (densitometry, bioimpedance analysis, magnetic resonance imaging). Furthermore, the pathogenetic relationship between the lack of physical activity and muscle dysfunction in elderly people is broached, including in particular the role of myostatin, interleukin-6, somatotropin and insulin resistance. The article represents possibilities of impact of aerobic, strength and neuromuscular physical exercises on prevention and correction of sarcopenic changes in different age groups based on the analysis of current clinical studies.

Skipping breakfast regimen induces an increase in body weight and a decrease in muscle weight with a shifted circadian rhythm in peripheral tissues of mice

Meal timing is a key factor in synchronising the circadian clock in peripheral tissues. Circadian disorders are associated with the metabolic syndrome. Previously, we demonstrated that a skipping breakfast regimen (SBR) with a high-fat diet increased body weight gain in rats. In this study, we investigated whether SBR with a normal diet led to abnormal lipid metabolism and muscle metabolism in mice. Male C57BL/6 mice were fed during zeitgeber time (ZT) 12-24 in the control group and ZT 16-24 in the SBR group for 2 weeks. SBR mice showed increased body weight gain and perirenal adipose tissue weight. The plantar muscle weight was decreased in the SBR group compared with that in the control group. Furthermore, SBR delayed the circadian oscillations in clock gene expression in peripheral tissues, such as the liver, adipose tissue and muscle, as well as the oscillations in the expression of lipid metabolism-related genes in the liver and adipose tissue. These results suggest that skipping breakfast over a long period of time is associated with a risk of obesity, the metabolic syndrome and muscle loss, such as sarcopenia.

Association between Sarcopenia and Nutritional Status in Chilean Older People Aged 65 Years and Older

In 2018 the European Working Group on Sarcopenia in Older People (EWGSOP2) updated the definition of sarcopenia, with loss of muscle strength being the primary feature. The objective is to describe and associate sarcopenia and nutritional status in a group of Chilean older adults aged 65 years and older.

METHODS

Descriptive, associative and comparative study, with a cross-sectional design and a quanti-qualitative approach. A number of 155 institutionalized and community-dwelling Chilean older people aged 65 years and older participated in the study (year 2018). Sarcopenia was diagnosed using the algorithm proposed by the EWGSOP2. Muscle strength, muscle quantity and physical performance were assessed; Body Mass Index (BMI) and Mini Nutritional Assessment (MNA) were used. Variables were described according to sex and age groups (65-69; 70-79; and ≥80 years). The association between sarcopenia and nutritional status was studied by the application of multivariate logistic regression analysis with adjustments for age and sex.

RESULTS

49.7% and 5.2% of older adults had probable sarcopenia and severe sarcopenia, respectively; 52.9% and 7% had malnutrition by excess and by deficit, respectively, according to their BMI; and 33.5% had malnutrition according to the MNA. Participants with obesity had 3.2 times more risk of presenting sarcopenia, versus subjects with normal nutritional status (OR: 3.2; 95% CI; 1.24; 8.26).

CONCLUSION

Sarcopenia, as defined by the criteria of the EWGSOP2, depends on the nutritional status according to BMI in older people, with obese individuals being at greater risk of suffering from sarcopenia. Nearly 50% had probable sarcopenia, a condition that could be detected early with the purpose of taking preventive measures, such a nutritional approach.

The Trajectory of Nutritional Status and Physical Activity before and after Transcatheter Aortic Valve Implantation

It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment—short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11−14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI −0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI −47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure.

