Mid-upper arm circumference, calf circumference and mortality in Chinese long-term care facility residents: a prospective cohort study

The diagnostic performance of Cr/CysC for sarcopenia and its predictive value on clinical outcomes in hospitalized older patients: a prospective cohort study

PURPOSE

The utilization of the creatinine-to-cystatin C ratio (Cr/CysC) represents an innovative method for predicting sarcopenia. Our objectives encompassed the evaluation of sarcopenia diagnostic accuracy for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score, as well as an exploration of the predictive value of Cr/CysC concerning clinical outcomes within hospitalized older individuals.

METHODS

We employed receiver operating characteristic (ROC) curves and calculated areas under the curves (AUCs) to assess the diagnostic accuracy. Furthermore, we applied univariate and multivariate Cox proportional-hazard models to calculate the hazard ratio (HR) and 95% confidence interval (CI) of risk factors affecting prognosis.

RESULTS

Our study included 312 participants, comprising 167 men and 145 women, with an average age of 71 years. Among males, the AUCs for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score were 0.717 [95% CI 0.642-0.784], 0.669 (95% CI 0.592-0.739), 0.845 (95% CI 0.781-0.896), 0.882 (95% CI 0.823-0.926), and 0.938 (95% CI 0.890-0.969), respectively. In females, the AUCs for Cr/CysC, SARC-F, SARC-CalF, the combination of Cr/CysC and SARC-CalF, and the Ishii score were 0.706 (95% CI 0.625-0.779), 0.631 (95% CI 0.547-0.710), 0.763 (95% CI 0.686-0.830), 0.789 (95% CI 0.714-0.853), and 0.898 (95% CI 0.837-0.942), respectively. After adjusting for age, sex, physical exercise, smoking, drinking, hypertension, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and cancer, sarcopenia identified by Cr/CysC (adjusted HR = 2.176, 95% CI 1.062-4.460, P = 0.034) was independently associated with poor overall survival in hospitalized older patients.

CONCLUSIONS

Cr/CysC has satisfactory diagnostic accuracy for sarcopenia diagnosis and predictive value for poor outcomes in hospitalized older patients. The combination of Cr/CysC and SARC-CalF may provide a more accurate screening for sarcopenia and the Ishii score may be the most accurate clinical method for detecting sarcopenia.

Neck circumference is a highly reliable anthropometric measure in older adults requiring long-term care

The reliability of neck circumference measurement as an assessment tool for older adults requiring long-term care remains unknown. This study aimed to evaluate the reliability of neck circumference measurement in older adults requiring long-term care, and the effect of edema on measurement error. Two physical therapists measured the neck circumference. Intraclass correlation coefficient (ICC) and Bland-Altman analyses were performed to examine the reliability of neck circumference measurement. Correlation analysis was used to evaluate the relationship between edema values (extracellular water/total body water) and neck circumference measurement difference. For inter-rater reliability of neck circumference measurement, the overall ICC (2,1) was 0.98. The upper and lower limits of the difference between examiners ranged from -0.9 to 1.2 cm. There was no association between edema values and neck circumference measurement error. Thus, measurement of the neck circumference in older adults requiring long-term care is a reliable assessment tool, with a low error rate, even in older adults with edema.

Association between decreased neck circumference and impaired activities of daily living among older adults in long-term care

AIM

Assessment interventions for the decline of activities of daily living (ADLs) in older adults are crucial, as ADL decline increases hospitalization duration and mortality risk. Decreased neck circumference may result in various physical dysfunctions, including malnutrition. However, the association between neck circumference and ADLs has not been fully clarified. This study aimed to determine the association between decreased neck circumference and ADLs in older adults requiring long-term care.

METHODS

The study included 152 older adults deemed to require support or care under Japan's long-term care insurance system. Neck circumference was measured just below the thyroid cartilage with a measuring tape. The Barthel index was used to evaluate ADLs, and skeletal muscle mass and nutritional status were assessed by bioelectrical impedance analysis instruments. A multivariate analysis was conducted to investigate the association between neck circumference and ADLs.

RESULTS

Neck circumference demonstrated a significant inverse correlation with age and a significant positive correlation with body mass index, skeletal muscle mass index, phase angle, and Barthel index. In the multivariate analysis, ADLs was significantly associated with neck circumference (odds ratio [OR] = 0.51, P = 0.002) and phase angle (OR = 0.04, P < 0.001).

CONCLUSIONS

Neck circumference is associated with age, skeletal muscle mass, and nutritional status. Furthermore, a decrease in neck circumference is suggested as an independent risk factor for ADL decline in older adults requiring long-term care. Geriatr Gerontol Int 2023; 23: 906-911.

Modification of resting metabolism, body composition, and muscle strength after resolution of coronavirus disease 2019

BACKGROUND & AIMS

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causes changes that can influence human metabolism and modify the distribution of body compartments. We aimed to describe the clinical findings of changes in resting metabolism, muscle strength, and body composition in nonhospitalized patients after being diagnosed with coronavirus disease 2019 (COVID-19).

METHODS

Physically active patients were evaluated at a nutrition clinic, and indirect calorimetry (IC) and body composition analysis using portable ultrasound were performed. After a routine appointment, all patients were instructed to inform the staff if they tested positive for SARS-CoV-2 infection. Our sample included individuals diagnosed with COVID-19, confirmed by real-time reverse transcription polymerase chain reaction (RT-PCR), within 7 days of the routine appointment. After an average incubation period of 14-21 days, in which there was no proven transmission of disease by RT-PCR, all of the patients were re-evaluated.

RESULTS

A total of 38 volunteers (63.2% female) completed the study and were included in the analysis. The mean age of the participants was 37.3 ± 8.8 years. The comparison between pre- and post-COVID-19 stratified by sex demonstrated significant reduction in the RMR and RMR adjusted for weight (p < 0.0001) for both groups. Regarding body composition, there was a significant increase observed in fat mass in men (p < 0.002) and women (p < 0.01), and a significant reduction observed in fat-free mass (men: p < 0.002; women: p < 0.001) and skeletal muscle mass (men: p = 0.003; women: p < 0.0001). There was a significant difference between the change in the RMR measured by IC (p < 0.0001) and that calculated by the predictive equation of Cunningham (1980) (p < 0.0001), whereas the Harris and Benedict (1918) and Mifflin (1990) equations exhibited no difference. However, the mean difference in RMR between the post- and pre-COVID-19 calculated by the Cunningham equation was -40.4 kcal/day (95% confidence interval [CI]: -56.38 to -24.45), whereas the mean difference measured by IC was -362.3 kcal/day (95% CI: -452.7 to -271.9).

CONCLUSION

This study describes the trends in the RMR, and body composition in individuals with COVID-19 who were not hospitalized from the pre-COVID-19 period to the post-COVID-19 period. A significant reduction in resting energy expenditure, and loss of fat-free mass and muscle mass in the post-COVID-19 period were observed in both men and women.

