Nutrition and Weight Management in the Elderly

Global patterns of change in the burden of malnutrition in older adults from 1990 to 2021 and the forecast for the next 25 years

Background

Malnutrition poses a significant public health challenge, particularly as the global population ages. However, there is a notable lack of comprehensive literature analyzing the global burden of malnutrition among the elderly.

Methods

Data on nutritional deficiencies indicators-prevalence, incidence, and disability-adjusted life years (DALYs)-for individuals aged 70 and older were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) database from 1990 to 2021. The estimated annual percentage change (EAPC) was used to assess trends in malnutrition burden. Predictions for new cases over the next 25 years were also made.

Results

In 2021, over 97.60 million cases of malnutrition among the elderly were reported globally, a 1.2-fold increase from 44.36 million cases in 1990. The global prevalence rate of malnutrition has decreased with an EAPC of -0.32%. Women experienced more cases than men but had a lower prevalence rate. Furthermore, in high socio-demographic index (SDI) regions, both prevalence rate and DALYs rates increased from 1990 to 2021, with EAPCs of 0.33% and 1.34%, respectively. The burden of malnutrition in the elderly was negatively correlated with SDI. Predictions from 2022 to 2046 estimated approximately 29.64 million new cases of malnutrition by 2046, despite a declining incidence rate.

Conclusion

Despite a decline in malnutrition prevalence rate and DALYs rate since 1990, the burden remains high, particularly in high SDI regions where rates have increased. With a projected rise in new cases, effective prevention and management strategies are urgently needed to support the health of older adults.

Nutritional Challenges in Paediatric Oncology: Screening and Managing Malnutrition and Sarcopenia

Sarcopenia and malnutrition can coexist in pediatric patients with neoplasia, worsening the patient's prognosis. The classification of primary and secondary sarcopenia may be helpful in clinical practice, as it can help with timely initiation of appropriate and tailored dietary treatments to address it. This review summarizes the current state of the art of assessing skeletal muscle function in children and adolescents with cancer and discusses the role of nutritional interventions in the management of children with cancer. It highlights the urgent need for comprehensive nutritional support and interventions to mitigate the impact of malnutritions on both treatment outcomes and patients' well-being.

The effects of sarcopenic obesity on immediate postoperative outcomes after pancreatoduodenectomy: a retrospective cohort study

Purpose

Several studies have evaluated the impact of sarcopenic obesity (SO) on postoperative complications, including postoperative pancreatic fistula (POPF), in patients undergoing pancreatoduodenectomy (PD). Previous studies have shown that SO increases POPF, but it remains unclear whether SO increases postoperative complications. In this study, we aimed to determine the relationship between SO and immediate postoperative complications.

Methods

From January 2005 to December 2019, the medical records of patients who underwent PD for periampullary cancer were retrospectively reviewed. Skeletal muscle index (SMI) and visceral fat area (VFA) were calculated from preoperative computed tomography images. Patients with high VFA were classified as obese, while those with low SMI were classified as sarcopenic. Patients were divided into 4 groups: normal group, sarcopenia only group, obesity only group, and SO group. Postoperative outcomes were compared between groups, and factors affecting postoperative complications were analyzed by multivariate analysis.

Results

Normal group (n = 176), sarcopenia only group (n = 130), obesity only group (n = 207), and SO group (n = 117) were analyzed retrospectively. SO group had significantly more frequent major complications compared to the normal group (P = 0.006), as well as a significantly more frequent clinically relevant POPF compared to the other groups (P = 0.002). In multivariate analysis, SO was an independent risk factor for major complications (P = 0.008) and clinically relevant POPF (P = 0.003).

Conclusion

SO is a factor associated with poor immediate postoperative outcomes after PD for periampullary cancer.

Alternative protein sources from selected legumes and mushrooms in the development of high-protein instant soup for the elderly

Elderly people are susceptible to malnutrition due to many factors. An essential public health priority is ensuring that seniors have appropriate nutrition to prevent and treat malnutrition and dehydration as well as fulfilling the nutrition necessity. This study was conducted to utilize selected legumes and mushrooms to develop a high-protein instant soup (HPIS) product that is nutritious and suitable for the consumption of the elderly. Black bean, along with oyster mushroom and split-gill mushrooms, exhibited considerable amounts of protein (19.13 ± 1.13, 2.77 ± 0.09, and 4.65 ± 0.61 g/100 g, respectively), calcium (2308.65 ± 113.07, 640.19 ± 0.80, and 743.89 ± 0.66, respectively), iron (40.84 ± 2.42, 7.31 ± 0.05, and 40.10 ± 2.15, respectively), and zinc (18.06 ± 1.07, 3.87 ± 0.03, and 26.23 ± 0.78, respectively) content, and were incorporated into the HPIS formula. Drum dryer rotation speed significantly affected the HPIS properties. The study on the effect of different rotation speeds (3, 5, 7, and 9 RPM) used during the drying process revealed the use of 7 RPM resulting in the soup product with considerable quality. The optimized HPIS formula, which was supplemented with minerals, was moderately liked (7.1-7.5) by the elderly consumer. The majority of the consumers accepted the product (97 %) and were interested in purchasing the product (91 %) if it was available on the market. Incorporating selected legumes and mushrooms resulted in a soup product containing nutrition conforming to the Thai recommended daily intake (RDI), possessing adequate physicochemical and sensory properties for the consumption of the elderly.