Dietary advanced glycation end-products (dAGEs) intake and its relation to sarcopenia and frailty - The Rotterdam Study

Studies on mice have shown a relationship between dietary intake of advanced glycation end-products (dAGEs) and deterioration of musculoskeletal health, but human studies are absent. We investigated the relationship between dietary intake of carboxymethyllysine (dCML) - an AGE prototype - and risk of sarcopenia at baseline and after 5 years of follow-up and a single evaluation of physical frailty in participants from the population-based Rotterdam Study. Appendicular lean mass (ALM) was obtained using insight dual-energy X-ray absorptiometry and hand grip strength (HGS) using a hydraulic hand dynamometer. Subjects with both low ALM and weak HGS were classified as having sarcopenia. Frailty (yes/no) was defined by presence of ≥3 and pre-frailty by presence of 1 or 2 components namely, exhaustion, weakness, slowness, weight loss or low physical activity. dCML was calculated using a food frequency questionnaire and dAGE databases. Logistic regression analysis was used to evaluate the odds of physical frailty and prevalent sarcopenia at baseline and follow-up and incident sarcopenia. 2782 participants with an age 66.4 ± 9.9 years and dCML intake 3.3 ± 1.3 mg/day, had data on sarcopenia at both time points. Of whom 84 had sarcopenia at baseline and 73 developed sarcopenia at follow-up. We observed an association of one SD increase in dCML intake with prevalent sarcopenia at baseline [odds ratio, OR = 1.27 (1.01-1.59)] and no association of dCML with incident sarcopenia at 5-year follow-up [OR = 1.12 (0.86-1.44)]. For frailty we analyzed 3577 participants, of whom 1972 were pre-frail and 158 were frail. We observed no association of dCML with either pre-frailty [OR = 0.99 (0.91-1.07)] or frailty [OR = 1.01 (0.83-1.22)] when non-frail subjects were used as reference. Our results show an association of dAGEs with sarcopenia cross-sectionally but not longitudinally where inconclusive findings are observed possibly due to a very low incidence of sarcopenia. There was no association with frailty cross-sectionally.

Use of surface electromyography to evaluate effects of whole-body vibration exercises on neuromuscular activation and muscle strength in the elderly: a systematic review

PURPOSE

Reduction of muscle strength and lean mass, increase in the risk of falls, higher mortality, and morbidity are observed in geriatric syndromes. Physical activity is an effective intervention in reducing signs and symptoms of geriatric syndromes. Whole-body vibration exercise (WBVE) is an intervention with low cost and has been effective.

MATERIALS AND METHODS

The aim of this systematic review aimed to determine the effects of WBVE on neuromuscular activation and muscle strength in the elderly. Searches in PubMed, Embase, Science direct, and Scopus databases were conducted. Six studies, that analyzed the use of surface electromyography evaluating effects of WBVE on neuromuscular activation and muscle strength in the elderly, published in English, were included.

RESULTS

Six studies were included. One hundred forty-six individuals participated in the studies and 24 were males (16.43%), with an average age of 74.20 ± 7.66 years. Five publications were defined as "fair" methodological in the PEDro scale, the risk of bias was high and the risk of bias for non-randomized studies was moderate/high. In general, increased strength muscle was reported in the studies.

CONCLUSION

This systematic review suggests that WBVE might promote desirable neuromuscular responses in healthy elderly. However, it is necessary to perform further studies to reinforce the reported findings.IMPLICATIONS FOR REHABILITATIONThe reduction in lean mass and consequent reduction in muscle strength are present in healthy elderly people and the whole-body vibration exercise can reduce or alleviate these symptoms caused by the geriatric syndrome.Whole-body vibration exercise is a training modality that increases neuromuscular activation and muscle strength.Surface electromyography is a useful tool for the evaluation of the neuromuscular activation of the muscle fibers.

Opportunities and barriers for food intake in older age - a Norwegian perspective

Background

The ageing processes occur slowly over time and are often not detectable by the individual. Thus, preparing for dietary needs in later years should start at an earlier age than most people realise.

Objective

This study aims at better understanding what characterises food-related practices in active, home-living older adults, in order to identify food-related factors that act as barriers and those that promote healthy ageing.

Design

Three experiments were conducted: First, a web-based quantitative survey to collect information about home-living older adults' food-related behaviours (67+ years, N = 1,005). Second, two focus groups with respondents 67-74 years (N = 7) and 75-84 years (N = 6) to elicit aspects not adequately covered in the survey. Third, 10 individual interviews to provide in-depth insights.

