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Formiga F, Badía-Tejero AM, Corsonello A, Ärnlöv J, Carlsson AC, Mattace-Raso F, Tap L, Kostka T, Guligowska A, Sieber CC, Kob R, Ben-Romano R, Yehoshua I, Roller-Wirnsberger R, Wirnsberger GH, Fabbietti P, Lattanzio F, Moreno-González R. Diabetes and factors associated with cognitive and functional decline. The screening for CKD among older people across Europe (SCOPE) study. Aging Clin Exp Res 2023; 35:2693-2701. [PMID: 37668841 DOI: 10.1007/s40520-023-02536-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Type 2 diabetes mellitus (DM) in older people is a heterogeneous condition that exhibits differential characteristics in comparison with younger adults. DM increases the risk of disability, is associated with dementia and loss of function, and cognition may often be interrelated and more pronounced in older patients with DM than in those without. AIMS Our aim was to evaluate the incidence of functional and/or cognitive impairment in older adults with and without DM, and its associated factors in DM participants. METHODS A 2-year prospective analysis was conducted in a European multicenter prospective cohort (SCOPE study). Older community-dwelling adults (aged ≥ 75 years) underwent a comprehensive geriatric assessment. New functional and/or cognitive decline was explored. RESULTS Of 1611 participants, 335 (22.0%) had DM at baseline. The percentage of participants scoring at least one ADL impairment and/or cognitive impairment (MMSE < 24) was similar in both groups (9.6%). Factors associated with any new disability in participants with DM in the multivariate analysis were female sex (OR 3.28, 95% CI 1.42-7.56), history of stroke (OR 4.58, 95% CI 1.64-12.7), and greater IADL dependency (OR 1.08 95% CI 1.02-1.15). DISCUSSION Association between DM and cognitive or functional decline in outpatients of 75 years and older was not found, but factors such as female gender, history of stroke, and IADL dependency could be related. CONCLUSION Decline in functional and cognitive status of community-dwelling older adults with DM was similar to participants without DM in a short period of 2 years of follow-up, though several clinical factors may increase its risk in this population.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ana María Badía-Tejero
- Geriatric Unit, Internal Medicine Department, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Corsonello
- Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
- Center for Biostatistic and Applied Geriatric Clinical Epidemiology (IRCCS INRCA), National Institute of Health and Science on Ageing, Cosenza, Ancona, Italy
| | - Johan Ärnlöv
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Francesco Mattace-Raso
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lisanne Tap
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Tomasz Kostka
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Łódź, Hallera 1, 90-647, Łódź, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Healthy Ageing Research Centre, Medical University of Łódź, Hallera 1, 90-647, Łódź, Poland
| | - Cornel C Sieber
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Ronit Ben-Romano
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Maccabi Health Organization, Negev District, Beersheba, Israel
| | - Ilan Yehoshua
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
- Maccabi Health Organization, Negev District, Beersheba, Israel
| | | | | | - Paolo Fabbietti
- Center for Biostatistic and Applied Geriatric Clinical Epidemiology (IRCCS INRCA), National Institute of Health and Science on Ageing, Cosenza, Ancona, Italy.
| | | | - Rafael Moreno-González
- Geriatric Unit, Internal Medicine Department, Systemic Diseases and Ageing Group, Cardiovascular, Respiratory and Systemic Diseases and Cellular Aging Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Keppner V, Sieber CC, Freiberger E, Kob R, Krumpoch S, Siebentritt HM. Characteristics of older cyclists with self-perceived needs for improvement in cycling competence: SiFAr trial. Eur Geriatr Med 2023:10.1007/s41999-023-00765-2. [PMID: 36973532 DOI: 10.1007/s41999-023-00765-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Older cyclists are in great risk of being injured or killed in a traffic-related accident and their needs should find more consideration in safety guidelines, urban planning, and future intervention programs. OBJECTIVE The aim for this cross-sectional analysis was to comprehensively explore characteristics of community-dwelling cyclists aged 65 years and older with a self-perceived need to increase cycle competence. METHODS 118 older adults (mean age 73.3 ± 5.2 years, 61% women) performed a standardized cycle course representing specific cycling skills. Additionally, health and functional assessments were carried out and characteristics regarding demographic, health, falls, bicycle equipment/type and cycling biography/behavior were obtained. RESULTS The majority (67.8%) of this community-dwelling adults reported being unsafe when cycling and 41.3% had a bicycle fall in the past year. More than half of the participants showed at least one limitation in each of the measured cycling skills. Women significantly had more frequent limitations in four of the cycling skills measured (p ≤ 0.001) compared to men. While no significant differences were found for falls, health and functional characteristics, women and men differed significantly in terms of bicycle type, equipment, and perceived safety (p < 0.001). CONCLUSION Limitations in cycling should be compensated by preventive bicycle training and a safe cycling infrastructure. Bicycle fit, the wearing of bicycle helmets and promotion of a sense of security while cycling can further reduce accident risk and must find recognition in safety guidelines. In addition, educational initiatives have to dismantle gender-related bicycle stereotypes.
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Affiliation(s)
- Veronika Keppner
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nuremberg, Bavaria, Germany.
| | - Cornel C Sieber
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nuremberg, Bavaria, Germany
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ellen Freiberger
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nuremberg, Bavaria, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nuremberg, Bavaria, Germany
| | - Sebastian Krumpoch
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nuremberg, Bavaria, Germany
| | - Hanna M Siebentritt
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Kobergerstr. 60, 90408, Nuremberg, Bavaria, Germany
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Keppner V, Krumpoch S, Kob R, Rappl A, Sieber CC, Freiberger E, Siebentritt HM. Safer cycling in older age (SiFAr): effects of a multi-component cycle training. a randomized controlled trial. BMC Geriatr 2023; 23:131. [PMID: 36882759 PMCID: PMC9990551 DOI: 10.1186/s12877-023-03816-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/10/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The risk of older adults being injured or killed in a bicycle accident increases significantly due to the age-related decline of physical function. Therefore, targeted interventions for older adults to improve safe cycling competence (CC) are urgently needed. METHODS The "Safer Cycling in Older Age" (SiFAr) randomized controlled trial investigated if a progressive multi-component training program related to cycling improves CC of older adults. Between June 2020 and May 2022, 127 community-dwelling persons living in the area Nürnberg-Fürth-Erlangen, Germany aged 65 years and older were recruited, who are either (1) beginners with the e-bike or (2) feeling self-reported unsteadiness when cycling or (3) uptaking cycling after a longer break. Participants were either randomized 1:1 to an intervention group (IG; cycling exercise program, 8 sessions within 3 months) or an active control group (aCG; health recommendations). The CC as primary outcome was tested not blinded in a standardized cycle course prior and after the intervention period and after 6-9 months, which consists of variant tasks requiring skills related to daily traffic situations. Regression analyses with difference of errors in the cycling course as dependent variable and group as independent variable adjusted for covariates (gender, number of errors at baseline, bicycle type, age and cycled distance) were performed. RESULTS 96 participants (73.4 ± 5.1 years; 59.4% female) were analyzed for primary outcome. Compared to the aCG (n = 49), the IG (n = 47) made an average of 2.37 fewer errors in the cycle course after the 3 months intervention period (p = 0.004). People with more errors at baseline had higher potential for improvement (B=-0.38; p < 0.001). Women on average made 2.31 (p = 0.016) more errors than men, even after intervention. All other confounders had no significant effect on the difference in errors. The intervention effect was very stable until 6-9 months after the intervention (B=-3.07, p = 0.003), but decreased with a higher age at baseline in the adjusted model (B = 0.21, p = 0.0499). CONCLUSION The SiFAr program increases cycling skills among older adults with self-perceived needs for improvement in CC and could easily be made available to a broad public due to its standardized structure and a train-the-trainer approach. TRIAL REGISTRATION This study was registered with clinicaltrials.gov: NCT04362514 (27/04/2020), https://clinicaltrials.gov/ct2/show/NCT04362514 .
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Affiliation(s)
- Veronika Keppner
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany.
| | - Sebastian Krumpoch
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany
| | - Anja Rappl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany
| | - Hanna Maria Siebentritt
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany
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Kiesswetter E, Siebentritt HM, Schoene D, Kob R, Freiberger E, Sieber CC, Visser M, Wijnhoven HAH, Volkert D. Validation of the German version of the Protein Screener 55. Eur J Clin Nutr 2023; 77:579-585. [PMID: 36702924 PMCID: PMC10169657 DOI: 10.1038/s41430-023-01266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND/OBJECTIVES The Protein Screener 55 + (Pro55 + ) is a brief food questionnaire to screen older community-dwelling adults for low protein intake. The result is the predicted probability of protein intake <1.0 g/kg adjusted body weight (aBW)/d ranging from 0-1. For purposes of cross-cultural validation, we translated the Pro55+ into German and tested its discriminative accuracy in detecting low protein intake of older community-dwelling people in Germany. SUBJECTS/METHODS After translation and pilot-testing, the Pro55+ and the reference standard (3-day dietary record) were completed by 144 participants (81.6 ± 3.9 years, 61.8% female). Discriminative properties were tested by receiver operating characteristic curves and by calculating sensitivity and specificity for different cut-offs of predicted probability (>0.3/>0.5/>0.7) using <1.0 or <0.8 g/kg aBW/d to define low protein intake. RESULTS Protein intake was <1.0 g/kg aBW/d in 39.6% of the sample and <0.8 g/kg aBW/d in 17.4%. Area under the curve was 62.0% (95%CI 52.6-71.5) and 68.8% (58.1-79.4), respectively. Specificity was 82-90% using probability cut-offs of 0.5 and 0.7 for both protein thresholds. Sensitivity was poor for protein threshold of 1.0 g/kg aBW/d regardless of the used probability cut-offs. For protein threshold of <0.8 g/kg aBW/d, sensitivity was 88.0% (71.8-96.9) using a probability cut-off of 0.09. CONCLUSION The overall discriminative accuracy of the German Pro55+ to identify older community-dwelling people with low protein intake was poor. However, applying different probability cut-offs allows increasing specificity and sensitivity for 0.8 g/kg aBW/d to levels justifying the use for certain purposes e.g. excluding individuals with adequate protein intake. Further validation is needed.
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Affiliation(s)
- Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - Hanna M Siebentritt
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Institute of Exercise and Public Health, Leipzig University, Leipzig, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Galicia Ernst I, Torbahn G, Schwingshackl L, Knüttel H, Kob R, Kemmler W, Sieber CC, Batsis JA, Villareal DT, Stroebele-Benschop N, Visser M, Volkert D, Kiesswetter E, Schoene D. Outcomes addressed in randomized controlled lifestyle intervention trials in community-dwelling older people with (sarcopenic) obesity-An evidence map. Obes Rev 2022; 23:e13497. [PMID: 35891613 DOI: 10.1111/obr.13497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 12/24/2022]
Abstract
Obesity and sarcopenic obesity (SO) are characterized by excess body fat with or without low muscle mass affecting bio-psycho-social health, functioning, and subsequently quality of life in older adults. We mapped outcomes addressed in randomized controlled trials (RCTs) on lifestyle interventions in community-dwelling older people with (sarcopenic) obesity. Systematic searches in Medline, Embase, Cochrane Central, CINAHL, PsycInfo, Web of Science were conducted. Two reviewers independently performed screening and extracted data on outcomes, outcome domains, assessment methods, units, and measurement time. A bubble chart and heat maps were generated to visually display results. Fifty-four RCTs (7 in SO) reporting 464 outcomes in the outcome domains: physical function (n = 42), body composition/anthropometry (n = 120), biomarkers (n = 190), physiological (n = 30), psychological (n = 47), quality of life (n = 14), pain (n = 4), sleep (n = 2), medications (n = 3), and risk of adverse health events (n = 5) were included. Heterogeneity in terms of outcome definition, assessment methods, measurement units, and measurement times was found. Psychological and quality of life domains were investigated in a minority of studies. There is almost no information beyond 52 weeks. This evidence map is the first step of a harmonization process to improve comparability of RCTs in older people with (sarcopenic) obesity and facilitate the derivation of evidence-based clinical decisions.