Effect of oral supplementation with whey protein on muscle mass in adults with type 2 diabetes mellitus: a systematic review of randomized controlled trials

OBJECTIVE

To investigate the overall effect of whey protein supplementation on skeletal muscle mass in adults with type 2 diabetes mellitus (T2DM).

METHODS

Systematic review of reports on corporal muscle mass from clinical trials that assessed the use of whey protein supplementation by means of validated techniques in patients with T2DM. PubMed, SCOPUS, Web of Science, LILACS, and SciELO databases were searched up to April 2022. Risk of bias was assessed by the Cochrane Collaboration Risk of Bias tool. We conducted a qualitative synthesis of information.

RESULTS

Four studies (424 participants) that met the selection criteria were identified out of 1,787 records. Of these, 3 studies assessed the total muscle mass using dual-energy X-ray absorptiometry (DXA), and 1 reported changes to the transverse diameter of the vastus lateralis muscle with ultrasound imaging. In the intervention groups, DXA assessments demonstrated an increase in total muscle mass in 3 studies and in the appendicular muscle mass in 2. Changes to the proportion of muscle mass were not seen in the DXA studies and only a discrete difference was seen in the comparative groups studied by ultrasound imaging.

CONCLUSION

Following the administration of whey protein supplementation in patients with T2DM, a partially positive effect was seen in skeletal muscle mass gain with a moderate certainty of evidence.

Discriminant analysis of ecological factors influencing sarcopenia in older people in South Korea

This study aimed to investigate the ecological system factors that influence discrimination of sarcopenia among older individuals living in contemporary society. Data analysis included information from 618 older adults individuals aged 65 years or older residing in South Korea. To assess variations in ecological system factors related to SARC-F scores, we conducted correlation analysis and t-tests. Discriminant analysis was used to identify factors contributing to group discrimination. The key findings are summarized as follows. First, significant differences at the p < 0.001 level were observed between the SARC-F score groups in various aspects, including attitudes toward life, wisdom in life, health management, social support, media availability, sports environment, collectivist values, and values associated with death. Further, service environment differences were significant at p < 0.01 level, while social belonging and social activities exhibited significance at p < 0.05. Second, factors influencing group discrimination based on the SARC-F scores were ranked in the following order: health management, attitudes toward life, fear of own death, wisdom in life, physical environment, sports environment, media availability, social support, fear of the own dying, collectivist values, service environment, social activities, and social belonging. Notably, the SARC-F tool, which is used for sarcopenia discrimination, primarily concentrates on physical functioning and demonstrates relatively low sensitivity. Therefore, to enhance the precision of sarcopenia discrimination within a score-based group discrimination process, it is imperative to incorporate ecological system factors that exert a significant influence. These modifications aimed to enhance the clarity and precision of the text in an academic context.

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

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

Physicochemical Properties of Mixed Gelatin Gels with Soy and Whey Proteins

The physicochemical properties of the mixed gelatin gels with soy and whey proteins were investigated to develop the gel base with a soft texture and abundant essential amino acids for the elderly. Gelatin-only gel (control) was prepared at 6% (w/v), and mixed gelatin gels were formulated by replacing gelatin with soy protein isolate and whey protein concentrate at different mixing ratios [gelatin (G):soy protein isolate (S):whey protein concentrate (W)]. Results showed that replacing gelatin with the globular proteins in gelatin gels increased the pH value and processing yield (p < 0.05). Moreover, the mixed gelatin gels, particularly the G2:S1:W3 treatment, showed significantly higher essential amino acids than the gelatin-only control. The partial replacement of gelatin with the globular proteins could decrease the hardness of gelatin gel (p < 0.05), but there was no difference in hardness between the G2:G3:W1, G2:S2:W2, and G2:S1:W3 treatments (p > 0.05). The results of protein pattern, x-ray diffraction, and microstructure had no clear evidence for specific protein-protein interaction in the mixed gelatin gels. Therefore, this study indicates that mixed gelatin gels with the globular proteins at specific mixing ratios could be a practical approach to providing a soft texture and high-level essential amino acids to the elderly.