Results

Two distinct groups were identified in the survey; 67-79 years and 80+ years. The older age group experienced more barriers and restrictions in food intake and food-related behaviours compared to the younger group. Good taste, routines and social settings were important for appetite and food intake.

Discussion

Using a mixed-methods approach proved valuable for extracting information and a better understanding of what impacts on food-related aspects amongst older adults. Strategies for upholding a healthy food intake involve establishing daily routines and meeting arenas where older adults can socialise and eat food together.

Conclusion

This study confirmed that knowledge of older adults' physical needs, barriers and abilities must be a part in preparation for a healthy diet.

Association between dietary inflammatory potential and the probable sarcopenia among community-dwelling older adults: a cross-sectional study

BACKGROUND

Unlike the numerous studies concerning the role of dietary inflammatory potential in chronic diseases, limited studies focused on the association of dietary inflammatory potential with handgrip strength (HGS) and probable sarcopenia (PS). This study tends to explore the association between dietary inflammatory potential and PS among older adults in Tehran.

METHODS

The cross-sectional study was conducted between May and October 2019 on 201 randomly selected older adults in Tehran, Iran. A validated food frequency questionnaire was utilized for recording dietary intake. Dietary habits were evaluated through Dietary Inflammatory Index (DII) and Empirical Dietary Inflammatory Index (EDII). PS assessment was done by HGS estimation. Statistical evaluation included descriptive analyses, logistic, and linear regression.

RESULTS

Those probably suffering from sarcopenia were older than healthy ones (p < 0.0001) and had significantly higher DII scores (p = 0.05) but not EDII (p = 0.85). Besides, PS subjects had a lower intake of anti-inflammatory nutrients. The odds of PS were doubled in people on the top tertile of DII (OR = 2.49, 95% (CI) = 1.11-5.58) and second tertile of EDII (OR = 2.29, 95% (CI) = 1.03-5.07) relative to bottom tertiles after adjusting for confounders. The relationships between index scores and HGS were simply significant in the adjusted model of EDII and HGS (B = -0.49, p = 0.04).

CONCLUSION

Conclusively, participants adhering to a pro-inflammatory diet had more likelihood of PS. Findings are in line with current recommendations to reduce unhealthy foods with more inflammatory potential. These findings warrant confirmation in high-quality interventional studies.

Effect of Different Nutritional Education Based on Healthy Eating Index for HemoDialysis Patients on Dietary Quality and Muscle Mass

BACKGROUND

Hemodialysis patients are at high risk of muscle loss as a result of aging and disease, and combined with inadequate dietary intake. The Healthy Eating Index for HemoDialysis patients (HEI-HD) was developed to assess the dietary quality of hemodialysis patients. The purposes of this study were to examine the effects of different nutritional education models using HEI-HD-based education on dietary quality and muscle mass in hemodialysis patients.

METHODS

A quasi-experimental study was conducted from May 2019 to April 2021, with four groups, including no course for patients and nurses (Non-C), course for nurses (CN), course for patients (CP), and course for patients and nurses (CPN). The courses were delivered by registered dietitians. The data of 94 patients were collected and analyzed at baseline, after 2 months of intervention, and 2 months follow-up, including demographics, body composition, 3-day dietary records, and hemodialysis dietary knowledge. The HEI-HD index score was calculated.

RESULTS

Patients aged 58.3 ± 10.1 years. The dietary quality change in the CPN group was improved as compared with the Non-C group (-3.4 ± 9.5 vs. 3.0 ± 5.5, 0.04). The skeletal muscle mass of the Non-C group at intervention was also significantly lower than baseline, but the CPN group was not.

CONCLUSIONS

The HEI-HD-based nutritional education for both patients and nurses showed a positive effect on improving the dietary quality and maintaining muscle mass in hemodialysis patients.