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Affiliation(s)
- Isabel Galicia Ernst
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Department of Pediatrics, Paracelsus Medical University, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität Nürnberg, Nuremberg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, Regensburg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - John A Batsis
- Division of Geriatric Medicine, School of Medicine and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dennis T Villareal
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, Texas, USA
| | - Nanette Stroebele-Benschop
- Department of Nutritional Psychology, Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Institute for Evidence in Medicine, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Institute for Exercise and Public Health, University of Leipzig, Leipzig, Germany
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Sieber CC, Thimme R. [Urinary and fecal incontinence]. Dtsch Med Wochenschr 2022; 147:885. [PMID: 35868313 DOI: 10.1055/a-1665-1738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Bernabei R, Landi F, Calvani R, Cesari M, Del Signore S, Anker SD, Bejuit R, Bordes P, Cherubini A, Cruz-Jentoft AJ, Di Bari M, Friede T, Gorostiaga Ayestarán C, Goyeau H, Jónsson PV, Kashiwa M, Lattanzio F, Maggio M, Mariotti L, Miller RR, Rodriguez-Mañas L, Roller-Wirnsberger R, Rýznarová I, Scholpp J, Schols AMWJ, Sieber CC, Sinclair AJ, Skalska A, Strandberg T, Tchalla A, Topinková E, Tosato M, Vellas B, von Haehling S, Pahor M, Roubenoff R, Marzetti E. Multicomponent intervention to prevent mobility disability in frail older adults: randomised controlled trial (SPRINTT project). BMJ 2022; 377:e068788. [PMID: 35545258 PMCID: PMC9092831 DOI: 10.1136/bmj-2021-068788] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether a multicomponent intervention based on physical activity with technological support and nutritional counselling prevents mobility disability in older adults with physical frailty and sarcopenia. DESIGN Evaluator blinded, randomised controlled trial. SETTING 16 clinical sites across 11 European countries, January 2016 to 31 October 2019. PARTICIPANTS 1519 community dwelling men and women aged 70 years or older with physical frailty and sarcopenia, operationalised as the co-occurrence of low functional status, defined as a short physical performance battery (SPPB) score of 3 to 9, low appendicular lean mass, and ability to independently walk 400 m. 760 participants were randomised to a multicomponent intervention and 759 received education on healthy ageing (controls). INTERVENTIONS The multicomponent intervention comprised moderate intensity physical activity twice weekly at a centre and up to four times weekly at home. Actimetry data were used to tailor the intervention. Participants also received personalised nutritional counselling. Control participants received education on healthy ageing once a month. Interventions and follow-up lasted for up to 36 months. MAIN OUTCOME MEASURES The primary outcome was mobility disability (inability to independently walk 400 m in <15 minutes). Persistent mobility disability (inability to walk 400 m on two consecutive occasions) and changes from baseline to 24 and 36 months in physical performance, muscle strength, and appendicular lean mass were analysed as pre-planned secondary outcomes. Primary comparisons were conducted in participants with baseline SPPB scores of 3-7 (n=1205). Those with SPPB scores of 8 or 9 (n=314) were analysed separately for exploratory purposes. RESULTS Mean age of the 1519 participants (1088 women) was 78.9 (standard deviation 5.8) years. The average follow-up was 26.4 (SD 9.5) months. Among participants with SPPB scores of 3-7, mobility disability occurred in 283/605 (46.8%) assigned to the multicomponent intervention and 316/600 (52.7%) controls (hazard ratio 0.78, 95% confidence interval 0.67 to 0.92; P=0.005). Persistent mobility disability occurred in 127/605 (21.0%) participants assigned to the multicomponent intervention and 150/600 (25.0%) controls (0.79, 0.62 to 1.01; P=0.06). The between group difference in SPPB score was 0.8 points (95% confidence interval 0.5 to 1.1 points; P<0.001) and 1.0 point (95% confidence interval 0.5 to 1.6 points; P<0.001) in favour of the multicomponent intervention at 24 and 36 months, respectively. The decline in handgrip strength at 24 months was smaller in women assigned to the multicomponent intervention than to control (0.9 kg, 95% confidence interval 0.1 to 1.6 kg; P=0.028). Women in the multicomponent intervention arm lost 0.24 kg and 0.49 kg less appendicular lean mass than controls at 24 months (95% confidence interval 0.10 to 0.39 kg; P<0.001) and 36 months (0.26 to 0.73 kg; P<0.001), respectively. Serious adverse events occurred in 237/605 (39.2%) participants assigned to the multicomponent intervention and 216/600 (36.0%) controls (risk ratio 1.09, 95% confidence interval 0.94 to 1.26). In participants with SPPB scores of 8 or 9, mobility disability occurred in 46/155 (29.7%) in the multicomponent intervention and 38/159 (23.9%) controls (hazard ratio 1.25, 95% confidence interval 0.79 to 1.95; P=0.34). CONCLUSIONS A multicomponent intervention was associated with a reduction in the incidence of mobility disability in older adults with physical frailty and sarcopenia and SPPB scores of 3-7. Physical frailty and sarcopenia may be targeted to preserve mobility in vulnerable older people. TRIAL REGISTRATION ClinicalTrials.gov NCT02582138.
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Affiliation(s)
- Roberto Bernabei
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | | | - Stefan D Anker
- Department of Cardiology and Berlin Institute of Health Centre for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | - Mauro Di Bari
- Geriatric Intensive Care Medicine, Università degli Studi di Firenze and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Tim Friede
- Department of Medical Statistics, University of Goettingen Medical Centre, Goettingen, Germany
- German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Goettingen, Germany
| | | | | | - Pálmi V Jónsson
- Department of Geriatrics, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | - Marcello Maggio
- Department of Medicine and Surgery, Università degli Studi di Parma, Parma, Italy
- Cognitive and Motor Centre, Medicine and Geriatric Rehabilitation Department of Parma, University Hospital of Parma, Parma, Italy
| | - Luca Mariotti
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ram R Miller
- Translational Medicine, Novartis Institutes for Biomedical Research, Cambridge, MA, USA
| | | | | | | | - Joachim Scholpp
- Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma, Biberach an der Riss, Germany
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Universiteit Maastricht, Maastricht, Netherlands
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nurnberg, Germany
| | | | - Anna Skalska
- Department of Internal Medicine and Gerontology, Uniwersytet Jagiellonski Collegium Medicum, Faculty of Medicine, Krakow, Poland
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- University of Oulu, Centre for Life Course Health Research, Oulo, Finland
| | - Achille Tchalla
- Pôle Gérontologie Clinique, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Eva Topinková
- First Faculty of Medicine, Univerzita Karlova v Praze, Prague, Czech Republic
| | - Matteo Tosato
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
| | - Bruno Vellas
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Stephan von Haehling
- German Centre for Cardiovascular Research (DZHK) partner site Göttingen, Goettingen, Germany
- Department of Cardiology and Pneumology, University of Goettingen Medical Centre, Goettingen, Germany
| | - Marco Pahor
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Ronenn Roubenoff
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Rome, Italy
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Chareh N, Kiesswetter E, Kob R, Hannink A, Brandl B, Skurk T, Hauner H, Sieber CC, Volkert D. Association Between Inflammation and Appetite in Healthy Community-Dwelling Older Adults—An enable Study. Front Aging 2022; 3:826816. [PMID: 35821805 PMCID: PMC9261305 DOI: 10.3389/fragi.2022.826816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022]
Abstract
Aging is associated with reduced appetite as well as a slight increase in pro-inflammatory status, which both might contribute to the development of malnutrition. We aimed to evaluate the association between inflammation based on serum C-reactive protein (CRP), and appetite in healthy community-dwelling older adults. In this cross-sectional study of 158 healthy and non-smoking persons (aged 75–85 years), appetite was assessed in personal interviews by a single question with five answer categories. As nobody reported (very) poor appetite, the remaining three categories were dichotomised into “(very) good” and “moderate” appetite. Fasting serum CRP was analysed according to standard procedures, values ≥ 5.0 mg/L were considered as inflammation. The association between inflammation and appetite was examined by binary logistic regression, unadjusted and adjusted for age, sex, waist circumference, leptin, depressive mood, number of medications, interleukin-6 and tumor necrosis factor-α. Appetite was very good in 27.8%, good in 58.9%, and moderate in 13.3% of participants. Inflammation was present in 10.8% overall, in 8.8% of those with (very) good and in 23.8% of those with moderate appetite (p = 0.038). In the unadjusted model, participants with inflammation were 3.2 times more likely to have moderate appetite (95%CI: 1.01–10.44, p = 0.047). In the adjusted model, the odds of having moderate appetite was 3.7 times higher in participants with inflammation, but no longer significant (95%CI: 0.77–18.55, p = 0.102). In healthy older people, we found hints for a potential association between increased levels of CRP and a slightly reduced appetite. More studies in larger samples are needed.
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Affiliation(s)
- Neshat Chareh
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
- *Correspondence: Neshat Chareh,
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Anne Hannink
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Beate Brandl
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Thomas Skurk
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
| | - Hans Hauner
- ZIEL–Institute for Food and Health, Technical University of Munich, Freising, Germany
- Institute of Nutritional Medicine, Else Kroener-Fresenius-Centre for Nutritional Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Cornel C. Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, Bauer JM, Boirie Y, Cruz-Jentoft AJ, Dicker D, Frara S, Frühbeck G, Genton L, Gepner Y, Giustina A, Gonzalez MC, Han HS, Heymsfield SB, Higashiguchi T, Laviano A, Lenzi A, Nyulasi I, Parrinello E, Poggiogalle E, Prado CM, Salvador J, Rolland Y, Santini F, Serlie MJ, Shi H, Sieber CC, Siervo M, Vettor R, Villareal DT, Volkert D, Yu J, Zamboni M, Barazzoni R. Definition and diagnostic criteria for sarcopenic obesity: ESPEN and EASO consensus statement. Clin Nutr 2022; 41:990-1000. [DOI: 10.1016/j.clnu.2021.11.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 02/08/2023]
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10
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Donini LM, Busetto L, Bischoff SC, Cederholm T, Ballesteros-Pomar MD, Batsis JA, Bauer JM, Boirie Y, Cruz-Jentoft AJ, Dicker D, Frara S, Frühbeck G, Genton L, Gepner Y, Giustina A, Gonzalez MC, Han HS, Heymsfield SB, Higashiguchi T, Laviano A, Lenzi A, Nyulasi I, Parrinello E, Poggiogalle E, Prado CM, Salvador J, Rolland Y, Santini F, Serlie MJ, Shi H, Sieber CC, Siervo M, Vettor R, Villareal DT, Volkert D, Yu J, Zamboni M, Barazzoni R. Definition and Diagnostic Criteria for Sarcopenic Obesity: ESPEN and EASO Consensus Statement. Obes Facts 2022; 15:321-335. [PMID: 35196654 PMCID: PMC9210010 DOI: 10.1159/000521241] [Citation(s) in RCA: 173] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 11/26/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Loss of skeletal muscle mass and function (sarcopenia) is common in individuals with obesity due to metabolic changes associated with a sedentary lifestyle, adipose tissue derangements, comorbidities (acute and chronic diseases) and during the ageing process. Co-existence of excess adiposity and low muscle mass/function is referred to as sarcopenic obesity (SO), a condition increasingly recognized for its clinical and functional features that negatively influence important patient-centred outcomes. Effective prevention and treatment strategies for SO are urgently needed, but efforts are hampered by the lack of a universally established SO definition and diagnostic criteria. Resulting inconsistencies in the literature also negatively affect the ability to define prevalence as well as clinical relevance of SO for negative health outcomes. AIMS AND METHODS The European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Association for the Study of Obesity (EASO) launched an initiative to reach expert consensus on a definition and diagnostic criteria for SO. The jointly appointed international expert panel proposes that SO is defined as the co-existence of excess adiposity and low muscle mass/function. The diagnosis of SO should be considered in at-risk individuals who screen positive for a co-occurring elevated body mass index or waist circumference, and markers of low skeletal muscle mass and function (risk factors, clinical symptoms, or validated questionnaires). Diagnostic procedures should initially include assessment of skeletal muscle function, followed by assessment of body composition where presence of excess adiposity and low skeletal muscle mass or related body compartments confirm the diagnosis of SO. Individuals with SO should be further stratified into stage I in the absence of clinical complications or stage II if cases are associated with complications linked to altered body composition or skeletal muscle dysfunction. CONCLUSIONS ESPEN and EASO, as well as the expert international panel, advocate that the proposed SO definition and diagnostic criteria be implemented into routine clinical practice. The panel also encourages prospective studies in addition to secondary analysis of existing data sets, to study the predictive value, treatment efficacy and clinical impact of this SO definition.