Correlation of FIRE-MADE (Frailty Index in Rural Elderly - Mental Status, Activities of Daily Living, Depression, and Events) With Sarcopenia in Elderly Population of Central Rural India

Introduction Ageing results in the deprivation of various physiological reserves and resources resulting in the development of frailty. Frailty in turn brings various morbidities and dependence on others for the survival of an individual making him weak and vulnerable to various infective and non-infective insults leading to death. The present study assessed frailty in rural older adults of central India by using the Frailty Index in Rural Elderly - Mental Status, Activities of Daily Living, Depression, and Events (FIRE-MADE) and correlated it with sarcopenia assessed by the Asian Working Group for Sarcopenia (AWGS) and European Working Group on Sarcopenia in Older People (EWGSOP2) criteria. Materials This study was a prospective cross-sectional study, involving 250 older adults (i.e. age >60 years) with good functional status (i.e. able to perform basic activities of daily living or more), visiting the Medicine Department of Acharya Vinoba Bhave Rural Hospital (AVBRH), Sawangi, Wardha, from December 2019 to May 2020. Frailty was assessed and estimated by FIRE-MADE frailty index (FI) and then correlated it with sarcopenia assessed by AWGS and EWGSOP2 criteria. And effects of various parameters of FIRE-MADE (like mental status, functional status, depression, polypharmacy, diabetes mellitus, chronic obstructive airway disease, ischemic heart disease, stroke and cancer) and sarcopenia on frailty were studied. Results The mean age of the present study group was 68.08±4.46 years. Out of 250, 204 (91.07%) were frail and 178 (71.2%) were sarcopenic, and among the whole study population, 72 (28.8%) were severely frail, whereas 89 (35.6%) were severely sarcopenic. Frailty and sarcopenia increase with an increase in age. Females were more sarcopenic than males in all age groups. All the components of FIRE-MADE were significant contributors to frailty, but sarcopenia was the most important factor, with an odds ratio of 295.00. Conclusion In the rural regions of India, there is an elevated probability of frailty, with sarcopenia being the main reason behind it.

The association between reduced calf and mid-arm circumferences and ICU mortality in critically ill COVID-19 patients

BACKGROUND & AIMS

Patients with COVID-19 are at a high risk of malnutrition caused by inflammatory syndrome and persistent hypermetabolism, which may affect clinical outcomes. This study aimed to evaluate the changes in nutritional status indicators between two time points of nutritional assessments of COVID-19 patients during their stay in the intensive care unit (ICU). Moreover, the study also assessed the association of nutritional status with ICU mortality.

METHODS

This cohort study included retrospective data of adult patients admitted to a public hospital ICU in southern Brazil, between March and September 2020. These participants with confirmed COVID-19 diagnosis received nutritional assessment within the first 72 h after ICU admission. The anthropometric measurements collected included mid-arm circumference (MAC) and calf circumference (CC). The percentage (%) of MAC adequacy was calculated, and values < 50th percentile for sex and age were considered low. CC values of ≤33 cm for women and ≤34 cm for men were indicative of reduced muscle mass. Data on the date of discharge from the ICU and mortality outcome were collected.

RESULTS

A total of 249 patients were included (53.4% men, 62.2 ± 13.9 years of age, SOFA severity score 9.6 ± 3.5). Of these, 22.7 and 39.1% had reduced MAC and CC at ICU admission, respectively. In these participants, weight, MAC, CC, and % MAC decreased significantly from the first to second nutritional assessment (p < 0.05), but there was no significant difference between survivors and non-survivors. Patients with reduced CC (HR = 2.63; 95% CI 1.65-4.18) or reduced MAC (HR = 2.11; 95% CI 1.37-3.23) at the first nutritional assessment had approximately twice the risk of death in the ICU than those with normal CC and normal MAC, regardless of the severity assessed by the SOFA score and age.

CONCLUSION

Reduced MAC and CC values were identified in approximately 20 and 40% of COVID-19 patients admitted to the ICU, respectively. Additionally, these indicators of nutritional depletion were associated with an approximately 2-fold increase in the risk of ICU mortality. A significant reduction in anthropometric indicators during the first weeks of ICU stay confirmed the deterioration of nutritional status in these patients, although this was not associated with mortality.

Prevalence of Four Sarcopenia Criteria in Older Patients with Cancer, and Their Predictive Value for 6-Month Mortality: The NutriAgeCancer National Prospective Cohort Study

Older cancer patients have an elevated risk of sarcopenia. The aim was to estimate the prevalence of four criteria for sarcopenia case finding, assessment, diagnosis, and severity determination: abnormal strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F), low hand-grip strength (HGS), low arm circumference (AC, a muscle mass proxy), and low physical performance (PP). Sarcopenia (low HGS and AC) and severe sarcopenia (low HGS, AC, and PP) and their predictive values for 6-month mortality were estimated in the whole population and by metastatic status. We analyzed data from the NutriAgeCancer French nationwide study of cancer patients aged ≥70 referred for geriatric assessment before anti-cancer treatment. We performed Cox proportional hazards analysis for each criterion separately and all criteria combined. Overall, 781 patients from 41 geriatric oncology clinics were included (mean age: 83.1; females: 53%; main cancer types: digestive (29%) and breast (17%); metastases: 42%). The prevalence of abnormal SARC-F, low HGS, a low AC, low PP, sarcopenia, and severe sarcopenia were, respectively, 35.5%, 44.6%, 44.7%, 35.2%, 24.5%, and 11.7%. An abnormal SARC-F and/or low HGS, sarcopenia, and severe sarcopenia were associated with 6-month mortality in patients with metastases (adjusted hazard ratios [95% confidence interval]: 2.72 [1.34-5.49], 3.16 [1.48-6.75] and 6.41 [2.5-16.5], respectively). Sarcopenia was strongly predictive of 6-month mortality in patients with metastatic cancer.

Calf circumference change and all-cause mortality among community-dwelling Chinese older people

BACKGROUND

Previous studies have described an association between single time point calf circumference (CC) and mortality. Evidence of associations between CC change and mortality is lacking. We aimed to determine the relationship between the CC change over time and all-cause mortality.

METHODS

We conducted a retrospective cohort study of 906 participants in the 2014-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). Restricted cubic splines were used to analyze associations between the relative CC change (exposure) and all-cause mortality (primary outcome). When there was evidence of non-linearity, a piecewise Cox regression model was next fitted, adjusting for sociodemographic characteristics, health behaviours, health status and baseline CC.

RESULTS

The mean (SD) age was 83.8 (12.2) years old, and 50.2% (455/906) of participants were male. We observed a U-shaped association between the relative CC change (%) and all-cause mortality (P for non-linearity <0.001). Participants with stable CC over time had the lowest risk of death. After adjusting for covariates, when CC decreased over time, the hazard ratio per 10% higher in CC change was 1.32 (1.01-1.69). When CC increased over time, the hazard ratio per 10% higher in CC change was 1.35 (1.10-1.66).

CONCLUSION

Stable CC over time was associated with the lowest mortality risk. Our findings indicate the practical significance of monitoring CC change in older adult.