Nutrition and sarcopenia: Current knowledge domain and emerging trends

Objective

Non-pharmacological management like nutrient supplements has shown positive impacts on muscle mass and strength, which has burgeoned clinical and research interest internationally. The aim of this study was to analyze the current knowledge domain and emerging trends of nutrition-related research in sarcopenia and provide implications for future research and strategies to prevent or manage sarcopenia in the context of aging societies.

Materials and methods

Nutrition- and sarcopenia-related research were obtained from the Web of Science Core Collection (WoSCC) database from its inception to April 1, 2022. Performance analysis, science mapping, and thematic clustering were performed by using the software VOSviewer and R package “bibliometrix.” Bibliometric analysis (BA) guideline was applied in this study.

Results

A total of 8,110 publications were extracted and only 7,510 (92.60%) were selected for final analysis. The production trend in nutrition and sarcopenia research was promising, and 1,357 journals, 107 countries, 6,668 institutions, and 31,289 authors were identified in this field till 2021. Stable cooperation networks have formed in the field, but they are mostly divided by region and research topics. Health and sarcopenia, metabolism and nutrition, nutrition and exercise, body compositions, and physical performance were the main search themes.

Conclusions

This study provides health providers and scholars mapped out a comprehensive basic knowledge structure in the research in the field of nutrition and sarcopenia over the past 30 years. This study could help them quickly grasp research hotspots and choose future research projects.

[Identification of dietary patterns and their relationship with physical performance in adults of 85 years of age and older -A cross sectional study from The Tokyo Oldest Old survey on Total Health study]

AIM

While the proportion of people of ≥85 years of age is expected to increase, there is limited research on the dietary patterns and physical performance of this population in Japan. The purpose of this study was to identify the dietary patterns of people of ≥85 years of age who live in Tokyo and to examine the relationship with their physical performance.

METHODS

Using data from the baseline survey (conducted in 2008-2009) of The Tokyo Oldest Old survey on Total Health study, the estimated 58 food intake items were aggregated into 33 items after energy adjustment, and a principal component analysis was performed. For physical performance, the results of grip strength, chair standing test, and 3 m timed up and go test conducted at normal walking speed were used. A multiple regression analysis was used to adjust for confounders and to examine the relationship between each dietary pattern and physical performance.

RESULTS

The subjects of the analysis were 87.3 (86.2-88.8) years of age (median [25-75th percentile] ). From the principal component analysis, three dietary patterns were identified: "various vegetable foods", "fish and mushrooms", and "cooked rice and miso soup". A higher propensity for the "fish and mushrooms" dietary pattern was significantly associated with grip strength (partial regression coefficient, B (95% confidence interval): 0.48 (0.13-0.83) ).

CONCLUSIONS

In a population of people of ≥85 years of age in Tokyo, a positive association was observed between hand grip strength and a dietary pattern characterized by fish and mushroom intake.

Associations of body mass index and sarcopenia with screen-detected mild cognitive impairment in older adults in Colombia

Background and objective

More research is required to understand associations of body mass index (BMI) and sarcopenia with cognition, especially in Latin America. The objective of this study was to investigate associations of BMI and sarcopenia with mild cognitive impairment in Colombia.

Design, setting, and participants

Data were from the National Survey of Health, Wellbeing and Aging in Colombia (SABE Colombia, in Spanish). Community-dwelling adults aged 60 years or older were invited to participate.

Methods

Trained interviewers administered a shorter version of the mini-mental state examination and mild cognitive impairment was defined as a score of 12 or less out of 19. Body mass index was defined using standard cut-offs. Sarcopenia was defined as low grip strength or slow chair stands. Logistic regression models were adjusted for age, sex, height, education, income, civil status, smoking, and alcohol drinking.