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Affiliation(s)
| | | | | | | | | | - John A. Batsis
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Yves Boirie
- University of Clermont Auvergne, INRA, CRNH, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Dror Dicker
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Stefano Frara
- San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy
| | - Gema Frühbeck
- Clínica Universidad de Navarra, CIBEROBN, IdiSNA, Pamplona, Spain
| | | | | | - Andrea Giustina
- San Raffaele, Vita-Salute University and IRCCS Hospital, Milan, Italy
| | | | - Ho-Seong Han
- Seoul National University Bundang Hospital (SNUBH), Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | | - Yves Rolland
- Gerontopole of Toulouse, INSERM 1027, Toulouse University Hospital, Toulouse, France
| | | | | | - Hanping Shi
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Cornel C. Sieber
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Mario Siervo
- University of Nottingham, Nottingham, United Kingdom
| | | | | | - Dorothee Volkert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Jianchun Yu
- Peking Union Medical College Hospital, Beijing, China
| | | | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- **Rocco Barazzoni,
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11
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Seemer J, Kiesswetter E, Fleckenstein-Sußmann D, Gloning M, Bader-Mittermaier S, Sieber CC, Sixt B, Wurm S, Volkert D. Effects of an individualised nutritional intervention to tackle malnutrition in nursing homes: a pre-post study. Eur Geriatr Med 2021; 13:741-752. [PMID: 34854062 PMCID: PMC9151515 DOI: 10.1007/s41999-021-00597-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/23/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE Individualised interventions are recommended to tackle malnutrition in older adults, but approaches for nursing home (NH) residents are scarce. This study investigated the effects of an individualised nutritional intervention in NH residents with (risk of) malnutrition. METHODS In a pre-post study, 6 weeks (w) of usual care were followed by 6w of intervention. The intervention consisted of up to three supplement modules (sweet and savoury protein creams and protein-energy drink, single or combined) and, if required, reshaped texture-modified meals (RTMM). RESULTS Fifty residents completed the study (84 ± 8 years, 74% female). One-third (32%) received RTMM. Additional 258 ± 167 kcal/day and 23 ± 15 g protein/day were offered. Mean daily energy intake increased by 207 (95%CI 47-368, p = 0.005) kcal and protein intake by 14 (7-21, p < 0.001) g (w12 vs w1). Quality of life (QoL) increased in the subscale "care relationship" (+ 9 (3-15) points, p = 0.002, w12 vs w6). Body weight, handgrip strength, and other QoL subscales did not change. CONCLUSION Our intervention improved dietary intake and one QoL subscale in NH residents with (risk of) malnutrition. As a next step, randomized controlled trials are needed to investigate the impact of individualised interventions more comprehensively.
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Affiliation(s)
- J Seemer
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - E Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | | | - M Gloning
- Institute of Food Technology, Hochschule Weihenstephan-Triesdorf, Freising, Germany
| | - S Bader-Mittermaier
- Fraunhofer Institute for Process Engineering and Packaging, Freising, Germany
| | - C C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - B Sixt
- Institute of Food Technology, Hochschule Weihenstephan-Triesdorf, Freising, Germany
| | - S Wurm
- Institute for Community Medicine, Department of Prevention Research and Social Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - D Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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12
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Siebentritt HM, Keppner V, Britting S, Kob R, Rappl A, Sieber CC, Freiberger E. Safer cycling in older age (SiFAr): a protocol of a randomized controlled trial. BMC Geriatr 2021; 21:546. [PMID: 34641821 PMCID: PMC8507335 DOI: 10.1186/s12877-021-02502-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cycling has positive effects on health and the proportion of older cyclists is rising. However, the risk for older adults to be injured or killed by a bicycle accident increases. The aim of the ongoing project “Safer Cycling in Older Age (SiFAr)” is to promote safer cycling in community-dwelling older adults with a structured, multi-component exercise training. Methods SiFAr is a randomized, controlled trial with a duration of 3 months for the intervention and a 6–9 months follow-up. We address community-dwelling persons aged 65 years and older living in the area Nürnberg-Fürth-Erlangen (Germany) who are either 1) beginners with the e-bike or 2) feeling self-reported unsteadiness when cycling or 3) uptaking cycling after a longer break. Long-term, experienced cyclists without subjectively reported limitations or worries when cycling are excluded. Participants are either randomized 1:1 to an intervention group (IG; receiving multi-component exercise program related to cycling, MEPC) or an active control group (aCG; receiving health and bicycle-related presentations, HRP). The purpose of this study is to investigate if the cycling competence of the IG will improve compared to the aCG. The cycling competence as primary outcome is tested not blinded in a standardized cycle course prior and after the intervention period, which consists of variant tasks requiring motor and cognitive skills related to traffic situations in daily life. Additional assessments such as physical functioning, quality of life, fear of falling, questionnaires regarding cycling behavior are obtained. To investigate the primary objective, regression analyses with difference of errors in the cycling course as independent variable and group as dichotomous dependent variable adjusted for covariates (sex, bicycle type) will be performed. The trial design is described in the present manuscript, using the extended CONSORT checklist for reporting pragmatic trials. Discussion Since there is a lack of cycling-related interventions for older people, SiFAr aims to evaluate a standardized intervention to enhance cycling safety. The results of the SiFAr trial could contribute to the implementation of an evaluated cycling course concept promoting mobility and independence of older adults. Trial registration This study was registered with clinicaltrials.gov: NCT04362514 on April 27, 2020 Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02502-5.
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Affiliation(s)
- Hanna Maria Siebentritt
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany.
| | - Veronika Keppner
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany
| | - Sabine Britting
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany
| | - Anja Rappl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Bavaria, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Bavaria, Germany
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13
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Grosshauser FJ, Kiesswetter E, Torbahn G, Sieber CC, Volkert D. Reasons for and against Nutritional Interventions. An Exploration in the Nursing Home Setting. Geriatrics (Basel) 2021; 6:geriatrics6030090. [PMID: 34562991 PMCID: PMC8482186 DOI: 10.3390/geriatrics6030090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022] Open
Abstract
Malnutrition (MN) is widespread in nursing homes. Sometimes, but not always, nutritional interventions (NIs) are made, and the reasons for or against NIs are unknown. The aim of this cross-sectional study was to describe these reasons for residents with and without MN according to nurses’ subjective judgement and according to objective signs of MN. The nutritional status of 246 nursing home residents was subjectively judged by nurses (MN, at risk of MN, no MN) and objectively assessed by body mass index (BMI), weight loss (WL), and low food intake. NIs (enriched meals and/or oral nutritional supplements) were recorded using a standardized questionnaire, and nurses’ main reasons for (not) giving NIs were obtained in an open question. Of the residents, 11.0% were subjectively malnourished, and 25.6% were at risk of MN; 32.9% were malnourished according to objective criteria. Overall, 29.7% of the residents received NIs, 70.4% of those with MN as assessed by the nurses, 53.0% of those with objective MN, and 11.0% and 18.0% of non-malnourished residents, respectively. Reasons for NIs most often stated were low intake (47.9%), WL (23.3%), and low BMI (13.7%). Reasons against NIs mostly mentioned were adequate BMI (32.9%) and sufficient intake (24.3%). The lack of NIs for residents with MN was partially—but not always—explained by valid reasons. As residents without MN frequently received NIs, criteria for both MN rating and providing NIs, require closer scrutiny.
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Affiliation(s)
- Franz J. Grosshauser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (G.T.); (C.C.S.); (D.V.)
- Correspondence: ; Tel.: +49-911-5302-96166
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (G.T.); (C.C.S.); (D.V.)
| | - Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (G.T.); (C.C.S.); (D.V.)
| | - Cornel C. Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (G.T.); (C.C.S.); (D.V.)
- Department of Medicine, Kantonsspital Winterthur, 8401 Winterthur, Switzerland
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany; (E.K.); (G.T.); (C.C.S.); (D.V.)
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14
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Cunnane SC, Sieber CC, Swerdlow RH, Cruz-Jentoft AJ. Mild cognitive impairment: when nutrition helps brain energy rescue-a report from the EuGMS 2020 Congress. Eur Geriatr Med 2021; 12:1285-1292. [PMID: 34227053 PMCID: PMC8626370 DOI: 10.1007/s41999-021-00534-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/22/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is characterized by a decline in cognition and mainly affects older individuals above the age of 60. The global incidence of MCI varies, but it is often underdiagnosed and untreated. There is a distinct lack of approved pharmacologic options to treat MCI. There is, however, evidence to support the efficacy of nutritional interventions, such as ketogenic supplements/diets, which offer ketones as an alternative energy source to brain cells. This article explores the effect of ketones on metabolic activity in the brain and the mechanisms by which ketogenic medium-chain triglycerides (kMCTs) induce ketosis in patients with MCI. KEY TAKEAWAYS This article reviews the effect of ketogenic supplements/diets on brain metabolism, including evidence supporting the efficacy of ketones as an efficient fuel for the brain. It discusses the use of oral nutritional ketogenic supplements, with particular reference to the 6-month randomized controlled BENEFIC trial, which showed that consumption of a kMCT drink, BrainXpert Energy Complex, improved cognitive performance in individuals with MCI compared with placebo. CONCLUSION While there is a need for more long-term studies, results from the BENEFIC trial revealed the benefits of a brain-specific ketogenic supplement, as a nutritional intervention, on cognitive performance in individuals with MCI.
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Affiliation(s)
- Stephen C Cunnane
- Research Center on Aging and Department of Medicine, Université de Sherbrooke, Québec, Canada
| | - Cornel C Sieber
- Department of Internal Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Russell H Swerdlow
- University of Kansas Alzheimer's Disease Center, KUMC Neurodegenerative Disorders Program, University of Kansas School of Medicine, Lawrence, KS, USA
| | - Alfonso J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Ctra. Colmenar km 9.1, Madrid, 28034, Spain.
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15
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Lindemann U, Krumpoch S, Becker C, Sieber CC, Freiberger E. The course of gait speed during a 400m walk test of mobility limitations in community-dwelling older adults. Z Gerontol Geriatr 2021; 54:768-774. [PMID: 34115171 PMCID: PMC8636438 DOI: 10.1007/s00391-021-01908-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023]
Abstract
Background The 400‑m walk test (400MWT) of usual gait speed is an assessment of mobility limitations in geriatric medicine and sarcopenic research. Objective The aim of this study was to describe the course of gait speed during a 400MWT in community-dwelling older adults in terms of physical, psychological and general health-related outcomes. Possible plateau phases during the 400MWT could enable integrated measurements of short distance walk tests. Methods In this study 148 community-dwelling older adults (mean age 80.4 ± 4.4 years, 61% women) performed a 400MWT at comfortable gait speed. Additionally, an 8m walk test was carried out and history of falling, sex, comorbidities, fear of falling, executive function and gait variability were determined as covariates. Results Gait speed was higher in the beginning and the end of the 400MWT compared to the middle part with respect to all analyzed covariates. Mean gait speed of the 8 m walk test was significantly faster than mean gait speed of the 400MWT (t (df = 147) = 0.07, p = 0.001). Conclusion The course of gait speed during a 400MWT performed by community-dwelling older adults was not affected by sex, gait variability, comorbidity, history of falling, fear of falling or executive function. Gait speed measurements of the 400MWT do not fully represent assessment of supervised short distance gait speed in community-dwelling adults.
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Affiliation(s)
- Ulrich Lindemann
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Sebastian Krumpoch
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nuremberg, Germany.
| | - Clemens Becker
- Department of Clinical Gerontology and Rehabilitation, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nuremberg, Germany.,Department of Internal Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Ellen Freiberger
- Institute for Biomedicine of Aging (IBA), Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), Nuremberg, Germany
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16
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Krumpoch S, Lindemann U, Rappl A, Becker C, Sieber CC, Freiberger E. The effect of different test protocols and walking distances on gait speed in older persons. Aging Clin Exp Res 2021; 33:141-146. [PMID: 32930990 PMCID: PMC7897617 DOI: 10.1007/s40520-020-01703-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 11/25/2022]
Abstract
Background and aims Walking is the core physical activity of older persons. The assessment of walking capacity is increasingly important for clinical purposes and clinical research. Differences between assessment tools and protocols for short walks to obtain gait characteristics can be responsible for changes, e.g., in gait speed from 0.1 to 0.2 m/s. The purpose of this study was to generate further knowledge for the harmonization and/or standardization of short walk-test protocols for assessing gait characteristics under supervised conditions. Methods For this cross-sectional study, 150 community-dwelling older adults (mean age 80.5 ± 4.5 years) were recruited. Participants performed eight walks differing in the distance (8-versus 4-m), static versus dynamic trials and comparing different test speed instructions (usual versus maximal) on an electronic walkway. Results A meaningful significant difference in mean usual gait speed was documented comparing the 4-m dynamic and static test protocol (0.12 m/s; p = 0.001). For the same comparison over an 8-m distance (dynamic versus static) and for the comparison between usual gait speed over 4-and 8-m, the differences in gait speed were smaller, but still statistically significant (p = 0.001). Conclusions Gait speed was faster, if the test protocol did not include a static start or stop. The differences were greater for a shorter walking distance. This aspect should be considered for the comparison of study results and is particularly relevant for systematic reviews and meta-analyses.
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Torbahn G, Schoene D, Schwingshackl L, Rücker G, Knüttel H, Kemmler W, Sieber CC, Batsis JA, Villareal DT, Stroebele-Benschop N, Volkert D, Kiesswetter E. Effective SLOPE: EffectS of Lifestyle interventions in Older PEople with obesity: a systematic review and network meta-analysis protocol. BMJ Open 2020; 10:e038330. [PMID: 33033022 PMCID: PMC7542917 DOI: 10.1136/bmjopen-2020-038330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Obesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity. METHODS AND ANALYSES Six databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention. ETHICS AND DISSEMINATION We will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups. PROSPERO REGISTRATION NUMBER CRD42019147286.