Arm Circumference, Arm-to-Waist Ratio in Relation to Cardiovascular and All-Cause Mortality among Patients with Diabetes Mellitus

Among patients with diabetes mellitus, limited studies have investigated the relationship between anthropometric parameters and cardiovascular disease (CVD), with all-cause mortality. We examined the associations of arm circumference (AC), arm-to-waist ratio (AC/WC), and CVD, with all-cause mortality among patients with diabetes. This is a cohort study of 5497 diabetic individuals aged 20 or over who were recruited in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. Cox proportional hazards regression models were used to analyze the associations between AC, AC/WC, and CVD, with all-cause mortality. We also conducted stratified analyses and explored the possible non-linear relation by restricted cubic splines. During a median follow-up of 7.2 years, there were 271 and 1093 cases of CVD and all-cause death. The multivariable adjusted hazard ratios (HRs) with 95% confidence intervals (Cis) of CVD mortality in Q2, Q3, and Q4 groups compared with Q1 group were 0.37 (0.22, 0.62), 0.24 (0.12, 0.48), 0.18 (0.07, 0.46) for AC, and 0.18 (0.07, 0.46), 0.34 (0.20, 0.60), 0.28 (0.15, 0.53) for AC/WC. Similar results were observed in the analysis for all-cause mortality risk. AC and AC/WC were both inversely associated with CVD and all-cause mortality among individuals with diabetes. It is important to pay attention to these anthropometric parameters of diabetic patients.

Plasma omega-3 fatty acids are positively associated with appendicular muscle mass index only in adults with low protein intake: Results from NHANES 2011-2012

BACKGROUND

Omega-3 (ω-3) fatty acids may indirectly increase muscle protein synthesis making the muscle more sensitive to amino acids uptake; therefore, ω-3 could promote benefits on muscle mass mainly when protein intake is low. However, no study has evaluated the association between ω-3 fatty acids and muscle mass according to protein intake.

AIM

To evaluate the association between plasma ω-3 fatty acids and appendicular muscle mass index (AMMI) in adults according to the protein intake.

METHODS

A cross-sectional study was performed evaluating 1037 individuals aged 20-59 years from a sub-sample of the National Health and Nutrition Examination Survey (NHANES) 2011-2012. Gas chromatography-mass spectrometry method was used to assess plasma ω-3 fatty acids. The lean mass was evaluated by dual-energy x-ray absorptiometry (DXA) and AMMI (kg/m²) was calculated by appendicular lean mass (kg) divided by height squared. The evaluation of protein intake was performed using two 24-h dietary recalls. Linear regression analysis was performed to assess the association of total plasma ω-3, docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), alpha-linolenic acid (ALA), and EPA plus DHA with AMMI according to protein intake (<0.8; ≥0.8; ≥0.8 - <1.2; ≥1.2 - <1.6; and ≥1.6 g/kg/d).

RESULTS

Total plasma ω-3 (β = 0.0030; CI = 0.0013-0.0046; p = 0.002), ALA (β = 0.0063; CI = 0.0020-0.0107; p = 0.008), EPA (β = 0.0073; CI = 0.0005-0.0142, p = 0.037), DHA (β = 0.0057; CI = 0.0022-0.0093; p = 0.004) and EPA + DHA (β = 0.0040; CI = 0.0010-0.0071; p = 0.013) were positively associated with AMMI in individuals with low protein intake (<0.8 g/kg). However, no association was observed in individuals with protein intake higher than 0.8 g/kg.

CONCLUSION

Plasma ω-3 fatty acids were positively associated with AMMI only in individuals with low protein intake.

The effect of synbiotic and vitamin D co-supplementation on body composition and quality of life in middle-aged overweight and obese women: A randomized controlled trial

BACKGROUND & AIMS

Obesity is a worldwide problem which has involved large populations. Since some dietary factors might modify obesity through various signaling pathways, the aim of this study was to investigate the effect of synbiotic plus vitamin D co-supplementation on body composition parameters and quality of life, in middle-aged overweight and obese women.

METHODS

A randomized, controlled, double-blinded trial was performed and 88 overweight and obese women were assigned to 4 groups (22 per group), receiving synbiotic plus vitamin D, synbiotic, vitamin D and placebo for 8 weeks. At the beginning and at the end of the trial, anthropometric indices, body composition indicators, physical activity level, dietary intake, and quality of life score were measured by trained nutritionists. Statistical analysis was performed with SPSS version 22.

RESULTS

The results showed significant difference between 4 groups in waist circumference (WC), fat mass (FM), body fat percentage (BFP) and visceral fat area (VFA) values after 8 weeks of treatment (P = 0.005, P = 0.007, P = 0.003, and P = 0.009, respectively), with the greatest reduction in synbiotic plus vitamin D group compare to placebo. No significant results were demonstrated between groups in relation to other body composition variables. In addition, there were no significant differences between the 4 groups regarding physical, mental and total aspects of life quality over time.

CONCLUSIONS

Our study demonstrated that synbiotic and vitamin D co-supplementation for 8 weeks, had favorable effect on various anthropometric indices and body composition indicators, but no desirable change in life quality score.

CLINICAL TRIAL REGISTRY

IRCT (registration no. IRCT20090822002365N25).

Effects of hydrolysed meat on dietary intake and nutritional status in aged care residents requiring pureed diets: a crossover randomised controlled trial

BACKGROUND

As a result of the high prevalence of dysphagia in aged care facilities, demand for pureed diets is increasing. One of the biggest challenges for pureed diets is the reduced nutritional density due to the cooking process, such as when blending or softening with liquid. This study aimed to investigate the impact of innovative energy and protein-enriched meat puree on the nutrition intake and nutritional status of aged care residents requiring pureed diets.

METHODS

This is a single-blinded randomised controlled trial conducted in two aged care facilities using a crossover design. Twenty-two residents aged 83.2 ± 7.3 years participated in a 12-week study. Participants were blocked randomised into two groups and received a 6-week of either control (unaltered freshly made pureed diets by facilities) or intervention diet, followed by a 2-week washout and then 6-week of alternative treatment. During the intervention, freshly made meat pureed portions were swapped to hydrolysed meat, which contained 144 -392 kcal and 5.6-6.8 g more energy and protein per 100 g. Nutrition intake was collected using a validated visual estimation method over 24 h on two non-consecutive days during the control and intervention phases. A two-tailed t-test was used to compare the significance.

RESULTS

The intervention diet significantly increased energy (147 ± 285 kcal, p = .02), protein (4 ± 7 g, p = .04), and fat (3 ± 8 g, p = .07) intake in comparison to the control diet. Nutritional status was improved by the end of the intervention as evidenced by a higher nutritional assessment score using Mini-Nutritional Assessment - Short Form (9.1 ± 1.8) and a weight gain of 1.3 ± 1.7 g, p = .04. No significant differences were found in body composition using bioelectrical impedance analysis, calf circumference and mid-upper arm circumference. Though handgrip strength did not differ at the end of control and intervention, significance was found between the changes in control and intervention period. Plasma branched-chain amino acid increased significantly with hydrolysed meat consumption.

CONCLUSIONS

As a dietary enrichment, hydrolysed meat is a promising intervention for pureed diet consumers in aged care facilities, improving residents' dietary intake and reducing malnutrition risk. Future larger multicentre studies with longer intervention periods are required to confirm the effectiveness and residents' acceptance.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ACTRN12622000888763).

Comparing the validity of anthropometric measurements in identifying malnutrition status of older age people in Borena district, North Central Ethiopia: a cross_sectional study

Background

Malnutrition among older age people is becoming significantly higher in spite of improvements in the health care system. Life expectancy of Ethiopian elders is increasing; but reliable and valid tools for screening and diagnosis of malnutrition in this subgroup are limited. This study aimed to assess the validity of anthropometric measurements: Mid Upper Arm Circumference (MUAC), Body Mass Index (BMI), and Calf Circumference (CC) in detecting malnutrition status of older age people in Ethiopia.

