Nutritional Intervention to Prevent the Functional Decline in Community-Dwelling Older Adults: A Systematic Review

Sarcopenia and frailty in inflammatory bowel disease: Emerging concepts and evidence

Sarcopenia is a condition marked by progressive loss of skeletal muscle mass and function while frailty is a multidimensional concept characterized by diminished physiological reserve and increased vulnerability to stressors. Both of these were previously considered as related to aging and shown to impact the quality of life and carry prognostic significance. Emerging data show that both sarcopenia and frailty carry similar relevance in chronic illness. Inflammatory bowel disease (IBD) is characterized by chronic inflammation of the gastrointestinal tract and malnourishment, both of which contribute to the development of sarcopenia by increasing protein breakdown and reducing protein synthesis. The coexistence of frailty further compounds the clinical complexity of IBD patients. Published evidence suggests a bidirectional association with IBD contributing to muscle wasting, while the resultant sarcopenia and frailty could further exacerbate the disease course. Sarcopenia and frailty are independently associated with adverse outcomes, including hospitalizations, increased surgical interventions, and surgical complications. As therapeutic strategies for IBD evolve, understanding the nuanced relationship between inflammatory bowel disease, sarcopenia, and frailty is crucial for devising holistic management. Comprehensive care should encompass not only disease-modifying therapies but also interventions targeting frailty and sarcopenia, as they have been shown to have a significant impact not only on the disease course but also on the quality of life. Future research could focus on further elucidating underlying mechanisms, simple screening strategies, and developing targeted interventions to improve the overall quality of life for individuals grappling with the complex interplay of IBD, sarcopenia, and frailty.

Effectiveness of individual nutrition counselling for the prevention of undernutrition among elderly people living in depopulated areas: secondary analysis of a model project in Tsu city

Objectives

To examine the effectiveness of nutrition counselling (NC) in preventing undernutrition in elderly people living in depopulated areas.

Design

Participants were elderly people aged at least 65 years living in a depopulated area. Participants completed self-administered questionnaires evaluating nutritional status, frailty and body composition at the start of the study, after a non-NC period (3-month control) and after an NC period (3-month intervention). During the NC period, participants attended monthly 1-hour NC sessions over 3 months. Sessions were conducted in three areas (A, B and C), and the schedule was staggered so that the NC period in one area was conducted simultaneously with the non-NC period of the next. All sessions within an area were attended by the same registered dietitian. Outcomes were assessed three times: before the non-NC period, after the non-NC period and after the NC period. The effects of NC were assessed by comparing the results between the non-NC and NC periods of all participants, using the Cochran-Mantel-Haenszel stratified test.

Outcome measures

The primary outcome was undernutrition, as determined by the Mini Nutritional Assessment-Short Form. Secondary outcomes were Dietary Diversity Score (DVS), body weight and frailty. Body composition was also assessed.

Results

Of 106 individuals who joined the project, 61 completed the project and were analysed. The NC in this study had no effect on the primary outcome. DVS in area A was significantly higher after the NC period than after the non-NC period (p=0.012). Frailty in area C was significantly lower after the NC period than after the non-NC period (p=0.025). NC had no significant effects on the other outcomes.

Conclusions

NC improved food variety but did not improve nutritional status, frailty or body composition.

The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial

BACKGROUND

The Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic.

METHODS

Participants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component.

RESULTS

The program enrolled 33% (n = 72) of referrals to the study (n = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant's adherence levels included virtual exercise sessions 81% (95% CI: 75-88%), home-based exercise 50% (95% CI: 38-62%), protein supplements consumption 68% (95% CI: 55-80%), and medication optimization 38% (95% CI: 21-59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms.

CONCLUSION

The GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant's intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366.