Results

The prevalence of mild cognitive impairment was 20% in 23,694 participants in SABE Colombia and 17% in 5,760 participants in the sub-sample in which sarcopenia was assessed. Overweight and obesity were associated with decreased risk of mild cognitive impairment and sarcopenia was associated with increased risk. Sarcopenia was a risk factor for mild cognitive impairment in those with normal BMI (adjusted model included 4,911 men and women). Compared with those with normal BMI and without sarcopenia, the odds ratio for mild cognitive impairment was 1.84 in those with normal BMI and sarcopenia (95% confidence interval: 1.25, 2.71). Sarcopenia was also a risk factor in those with obesity but did not present a greater risk than sarcopenia alone. Compared with those with normal BMI and without sarcopenia, the odds ratio was 1.62 in those with obesity and sarcopenia (95% confidence interval: 1.07, 2.48). Sarcopenia was not a risk factor for mild cognitive impairment in those with overweight. Similar results were observed when reference values from Colombia were used to set cut-offs for grip strength. Similar results were also observed in cross-validation models, which suggests the results are robust.

Conclusion

This is the first study of the combined associations of sarcopenia and obesity with cognition in Colombia. The results suggest that sarcopenia is the major predictor of screen-detected mild cognitive impairment in older adults, not overweight or obesity.

Association of Micronutrients and Handgrip Strength in Korean Older Population: A Cross-Sectional Study

Sarcopenia is characterized by the loss of skeletal muscle mass, strength, and physical performance. Dynapenia and kratopenia are described as the loss of muscle strength and power. Nutritional intake status is one of the factors affecting the prevention of an age-related muscle decline such as sarcopenia, dynapenia, or kratopenia in older populations. This study aimed to investigate the association between the intake of micronutrients and handgrip strength in 1254 individuals (546 men and 708 women) of the Korean older population from the most recent dataset. They were analyzed and divided into two groups: a LHS group with low handgrip strength (<28 kg for men and <18 kg for women) and a normal group with normal handgrip strength. Logistic regression analysis was performed to estimate the odds ratios (ORs) and 95% confidence intervals (Cis) of the associations between micronutrient intakes and low handgrip strength in Korean older population by gender. Among micronutrients, insufficient potassium intake showed a significant association with low handgrip strength for men (OR: 3.159, 95% CI: 1.164−8.578) and women (OR: 2.793, 95% CI: 1.380−5.654) aged ≥65 years, respectively (p = 0.005 for men, p = 0.024 for women), as a result of adjusting for all confounding factors that could affect low handgrip strength. In conclusion, potassium intake among micronutrients in Korean older populations with low handgrip strength might need continuous monitoring for the intervention or prevention of dynapenia or sarcopenia.

High Adherence to the Mediterranean Diet is Associated with Higher Physical Fitness in Adults: a Systematic Review and Meta-Analysis

Although prior research has synthesized the relationships between the Mediterranean diet (MD) and components of physical fitness (PF) in adults, they are limited and inconclusive. This study aimed to synthesize the associations between high (compared with low) MD adherence and PF levels with each of its components (cardiorespiratory, motor, and musculoskeletal) in adulthood. We conducted a systematic search in 5 databases from inception to January 2022. Observational studies and randomized controlled trials were included. Pooled odds ratios (ORs) and effect sizes (Cohen d index) with their 95% CIs were calculated via a random effects model. A total of 30 studies were included (19 cross-sectional in young, middle-aged, and older adults; 10 prospective cohort in older adults; and 1 randomized controlled trial in young adults) involving 36,807 individuals (mean age range: 20.9-86.3 y). Pooled effect sizes showed a significant cross-sectional association between higher MD adherence scores (as a continuous variable) and overall PF (d = 0.45; 95% CI: 0.14, 0.75; I2 = 91.0%, n = 6). The pooled ORs from cross-sectional data showed that high adherence to MD was associated with higher cardiorespiratory fitness (OR: 2.26; 95% CI: 2.06, 2.47; I2 = 0%, n = 4), musculoskeletal fitness (OR: 1.26; 95% CI: 1.05, 1.47; I2 = 61.4%, n = 13), and overall PF (OR: 1.44; 95% CI: 1.20, 1.68; I2 = 83.2%, n = 17) than low adherence to MD (reference category: 1). Pooled ORs from prospective cohort studies (3- to 12-y follow-up) showed that high adherence to MD was associated with higher musculoskeletal fitness (OR: 1.20; 95% CI: 1.01, 1.38; I2 = 0%, n = 4) and overall PF (OR: 1.14; 95% CI: 1.02, 1.26; I2 = 9.7%, n = 7) than low adherence to MD (reference category: 1). Conversely, no significant association was observed between MD and motor fitness. High adherence to MD was associated with higher PF levels, a crucial marker of health status throughout adulthood. This trial was registered at PROSPERO as CRD42022308259.