Methods

A community based cross-sectional study was conducted in Borena District from January to March, 2020. A total of 421 participants aged were systematically included in the study. To test reliability and validity of the measurements,Cronbach’s α coefficient and Pearson’s correlations were used, respectively. The full Mini-Nutritional Assessment (MNA) tool was used to diagnosis malnutrition. Overall accuracy, sensitivity and specificity of BMI, MUAC and CC were estimated using Receiver Operating Characteristic curves. The Youden Index was used to determine the best cut-off point.

Results

The reliability of BMI, MUAC and CC by Cronbach’s alpha was found 0.847. Significant positive correlations between MNA, BMI(r = 0.56, p < 0.01); MNA, MUAC(r = 0.43, p < 0.01; and MNA, CC(r = 0.52, p < 0.01) revealed. The area under the curve (AUC) of BMI, MUAC and CC were found: 0.98(95% CI, 0.96–0.99, p < 0.001), 0.94(95% CI, 0.89–0.98, p < 0.001) and 0.96(95% CI, 0.94–0.98, p < 0.001) indicating the overall accuracy respectively. The sensitivity and specificity of BMI, MUAC and CC using established cut off points were found: 90%, 96%; 78%, 94% and 84%, 95% respectively. However, using the Youden index the best cut-off point, the sensitivity and specificity of MUAC and CC were 88%, 86%; 92% and 89% respectively and adjusted for age and sex.

Conclusions

The current study demonstrated that BMI was a reliable and valid method to identify the malnutrition status of older age people. A MUAC value of 19 cm and CC of 30 cm were simple and efficient cut-off points for the determination of malnutrition in the older age people. A future study is needed to validate the validity of BMI, MUAC and CC against biochemical tests as gold standard.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03467-9.

Cooking Methods and Their Relationship with Anthropometrics and Cardiovascular Risk Factors among Older Spanish Adults

Food consumption has a prominent role in the occurrence of cardiometabolic diseases, however, little is known about the specific influence of cooking methods. This study examined the association between cooking methods and anthropometrics, cardiovascular risk factors, and cardiac damage biomarkers in older adults. Data were taken from 2476 individuals aged ≥65 from the Seniors-ENRICA 2 cohort in Spain and recruited between 2015 and 2017. Eight cooking methods (raw, boiling, roasting, pan-frying, frying, toasting, sautéing, and stewing) were assessed using a face-to-face validated dietary history. Study associations were summarized as adjusted percentage differences (PDs) in anthropometrics, cardiovascular risk factors, and cardiac damage biomarkers between extreme sex-specific quintiles ((5th − 1st/1st) × 100) of food consumed with each cooking method, estimated using marginal effects from generalized linear models. After adjusting for potential confounders, including diet quality, PDs corresponding to raw food consumption were −13.4% (p-trend: <0.001) for weight, −12.9% (p-trend: <0.001) for body mass index (BMI), −14.8% (p-trend: <0.001) for triglycerides, and −13.6% (p-trend: <0.115) for insulin. PDs for boiled food consumption were −13.3% (p-trend: <0.001) for weight, −10.0% (p-trend: <0.001) for BMI, and −20.5% (p-trend: <0.001) for insulin. PDs for roasted food consumption were −11.1 (p-trend: <0.001) for weight and −23.3% (p-trend: <0.001) for insulin. PDs for pan-fried food consumption were −18.7% (p-trend: <0.019) for insulin, −15.3% (p-trend: <0.094) for pro-B-type natriuretic peptide amino-terminal, and −10.9% (p-trend: <0.295) for troponin T. No relevant differences were observed for blood pressure nor for other cooking methods. Raw food consumption along with boiling, roasting, and pan-frying were associated with healthier cardiovascular profiles, mainly due to lower weight and insulin levels. Future experimental research should test the effectiveness of these cooking methods for cardiovascular prevention in older adults.

The Predictive Values of Five Sarcopenia Screening Tools on Clinical Outcomes Following Surgery in Patients with Gastric Cancer: A Prospective Cohort Study

BACKGROUND

The association between strength, assistance with walking, rise from a chair, climb stairs and falls (SARC-F), strength, assistance with walking, rise from a chair, climb stairs, falls and calf circumference (SARC-CalF), Ishii score chart, the short version of mini sarcopenia risk assessment (MSRA-5), the full version of mini sarcopenia risk assessment (MSRA-7) and clinical outcomes in patients with gastric cancer were unclear. We aimed to investigate the predictive values of the above five sarcopenia screening tools on clinical outcomes following surgery in patients with gastric cancer.

METHODS

The clinical data of consecutive patients who would undergo gastrectomy from May 2020 to October 2020 at the First Affiliated Hospital of Nanjing Medical University were prospectively collected. On the first admission day, patients' characteristics, Nutrition risk screening 2002 (NRS 2002), the above five sarcopenia screening tools and anthropometric measurements were preoperatively collected. Within 24 hours after discharge, operation information, tumor-node-metastasis (TNM) stage and clinical outcomes in hospital (postoperative complications, hospitalization expenditures and postoperative hospital stay) were collected. Three months after discharge, clinical outcomes out of hospital (hospital readmissions and mortality) were collected. Multivariate analyses were conducted to identify the independent predictors for clinical outcomes.

RESULTS

A total of 263 patients were finally included in the study, with the average age being 62.44 years. The prevalence of sarcopenia risk ranged from 3.42% to 73.76%. For the above five sarcopenia screening tools, multivariate analyses showed that sarcopenia risk indicated by SARC-CalF was an independent predictor for postoperative complications (OR=3.145 [95%CI: 0.594, 16.665], P=0.037), prolonged postoperative hospital stay (B=2.383 [95%CI: 0.377, 4.388], P=0.020), increased hospitalization expenditures (B=1.305 [95%CI: 0.402, 2.208], P=0.005) and 3-month hospital readmissions (HR=3.626 [95%CI: 1.126, 11.676], P=0.031). Sarcopenia risk indicated by Ishii score chart was an independent predictor for postoperative complications (OR=6.491 [95%CI: 1.514, 27.840], P=0.012) and hospitalization expenditures (B=0.767 [95%CI: 0.065, 1.469], P=0.032). Sarcopenia risk indicated by MSRA-7 was an independent predictor for prolonged postoperative hospital stay (B=1.636 [95%CI: 0.119, 3.153], P=0.035)and increased hospitalization expenditures (B=0.831 [95%CI: 0.146, 1.516], P=0.018).

CONCLUSION

Among the above five sarcopenia screening tools, SARC-CalF seemed to have better predictive values on clinical outcomes. Preoperative gastric cancer patients with sarcopenia risk indicated by SARC-CalF could have a higher risk of postoperative complications, prolonged postoperative hospital stay, increased hospitalization expenditures and 3-month hospital readmissions.

Evaluation of an alternative skeletal muscle index for skeletal muscle mass assessment in a group of Australian women

Background

Sarcopenia is assessed by several methods, including dual energy X-ray absorptiometry (DEXA), which provide a height-adjusted skeletal muscle index (H-SMI). A SMI 2 standard deviation below the young adult reference [1] combined with low muscle strength or performance is used to identify sarcopenia. As height declines with age, H-SMI may underestimate low skeletal muscle mass in the older population. Our study aims to evaluate an alternative SMI and to examine its relationship to grip strength in a group of Australian women.