Osteocalcin inhibits myocyte aging through promotion of starvation-induced autophagy via IL-6/STAT3 signaling

This study aimed to investigate the effects and mechanisms of osteocalcin on autophagy in myoblasts, as well as its possible therapeutic effects in aging muscle. Starved murine myoblast C2C12 cells with or without interleukin (IL)-6 siRNA were treated with osteocalcin. Expression of the autophagy protein marker LC3, as well as IL-6 and phosphorylated STAT3 were detected by immunoblotting, immunofluorescence, or immunohistochemistry. Autophagosomes were observed with transmission electron microscopy. Levels of reactive oxygen species (ROS) were detected by flow cytometry. Fasted young mice were injected intraperitoneally with osteocalcin, with or without the JAK inhibitor CP-690550 to inhibit IL-6 signaling. Older mice were treated with osteocalcin and muscle mass, grip strength and muscle structure were assessed. The results revealed that compared to control and serum-starved cells, osteocalcin treatment significantly increased the relative expression of LC3-II/LC3-I protein, the numbers of autophagosomes, and levels of intracellular ROS. Osteocalcin injection in mice also resulted in increased relative LC3-II/LC3-I protein expression and autophagosome numbers. Osteocalcin treatment significantly increased the secretion of IL-6 in muscle cells and tissue, and activated STAT3 signaling. Moreover, knockdown of IL-6 or blocking IL-6 signaling inhibited the phosphorylation of STAT3, and further inhibited autophagy in starved myoblasts and fasting-treated murine muscle tissue. In addition, osteocalcin treatment significantly increased muscle mass and grip strength in both aged mice and aged fasting mice. In conclusion, the inhibition of osteocalcin on muscle cell aging is accompanied by the induction of IL-6-STAT3-dependent autophagy, indicating osteocalcin might be a promising therapeutic candidate for aging-related myopathies.

Intrinsic Capacities, Functional Ability, Physiological Systems, and Caregiver Support: A Targeted Synthesis of Effective Interventions and International Recommendations for Older Adults

The ageing population calls for interventions that can assist older people to age healthily. This study aimed to provide a targeted synthesis of high-level research and current evidence-based recommendations on effective interventions for maintaining or preventing the decline in intrinsic capacity, functional ability, and physiological systems, or for caregiver support. Nestled within the healthy ageing framework by the World Health Organization, available evidence was selected in a targeted manner, with the purpose of providing a synthesis that would allow the application of this knowledge in real life. As such, the outcome variables were examined through an Evidence and Gap Map of interventions for functional ability and through guidelines from leading institutions. Systematic reviews, meta-analyses, and guidelines on community-dwelling older adults with or without minor health limitations were considered. Thirty-eight documents were included and over fifty interventions identified. Physical activity interventions were consistently effective across several domains. Recommendations point to screening, whilst highlighting the importance of behavioural factors in the endeavour to age healthily. There is a wide range of activities which are likely to foster healthy ageing. To encourage their uptake, it is important for communities to offer suitable promotion and support, and to make these accessible to the public.

A systematic review and meta-analysis of the association between sarcopenia and myocardial infarction

BACKGROUND

Systematic review and meta-analysis of the association between sarcopenia and the development of myocardial infarction.

METHODS

PubMed, Cochrane Library, and Embase were searched for studies on the association between sarcopenia and myocardial infarction from their inception until November 26, 2022. The fixed-effects model was used to calculate the combined risk ratio (RR) of sarcopenia in patients with myocardial infarction. Sensitivity analysis was used to test the robust of the combined result, and funnel plot were used to test publication bias.

RESULTS

Five studies were included finally. There was no significant association between sarcopenia and risk of developing myocardial infarction [RR = 1.01; 95% CI = 0.94, 1.08; P = 0.317]. The sensitivity analysis showed robust of the combined result. The funnel plot showed no significant publication bias.

CONCLUSION

Limited evidence suggests no definitive association between sarcopenia and risk of myocardial infarction.

Factors for the change in frailty status during the COVID-19 pandemic: A prospective cohort study over six- and 12-month periods in Japan

We aimed to verify the frailty status and the factors associated with the change in frailty status during the COVID-19 pandemic. A three-wave cohort study was conducted every six months, from May to July 2020, November 2020 to January 2021, and again from May to July 2021. The frailty status was assessed using the frailty screening index. Multivariate generalized linear mixed-effects models were used to determine whether changes in frailty status were associated with health conditions and lifestyle. The 404 survey forms were analyzed. Decline in chewing function (beta = 0.552) and leg muscle strength weakness (beta = 0.515) were significantly associated with the change in frailty status over six months, and leg muscle strength weakness (beta = 0.512) was significantly associated over 12 months. Risk factors associated with worsening health should be assessed for appropriate support. It is especially important to assess subjective leg muscle weakness in older adults.