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Affiliation(s)
- Gabriel Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
| | - Daniel Schoene
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Gerta Rücker
- Institute of Medical Biometry and Medical Informatics, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, Regensburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
- Department of Medicine, Kantonsspital Winterthur, Winterthur, Zurich, Switzerland
| | - John A Batsis
- Division of Geriatric Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dennis T Villareal
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, Texas, USA
| | - Nanette Stroebele-Benschop
- Department of Nutritional Psychology, Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
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Michels G, Sieber CC, Marx G, Roller-Wirnsberger R, Joannidis M, Müller-Werdan U, Müllges W, Gahn G, Pfister R, Thürmann PA, Wirth R, Fresenborg J, Kuntz L, Simon ST, Janssens U, Heppner HJ. [Geriatric intensive care : Consensus paper of DGIIN, DIVI, DGAI, DGGG, ÖGGG, ÖGIAIN, DGP, DGEM, DGD, DGNI, DGIM, DGKliPha and DGG]. Med Klin Intensivmed Notfmed 2020; 115:393-411. [PMID: 31278437 DOI: 10.1007/s00063-019-0590-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The proportion of elderly, frail, and multimorbid people has increased dramatically in recent decades resulting from demographic changes and will further increase, which will impact acute medical care. Prospective, randomized studies on geriatric intensive care are still lacking. There are also no international or national recommendations regarding the management of critically ill elderly patients. Based on an expert opinion, this consensus paper provides 16 statements that should be considered when dealing with geriatric critical care patients.
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Affiliation(s)
- Guido Michels
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - Cornel C Sieber
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - Gernot Marx
- Klinik für Operative Intensivmedizin und Intermediate Care, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | | | - Michael Joannidis
- Gemeinsame Einrichtung für Internistische Intensiv- und Notfallmedizin, Department Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Ursula Müller-Werdan
- Klinik für Geriatrie und Altersmedizin, Evangelisches Geriatriezentrum Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Wolfgang Müllges
- Neurologische Klinik und Poliklinik, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Georg Gahn
- Neurologische Klinik, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Roman Pfister
- Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Petra A Thürmann
- Lehrstuhl für Klinische Pharmakologie, Helios Universitätsklinkum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Rainer Wirth
- Klinik für Altersmedizin und Frührehabilitation, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Jana Fresenborg
- Seminar für Allgemeine BWL und Management im Gesundheitswesen, Universität zu Köln, Köln, Deutschland
| | - Ludwig Kuntz
- Seminar für Allgemeine BWL und Management im Gesundheitswesen, Universität zu Köln, Köln, Deutschland
| | - Steffen T Simon
- Zentrum für Palliativmedizin, Uniklinik Köln, Köln, Deutschland
| | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital Eschweiler, Eschweiler, Deutschland
| | - Hans Jürgen Heppner
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
- Geriatrische Klinik und Tagesklinik, Lehrstuhl für Geriatrie, HELIOS Klinikum Schwelm, Universität Witten/Herdecke, Schwelm, Deutschland
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19
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Kemmler W, von Stengel S, Kohl M, Rohleder N, Bertsch T, Sieber CC, Freiberger E, Kob R. Safety of a Combined WB-EMS and High-Protein Diet Intervention in Sarcopenic Obese Elderly Men. Clin Interv Aging 2020; 15:953-967. [PMID: 32612355 PMCID: PMC7322975 DOI: 10.2147/cia.s248868] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
Purpose Whole-body electromyostimulation (WB-EMS) especially in combination with a high-protein supplementation has been established as an efficient treatment against sarcopenia. However, there are several case reports of rhabdomyolysis after WB-EMS application. Thus, we asked if this training could potentially lead to deteriorations of the cardiac as well as the renal function. Materials and Methods One hundred sarcopenic obese men aged 70 years and older were randomly balanced (1-1-1) and allocated to one of the three study arms. During 16 weeks of intervention, these groups either performed WB-EMS and took a protein supplement (WB-EMS&P), solely received the protein supplement (Protein) or served as control group (CG). WB-EMS consisted of 1.5×20 min (85 Hz, 350 μs, 4 s of strain to 4 s of rest) applied with moderate-to-high intensity while moving. We further generated a daily protein intake of 1.7-1.8 g/kg/body mass per day. At baseline and 8-10 days after completion of the intervention, blood was drawn and biomarkers of muscle, cardiac and renal health were assessed. Results Hereby, we found slight but significant elevations of creatine kinase (CK) levels in the WB-EMS group pointing to minor damages of the skeletal muscle (140 U/l [81-210], p < 0.001). This was accompanied by a significant, low-grade increase of creatine kinase-muscle brain (CK-MB, 0.43 ng/mL [-0.29-0.96], p < 0.01) and high-sensitivity troponin T (hsTnT, 0.001 ng/mL. [0.000-0.003], p < 0.001) but without a higher risk of developing heart failure according to N-terminal prohormone of brain natriuretic peptide (NT-proBNP, -5.7 pg/mL [-38.8-24.6], p = 0.17). Estimated glomerular filtration rate (eGFR) was impaired neither by the high-protein supplementation alone nor in combination with WB-EMS (CG 76.0 mL/min/1.73 m2 [71.9-82.2] vs Protein 73.2 mL/min/1.73 m2 [63.0-78.9] vs WB-EMS&P 74.6 mL/min/1.73 m2 [62.8-84.1], p = 0.478). Conclusion In conclusion, even in the vulnerable group of sarcopenic obese seniors, the combination of WB-EMS with a high-protein intake revealed no short-term, negative impact on the eGFR, but potential consequences for the cardiovascular system need to be addressed in future studies.
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Affiliation(s)
- Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Kohl
- Faculty of Medical and Life Science, University of Furtwangen, Schwenningen, Germany
| | - Nicolas Rohleder
- Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Freiberger E, Sieber CC, Singler K. [Mobility and Fall Prevention in older Community-dwelling Persons]. Dtsch Med Wochenschr 2020; 145:932-943. [PMID: 32615609 DOI: 10.1055/a-0922-7535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An increasing proportion of oldest old persons (over 80 years) accompanies the demographic change. Furthermore, the gender ration will also change and the percentage of older men will increase. Mobility is an important factor for maintaining independence and for "healthy aging". Mobility has to be regarded in the context of individual and environmental factors. With increasing age, the risk of mobility limitation increases. Next to mobility, falls are also a drastic experience for older persons and cannot only have physical consequences like injuries but also psychological consequences as fall-related psychological concerns. These psychological consequences can produce negative behavior e. g. reducing physical activity.
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Torbahn G, Strauss T, Sieber CC, Kiesswetter E, Volkert D. Nutritional status according to the mini nutritional assessment (MNA)® as potential prognostic factor for health and treatment outcomes in patients with cancer - a systematic review. BMC Cancer 2020; 20:594. [PMID: 32586289 PMCID: PMC7318491 DOI: 10.1186/s12885-020-07052-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 06/08/2020] [Indexed: 02/08/2023] Open
Abstract
Background Patients with cancer have an increased risk of malnutrition which is associated with poor outcome. The Mini Nutritional Assessment (MNA®) is often used in older patients with cancer but its relation to outcome is not known. Methods Four databases were systematically searched for studies relating MNA-results with any reported outcome. Two reviewers screened titles/abstracts and full-texts, extracted data and rated the risk of bias (RoB) independently. Results We included 56 studies which varied widely in patient and study characteristics. In multivariable analyses, (risk of) malnutrition assessed by MNA significantly predicts a higher chance for mortality/poor overall survival (22/27 studies), shorter progression-free survival/time to progression (3/5 studies), treatment maintenance (5/8 studies) and (health-related) quality of life (2/2 studies), but not treatment toxicity/complications (1/7 studies) or functional status/decline in (1/3 studies). For other outcomes – length of hospital stay (2 studies), falls, fatigue and unplanned (hospital) admissions (1 study each) – no adjusted results were reported. RoB was rated as moderate to high. Conclusions MNA®-result predicts mortality/survival, cancer progression, treatment maintenance and (health-related) quality of life and did not predict adverse treatment outcomes and functional status/ decline in patients with cancer. For other outcomes results are less clear. The moderate to high RoB calls for studies with better control of potential confounders.
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Affiliation(s)
- G Torbahn
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany.
| | - T Strauss
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany
| | - C C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany.,Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - E Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany
| | - D Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nuremberg, Germany
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22
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Abstract
The protein intake of older people has gained increasing scientific interest as a potential factor to delay the age-associated decline in muscle mass and consequently to counteract the development of sarcopenia. The skeletal muscle of older people seems less responsive to the anabolic stimulus of protein intake. Therefore, higher protein needs are discussed to overcome this anabolic resistance and to maintain muscle mass as far as possible. Besides the total amount of protein consumed, the distribution, quality and timing in relation to physical exercise are considered relevant; however, deriving clear recommendations for clinical practice is still difficult as positive results of protein intake on muscle metabolism found in experimental trials cannot simply be transferred to everyday conditions and randomized controlled trials often failed to show improvements in muscular outcomes related to protein supplementation. The effectiveness of protein supplementation may depend on functional resources of the older persons and the habitual protein intake. There is still a need for studies with well-defined protocols and populations to further elucidate the role of protein in the prevention and treatment of sarcopenia.
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Affiliation(s)
- Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Germany.
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Germany
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23
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Rempe HM, Sproesser G, Hannink A, Skurk T, Brandl B, Hauner H, Renner B, Volkert D, Sieber CC, Freiberger E, Kiesswetter E. The Relationship Between Healthy Eating Motivation and Protein Intake in Community-Dwelling Older Adults With Varying Functional Status. Nutrients 2020; 12:nu12030662. [PMID: 32121298 PMCID: PMC7146591 DOI: 10.3390/nu12030662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 11/19/2022] Open
Abstract
In older adults, the relationship between healthy eating motivation (HEM) and protein intake as key component of a healthy diet is poorly understood. Therefore, we investigate the association of HEM with (1) total protein intake and (2) intake of different protein sources in older adults with varying functional status. In this cross-sectional study including 250 adults (≥70 years), we assessed HEM with “The Eating Motivation Survey” and protein intake by 7-day food records. In addition, gender, age, Body Mass Index (BMI), energy intake and functional status were considered. Regression analyses revealed that HEM was neither related to total (β = −0.02; p = 0.723) nor to relative protein intake (β = 0.04; p = 0.370). Notwithstanding this, participants with stronger HEM showed lower intake of protein from meat and meat products (β = −0.14; p = 0.018), higher intake of overall plant-based protein (β = 0.11; p = 0.032), protein from fruit and vegetables (β = 0.20; p = 0.002) and from pulses, nuts an seeds (β = 0.16; p = 0.016). Our findings suggest HEM as a valuable indicator for intake of distinct protein sources. However, since HEM is not related to total protein intake, the importance of sufficient protein consumption should be emphasized by promoting healthy eating, regardless of self-perceived HEM.
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Affiliation(s)
- Hanna M. Rempe
- Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany; (A.H.); (D.V.); (C.C.S.); (E.F.); (E.K.)
- Correspondence: ; Tel.: +49 911 5302-96163
| | - Gudrun Sproesser
- Psychological Assessment and Health Psychology, University of Konstanz, Box 47, 78457 Konstanz, Germany; (G.S.); (B.R.)
| | - Anne Hannink
- Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany; (A.H.); (D.V.); (C.C.S.); (E.F.); (E.K.)
| | - Thomas Skurk
- Else-Kröner-Fresenius-Center for Nutritional Medicine, Technical University of Munich, Gregor-Mendel-Straße, 85354 Freising-Weihenstephan, Germany; (T.S.); (H.H.)
- ZIEL Institute for Food and Health, Core Facility Human Studies, Technical University of Munich, Gregor-Mendel-Str. 2, 85354 Freising, Germany;
| | - Beate Brandl
- ZIEL Institute for Food and Health, Core Facility Human Studies, Technical University of Munich, Gregor-Mendel-Str. 2, 85354 Freising, Germany;
| | - Hans Hauner
- Else-Kröner-Fresenius-Center for Nutritional Medicine, Technical University of Munich, Gregor-Mendel-Straße, 85354 Freising-Weihenstephan, Germany; (T.S.); (H.H.)
- Klinikum Rechts der Isar, Institute of Nutritional Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany
| | - Britta Renner
- Psychological Assessment and Health Psychology, University of Konstanz, Box 47, 78457 Konstanz, Germany; (G.S.); (B.R.)