Methods

Women from two cohorts were analysed. 2041 women had body composition data (112 had calf circumference, 137 had leg length measurements) without grip strength, and 49 women had grip strength measured (40 had body composition data).The relationship between leg length-adjusted SMI (LL-SMI) to grip strength and anthropometric variables to skeletal muscle mass by DEXA were examined by linear regression analysis.

Results

Cohort 1: Older women were compared to younger women. Older women were shorter but leg length did not differ between different age groups. H-SMI was not different between groups (P = 0.528). LL-SMI was lower in older women (P = 0.002). Cohort 2: LL-SMI was significantly associated with grip strength (P = 0.048) after adjustment for age.

Conclusion

Older women were shorter, while leg length did not differ from the younger group. H-SMI may obscure and may underestimate low muscle mass in older individuals. LL-SMI may be a better measure of skeletal muscle mass in older individuals. These alternate SMI would benefit from further exploration in older individuals.

Calf Circumference and All-Cause Mortality: A Systematic Review and Meta-Analysis Based on Trend Estimation Approaches

OBJECTIVES

To perform a systematic review and meta-analysis and quantify the associations of total mortality with calf circumference (CC) in adults 18 years and older via combining various analyses based on empirical dichotomic CC, continuous CC, and dose-response CC.

METHODS

We conducted a systematic search of relevant studies in PubMed, EMBASE, Cochrane Library, and Web of Science published through April 12, 2022. This systematic review includes longitudinal observational studies reporting the relationships of total mortality with CC. We calculated the pooled relative risk (RR) and 95% confidence interval (CI) of total mortality with CC per 1 cm for each study and combined the values using standard meta-analysis approaches. Newcastle-Ottawa scale (NOS), Grading of Recommendations, Assessment, Development and Evaluations approach (GRADE), and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN) were assessed for meta-analyses.

RESULTS

Our analysis included a total of 37 cohort studies involving 62,736 participants, across which moderate heterogeneity was observed (I2=75.7%, P<0.001), but no publication bias was found. Study quality scores ranged from 6 to 9 (mean 7.7), with only three studies awarded a score of 6 (fair quality). We observed an inverse trend between total death risk and CC per 1 cm increase (RR, 0.95, 95% CI, 0.94-0.96; P<0.001; GRADE quality=high). Only a very slight difference was found among residents of nursing homes (6.9% mortality risk reduction per one cm CC increase), community-dwellers (5.4%), and those living in hospitals (4.8%), respectively (P for meta-regression=0.617). Low credible subgroup difference was found based on the ICEMAN tool.

CONCLUSIONS

Calf circumference is a valid anthropometric measure for mortality risk prediction in a community, nursing home, or hospital.

Physical Activity and Dietary Composition Relate to Differences in Gut Microbial Patterns in a Multi-Ethnic Cohort-The HELIUS Study

Physical activity (PA) at recommended levels contributes to the prevention of non-communicable diseases, such as atherosclerotic cardiovascular disease (asCVD) and type 2 diabetes mellitus (T2DM). Since the composition of the gut microbiota is strongly intertwined with dietary intake, the specific effect of exercise on the gut microbiota is not known. Moreover, multiple other factors, such as ethnicity, influence the composition of the gut microbiota, and this may be derived by distinct diet as well as PA patterns. Here we aim to untangle the associations between PA and the gut microbiota in a sample (n = 1334) from the Healthy Life In an Urban Setting (HELIUS) multi-ethnic cohort. The associations of different food groups and gut microbiota were also analyzed. PA was monitored using subjective (n = 1309) and objective (n = 162) methods, and dietary intake was assessed with ethnic-specific food frequency questionnaire (FFQ). The gut microbiota was profiled using 16S rRNA gene amplicon sequencing, and the functional composition was generated with the Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt2). Associations were assessed using multivariable and machine learning models. In this cohort, a distinct gut microbiota composition was associated with meeting the Dutch PA norm as well as with dietary intake, e.g., grains. PA related parameters such as muscle strength and calf circumference correlated with gut microbiota diversity. Furthermore, gut microbial functionality differed between active and sedentary groups. Differential representation of ethnicities in active and sedentary groups in both monitor methods hampered the detection of ethnic-specific effects. In conclusion, both PA and dietary intake were associated with gut microbiota composition in our multi-ethnic cohort. Future studies should further elucidate the role of ethnicity and diet in this association.

Correlation of Sarcopenia With Modified Frailty Index as a Predictor of Outcome in Critically Ill Elderly Patients: A Cross-Sectional Study

INTRODUCTION

Frailty phenotype represents weight loss, decreased functional and physical capacity and activity, falls, slow gait, and memory impairment. Sarcopenia is a generalized and progressive loss of skeletal muscle mass, strength, and function, which occurs due to primary effects of aging and secondary effects of other causes including diseases, malnutrition, and inactivity.

MATERIALS AND METHODS

This prospective cross-sectional study was performed on 70 critically ill geriatric patients (of age > 60 years) admitted in Medicine ICU (MICU) from December 2020 to May 2021 at a rural medical school at Wardha in central rural India. We assessed sarcopenia in all the patients by the European Working Group on Sarcopenia in Older People (EWGSOP) criteria and compared it with the modified frailty index. All the patients were divided in sarcopenic and non-sarcopenic groups; frailty index was applied, and outcomes were measured in terms of mortality, the need for ventilation, and length of ICU stay.

RESULTS

In this study, the mean age of the patients was 68.61 ± 5.88 years in the sarcopenic group and 69.10 ± 6.31 years in the non-sarcopenic group. Eighteen (42.86%) patients in the sarcopenic group were severely frail, whereas eight (28.57%) patients in the non-sarcopenic group (p = 0.532) were not. In the sarcopenic severely frail group, mortality was six (14.29%), and eight (19.05%) required ventilation (p = 0.001), whereas in the non-sarcopenic severely frail group, mortality as well as the need for ventilation were four (14.29%) (p = 0.0001). Total duration of ICU stays was 4.30 ± 1.07 days in the sarcopenic group (n = 42), whereas it was 3.85 ± 1.23 days in the non-sarcopenic group (n = 28) (p = 0.10).

CONCLUSION

Our study found that critically ill patients with sarcopenia had more tendency to become frail, thereby increased risk of mortality. A timely routine assessment for sarcopenia upon ICU admission may provide an important prognostic factor in patient outcomes.

Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID-19: a prospective observational study

BACKGROUND

Strength and muscle mass are predictors of relevant clinical outcomes in critically ill patients, but in hospitalized patients with COVID-19, it remains to be determined. In this prospective observational study, we investigated whether muscle strength or muscle mass are predictive of hospital length of stay (LOS) in patients with moderate to severe COVID-19 patients.

METHODS

We evaluated prospectively 196 patients at hospital admission for muscle mass and strength. Ten patients did not test positive for SARS-CoV-2 during hospitalization and were excluded from the analyses.