Healthcare cost expenditures associated to frailty and sarcopenia

Objectives

Frailty and sarcopenia have been related with adverse events, including hospitalization. However, its combined effect with hospitalization-related outcomes, including costs, has not been previously investigated. Our purpose was to explore how frailty, sarcopenia and its interaction could impact on healthcare expenditures.

Methods

1358 community-dwelling older adults from the Toledo Study of Healthy Ageing (TSHA) were included. Sarcopenia was measured using the Foundation for the National Institutes of Health criteria fitted to our cohort. Frailty was defined according to Frailty Trait Scale 5 (FTS5) and the Frailty Index fitted to the cut-off points of TSHA population. Hospitalization costs were taken from hospital records and costs were attributed according to Diagnostic-Related Groups, using as the cost base year 2015. Two-part regression models were used to analyze the relationship between frailty and sarcopenia and hospital admission, number of hospitalizations, length of stay and hospitalization costs.

Results

Sarcopenia was associated only with the probability of being admitted to hospital. Frailty was also associated with higher hospital use, regardless of the frailty tool used, but in addition increased hospital admission costs at follow-up by 23.72% per year and by 19.73% in the full model compared with non-frail individuals. The presence of sarcopenia did not increase the costs of frailty but, by opposite, frailty significantly increased the costs in people with sarcopenia, reaching by 46–56%/patient/year at follow-up. Older adults with frailty and sarcopenia had a higher risk of hospitalization, disregarding the tool used to assess frailty, and higher hospitalization costs (FTS5) in the full model, at the cross-sectional and at the follow-up level.

Conclusions

Frailty is associated with increased hospitalization costs and accounts for the potential effects of sarcopenia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03439-z.

Physical activity in inflammatory bowel disease: benefits, challenges and perspectives

PURPOSE OF THE REVIEW

Physical activity is gaining significative interest in the field of inflammatory bowel disease (IBD). In the light of the most recent publications, the present review aims to describe the level of physical activity in adult patients with IBD; describe the current body of evidence on the benefits of physical activity and discuss the challenges and perspectives related to physical activity in this population.

RECENT FINDINGS

Recent studies showed that IBD patients tend to be less active than healthy people. There is growing evidence of a positive impact of physical activity on mortality, quality of life, fatigue, body composition, strength and physical performance. The direct benefits of physical activity on clinical remission and disease activity have recently been observed only in Crohn's disease. Limitations to physical activity related to the disease, such as gastrointestinal and psychological symptoms, need to be considered in this population. Finally, no guidelines are available and there is no evidence regarding the effects of combined physical activity and nutritional support.

SUMMARY

Although physical activity seems beneficial and safe for IBD patients, future studies are needed to clearly define recommendations in this population.

Association between Dysphagia and Frailty in Older Adults: A Systematic Review and Meta-Analysis

Background: Increasing bodies of epidemiological evidence indicate potential associations between dysphagia and the risk of frailty in older adults. We hypothesized that older adults with symptoms of dysphagia might have a higher prevalence of frailty or prefrailty than those without dysphagia. Methods: We systematically searched the PubMed, Embase, and Cochrane Library databases for relevant studies published through 20 April 2022. Cross-sectional and longitudinal studies that examined the associations between dysphagia and the existence of frailty or prefrailty in community-dwelling, facility-dwelling, or hospitalized adults aged 50 years or older were synthesized. The Newcastle–Ottawa Scale was used to evaluate study quality. Results: The meta-analysis comprised 12 cohorts, including 5,503,543 non-frailty participants and 735,303 cases of frailty or prefrailty. Random-effect meta-analysis demonstrated a significant association between dysphagia and the risk of frailty and prefrailty (OR, 3.24; 95% CI, 2.51–4.20). In addition, we observed consistent results across the subgroups and heterogeneity assessments. Conclusions: We propose including dysphagia assessment as a critical factor in the cumulative deficit model for identifying frailty in older adults. Understanding dysphagia and the potential role of nutritional supplements in older adults may lead to improved strategies for preventing, delaying, or mitigating frailty.