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany; (A.H.); (D.V.); (C.C.S.); (E.F.); (E.K.)
| | - Cornel C. Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany; (A.H.); (D.V.); (C.C.S.); (E.F.); (E.K.)
- Department of Medicine, Kantonsspital Winterthur, Brauerstraße 15, 8400 Winterthur, Switzerland
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany; (A.H.); (D.V.); (C.C.S.); (E.F.); (E.K.)
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany; (A.H.); (D.V.); (C.C.S.); (E.F.); (E.K.)
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Rempe HM, Calvani R, Marzetti E, Picca A, Sieber CC, Freiberger E, Landi F. Are Health Behaviors and Self-Rated Health Related to Cardiovascular Health and Functional Performance? Results from the Lookup 7+ Cross-Sectional Survey among Persons Aged 65+. J Nutr Health Aging 2020; 24:379-387. [PMID: 32242205 DOI: 10.1007/s12603-020-1342-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Cardiovascular health (CVH) and physical performance (PP) are key factors of successful ageing. This study investigated whether self-reported CVH behaviours and self-rated health (SRH) are related to ideal CVH and PP. DESIGN Cross-sectional survey. SETTING Public places in Italy (e.g. exhibitions, malls, health promotion campaigns), outside of conventional healthcare settings. PARTICIPANTS 1415 community-living persons aged 65+ years (mean age 72.2 ± 5.4; 58.4% female). MEASUREMENTS Three ideal CVH behaviors [regular physical activity (PA), healthy diet, no smoking] and SRH (1 excellent - 4 poor) were assessed through a brief questionnaire. Four ideal CVH factors [iBMI ≤ 25 kg/m2, untreated random total blood cholesterol ≤200 mg/dl, absence of diabetes (untreated random blood glucose ≤200 mg/dl), untreated blood pressure (iBP) <140/90mmHg] and two ideal PP factors [grip strength (iGrip), 5-repetition chair-stand test <10 seconds (iStand)] were measured. RESULTS Adjusted for age and gender, regular PA was positively related to CVH factor score (β = 0.1; p = < .001), iBMI (OR = 1.8; 95% CI = 1.5-2.3), iBP (OR = 1.3; 95% CI = 1.1-1.6) and iStand (OR = 1.6; 95% CI = 1.3-2.1). Healthy diet was positively related to CVH factor score (β = 0.1; p = < .05) and iGrip (OR = 1.4; 95% CI = 1.1-1.8). Participants rating SRH as "good" (OR = 2.0; 95% CI = 1.1-3.9) and "not so good" (OR = 2.3; 95% CI = 1.2-4.5) met iDiabetes more often than those with poor SRH. Moreover, iStand (OR = 3.2; 95% CI = 1.6-6.6) and iGrip (OR = 4.2; 95% = CI 2.0-8.8) were more prevalent among participants with excellent SRH compared with those with poor SRH. CONCLUSIONS Physical activity, diet and self-rated health may provide quick and easy-to-assess metrics to identify persons aged 65+ years at risk of cardiovascular events and functional impairment, who could particularly benefit from engaging in health promotion programs.
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Affiliation(s)
- H M Rempe
- Hanna M. Rempe, Kobergerstraße 60, 90408 Nürnberg, Germany, E-mail:
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Ott A, Senger M, Lötzbeyer T, Gefeller O, Sieber CC, Volkert D. Effects of a Texture-Modified, Enriched, and Reshaped Diet on Dietary Intake and Body Weight of Nursing Home Residents with Chewing and/or Swallowing Problems: An Enable Study. J Nutr Gerontol Geriatr 2019; 38:361-376. [PMID: 31223063 DOI: 10.1080/21551197.2019.1628158] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This proof-of-concept study investigated the effects of an innovative nutrition concept, comprising texture modification, enrichment, and reshaping, on dietary intake and nutritional status of 16 nursing home residents with chewing and/or swallowing problems (mean age 86.5 ± 7.4 years) in a pre-test post-test design. During 6 weeks with usual texture-modified diet (P1) energy and protein intake were constant. After the implementation of the innovative diet, daily energy intake increased by 204.2 (median) [interquartile range 95.8-444.4] kcal (P = 0.011), and protein intake by 18.3 [9.9-26.3] g (P < 0.001) and remained constant during the following 6 weeks (P2). Body weight decreased during P1 (-0.5 [-1.4 to 0.2] kg), and increased during P2 (+1.1 [0.0 to 1.7] kg, P = 0.004). The present nutrition concept turned out to be a promising strategy for nutritional management of chewing and/or swallowing problems, however, the effects need to be confirmed in larger studies.
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Affiliation(s)
- Angela Ott
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg , Nürnberg , Bavaria , Germany
| | - Melanie Senger
- Institute of Food Technology, University of Applied Sciences Weihenstephan-Triesdorf , Freising , Bavaria , Germany
| | - Thomas Lötzbeyer
- Institute of Food Technology, University of Applied Sciences Weihenstephan-Triesdorf , Freising , Bavaria , Germany
| | - Olaf Gefeller
- Chair of Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen , Bavaria , Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg , Nürnberg , Bavaria , Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg , Nürnberg , Bavaria , Germany
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Zopf Y, Schink K, Reljic D, Herrmann HJ, Dieterich W, Kiesswetter E, Sieber CC, Neurath MF, Volkert D. Assessing cachexia in older patients: Different definitions - But which one is the most practical for clinical routine? Arch Gerontol Geriatr 2019; 86:103943. [PMID: 31561063 DOI: 10.1016/j.archger.2019.103943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/02/2019] [Accepted: 09/03/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Patients with chronic inflammatory diseases and malignant tumors have an increased risk of cachexia. No consistent definition exists to rapidly identify cachexia in older patients with and without cancer. METHODS One-hundred patients (53% male) aged 70 + years were included in the study by a university hospital. In addition to the detection of malnutrition and determination of body composition by bioelectrical impedance analysis, cachexia was assessed according to the well-established definitions of Evans (weight loss ≥ 5% within the last 12 months plus additional clinical parameters), Fearon (weight loss > 5% in 6 months) and Bozzetti (weight loss ≥ 10% of habitual weight). After a follow-up of 3.5 years, the mortality rate was recorded. RESULTS Thirty-three patients had a malignant tumor disease. The patients with a non-malignant underlying disease did not differ in their mental state, physical condition and state of health compared to patients with cancer. A higher percentage of patients with underlying malignancy had cachexia. There were significant differences in the body composition between the patients with or without cachexia. Cachectic patients exhibited a significantly lower skeletal muscle mass and fat mass. The risk of death was increased in cachectic patients of all three cachexia definitions. CONCLUSION For clinical daily routine, the assessments by a weight loss according to Fearon and Bozzetti are suggested to be practicable methods to detect cachexia in older patients with and without cancer.
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Affiliation(s)
- Yurdagül Zopf
- Medical Department 1, Friedrich-Alexander - University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; Hector Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany.
| | - Kristin Schink
- Medical Department 1, Friedrich-Alexander - University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; Hector Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Dejan Reljic
- Medical Department 1, Friedrich-Alexander - University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; Hector Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Hans J Herrmann
- Medical Department 1, Friedrich-Alexander - University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; Hector Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Walburga Dieterich
- Medical Department 1, Friedrich-Alexander - University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; Hector Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander- University Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander- University Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany
| | - Markus F Neurath
- Medical Department 1, Friedrich-Alexander - University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander- University Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany
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Gingrich A, Spiegel A, Gradl JE, Skurk T, Hauner H, Sieber CC, Volkert D, Kiesswetter E. Daily and per-meal animal and plant protein intake in relation to muscle mass in healthy older adults without functional limitations: an enable study. Aging Clin Exp Res 2019; 31:1271-1281. [PMID: 30519977 DOI: 10.1007/s40520-018-1081-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/21/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Animal protein sources are considered to be of higher quality than plant protein sources in terms of stimulating muscle metabolism. Our objective was to investigate whether protein intake from animal and plant sources on a daily and per-meal basis differs between healthy older adults with normal and with low muscle mass. METHODS In this cross-sectional study including 100 healthy, community-dwelling adults (51 women) aged 75-85 years without functional limitations dietary intake was assessed using 7-day food records. Protein intake was classified by six animal and six plant protein sources. Skeletal muscle index (SMI) was determined based on bioelectrical impedance analysis and categorized into 'normal' or 'low' (men ≤ 8.50, women ≤ 5.75 kg/m2). The absolute animal and plant protein intake and their proportion of total protein intake were compared between these groups using Mann-Whitney U test. RESULTS Daily protein intake was 0.96 ± 0.27 g/kg body weight (BW), 61 ± 10% hereof were from animal origin with no difference between men and women. SMI was low in 39% of men and 35% of women. No differences in absolute daily animal and plant protein intake between participants with normal vs. low SMI were observed. The proportion of animal protein was not different on neither a daily nor a per-meal basis between those with normal and those with low SMI. Women with low SMI consumed less animal protein (in g) for breakfast (4.8 ± 4.1 g vs. 8.5 ± 6.9 g, p = 0.031) and fewer meals per day with at least 50% animal protein (2.2 ± 0.9 vs. 2.7 ± 1.0, p = 0.046) compared to those with normal SMI. CONCLUSION On a daily basis, the absolute and relative animal protein intake does not differ between healthy older adults without functional limitations with normal vs. low SMI. However, our results indicate that in women animal protein intake on a per-meal basis might be of relevance for the maintenance of muscle mass.
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Affiliation(s)
- Anne Gingrich
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany.
| | - Alexandra Spiegel
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
| | - Julia E Gradl
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
| | - Thomas Skurk
- Chair of Nutritional Medicine, Technische Universität München, Gregor-Mendel-Str. 2, 85354, Freising, Weihenstephan, Germany
| | - Hans Hauner
- Chair of Nutritional Medicine, Technische Universität München, Gregor-Mendel-Str. 2, 85354, Freising, Weihenstephan, Germany
- Institute of Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
- Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nuremberg, Germany
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Volkert D, Beck AM, Cederholm T, Cereda E, Cruz-Jentoft A, Goisser S, de Groot L, Großhauser F, Kiesswetter E, Norman K, Pourhassan M, Reinders I, Roberts HC, Rolland Y, Schneider SM, Sieber CC, Thiem U, Visser M, Wijnhoven HAH, Wirth R. Management of Malnutrition in Older Patients-Current Approaches, Evidence and Open Questions. J Clin Med 2019; 8:E974. [PMID: 31277488 PMCID: PMC6678789 DOI: 10.3390/jcm8070974] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 06/27/2019] [Accepted: 07/01/2019] [Indexed: 01/07/2023] Open
Abstract
Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.
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Affiliation(s)
- Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany.
| | - Anne Marie Beck
- Department Nutrition and Health, University College Copenhagen, 2200 Copenhagen, Denmark
- Herlev and Gentofte University Hospital, 2703 Herlev, Denmark
| | - Tommy Cederholm
- Clinical Nutrition and Metabolism, Department of Public Health and Caring Sciences, Uppsala University, 701 05 Uppsala, Sweden
- Theme Ageing, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Alfonso Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), 28034 Madrid, Spain
| | - Sabine Goisser
- Heidelberg University Centre for Geriatric Medicine and Network Aging Research (NAR), University of Heidelberg, 69126 Heidelberg, Germany
| | - Lisette de Groot
- Division of Human Nutrition, Wageningen University, 6708 WE Wageningen, The Netherlands
| | - Franz Großhauser
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
| | - Kristina Norman
- German Institute for Human Nutrition Potsdam-Rehbrücke, Department of Nutrition and Gerontology, 14558 Nuthetal, Germany
- Research Group on Geriatrics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, 14558 Nuthetal, Germany
| | - Maryam Pourhassan
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
| | - Ilse Reinders
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Helen C Roberts
- Southampton NIHR Biomedical Research Centre, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Yves Rolland
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, 31059 Toulouse, France
| | - Stéphane M Schneider
- Nutritional Support Unit, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, 06200 Nice, France
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408 Nuremberg, Germany
- Department of Medicine, Kantonsspital Winterthur, 8401 Winterthur, Switzerland
| | - Ulrich Thiem
- Centre of Geriatrics and Gerontology, Albertinen-Haus, Hamburg, and Chair of Geriatrics and Gerontology, University Medical Centre Eppendorf, 20246 Hamburg, Germany
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Hanneke A H Wijnhoven
- Department of Health Sciences, Faculty of Science, and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Rainer Wirth
- Department for Geriatric Medicine, Marien Hospital Herne-University Hospital, Ruhr-Universität Bochum, 44625 Herne, Germany
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Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48:601. [PMID: 31081853 PMCID: PMC6593317 DOI: 10.1093/ageing/afz046] [Citation(s) in RCA: 984] [Impact Index Per Article: 196.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Indexed: 12/13/2022] Open
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Rempe HM, Sproesser G, Gingrich A, Spiegel A, Skurk T, Brandl B, Hauner H, Renner B, Volkert D, Sieber CC, Freiberger E, Kiesswetter E. Measuring eating motives in older adults with and without functional impairments with The Eating Motivation Survey (TEMS). Appetite 2019; 137:1-20. [PMID: 30776395 DOI: 10.1016/j.appet.2019.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 02/09/2023]
Abstract
Gaining a better understanding which motives play a role in daily eating is crucial in order to develop personalized interventions promoting adequate diet. The Eating Motivation Survey (TEMS) is a comprehensive tool to assess manifold reasons for eating but has not been specifically applied in an older sample including very old persons and persons differing in functional status. Therefore, the first step of the study was to investigate whether the basic motives of TEMS are consistent in an older sample and comparable across older adults with and without functional impairments. Second, the study aimed at describing which motives underlie eating behavior in older age most often as well as to analyze the relationship between eating motives and functional status. 376 community-dwelling older persons aged 70 years and older filled in the brief survey version (15 motives à 3 items) of TEMS. The sample comprises 149 unimpaired and 227 impaired participants in terms of physical function. Confirmatory factor analysis yielded good model fit with RMSEA 0.036 and SRMR 0.048. Furthermore, multi-group analysis revealed a generally invariant factor structure across participants with and without functional impairments. Liking was rated to underlie eating behavior most often, followed by Health and Natural Concerns. Considering gender, age and BMI, significant associations between functional status and the motive Sociability emerged. Since the results suggest that the fifteen basic eating motives are generalizable in older age and across different functional states, TEMS might be a valuable tool in nutrition-related health promotion to developing individualized approaches considering health aspects as well as hedonistic factors.