Association between lower parity and low muscle mass in postmenopausal women: data from KNHANES (2010-2011)

OBJECTIVE

This study aimed to investigate whether parity is associated with the prevalence of low muscle mass in postmenopausal women.

METHODS

This study was performed using data from the 2010-2011 Korean National Health and Nutrition Examination Survey, which included 1,338 postmenopausal women aged 46 to 70 years. The association between parity and low muscle mass was analyzed after adjusting parity, multiparity, age, body mass index, diabetes mellitus, education level, and Homeostatic Model Assessment of Insulin Resistance and using weighted multiple logistic regression analysis. Modifiable risk factors were evaluated in a susceptible population. Low muscle mass was defined as an appendicular skeletal muscle mass index below 2 SDs with a cutoff value of 5.45 kg/m 2 .

RESULTS

The low muscle mass group ( n = 343) had lower parity, lower body mass index, more frequent previous history of diabetes mellitus, higher Homeostatic Model Assessment of Insulin Resistance, and higher education level compared with the non-low muscle mass group ( n = 995). After adjusting for the confounding factors, parity with three births or more was associated with a significantly lower odds of postmenopausal low muscle mass than nulliparity (model 1: odds ratio, 0.32; 95% confidence interval, 0.12-0.87; P = 0.03; model 2: odds ratio, 0.27; 95% confidence interval, 0.11-0.67; P < 0.05). In the subgroup analysis of the lower parity group, moderate aerobic activity was associated with a lower low muscle mass prevalence.

CONCLUSIONS

A lower parity is associated with increasing the odds of low muscle mass in postmenopausal Korean women. Moderate aerobic activity may be effective in lowering the odds of low muscle mass in postmenopausal women with lower parity.

Preprocedural muscle strength and physical performance and the association with functional decline or mortality in frail older patients after transcatheter aortic valve implementation: a systematic review and meta-analysis

BACKGROUND

A significant number of older patients planned for transcatheter aortic valve implantation (TAVI) experience a decline in physical functioning and death, despite a successful procedure.

OBJECTIVE

To systematically review the literature on the association of preprocedural muscle strength and physical performance with functional decline or long-term mortality after TAVI.

METHODS

We followed the PRISMA guidelines and pre-registered this review at PROSPERO (CRD42020208032). A systematic search was conducted in MEDLINE and EMBASE from inception to 10 December 2021. Studies reporting on the association of preprocedural muscle strength or physical performance with functional decline or long-term (>6 months) mortality after the TAVI procedure were included. For outcomes reported by three or more studies, a meta-analysis was performed.

RESULTS

In total, two studies reporting on functional decline and 29 studies reporting on mortality were included. The association with functional decline was inconclusive. For mortality, meta-analysis showed that low handgrip strength (hazard ratio (HR) 1.80 [95% confidence interval (CI): 1.22-2.63]), lower distance on the 6-minute walk test (HR 1.15 [95% CI: 1.09-1.21] per 50 m decrease), low performance on the timed up and go test (>20 s) (HR 2.77 [95% CI: 1.79-4.30]) and slow gait speed (<0.83 m/s) (HR 2.24 [95% CI: 1.32-3.81]) were associated with higher long-term mortality.

CONCLUSIONS

Low muscle strength and physical performance are associated with higher mortality after TAVI, while the association with functional decline stays inconclusive. Future research should focus on interventions to increase muscle strength and physical performance in older cardiac patients.