RESULTS

The sample comprised patients of both sexes (50% male) with a mean age (SD) of 59 (±15) years, body mass index of 29.5 (±6.9) kg/m² . The prevalence of current smoking patients was 24.7%, and more prevalent coexisting conditions were hypertension (67.7%), obesity (40.9%), and type 2 diabetes (36.0%). Mean (SD) LOS was 8.6 days (7.7); 17.0% of the patients required intensive care; 3.8% used invasive mechanical ventilation; and 6.6% died during the hospitalization period. The crude hazard ratio (HR) for LOS was greatest for handgrip strength comparing the strongest versus other patients (1.47 [95% CI: 1.07-2.03; P = 0.019]). Evidence of an association between increased handgrip strength and shorter hospital stay was also identified when handgrip strength was standardized according to the sex-specific mean and standard deviation (1.23 [95% CI: 1.06-1.43; P = 0.007]). Mean LOS was shorter for the strongest patients (7.5 ± 6.1 days) versus others (9.2 ± 8.4 days). Evidence of associations were also present for vastus lateralis cross-sectional area. The crude HR identified shorter hospital stay for patients with greater sex-specific standardized values (1.20 [95% CI: 1.03-1.39; P = 0.016]). Evidence was also obtained associating longer hospital stays for patients with the lowest values for vastus lateralis cross-sectional area (0.63 [95% CI: 0.46-0.88; P = 0.006). Mean LOS for the patients with the lowest muscle cross-sectional area was longer (10.8 ± 8.8 days) versus others (7.7 ± 7.2 days). The magnitude of associations for handgrip strength and vastus lateralis cross-sectional area remained consistent and statistically significant after adjusting for other covariates.

CONCLUSIONS

Muscle strength and mass assessed upon hospital admission are predictors of LOS in patients with moderate to severe COVID-19, which stresses the value of muscle health in prognosis of this disease.

Association of Household Food Insecurity with Nutritional Status and Mental Health of Pregnant Women in Rural Bangladesh

Food insecurity may affect women’s health; however, pertinent research is scant among pregnant women. This study investigated the association of household food insecurity (HFI) with the nutritional status and mental health of 672 early-gestation (5–16 weeks) pregnant women with a singleton fetus, who participated in the screening activity of a community-based trial (NCT04868669) in Matlab, Bangladesh. Height (cm), weight (kg), body mass index (kg/m²), mid-upper arm circumference (MUAC) (cm), depression, anxiety, and stress were the outcomes studied. HFI was assessed using the Household Food Insecurity Access Scale. Women’s depression, anxiety, and stress were assessed using the Depression, Anxiety, and Stress Scales-21. Propensity score matching based weighted multivariable linear and logistic regression were used to evaluate the independent association of HFI with the outcomes. In adjusted models, pregnant women from food-insecure households in rural Matlab were on average 2.0 cm shorter (β = −2.0, 95% CI: −3.3, −0.7), 2.0 kg lighter (β = −2.0, 95% CI: −3.4, −0.7), and had 0.6 cm lower MUAC (β = −0.6, 95% CI: −1.1, −0.1) than their food-secure counterparts. HFI was associated with higher odds of depression (OR = 3.3, 95% CI: 1.8, 5.9), anxiety (OR = 6.1, 95% CI: 3.7, 10.0), and stress (OR = 4.8, 95% CI: 1.6, 14.2) among the women. Public health measures should focus on ensuring proper nutrition during the critical growth periods of life, pregnancy, and external environmental shocks, to mitigate the adverse effects of HFI on women’s health.

Calf circumference is an independent predictor of mortality in older adults: An approach with generalized additive models

BACKGROUND

There is a wide variation in the cutoff points of body mass index (BMI) and calf circumference (CC) , and it is necessary to assess their adequacy in predicting mortality, especially in the older adults in the community. This study aimed to investigate the association of low muscle mass and underweight with mortality in older adults, comparing different cutoff points.

METHODS

This was a prospective study that included 796 older adults, not institutionalized, from a Brazilian city. Generalized additive models (GAMs) were used to identify cutoff points for CC and BMI, which were compared with values available in the literature. Survival analysis using Cox regression models was used to assess the independent association between these nutrition indicators and mortality.

RESULTS

Over the 9 years of follow-up, 197 deaths (24.7%) occurred. Cutoff points established for CC and BMI as predictors of mortality were, respectively, <34.5 cm and <24.5. In the adjusted Cox models, older adults with a BMI <18.5 showed a significant increase in the risk of death (hazard ratio [HR], 2.57; 95% CI, 1.23-5.35). Higher mortality was observed among older adults with CC <34.5 cm (HR, 1.72; 95% CI, 1.27-2.33) and CC <31 cm (HR, 2.11; 95% CI, 1.44-3.10).

CONCLUSION

CC was an independent predictor of mortality, and the cutoff point identified by GAMs was higher than recommended by literature (31 cm). This study suggests a review of cutoff points for CC currently adopted to assess low muscle mass in older adults.

Low-cost and fast-performing indicators of muscle mass loss are good predictors of clinical outcomes in hospitalized patients: A longitudinal observational study

BACKGROUND

"Gold standard" methods for muscle mass (MM) assessment are expensive and difficult to use in clinical practice. The present study aimed to evaluate the association between easy-to-apply and low-cost indicators of MM and clinical outcomes in hospitalized patients.

METHODS

In this cohort study, calf circumference [CC], adductor pollicis muscle thickness [APMT], midarm muscle circumference [MAMC], and arm muscle area [AMA] were measured within 48 h of admission to detect MM loss, and it was also evaluated by physical examination. Patients were followed up until discharge for collection of in-hospital death and length of hospital stay (LOS) data, and they were contacted by phone to assess hospital readmission and mortality at 6 months after discharge.

RESULTS

We evaluated 601 patients (55.8 ± 14.8 years). Moderate/severe loss of MM (hazard ratio [HR], 4.12; 95% CI, 1.26-13.49), low CC (HR, 3.67; 95% CI: 1.07-12.55), low MAMC (HR, 5.20; 95% CI, 1.48-18.35), and low AMA (HR, 14.28; 95% CI, 1.80-113.14) were predictors of in-hospital mortality. Moderate/severe loss of MM was a predictor of prolonged LOS (odds ratio [OR], 2.27; 95% CI, 1.53-3.36), hospital readmission (OR, 4.14; 95% CI, 1.26-13.55), and mortality at 6 months (OR, 3.20; 95% CI, 1.71-6.01). Low CC (OR, 2.49; 95% CI, 1.27-4.85) and low APMT (OR, 3.22; 95% CI, 1.56-6.66) were associated with death 6 months after discharge.

CONCLUSION

Easy-to-apply and low-cost indicators of MM were associated with negative clinical outcomes and should be part of nutrition assessment in hospitals.

Sarcopenia measurement in research and clinical practice

Sarcopenia is a disease related to accelerated loss of skeletal muscle and subsequent decline in functional capacity. It affects approximately 13% of the world's population aged over 60 years. Sarcopenia is primarily managed and prevented through a combination of exercise prescription combined with appropriate nutritional strategies. This review outlines diagnostic and case finding/screening tools for age-related (primary) sarcopenia used in research and clinical practice. Diagnostic tools critically reviewed include those of the: European Workgroup for Sarcopenia (EWGSOP) versions 1 and 2; Asian Working Group for Sarcopenia (AWGS) versions 1 and 2; Foundation for the National Institutes of Health (FNIH); and the Sarcopenia Definition and Outcomes Consortium (SDOC). Criteria used by diagnostic tools (muscle mass, muscle strength and physical functioning/performance) are also detailed. Case-finding tools include the SARC-F questionnaire, Ishii's formula and Goodman's screening grid. Additionally, this review discusses the strengths and weaknesses of each diagnostic and case-finding tool, and examines their ability to reliably predict adverse clinical outcomes and patient responses to potential therapies.