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Affiliation(s)
- Hanna M Rempe
- Friedrich-Alexander-University of Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408, Nürnberg, Germany.
| | - Gudrun Sproesser
- University of Konstanz, Psychological Assessment and Health Psychology, Box 47, 78457, Konstanz, Germany
| | - Anne Gingrich
- Friedrich-Alexander-University of Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Alexandra Spiegel
- Friedrich-Alexander-University of Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Thomas Skurk
- Else-Kröner-Fresenius-Center for Nutritional Medicine, Technical University of Munich, Gregor-Mendel-Straße, 85354, Freising, Weihenstephan, Germany; Technical University of Munich, ZIEL Institute for Food and Health, Core Facility Human Studies, Gregor-Mendel-Str. 2, 85354, Freising, Germany
| | - Beate Brandl
- Else-Kröner-Fresenius-Center for Nutritional Medicine, Technical University of Munich, Gregor-Mendel-Straße, 85354, Freising, Weihenstephan, Germany; Technical University of Munich, ZIEL Institute for Food and Health, Core Facility Human Studies, Gregor-Mendel-Str. 2, 85354, Freising, Germany
| | - Hans Hauner
- Technical University of Munich, ZIEL Institute for Food and Health, Core Facility Human Studies, Gregor-Mendel-Str. 2, 85354, Freising, Germany; Technical University of Munich, Klinikum rechts der Isar, Institute of Nutritional Medicine, Georg-Brauchle-Ring 62, 80992, Munich, Germany
| | - Britta Renner
- University of Konstanz, Psychological Assessment and Health Psychology, Box 47, 78457, Konstanz, Germany
| | - Dorothee Volkert
- Friedrich-Alexander-University of Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Cornel C Sieber
- Friedrich-Alexander-University of Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408, Nürnberg, Germany; Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049, Regensburg, Germany
| | - Ellen Freiberger
- Friedrich-Alexander-University of Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Eva Kiesswetter
- Friedrich-Alexander-University of Erlangen-Nürnberg, Institute for Biomedicine of Aging, Kobergerstraße 60, 90408, Nürnberg, Germany
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Gingrich A, Volkert D, Kiesswetter E, Thomanek M, Bach S, Sieber CC, Zopf Y. Prevalence and overlap of sarcopenia, frailty, cachexia and malnutrition in older medical inpatients. BMC Geriatr 2019; 19:120. [PMID: 31029082 PMCID: PMC6487020 DOI: 10.1186/s12877-019-1115-1] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 03/24/2019] [Indexed: 12/26/2022] Open
Abstract
Background Sarcopenia, frailty, cachexia and malnutrition are widespread syndromes in older people, characterized by loss of body tissue and related to poor outcome. The aim of the present cross-sectional study was to assess the prevalence of these syndromes and their overlap in older medical inpatients. Methods Patients aged 70 years or older who had been admitted to the internal medical department of a German university hospital were recruited. Sarcopenia, frailty, cachexia and malnutrition were assessed in a standardized manner according to current consensus definitions. Prevalence rates of these syndromes and their constituents and the concurrent occurrence of the syndromes (overlap) were calculated. Results One hundred patients (48 female) aged 76.5 ± 4.7 years with a BMI of 27.6 ± 5.5 kg/m2 were included. The main diagnoses were gastroenterological (33%) and oncological diseases (31%). Sarcopenia was present in 42%, frailty in 33%, cachexia in 32% and malnutrition in 15% of the patients. 63% had at least one syndrome: 32% one, 11% two, 12% three and 8% all four. All four syndromes are characterized by significant weight loss during the last 12 months, which was most pronounced in malnourished patients and least pronounced in frail patients, and by significantly reduced physical performance. All syndromes were significantly pairwise related, except malnutrition and frailty. In 19% of patients sarcopenia and frailty occurred concurrently, in 20% frailty and cachexia and in 22% sarcopenia and cachexia with or without additional other syndromes. All malnourished patients except one were also cachectic (93%) and 80% of malnourished patients were also sarcopenic. 53% of malnourished patients were in addition frail, and these patients were affected by all four syndromes. Conclusions Nearly two thirds of older medical inpatients had at least one of the tissue loss syndromes sarcopenia, frailty, cachexia and malnutrition. The syndromes overlapped partly and were interrelated. Future studies with larger patient groups and longitudinal design are required to clarify the significance of single and concurrent occurrence of these syndromes for clinical outcome and successful therapy.
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Affiliation(s)
- Anne Gingrich
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany.
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany
| | - Marta Thomanek
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Svenja Bach
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408, Nürnberg, Germany.,Department of Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Yurdagül Zopf
- Department of Medicine 1, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany
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Schoene D, Heller C, Aung YN, Sieber CC, Kemmler W, Freiberger E. A systematic review on the influence of fear of falling on quality of life in older people: is there a role for falls? Clin Interv Aging 2019; 14:701-719. [PMID: 31190764 PMCID: PMC6514257 DOI: 10.2147/cia.s197857] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/17/2019] [Indexed: 11/03/2022] Open
Abstract
Maintaining or improving quality of life (QoL) is a key outcome of clinical interventions in older people. Fear of falling (FoF) is associated with activity restriction as well as with poorer physical and cognitive functions and may be an important contributor to a diminished QoL. The objectives of this systematic review were to determine i) the effect of FoF on QoL in older people, ii) whether the association between these two constructs depends on the use of specific conceptualizations and measurement instruments, and iii) the role of fall events as mediating factor in this relationship. Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Library) were searched from their inceptions to February 2018. Thirty mostly cross-sectional studies in nearly 30.000 people (weighted mean age 75.6 years (SD =6.1); 73% women) were included. FoF was associated with QoL in most studies, and this association appeared to be independent of the conceptualization of FoF. Moreover, this relationship was independent of falls people experienced which seemed to have a lower impact. FoF should be considered not only as by-product of falls and targeted interventions in parts different from those to reduce falls are likely required. Studies are needed showing that reducing FoF will lead to increased QoL.
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Affiliation(s)
- Daniel Schoene
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.,Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Claudia Heller
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Yan N Aung
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany.,Department of General Internal and Geriatric Medicine, Hospital of the Order of St. John of God Regensburg, Regensburg, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander University Erlangen-Nürnberg, Nuremberg, Germany
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Abstract
Since 2016 sarcopenia, the age-associated loss of muscle mass, strength and function, has the ICD-10-GM code M62.50 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification). The diagnosis of sarcopenia requires the combined presence of low muscle strength and low muscle mass. Well-established approaches for the prevention and therapy of sarcopenia are exercise programs-in particular strength, endurance and power training-and nutritional interventions, preferably a combination of both. Adequate protein intake is considered highly relevant, while the role of other nutrients involved in muscle metabolism (e. g. creatine, vitamin D, antioxidants, omega-3 fatty acids) is less clear, being still the subject of controversial discussions. Innovative pharmacological therapies are currently under investigation and their future relevance for this indication is unclear. In general, it has to be stated that there are still only few intervention studies available that focused specifically on sarcopenia in older individuals. More studies in this rapidly increasing population are urgently needed.
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Affiliation(s)
- S Goisser
- Netzwerk AlternsfoRschung (NAR) der Universität Heidelberg, Heidelberg, Deutschland. .,Geriatrisches Zentrum der Universität Heidelberg, Agaplesion Bethanien Krankenhaus gGmbH, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland.
| | - R Kob
- Institut für Biomedizin des Alterns (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - C C Sieber
- Institut für Biomedizin des Alterns (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland.,Klinik für Innere Medizin, Kantonsspital Winterthur, Winterthur, Schweiz
| | - J M Bauer
- Netzwerk AlternsfoRschung (NAR) der Universität Heidelberg, Heidelberg, Deutschland.,Geriatrisches Zentrum der Universität Heidelberg, Agaplesion Bethanien Krankenhaus gGmbH, Rohrbacher Straße 149, 69126, Heidelberg, Deutschland
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Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, Schneider SM, Sieber CC, Topinkova E, Vandewoude M, Visser M, Zamboni M. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 2019; 48:16-31. [PMID: 30312372 PMCID: PMC6322506 DOI: 10.1093/ageing/afy169] [Citation(s) in RCA: 5786] [Impact Index Per Article: 1157.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 09/21/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023] Open
Abstract
Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.
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Affiliation(s)
| | - Gülistan Bahat
- Department of Internal Medicine, Division of Geriatrics, Istanbul Medical School, Istanbul University, Istanbul, Turkey
| | - Jürgen Bauer
- Center for Geriatric Medicine, University Heidelberg, Agaplesion Bethanien Krankenhaus, Heidelberg, Germany
| | - Yves Boirie
- Research Department, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton; Southampton, UK; and Department of Epidemiology, University of Oxford, OX, UK
| | - Francesco Landi
- Instituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Yves Rolland
- Department of Geriatrics, Hospital and University of Toulouse, Toulouse, France
| | - Avan Aihie Sayer
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Stéphane M Schneider
- Department of Gastroenterology and Clinical Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, Nice, France
| | - Cornel C Sieber
- Department of Internal Medicine-Geriatrics, Institute for Biomedicine and Ageing, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University and General Faculty Hospital, Prague, Czech Republic
| | - Maurits Vandewoude
- Department Geriatrics, University of Antwerp, Ziekenhuisnetwerk Antwerpen (ZNA), Antwerp, Belgium
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam; and the Amsterdam Public Health Research Institute; Amsterdam, The Netherlands
| | - Mauro Zamboni
- Department of Medicine, Geriatric section, University of Verona, Verona, Italy
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Affiliation(s)
- G Hasenfuß
- Herzzentrum, Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - E Märker-Hermann
- Klinik für Innere Medizin IV, Helios Dr. Horst Schmidt Kliniken GmbH, Wiesbaden, Deutschland
| | - M Hallek
- Klinik I für Innere Medizin, Uniklinik Köln, Köln, Deutschland
| | - C C Sieber
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland.,Institut für Biomedizin des Alterns (IBA), Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Deutschland
| | - U R Fölsch
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
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Marzetti E, Cesari M, Calvani R, Msihid J, Tosato M, Rodriguez-Mañas L, Lattanzio F, Cherubini A, Bejuit R, Di Bari M, Maggio M, Vellas B, Dantoine T, Cruz-Jentoft AJ, Sieber CC, Freiberger E, Skalska A, Grodzicki T, Sinclair AJ, Topinkova E, Rýznarová I, Strandberg T, Schols AMWJ, Schols JMGA, Roller-Wirnsberger R, Jónsson PV, Ramel A, Del Signore S, Pahor M, Roubenoff R, Bernabei R, Landi F. The "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) randomized controlled trial: Case finding, screening and characteristics of eligible participants. Exp Gerontol 2018; 113:48-57. [PMID: 30261246 DOI: 10.1016/j.exger.2018.09.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND The ongoing "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies (SPRINTT)" randomized controlled trial (RCT) is testing the efficacy of a multicomponent intervention in the prevention of mobility disability in older adults with physical frailty & sarcopenia (PF&S). Here, we describe the procedures followed for PF&S case finding and screening of candidate participants for the SPRINTT RCT. We also illustrate the main demographic and clinical characteristics of eligible screenees. METHODS The identification of PF&S was based on the co-occurrence of three defining elements: (1) reduced physical performance (defined as a score on the Short Physical Performance Battery between 3 and 9); (2) low muscle mass according to the criteria released by the Foundation for the National Institutes of Health; and (3) absence of mobility disability (defined as ability to complete the 400-m walk test in 15 min). SPRINTT was advertised through a variety of means. Site-specific case finding strategies were developed to accommodate the variability across centers in catchment area characteristics and access to the target population. A quick "participant profiling" questionnaire was devised to facilitate PF&S case finding. RESULTS During approximately 22 months, 12,358 prescreening interviews were completed in 17 SPRINTT sites resulting in 6710 clinic screening visits. Eventually, 1566 candidates were found to be eligible for participating in the SPRINTT RCT. Eligible screenees showed substantial physical function impairment and comorbidity burden. In most centers, project advertisement through mass media was the most rewarding case finding strategy. CONCLUSION PF&S case finding in the community is a challenging, but feasible task. Although largely autonomous in daily life activities, older adults with PF&S suffer from significant functional impairment and comorbidity. This subset of the older population is therefore at high risk for disability and other negative health-related events. Key strategies to consider for successfully intercepting at-risk older adults should focus on mass communication methods.