Predictive Value of Machine Learning Models in Postoperative Mortality of Older Adults Patients with Hip Fracture: A Systematic Review and Meta-analysis

BACKGROUND

Some researchers have used machine learning to predict mortality in old patients with hip fracture, but its application value lacks an evidence-based basis. Hence, we conducted this meta-analysis to explore the predictive accuracy of machine learning for mortality in old patients with hip fracture.

METHODS

We systematically retrieved PubMed, Cochrane, Embase, and Web of Science for relevant studies published before July 15, 2022. The PROBAST assessment tool was used to assess the risk of bias in the included studies. A random-effects model was used for the meta-analysis of C-index, whereas a bivariate mixed-effects model was used for the meta-analysis of sensitivity and specificity. The meta-analysis was performed on R and Stata.

RESULTS

Eighteen studies were included, involving 8 machine learning models and 398,422 old patients undergoing hip joint surgery, of whom 60,457 died. According to the meta-analysis, the pooled C-index for machine learning models was 0.762 (95% CI: 0.691 ∼ 0.833) in the training set and 0.838 (95% CI: 0.783 ∼ 0.892) in the validation set, which is better than the C-index of the main clinical scale (Nottingham Hip Fracture Score), that is, 0.702 (95% CI: 0.681 ∼ 0.723). Among different machine learning models, ANN and Bayesian belief network had the best predictive performance.

CONCLUSION

Machine learning models are more accurate in predicting mortality in old patients after hip joint surgery than current mainstream clinical scoring systems. Subsequent research could focus on updating clinical scoring systems and improving their predictive performance by relying on machine learning models.

Feasibility and Outcomes of Simultaneous Gastric Bypass with Paraesophageal Hernia Repair in Elderly Patients

BACKGROUND

Paraesophageal hernias (PEH) have a higher incidence in patients with obesity. Roux-en-Y gastric bypass (RYGB) with concomitant PEH repair is established as a valid surgical option for PEH management in patients with obesity. The safety and feasibility of this approach in the elderly population are not well elucidated.

METHODS

We performed a multicenter retrospective cohort study of patients aged 65 years and older who underwent simultaneous PEH repair and RYGB from 2008 to 2022. Patient demographics, hernia characteristics, postoperative complications, and weight loss data were collected. Obesity-related medical conditions' resolution rates were evaluated at the last follow-up. A matched paired t-test and Pearson's test were used to assess continuous and categorical parameters, respectively.

RESULTS

A total of 40 patients (82.5% female; age, 69.2 ± 3.6 years; BMI, 39.4 ± 4.7 kg/m2) with a mean follow-up of 32.3 months were included. The average hernia size was 5.8 cm. Most cases did not require mesh use during surgery (92.5%) with only 3 (7.5%) hernial recurrences. Postoperative complications (17.5%) and mortality rates (2.5%), as well as readmission (2.5%), reoperation (2.5%), and reintervention (0%) rates at 30-day follow-up were reported. There was a statistically significant resolution in gastroesophageal reflux disease (p < 0.001), hypertension (p = 0.019), and sleep apnea (p = 0.014).

CONCLUSIONS

The safety and effectiveness of simultaneous PEH repair and RYGB are adequate for the elderly population. Patient selection is crucial to reduce postoperative complications. Further studies with larger cohorts are needed to fully assess the impact of this surgery on elderly patients with obesity.

Phase Angle as a Prognostic Indicator of Survival in Institutionalized Psychogeriatric Patients

Phase angle (PhA) has been evidenced to be a useful survival indicator and predictor of morbi-mortality in different pathologies, but not in psychogeriatric patients. The aim of this study was to evaluate the clinical utility of PhA as a prognostic indicator of survival in a group of institutionalized psychogeriatric patients. A survival study was conducted on 157 patients (46.5% dementia, 43.9% schizophrenia). Functional impairment stage, frailty, dependence, malnutrition (MNA), comorbidity, polypharmacy, BMI, and waist circumference were registered. Body composition was analyzed using a 50-kHz whole-body BIA; PhA was recorded. The association between mortality and standardized-PhA was evaluated through univariate and multivariate Cox regression models and ROC-curve. The risk of death decreased when Z-PhA, BMI, and MNA were higher. Mortality increases with age, frailty, and dependence. The risk of death was statistically significantly lower (56.5%) in patients with schizophrenia vs. dementia (89%). The Z-PhA cut-off point was -0.81 (Sensitivity:0.75; Specificity:0.60). Mortality risk was multiplied by 1.09 in subjects with a Z-PhA < -0.81, regardless of age, presence of dementia, and BMI. PhA presented a remarkable clinical utility as an independent indicator of survival in psychogeriatric patients. Moreover, it could be useful to detect disease-related malnutrition and to identify subjects eligible for an early clinical approach.