Dietary Intervention Effectiveness, Clinical Outcomes and Nutrient and Salicylate Intakes in Older Adults Living in Long-Term Care Homes: The Results from the Senior’s Plate Project

Optimal nutrition is an important part of the therapeutic process offered to patients in long-term care, as it can significantly influence their nutritional and health status. The aim of this study was to assess the impacts of a dietary intervention on the nutritional status, clinical outcomes and selected nutrient and salicylate intakes among older adults living in a long-term care nursing home. To achieve the research goal, a prospective, non-randomized, baseline-controlled intervention study was conducted. The study was conducted within the framework of the “Senior’s Plate Project”, a project established in 2018 by the Polish Society of Dietetics. Methods: A 3 month dietary intervention, which included one serving of supplementary food, served as a second breakfast (Nestle Sinlac). Energy, nutrients and salicylates intakes were estimated on the basis of the menus. Food and beverage intakes among residents were verified by health care personnel. Anthropometric measurements and clinical examinations were conducted according to standard procedures at baseline and after intervention. Results: Of the 38 residents qualified for the study, 29 completed the program. Residents’ body mass index (BMI) values ranged from 13.3 kg/m2 to 34 kg/m2. A BMI <22 kg/m2, indicating underweight, was found in 19 subjects. The dietary intervention resulted in increased body weight (57.8 ± 12.3 vs. 59.4 ± 12.6 kg), BMI (22.4 ± 4.0 vs. 23.0 ± 4.1 kg/m2) and body fat (19.2 ± 8.7 vs. 20.6 ± 8.9 kg). Significant changes in the levels of biochemical parameters, including serum calcium (8.7 vs. 9.5 mg/dL), potassium (4.1 ± 0.6 vs. 4.5 ± 0.5 mmol/L) and zinc (74.1 ± 10.9 vs. 109.0 ± 20.4 µg/dL), were observed. Energy, protein, fat and carbohydrate intakes were significantly higher in the third month of the intervention as compared to the baseline. The estimated medial daily intake of salicylates was low and ranged from 0.34 mg to 0.39 mg. Conclusions: The dietary intervention resulted in beneficial and significant changes in the nutritional status, biochemical parameters and nutrition of residents of the long-term care home. These results suggest that practical and individualized approaches are required to improve the nutritional status and clinical outcomes of nursing homes residents.

The Role of Immune Cells in Oxi-Inflamm-Aging

Aging is the result of the deterioration of the homeostatic systems (nervous, endocrine, and immune systems), which preserve the organism's health. We propose that the age-related impairment of these systems is due to the establishment of a chronic oxidative stress situation that leads to low-grade chronic inflammation throughout the immune system's activity. It is known that the immune system weakens with age, which increases morbidity and mortality. In this context, we describe how the function of immune cells can be used as an indicator of the rate of aging of an individual. In addition to this passive role as a marker, we describe how the immune system can work as a driver of aging by amplifying the oxidative-inflammatory stress associated with aging (oxi-inflamm-aging) and inducing senescence in far tissue cells. Further supporting our theory, we discuss how certain lifestyle conditions (such as social environment, nutrition, or exercise) can have an impact on longevity by affecting the oxidative and inflammatory state of immune cells, regulating immunosenescence and its contribution to oxi-inflamm-aging.