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Affiliation(s)
- Emanuele Marzetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Cesari
- Department of Clinical Sciences and Community Health, University of Milan, Italy; Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | - Matteo Tosato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | | | - Antonio Cherubini
- Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'Invecchiamento, IRCCS INRCA, Ancona, Italy
| | | | - Mauro Di Bari
- Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marcello Maggio
- Department of Geriatric Rehabilitation, University Hospital of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Bruno Vellas
- Gérontopôle, University Hospital of Toulouse, Toulouse, France
| | | | | | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Ellen Freiberger
- Institute for Biomedicine of Aging, Friedrich-Alexander-University, Nuremberg, Germany
| | - Anna Skalska
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Grodzicki
- Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Limited, Worcestershire, UK
| | - Eva Topinkova
- Department of Geriatrics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Timo Strandberg
- University of Helsinki, Clinicum, Helsinki, Finland; Helsinki University Hospital, Medicine and Rehabilitation, Helsinki, Finland; University of Oulu, Center for Life Course Health Research, Oulu, Finland
| | - Annemie M W J Schols
- Department of Respiratory Medicine, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos M G A Schols
- Department of Health Services Research, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - Pálmi V Jónsson
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | - Alfons Ramel
- Department of Geriatrics, Faculty of Medicine, Landspitali University Hospital, University of Iceland, Reykjavik, Iceland
| | | | - Marco Pahor
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Ronenn Roubenoff
- Translational Medicine, Novartis Institutes for Biomedical Research, Basel, Switzerland
| | - Roberto Bernabei
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Kiesskalt L, Volland-Schüssel K, Sieber CC, Bollheimer LC. [Hospital pastoral care of people with dementia : A qualitative interview study with professional hospital pastoral carers]. Z Gerontol Geriatr 2018; 51:537-542. [PMID: 29736605 DOI: 10.1007/s00391-018-1396-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 03/10/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Communicating and interacting with persons diagnosed with dementia (PwD) present a challenge to pastoral carers, since most classical pastoral care approaches concentrate on conversation as a medium of relationship formation and do not take limited communication skills into account. This study focuses on the following question: how can hospital-based pastoral carers find appropriate methods of communication and interaction with PwD and provide them with pastoral care? METHODS A total of 10 professional pastoral carers participated in the study. Each of these persons had extensive experience with PwD. Data were collected with the use of guideline-based interviews. The interviews were evaluated using Mayring's method of qualitative content analysis. RESULTS One of the main challenges faced by the pastoral carers in interacting with PwD was to explore communication strategies based on non-verbal communication, in addition to verbal communication. Pastoral carers need to find alternative communicative approaches, such as biographical, non-verbal, and physical sense-related methods. Clinical pastoral education did not adequately equip these professionals for communicating and interacting with PwD. The interviewed pastoral carers acquired this specific knowledge through independent research of the academic literature, observation of other professionals, dementia-specific training courses, and practical experience. CONCLUSION Pastoral carers can make a positive contribution to the holistic care of PwD through their unique communicative and relationship approach to care. It is imperative to develop adequate pastoral care concepts and to integrate methodologies for dealing with PwD into the training curriculum of pastoral carers.
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Affiliation(s)
- L Kiesskalt
- Institut für Psychogerontologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 62, 90408, Nürnberg, Deutschland. .,Alzheimer Gesellschaft München e. V., Josephsburgstr. 92, 81673, München, Deutschland.
| | - K Volland-Schüssel
- Institut für Psychogerontologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 62, 90408, Nürnberg, Deutschland
| | - C C Sieber
- Klinik für Allgemeine Innere Medizin und Geriatrie, Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.,Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland
| | - L C Bollheimer
- Lehrstuhl für Altersmedizin der Uniklinik RWTH Aachen mit Klinik für Innere Medizin und Geriatrie, Franziskushospital Aachen, Morillenhang 27, 52074, Aachen, Deutschland.
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Kwetkat A, Pfister W, Pansow D, Pletz MW, Sieber CC, Hoyer H. Naso- and oropharyngeal bacterial carriage in nursing home residents: Impact of multimorbidity and functional impairment. PLoS One 2018; 13:e0190716. [PMID: 29304069 PMCID: PMC5755901 DOI: 10.1371/journal.pone.0190716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 12/19/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE From April 2013 to February 2014 we performed a multicentre prospective cross-sectional study in 541 German nursing home residents. We determined pharyngeal carriage of Streptococcus pneumoniae (primary objective) and other bacteria (secondary objective) in naso- and oropharyngeal swabs by culture-based standard procedures and explored the influence of multimorbidity and functional status on bacterial carriage. METHODS Socio-demographic data, vaccination status, multimorbidity, nutrition and functional status defined by Comprehensive Geriatric Assessment were evaluated. We estimated carriage rates with 95% confidence intervals (CI) and explored potential risk factors by logistic regression analysis. RESULTS Pneumococcal post-serotyping carriage rate was 0.8% (95%CI 0.2-1.9%; 4/526). Serotyping revealed serotypes 4, 7F, 23B and 23F and S. pseudopneumoniae in two other cases. Odds of carriage were higher in men (Odds ratio OR 5.3 (95%CI 0.9-29.4)), in malnourished residents (OR 4.6 (0.8-25.7)), residents living in shared rooms (OR 3.0 (0.5-16.5)) or having contact with schoolchildren (OR 2.0 (0.2-17.6)). The most frequent pathogen was Staphylococcus aureus (prevalence 29.5% (25.6-33.6%)) with meticillin-resistant Staphylococcus aureus prevalence of 1.1%. Gram-negative bacteria (GNB) were found in 22.5% (19.0-26.3%) with a prevalence of extended-spectrum beta lactamase (ESBL) producing bacteria of 0.8%. Odds of S. aureus carriage were higher for immobility (OR 1.84 (1.15-2.93)) and cognitive impairment (OR 1.54 (0.98-2.40)). Odds of GNB carriage were higher in residents with more severe comorbidity (OR 1.13 (1.00-1.28)) and malnutrition (OR 1.54 (0.81-2.91)). CONCLUSIONS Given the observed data, at least long-term carriage of S. pneumoniae in nursing home residents seems to be rare and rather unlikely to cause nursing home acquired pneumonia. The low rate of colonization with multi drug resistant (MDR) bacteria confirms that nursing home residency is not a risk factor for MDR pneumonia in Germany. For individual risk assessment in this susceptible population, immobility and malnutrition should be considered as signs of functional impairment as well as comorbidity.
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Affiliation(s)
- Anja Kwetkat
- Department of Geriatric Medicine, Jena University Hospital, Jena, Thuringia, Germany
- * E-mail:
| | - Wolfgang Pfister
- Institute of Medical Microbiology, Jena University Hospital, Jena, Thuringia, Germany
| | - Diana Pansow
- Department of Geriatric Medicine, Jena University Hospital, Jena, Thuringia, Germany
| | - Mathias W. Pletz
- Centre for Infectious Diseases and Infection’s Control, Jena University Hospital, Jena, Thuringia, Germany
| | - Cornel C. Sieber
- Institute of Biomedicine of Ageing, Friedrich-Alexander University Erlangen-Nuremberg, Nuremberg, Bavaria, Germany
| | - Heike Hoyer
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Thuringia, Germany
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Dent E, Morley JE, Cruz-Jentoft AJ, Arai H, Kritchevsky SB, Guralnik J, Bauer JM, Pahor M, Clark BC, Cesari M, Ruiz J, Sieber CC, Aubertin-Leheudre M, Waters DL, Visvanathan R, Landi F, Villareal DT, Fielding R, Won CW, Theou O, Martin FC, Dong B, Woo J, Flicker L, Ferrucci L, Merchant RA, Cao L, Cederholm T, Ribeiro SML, Rodríguez-Mañas L, Anker SD, Lundy J, Gutiérrez Robledo LM, Bautmans I, Aprahamian I, Schols JMGA, Izquierdo M, Vellas B. International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management. J Nutr Health Aging 2018; 22:1148-1161. [PMID: 30498820 DOI: 10.1007/s12603-018-1139-9] [Citation(s) in RCA: 447] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR). METHODS To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process. RECOMMENDATIONS We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.
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Affiliation(s)
- E Dent
- Dr. Elsa Dent, , Torrens University Australia, Wakefield Street, Adelaide, SA, Australia
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Gingrich A, Spiegel A, Kob R, Schoene D, Skurk T, Hauner H, Sieber CC, Volkert D, Kiesswetter E. Amount, Distribution, and Quality of Protein Intake Are Not Associated with Muscle Mass, Strength, and Power in Healthy Older Adults without Functional Limitations-An enable Study. Nutrients 2017; 9:nu9121358. [PMID: 29240672 PMCID: PMC5748808 DOI: 10.3390/nu9121358] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/30/2017] [Accepted: 12/11/2017] [Indexed: 12/25/2022] Open
Abstract
To maintain muscle mass in older age, several aspects regarding the amount and distribution of protein intake have been suggested. Our objective was to investigate single and combined associations of daily protein intake, evenness of protein distribution across the three main meals, number of meals providing ≥0.4 g protein/kg body weight (BW), and number of meals providing ≥2.5 g leucine, with muscle mass, strength, and power in successful agers. In this cross-sectional study in 97 healthy community-dwelling adults without functional limitations aged 75-85 years, protein intake was assessed using 7-day food records. Muscle mass, leg muscle strength, leg muscle power, and handgrip strength were measured according to standardized protocols. Mean daily protein intake was 0.97 ± 0.28 g/kg BW and the coefficient of variance between main meals was 0.53 ± 0.19. Per day, 0.72 ± 0.50 meals providing ≥0.4 g protein/kg BW and 1.11 ± 0.76 meals providing ≥2.5 g leucine were consumed. No correlations between single or combined aspects of protein intake and skeletal muscle index, leg muscle power, leg muscle strength, or handgrip strength were observed (Spearman's r of -0.280 to 0.291). In this sample of healthy older adults without functional limitations, aspects of protein intake were not associated with muscle mass, strength, or power.
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Affiliation(s)
- Anne Gingrich
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany.
| | - Alexandra Spiegel
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany.
| | - Robert Kob
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany.
| | - Daniel Schoene
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany.
| | - Thomas Skurk
- Chair of Nutritional Medicine, Technical University of Munich, Gregor-Mendel-Str., 85354 Freising-Weihenstephan, Germany.
| | - Hans Hauner
- Chair of Nutritional Medicine, Technical University of Munich, Gregor-Mendel-Str., 85354 Freising-Weihenstephan, Germany.
- Institute of Nutritional Medicine, Klinikum rechts der Isar, Technical University of Munich, Georg-Brauchle-Ring 62, 80992 Munich, Germany.
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany.
- Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Straße 86, 93049 Regensburg, Germany.
| | - Dorothee Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany.
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstraße 60, 90408 Nürnberg, Germany.
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Hoffmann U, Sieber CC. [Is Age a Comorbidity?]. Dtsch Med Wochenschr 2017; 142:1030-1036. [PMID: 28728197 DOI: 10.1055/s-0042-109861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aging is normal process, only somehow questioned by the "anti-aging wave". Normal and pathological aging are therefore separate developments. Older adults often suffer from the frailty syndrome, partly due to diminished resilience. Aging per se is not a comorbidity.