Mid-Arm Muscle and Subcutaneous Fat Associated with All-Cause Mortality Independent of BMI: A Prospective Cohort Study

OBJECTIVE

This study aimed to systematically evaluate the association between triceps skinfold (TSF) thickness (which indicates subcutaneous fat) mid-arm muscle circumference (MAMC; which reflects muscle mass), mid-upper arm circumference (MUAC), and all-cause mortality.

METHODS

A total of 17,717 adults from the China Health and Nutrition Survey (1993-2015) were included. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality. The joint effect of TSF thickness and MAMC was examined, and planned subgroup analyses were performed.

RESULTS

The highest quartiles of TSF thickness, MAMC, and MUAC were significantly associated with low all-cause mortality, independent of BMI (TSF thickness: HR = 0.704 [95% CI: 0.575-0.862]; MAMC: HR = 0.729 [95% CI: 0.607-0.876]; MUAC: HR = 0.713 [95% CI: 0.583-0.872]). A 1-SD increase showed comparable risk reductions for TSF thickness and MAMC (14.6% and 14.0%), with 16.1% risk reductions in MUAC. There were positive additive interactions between TSF thickness and MAMC. The inverse association existed in young, middle-aged, and elderly participants (P-heterogeneity > 0.05).

CONCLUSIONS

Mid-arm muscle and subcutaneous fat were inversely associated with all-cause mortality, independent of BMI, beyond the elderly population. Mid-arm muscle and subcutaneous fat made comparable contributions to and had positive joint effects on all-cause mortality.

Correlation Between Mini Nutritional Assessment and Anthropometric Measurements Among Community-Dwelling Elderly Individuals in Rural Southern Thailand

Purpose

The Mini Nutritional Assessment (MNA) can be applied to assess nutrition status among community-dwelling elderly individuals by health care professionals. This study aimed to evaluate the correlation of MNA score and anthropometric measurements, gait speed, and handgrip strength among elderly community members. The secondary outcome was to compare the performance of the MNA-SF with the full MNA.

Materials and Methods

The study was a cross-sectional study with 176 elderly individuals aged ≥60 years living in rural southern Thailand. The MNA-SF and full MNA scores were obtained by using the standard form in the Thai version of the MNA. We collected anthropometric measurements, gait speed, handgrip strength, and MNA data.

Results

There was a significant positive correlation between body weight, BMI, waist circumference, hip circumference, waist-to-height ratio, waist-to-hip ratio, mid-upper arm circumference, calf circumference, triceps skinfold thickness, handgrip strength and full MNA total score using the partial correlation coefficient after controlling for age and sex. The MNA-SF had sensitivity of 78.79%, specificity of 81.82%, PPV of 50%, NPV of 94.35%, LR+ of 4.33, LR- of 0.26, accuracy of 81.25% and AUC 0.901 when using the full MNA as a reference standard.

Conclusion

The MNA correlated with many anthropometric measurements. The MNA-SF had a high specificity, NPV and accuracy of more than 80% when compared with the full MNA.

Mid-Upper Arm Circumference as an Alternative Screening Instrument to Appendicular Skeletal Muscle Mass Index for Diagnosing Sarcopenia

Purpose

Mid-upper arm circumference (MUAC) is a simple, noninvasive anthropometric indicator. This study evaluated the applicability of MUAC as an alternative screening instrument to appendicular skeletal muscle mass index (ASMI) for detecting sarcopenia, and determined the optimal MUAC cutoff values.

Patients and Methods

A total of 4509 subjects ≥50 years of age from the West China Health and Aging Trend study were included in the present study. ASM was measured by bioelectrical impedance analysis. MUAC, calf circumference (CC), and grip strength were evaluated and the Short Physical Performance Battery and 3-m timed up-and-go test were administered. Low muscle mass was diagnosed based on Asian Working Group for Sarcopenia 2019 (AWGS2019) and updated European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria.

Results

ASMI was positively correlated with MUAC in both men (r=0.726, P<0.001) and women (r=0.698, P<0.001). The area under the receiver operating characteristic curve (AUC) for MUAC as an indicator of low muscle mass in men and women was 0.86 (95% confidence interval [CI]: 0.85–0.88) and 0.85 (95% CI: 0.84–0.86), respectively, according to AWGS2019 criteria; and 0.86 (95% CI: 0.85–0.88) and 0.86 (95% CI: 0.85–0.88), respectively, according to EWGSOP2 criteria. Optimal MUAC cutoff values for predicting low muscle mass were ≤28.6 cm for men and ≤27.5 cm for women. There was no significant difference between the AUCs of MUAC and CC in men according to the 2 reference standards (P=0.809), whereas the AUC of CC was superior to that of MUAC in women according to AWGS2019 (P<0.001) and EWGSOP2 (P=0.008) criteria.

Conclusion

MUAC is strongly correlated with ASMI among community-dwelling middle-aged and older adults in China. MUAC can be used as a simple screening instrument to ASMI for diagnosing sarcopenia, especially in men.

Malnutrition is associated with increased risk of hospital admission and death in the first 18 months of institutionalization

OBJECTIVES

This study aimed to investigate the association between different nutritional and anthropometric parameters with the risk of hospitalizations and death within 18 months from nursing home admission. Our hypothesis was that measures of malnutrition could be more strongly associated with worse clinical outcomes than measures of overweight/obesity.

METHODS

This prospective study involved 144 older adults newly admitted in nursing home and followed up over 18 months. A multidimensional assessment focusing on clinical, functional and cognitive status was performed at baseline. Assessment also included body mass index (BMI), waist circumference, calf circumference, MNA Short-Form (MNA-SF), and serum albumin and lymphocytes levels. Anthropometric measurements were repeated at 6 months. Data on hospitalizations and mortality over the study period, with their respective causes, were obtained from administrative data. The associations between baseline nutritional parameters and the risk of hospitalizations or death were analyzed through multinomial logistic regressions and Cox regressions, respectively.

RESULTS

During the follow-up, 64 individuals (44.4%) were hospitalized, and 52 (36.1%) died. Residents who reported low MNA-SF and calf circumference at nursing home admission had more than threefold-increased odds of hospitalizations compared with their healthier counterparts. Adults with low calf circumference also had the highest mortality (HR = 3.39, 95%CI:1.80-6.39), while more attenuated results were observed for low serum albumin, MNA-SF, and BMI (either when considering cut-offs of excess weight or malnutrition). When assessing the associations between 0 and 6 month changes in calf circumference and mortality in the following 12 months, we found that each 1 cm decrease in calf circumference increased the one-year mortality by 29% (95%CI 1.04-1.60).

CONCLUSIONS

Malnutrition, but not overweight/obesity, seems associated with a higher risk of hospitalization and mortality after nursing home admission. Monitoring calf circumference, in particular, may help in the early detection of individuals who are potentially vulnerable to adverse health-related outcomes after institutionalization.