Functionality of Bread and Beverage Added with Brosimum alicastrum Sw. Seed Flour on the Nutritional and Health Status of the Elderly

Physiological changes in elderly individuals (EI) can contribute to nutritional deterioration and comorbidities that reduce their quality of life. Factors such as diet can modulate some of these effects. The aim was to evaluate the functionality of foods added with Brosimum alicastrum Sw. seed flour in EI. EI (n = 23) living in nursing home conditions agreed to participate. A control stage was carried out (30 days) and subsequently, an intervention stage (30 days) was realized in which a muffin and a beverage, designed for EI, were added to the participants’ their usual diet. In both stages, anthropometric parameters, body composition, nutritional status, dietary intake, sarcopenic status, cognitive and affective states, biometric parameters, and total phenolic compounds (TPC), and antioxidant capacity in foods and plasma of EI were determined. The results showed that the consumption of the foods improved the energy intake and preserved the muscle reserves of the EI. The EI gained body weight (+1.1 kg), increased their protein (+18.6 g/day; 1.5 g/kg BW/day), dietary fiber (+13.4 g/day), iron (+4.4 mg/day), zinc (+1.8 mg/day), folic acid (+83.4 µg/day) consumption while reducing their cholesterol (−66 mg/day) and sodium (−319.5 mg/day) consumption. LDL-C lipoproteins reduced (14.8%) and urea (33.1%) and BUN (33.3%) increased. The TPC increased (7.8%) in the plasma, particularly in women (10.7%). The foods improve the EI nutritional status, and this has a cardiovascular protective effect that can benefit the health of the EI.

Dairy Product Intake and Long-Term Risk for Frailty among French Elderly Community Dwellers

Dairy products (DP) are part of a food group that may contribute to the prevention of physical frailty. We aimed to investigate DP exposure, including total DP, milk, fresh DP and cheese, and their cross-sectional and prospective associations with physical frailty in community-dwelling older adults. The cross-sectional analysis was carried out on 1490 participants from the Three-City Bordeaux cohort. The 10-year frailty risk was examined in 823 initially non-frail participants. A food frequency questionnaire was used to assess DP exposure. Physical frailty was defined as the presence of at least 3 out of 5 criteria of the frailty phenotype: weight loss, exhaustion, slowness, weakness, and low physical activity. Among others, diet quality and protein intake were considered as confounders. The baseline mean age of participants was 74.1 y and 61% were females. Frailty prevalence and incidence were 4.2% and 18.2%, respectively. No significant associations were observed between consumption of total DP or DP sub-types and frailty prevalence or incidence (OR = 1.40, 95%CI 0.65–3.01 and OR = 1.75, 95%CI 0.42–1.32, for a total DP consumption >4 times/d, respectively). Despite the absence of beneficial associations of higher DP consumption on frailty, older adults are encouraged to follow the national recommendations regarding DP.

Dietary Intake of Vitamin E and Fats Associated with Sarcopenia in Community-Dwelling Older Japanese People: A Cross-Sectional Study from the Fifth Survey of the ROAD Study

Dietary habits are of considerable interest as a modifiable factor for the maintenance of muscle health, especially sarcopenia. The present study aimed to investigate the association between dietary intake and sarcopenia prevalence in community-dwelling Japanese subjects. This cross-sectional study was conducted using data from the fifth survey of the Research on Osteoarthritis/Osteoporosis against Disability (ROAD) study, and 1345 participants (437 men and 908 women) aged ≥60 years were included in the analysis. Sarcopenia was determined by the definition of the Asian Working Group for Sarcopenia established in 2014, and dietary intake was assessed with the brief-type self-administered diet history questionnaire. Overall, 77 subjects (5.7%) were identified as having sarcopenia, 5.0% of men and 6.1% of women. Multiple logistic regression analysis showed that the odds ratios of sarcopenia for the dietary intake of vitamin E (α-tocopherol, 0.14 (CI 0.04–0.49), β-tocopherol (0.24, CI 0.07–0.78), γ-tocopherol (0.28, CI 0.09–0.87), and fats (fat 0.27, CI 0.08–0.96; monounsaturated fatty acids, 0.22, CI 0.07–0.72, polyunsaturated fatty acids, 0.28, CI 0.09–0.89) at the highest quantile were significantly lower compared with those at the lowest quantile. Therefore, higher dietary intakes of vitamin E and fats would be associated with a lower prevalence of sarcopenia.