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Schoene D, Kiesswetter E, Sieber CC, Freiberger E. [Musculoskeletal factors, sarcopenia and falls in old age]. Z Gerontol Geriatr 2017; 52:37-44. [PMID: 28664287 DOI: 10.1007/s00391-017-1283-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/14/2017] [Indexed: 12/30/2022]
Abstract
Falls in older adults are a major public health problem with a high incidence and severe consequences for the older individual. The age-related loss of muscle strength as well as muscle mass and muscle function (sarcopenia) are i) risk factors for falling, ii) associated with physical function and iii) markers of the frailty syndrome. Muscle function appears to play a bigger role than muscle mass. The operationalization of sarcopenia using the European Working Group on Sarcopenia in Older People (EWGSOP) algorithm is consistently associated with falling events. Structured physical exercise plays the key role in the prevention of falls and the management of functional decline caused by sarcopenia and frailty. The combined supplementation with proteins and vitamin D supports muscle protein synthesis in undersupplied persons and improves aspects of physical function.
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Affiliation(s)
- Daniel Schoene
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland.
| | - Eva Kiesswetter
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland
| | - Cornel C Sieber
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus Barmherzige Brüder, Regensburg, Deutschland
| | - Ellen Freiberger
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, Kobergerstr. 60, 90408, Nürnberg, Deutschland
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Schlee S, Bollheimer LC, Bertsch T, Sieber CC, Härle P. Crystal arthritides - gout and calcium pyrophosphate arthritis : Part 3: Treatment. Z Gerontol Geriatr 2017; 51:703-710. [PMID: 28246893 DOI: 10.1007/s00391-017-1199-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/17/2017] [Indexed: 10/24/2022]
Abstract
The treatment of gout is based on several principles. Symptom control and termination of the inflammatory process are important early goals, whereas the urate level should be lowered in the long term to prevent further gout attacks and complications. The non-pharmacological approach is based on individually informing the patient on dietary measures and changes of life style. Besides physical measures, such as cold applications on the affected joint, various medications are available for treatment of an acute gout attack. The choice of drug depends on the individual risk profile. If non-steroidal anti-inflammatory drugs (NSAID) and coxibs are chosen it should be taken into account that the use is restricted in patients with renal insufficiency. Moreover, these drugs may have gastrointestinal side effects and are associated with increased cardiovascular morbidity and mortality. Colchicine has gastrointestinal side effects at high dosages but can also be used for differential diagnostics if there is a quick response to treatment. Steroids are an effective alternative and can be given orally or parenterally in patients with dysphagia. Moreover, steroids can be used in cases of renal insufficiency. After symptoms of the acute attack have subsided, urate lowering therapy should be initiated to prevent further attacks. Low-dose urate lowering therapy can be started during an acute gout attack when acute therapy is initiated. Allopurinol is still the medication of choice but its use is restricted in patients with renal insufficiency. A rare but serious side effect is allopurinol hypersensitivity syndrome. Febuxostat can be an alternative in patients who do not tolerate allopurinol. In February 2016, lesinurad, an URAT-1 and OAT-4 inhibitor, was approved in combination with allopurinol or febuxostat. Data on the effectiveness and safety of synthetic uricases and biologicals are still sparse for elderly patients. These substances are reserved for severe cases of gout.
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Affiliation(s)
- S Schlee
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus der Barmherzigen Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Germany.
| | - L C Bollheimer
- Lehrstuhl für Altersmedizin, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - T Bertsch
- Institut für Klinische Chemie, Laboratoriumsmedizin und Transfusionsmedizin, Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Prof.-Ernst-Nathan-Str. 1, 90419, Nürnberg, Germany
| | - C C Sieber
- Klinik für Allgemeine Innere Medizin und Geriatrie, Krankenhaus der Barmherzigen Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Germany
- Institut für Biomedizin des Alterns, Friedrich-Alexander-Universität Erlangen-Nürnberg, 90408, Koberger Straße 60, Nürnberg, Germany
| | - P Härle
- Klinik für Rheumatologie, Klinische Immunologie und Physikalische Therapie, Zentrum für Akutdiagnostik, Katholisches Klinikum Mainz, An der Goldgrube 11, 55131, Mainz, Germany
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Abstract
Frailty and sarcopenia are important concepts in the quest to prevent physical dependence, as geriatrics are shifting towards identifications of early stages of disability. Definitions of both sarcopenia and frailty are still developing, and both concepts clearly overlap in their physical aspects. Malnutrition (both undernutrition and obesity) plays a key role in the pathogenesis of frailty and sarcopenia. The quality of the diet along the lifespan has a close relation with the incidence of both entities, and nutritional interventions may be able to reduce the incidence or revert either of them. This brief review explores the role of energy and protein intake and other key nutrients on muscle function. Nutrition may be a key element of multimodal interventions for frailty and sarcopenia. The results of the "Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies" (SPRINTT) trial will offer key insights on the effect of such interventions in frail, sarcopenic older individuals.
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Affiliation(s)
- Alfonso J Cruz-Jentoft
- Servicio de Geriatría, Hospital Universitario Ramón y Cajal (IRYCIS), Ctra.Colmenar km 9,1, 28034, Madrid, Spain.
| | - Eva Kiesswetter
- Institute for Biomedicine of Aging, University of Erlangen-Nürnberg, Nuremberg, Germany
| | - Michael Drey
- Institute for Biomedicine of Aging, University of Erlangen-Nürnberg, Nuremberg, Germany
| | - Cornel C Sieber
- Institute for Biomedicine of Aging, University of Erlangen-Nürnberg, Nuremberg, Germany
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Sieber CC. Frailty – From concept to clinical practice. Exp Gerontol 2017; 87:160-167. [DOI: 10.1016/j.exger.2016.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/03/2016] [Accepted: 05/13/2016] [Indexed: 12/26/2022]
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Ritt M, Schülein S, Lubrich H, Bollheimer LC, Sieber CC, Gaßmann KG. High-Technology Based Gait Assessment in Frail People: Associations between Spatio-Temporal and Three-Dimensional Gait Characteristics with Frailty Status across Four Different Frailty Measures. J Nutr Health Aging 2017; 21:346-353. [PMID: 28244577 DOI: 10.1007/s12603-016-0764-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We analyzed associations between a battery of gait characteristics and frailty status across four different frailty instruments in old patients. DESIGN Cross-sectional study. SETTING Geriatric wards of a general hospital. PARTICIPANTS 123 hospitalized patients aged ≥65 years. MEASUREMENTS Spatio-temporal and three-dimensional gait characteristics were assessed by an electronic walkway and a shoe-mounted, inertial sensor-based mobile gait analysis system. Frailty status was assessed by the frailty phenotype (FP), Clinical Frailty Scale (CFS), frailty index (FI), and frailty index based on a comprehensive geriatric assessment (FI-CGA). RESULTS A reduction in walking speed (FP, FI, FI-CGA), stride length (FP, FI, FI-CGA), maximum toe clearance (FP, CFS, FI, FI-CGA), toe off angle (FP, CFS, FI, FI-CGA), heal strike angle (FI-CGA) and greater stride length variability (FP, CFS, FI, FI-CGA), stride time variability (FP, FI), double support time (FP, FI), and stride width (CFA, FI-CGA) were associated with frailty status across the four frailty instruments (all P < 0.05, respectively). Walking speed (FP, CFS, FI, FI-CGA), stride length (FP, CFS, FI, FI-CGA), maximum toe clearance (FP, CFS, FI, FI-CGA), toe off angle (FP, CFS, FI, FI-CGA), heal strike angle (FP, FI), stride length variability (CFS, FI, FI-CGA), stride time variability (FI), double support time (FP), and stride width (FP, CFS, FI) were related with frailty severity across the four frailty instruments independent of age and sex (all P adjusted < 0.05, respectively). CONCLUSIONS Gait changes in frail patients include more than solely a reduction in walking speed.
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Affiliation(s)
- M Ritt
- Martin Ritt, Department of Internal Medicine III (Medicine of Ageing), Geriatrics Center Erlangen, Hospital of the Congregation of St. Francis Sisters of Vierzehnheiligen, Rathsbergerstraße 57, D-91054 Erlangen, Tel: +49-(0)9131 822 3702, Fax: +49-(0)9131 822 3703,
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Burger C, Kiesswetter E, Gietl A, Pfannes U, Arens-Azevedo U, Sieber CC, Volkert D. Size Matters! Differences in Nutritional Care between Small, Medium and Large Nursing Homes in Germany. J Nutr Health Aging 2017; 21:464-472. [PMID: 28346574 DOI: 10.1007/s12603-016-0767-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES The aim of this study is to comprehensively describe nutritional care in German nursing homes (NHs) and to examine if nutritional care differs between small, medium and large NHs. DESIGN Nationwide cross-sectional postal survey. SETTING Nursing homes. PARTICIPANTS 541 NHs across Germany. MEASUREMENTS Information on structural NH characteristics and nutritional care (food provision and menu planning, nursing care, and management and quality assurance) was collected by means of a questionnaire addressed to the management of a random sample of German NHs. NHs were grouped by size as small (≤ 50 beds), medium (50 - 100 beds) or large (> 100 beds) institutions. Frequencies were used to describe nutritional care, and Chi2-test to identify differences in nutritional care by NH size. RESULTS Aspects in the domain of food provision and menu planning regarding food variety and choice were widely implemented in German NHs (77 - 100 %). Best results were achieved in the domain of nursing care, where all aspects were implemented in at least 68 % of the NHs. Aspects regarding management and quality assurance, especially those concerning staffing, i.e. the availability of an interface manager (14 %), an interdisciplinary nutrition team (12 %) and a dietician (42 %), were only rarely implemented. Differences by NH size were found between small and medium or large NHs. On the one hand, small NHs stated more often to consider individual capabilities of the residents with texture-modified food (81 % vs. 60 %, p<0.05) and produce more often hot meals at ward level on a regular base (46 % vs. 32 %, p<0.05) than large NHs. On the other hand, several aspects regarding food provision and menu planning, and management and quality assurance were significantly more often implemented in larger than smaller NHs. CONCLUSION Whereas kitchen and nursing-related aspects of nutritional care seem to be widely implemented in German NHs, management and quality assurance demands are often not met. The differences found by NH size support the hypothesis that the number of residents living in a NH has an impact on how nutritional care is performed.
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Affiliation(s)
- C Burger
- D. Volkert, Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany,
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Graf CE, Pichard C, Herrmann FR, Sieber CC, Zekry D, Genton L. Prevalence of low muscle mass according to body mass index in older adults. Nutrition 2016; 34:124-129. [PMID: 28063507 DOI: 10.1016/j.nut.2016.10.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 09/24/2016] [Accepted: 10/01/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Low muscle mass has been associated with increased morbi-mortality and should be identified for optimizing preventive and therapeutic strategies. This study evaluates the prevalence of bioelectrical impedance analysis (BIA)-derived low muscle mass in older persons using definitions found through a systematic literature search and determines the link between body mass index (BMI) and low muscle mass. METHODS We performed a systematic search of trials involving ≥100 persons that derived low muscle mass from BIA and reported cut-offs for low muscle mass normalized for body height or weight. These cut-offs were applied to all adults ≥65 y who underwent a BIA measurement at Geneva University Hospital between 1990 and 2011 (N = 3181). The association between BMI and low muscle mass was evaluated through multivariate logistic regressions. RESULTS We identified 15 cut-offs based on the fat-free mass index (FFMI), skeletal muscle index (SMI), or skeletal muscle percentage (SMP). Depending on the definition, the prevalence of low muscle mass was 17% to 68% in women and 17% to 85% in men. The risk of low muscle mass increased with a BMI <18.5 kg/m2 when using cut-offs based on FFMI (odds ratio [OR] ♀ 14.28-24.04/♂ 25.42-50.64) or SMI (OR ♀ 3.56-4.56/♂ 7.07-8.87) and decreased with a BMI ≥25 kg/m2 (FFMI: OR ♀ 0.03-0.04/♂ 0.01-0.04; SMI: OR ♀ 0.18-0.25/♂ 0.14-0.18). The opposite association appeared between BMI and cut-offs based on SMP. CONCLUSION The prevalence of low muscle mass varies widely depending on the definition, especially in persons with BMI <18.5 or ≥25 kg/m2.
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Affiliation(s)
- Christophe E Graf
- Medical Rehabilitation, Department of Rehabilitation and Palliative Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Claude Pichard
- Clinical Nutrition, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - François R Herrmann
- Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cornel C Sieber
- Friedrich-Alexander-University Erlangen-Nürnberg, Nürnberg, Germany
| | - Dina Zekry
- Geriatrics, Department of Internal Medicine, Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Laurence Genton
- Clinical Nutrition, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
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Abstract
Older people suffering from dementia are at increased risk of malnutrition due to various nutritional problems, and the question arises which interventions are effective in maintaining adequate nutritional intake and nutritional status in the course of the disease. In an international expert group, initiated by the European Society for Clinical Nutrition and Metabolism (ESPEN), 26 evidence-based recommendations for nutritional care of older persons with dementia have been developed, covering the topics of screening and assessment of malnutrition, strategies to support oral nutrition, oral supplementation and artificial nutrition. This article is a short version of the guideline.
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