Association of Eating Behavior, Nutritional Risk, and Frailty with Sarcopenia in Taiwanese Rural Community-Dwelling Elders: A Cross-Sectional Study

This cross-sectional study assessed the association of eating behavior, nutritional risk, and frailty with sarcopenia in 208 community-dwelling individuals aged ≥65 years who were recruited from random rural community care centers in Chiayi County, Taiwan. The participants’ eating behavior was categorized into six categories. The gait speed (GS), grip strength, and appendicular skeletal muscle mass (ASM) were assessed based on these three parameters, which revealed that 50.9% of the participants had sarcopenia. In an adjusted model, water intake (odds ratio (OR) = 0.99, p = 0.044), dairy product intake (OR = 0.42, p = 0.049), body mass index (BMI) (OR = 0.77, p = 0.019), and marital status with widowed (OR = 0.31, p = 0.005) were significantly associated with sarcopenia. After eight steps of eliminating the least significant independent variable, age (p = 0.002), sex (p = 0.000), marital status with widowed (p = 0.001), water intake (p < 0.018), dairy product intake (p < 0.019), and BMI (p = 0.005) were found to be indispensable predictors of sarcopenia. The logistic regression model with these six indispensable variables had a predictive value of 75.8%. Longitudinal analyses are warranted to examine whether eating behavior is a risk factor for sarcopenia onset.

Comparative analysis unveils the cadmium-induced reproductive toxicity on the testes of Pardosa pseudoannulata

Cadmium (Cd) pollution is one of the most serious heavy metal pollutions in the world, which has been demonstrated to cause different toxicities to living organisms. Cd has been widely suggested to cause reproductive toxicity to vertebrates, yet its reproductive toxicity to invertebrates is not comprehensive. In this study, the wolf spider Pardosa pseudoannulata was used as a bioindicator to evaluate the male reproductive toxicity of invertebrates under Cd stress. Cd stress had no effect on the color, size and length of testis. However, Cd significantly increased the contents of catalase, glutathione peroxidase and malondialdehyde, the antioxidants in the testis of P. pseudoannulata. Then we analyzed the transcriptome of testis exposed to Cd, and identified a total of 4739 differentially expressed genes (DEGs) compared to control, with 2368 up-regulated and 2371 down-regulated. The enrichment analysis showed that Cd stress could affect spermatogenesis, sperm motility, post-embryonic development, oxidative phosphorylation and metabolism and synthesis of male reproductive components. At the same time, the protein-protein interaction network was constructed with the generated DEGs. Combined with the enrichment analysis of key modules, it revealed that Cd stress could further affect the metabolic process in testis. In general, the analysis of testicular damage and transcriptome under Cd stress can provide a novel insight into the reproductive toxicity of Cd on rice filed arthropods and offer a reference for the protection of rice filed spiders under Cd pollution.

Dietary intake of creatine and risk of medical conditions in U.S. older men and women: Data from the 2017-2018 National Health and Nutrition Examination Survey

We examined dietary intake of creatine in U.S. men and women aged 65 years and over, and evaluated the association between creatine intake and risk of self-reported medical conditions, and physical functioning/disability variables using data from the 2017-2018 National Health and Nutrition Examination Survey (NHANES). The NHANES 2017-2018 target population included the noninstitutionalized civilian resident population of the United States aged 65 years and over. Detailed dietary intake data from NHANES elderly were obtained by dietary interview component through a 24-h dietary recall interview, with estimated individual values for total grams of creatine consumed per day for each respondent. A threshold for dietary intake of creatine used to calculate risk between creatine intake and medical conditions was set at 1.00 g/day. The sample population included 1500 participants aged 65 years and older, of which 1221 individuals (627 men and 594 women) provided detailed dietary data via a dietary interview. Creatine intake across all participants was 0.76 ± 0.79 g/day (95% CI from 0.72 to 0.81). As much as 70% of U.S. elderly consume <1.00 g of creatine per day, with about 1 in 5 individuals (19.8%) consume no creatine at all. Elderly with the suboptimal intake of creatine were found to have 2.62 times higher risk of angina pectoris (adjusted OR = 2.62, 95% CI from 1.14 to 6.01, p = .023) and 2.59 times higher risk of liver conditions (adjusted OR = 2.59, 95% CI from 1.23 to 5.48, p = .013), compared with older counterparts who consume ≥1.00 g of creatine per day after controlling for demographic and nutritional variables. The considerable shortage of dietary creatine is associated with an increased risk of heart and liver conditions, which calls for public measures that foster diets rich in creatine-containing foods, and additional research to investigate the role of creatine in age-related diseases.