Association between Body Fatness and Vitamin D3 Status in a Postmenopausal Population

Vitamin D is a micronutrient that plays a key role in phosphocalcic metabolism. The postmenopausal population presents a risk of deficiency in this vitamin due to hormonal alterations which, in the case of obesity, would be exacerbated. The objective was to assess the status of vitamin D in a postmenopausal population and determine the relationship of 25-hydroxivitamin D [25(OH)D] and its metabolites with anthropometric parameters. The study included 78 healthy postmenopausal women aged from 44 to 76. The nutrient intake assessment was carried out using the 24 h reminder (R24h). 25(OH)D was analyzed using ultra-high-performance liquid chromatography (UHPLC). A total of 80% and 68% of the women studied did not reach sufficient values of 25(OH)D and 25-hydroxivitamin D₃ [25(OH)D₃], respectively, which was inversely correlated with Body Mass Index (BMI) (r = −0.25, p = 0.04), hip perimeter (r = −0.26 and r = −0.24, all p < 0.05), arm circumference (r = −0.29, p = 0.01) and fat mass (r = −0.28 and r = −0.26, all p < 0.05). 25(OH)D₃ is the metabolite that contributed most to this association. In conclusion, 25(OH)D₃ levels are related to anthropometric parameters in the postmenopausal women in this study, confirming insufficient status in the majority of the population. Approach strategies are necessary to correct and avoid this risk in order to ensure future quality of life.

Calf Circumference Is a Good Predictor of Longer Hospital Stay and Nutritional Risk in Emergency Patients: A Prospective Cohort Study

Objective: This study aimed to evaluate the validity of calf circumference (CC) in identifying malnourished patients and patients at nutritional risk and determine the association between CC and clinical outcomes of hospitalized patients.Methods: A prospective cohort study was conducted involving patients admitted to the emergency department of a tertiary hospital in the first 48 hours of admission. Nutritional risk was determined using Nutritional Risk Screening, malnutrition was diagnosed using subjective global assessment, and CC was manually measured. Brazilian cutoff points for CC were used to identify low muscle mass. The outcomes of interest were length of emergency care and hospital stay, occurrence of infection, and death, besides nutritional risk and malnutrition.Results: In total, 528 patients (52.76 ± 16.18 years; 54.6% females) were followed up for 9.0 (3.0-19.0) days; 39.6% of them had reduced CC values. The accuracy of CC in identifying patients at nutritional risk and malnourished patients was 67.7% and 54.1%, respectively. The cutoff value of 36.5 cm was highly accurate in identifying nutritional risk [AUC-ROC curve = 0.764 (95% CI: 0.704-0.825) for men, and AUC-ROC curve = 0.716 (95% CI: 0.659-0.774) for women]. Patients with low CC had a 1.59-fold (95% CI: 1.07-2.36) greater likelihood of a long hospital stay than patients with normal CC.Conclusions: Low CC values have satisfactory validity in identifying nutritional risk and are associated with long hospital stay.

Use of Mid-Upper Arm Circumference (MUAC) to Predict Malnutrition among Sri Lankan Schoolchildren

The double burden of malnutrition (under- and overnutrition) is a serious public health issue in childhood. The mid-upper arm circumference (MUAC) is a simple tool for screening nutritional status, but studies of the optimal cutoff to define malnutrition are limited. This study aimed to explore the prediction of malnutrition by MUAC in Sri Lankan schoolchildren. The participants were 538 students (202 boys, 336 girls) aged 5–10 years. Spearman’s rank correlation was calculated for MUAC and both body-mass-index-for-age z-score (BAZ) and height-for-age z-score (HAZ). Receiver operating characteristic (ROC) analysis was conducted to assess the ability of MUAC to correctly classify malnutrition, after stratifying for age and birth weight. MUAC correlated significantly with BAZ (r = 0.84) and HAZ (r = 0.35). The areas under the ROC curve for thinness, overweight, obesity, and stunting were 0.88, 0.97, 0.97, and 0.77, respectively. The optimal MUAC cutoff values for predicting thinness and stunting were 167.5 mm and 162.5 mm, respectively; the optimal cutoffs for predicting overweight and obesity were 190.5 mm and 218.0 mm, respectively. These cutoffs differed after stratification by age group and birth weight. Our results confirm MUAC to be a useful tool for monitoring growth in schoolchildren.

Prognostic value of a rapid sarcopenia measure in acutely ill older adults

BACKGROUND

Current recommendations to assess sarcopenia requiring specialized equipment hinder its use as a prognostic tool in busy acute settings.

AIMS

To investigate the prognostic value of a rapid sarcopenia measure in acutely ill older outpatients for 1-year adverse outcomes.

METHODS

Prospective study with 665 acutely ill older adults (mean age 78.7 ± 8.3 years; 63% women) in need of intensive management to avoid hospital admission. Sarcopenia was screened upon admission, defined as the presence of both low muscle strength and low muscle mass. Low muscle strength was determined by handgrip strength according to the cutoffs of the Foundation for the National Institutes of Health (<16 kg for women and <26 kg for men). Low muscle mass was assessed by calf circumference, a validated surrogate measure of skeletal muscle mass, using previously established thresholds (≤33 cm for women and ≤34 cm for men). Outcomes were time to hospitalization, new dependence in basic activities of daily living (ADL), worsening walking ability, and death. To investigate the association of sarcopenia and its components with outcomes we used hazard models, considering death as a competing risk, adjusted for sociodemographic factors, Charlson comorbidity index, cognitive impairment, depressive symptoms, and weight loss.

RESULTS

On admission, 203 (31%) patients had sarcopenia. Comparing 1-year adverse outcomes between older adults with and without sarcopenia, respectively, cumulative incidences for hospitalization were 46% vs 32% (adjusted sub-hazard ratio [sHR] = 1.53; 95% CI = 1.16-2.04), for new ADL dependence, 47% vs 24% (adjusted sHR = 1.78; 95% CI = 1.31-2.42), for worsening walking ability, 28% vs 13% (adjusted sHR = 1.93; 95% CI = 1.28-2.90), and for death, 22% vs 10% (adjusted HR = 1.69; 95% CI = 1.05-2.73). Low muscle strength alone was associated with all outcomes, and low muscle mass was associated with all outcomes except mortality.

CONCLUSION

Sarcopenia was a strong predictor of 1-year adverse outcomes among acutely ill older outpatients. Combining handgrip strength with calf circumference may be a practical and efficient approach to screen for sarcopenia, and thereby identify high-risk older adults in busy clinical settings.

Skeletal Muscle Mass as a Mortality Predictor among Nonagenarians and Centenarians: A Prospective Cohort Study

This study aimed to evaluate the association between skeletal muscle mass and long-term all-cause mortality among nonagenarians and centenarians in China. We used data from the Project of Longevity and Aging in Dujiangyan (PLAD). A total of 738 community-dwelling people aged ≥ 90 years (mean age of 93.5 ± 3.2 years) were analyzed in this study. The appendicular skeletal muscle mass (ASM) was estimated using a previously validated anthropometric equation. The information on the survival status was requested from the local government registries during the 4 year follow-up period following the baseline investigation. The mean muscle mass index (SMI) was 6.11 ± 0.53 kg/m² in men and 4.00 ± 0.63 kg/m² in women, respectively. Low muscle mass was associated with a higher risk of death (hazard ratio [HR] 1.54; (95% confidence interval [CI]:1.10–2.16) in women; however, no significant association was found in men. Disability in activities of daily living (ADL) (HR = 1.73; 95% CI: 1.13–2.63) in men and women and cognitive impairment (HR = 1.49; 95% CI: 1.05–2.13) in men were also associated with increased all-cause mortality. In conclusion, low muscle mass were predictors of long-term mortality in nonagenarian and centenarian women.