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Liu C, Chen G, Xia Y, Wang P, Zhao Z, Zhang J, Xiao T, Li H. Sarcopenia as a predictor of nutritional status and comorbidities: a cross-sectional and mendelian randomization study. BMC Geriatr 2024; 24:752. [PMID: 39261770 PMCID: PMC11389292 DOI: 10.1186/s12877-024-05341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 08/28/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND With the advancement of world population aging, age-related sarcopenia (SP) imposes enormous clinical burden on hospital. Clinical research of SP in non-geriatric wards has not been appreciated, necessitating further investigation. However, observational studies are susceptible to confounders. Mendelian randomization (MR) can effectively mitigate bias to assess causality. OBJECTIVE To investigate the correlation between SP and comorbidities in orthopedic wards, and subsequently infer the causality, providing a theoretical basis for developing strategies in SP prevention and treatment. METHODS Logistic regression models were employed to assess the correlation between SP and comorbidities. The MR analysis was mainly conducted with inverse variance weighted, utilizing data extracted from the UK and FinnGen biobank (Round 9). RESULTS In the cross-sectional analysis, SP exhibited significant associations with malnutrition (P = 0.013) and some comorbidities, including osteoporosis (P = 0.014), body mass index (BMI) (P = 0.021), Charlson Comorbidity Index (CCI) (P = 0.006). The MR result also provided supporting evidence for the causality between SP and hypertension, osteoporosis and BMI. These results also withstood multiple sensitivity analyses assessing the validity of MR assumptions. CONCLUSION The result indicated a significant association between SP and BMI, CCI, malnutrition, and osteoporosis. We highlighted that SP and comorbidities deserved more attention in non-geriatric wards, urging further comprehensive investigation.
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Affiliation(s)
- Chao Liu
- Department of Orthopedics, the Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan , 410011, People's Republic of China
- Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha, 410011, People's Republic of China
| | - Guanyi Chen
- Department of Orthopedics, the Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan , 410011, People's Republic of China
| | - Yu Xia
- Department of Orthopedics, the Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan , 410011, People's Republic of China
- Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha, 410011, People's Republic of China
| | - Pingxiao Wang
- Department of Orthopedics, the Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan , 410011, People's Republic of China
- Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha, 410011, People's Republic of China
| | - Ziyue Zhao
- Department of Orthopedics, the Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan , 410011, People's Republic of China
- Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha, 410011, People's Republic of China
| | - JiaLin Zhang
- Department of Orthopedics, the Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan , 410011, People's Republic of China
- Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha, 410011, People's Republic of China
| | - Tao Xiao
- Department of Orthopedics, the Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan , 410011, People's Republic of China
- Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha, 410011, People's Republic of China
| | - Hui Li
- Department of Orthopedics, the Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, Hunan , 410011, People's Republic of China.
- Orthopedic Biomedical Materials Engineering Laboratory of Hunan Province, Changsha, 410011, People's Republic of China.
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Wang Q, Lan X, Ke H, Xu S, Huang C, Wang J, Wang X, Huang T, Wu X, Chen M, Guo Y, Zeng L, Tian XL, Xiang Y. Histone β-hydroxybutyrylation is critical in reversal of sarcopenia. Aging Cell 2024:e14284. [PMID: 39076122 DOI: 10.1111/acel.14284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 07/31/2024] Open
Abstract
Sarcopenia, a leading cause for global disability and mortality, is an age-related muscular disorder, characterized by accelerated muscle mass loss and functional decline. It is known that caloric restriction (CR), ketogenic diet or endurance exercise lessen sarcopenia and elevate circulating β-hydroxybutyrate (β-HB) levels. Whether the elevated β-HB is essential to the reversal of sarcopenia, however, remains unclear. Here we show in both Caenorhabditis elegans and mouse models that an increase of β-HB reverse myofiber atrophy and improves motor functions at advanced ages. β-HB-induced histone lysine β-hydroxybutyrylation (Kbhb) is indispensable for the reversal of sarcopenia. Histone Kbhb enhances transcription of genes associated with mitochondrial pathways, including oxidative phosphorylation, ATP metabolic process and aerobic respiration. This ultimately leads to improve mitochondrial integrity and enhance mitochondrial respiration. The histone Kbhb are validated in mouse model with CR. Thus, we demonstrate that β-HB induces histone Kbhb, increases mitochondrial function, and reverses sarcopenia.
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Affiliation(s)
- Qiquan Wang
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Xinqiang Lan
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Hao Ke
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Siman Xu
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Chunping Huang
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Jiali Wang
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Xiang Wang
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Tiane Huang
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Xia Wu
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Mengxin Chen
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Yingqi Guo
- Institutional Center for Shared Technologies and Facilities of the Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Lin Zeng
- Institutional Center for Shared Technologies and Facilities of the Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, China
| | - Xiao-Li Tian
- Aging and Vascular Diseases, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
| | - Yang Xiang
- Metabolic Control and Aging, Human Aging Research Institute and School of Life Science, Nanchang University, and Jiangxi Key Laboratory of Aging and Diseases, Nanchang, China
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Urquiza M, Fernández N, Arrinda I, Espin A, García-García J, Rodriguez-Larrad A, Irazusta J. Predictors of Hospital Readmission, Institutionalization, and Mortality in Geriatric Rehabilitation Following Hospitalization According to Admission Reason. J Geriatr Phys Ther 2024:00139143-990000000-00051. [PMID: 38875011 DOI: 10.1519/jpt.0000000000000414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND AND PURPOSE Older adults following an inpatient geriatric rehabilitation (GR) program commonly experience adverse health outcomes such as hospital readmission, institutionalization, and mortality. Although several studies have explored factors related to these outcomes, the influence of admission reason on the predictive factors of adverse health outcomes in the rehabilitation process remains unclear. Therefore, this study aimed to identify predictive factors for adverse health outcomes in inpatients attending GR according to their admission reason. METHODS This retrospective study included patients with orthogeriatric (OG) conditions and patients with hospital-associated deconditioning (HAD) admitted to GR after an acute hospitalization between 2016 and 2020. Patients were evaluated by a comprehensive geriatric assessment at admission, including sociodemographic data, social resources, clinical data, cognitive, functional and nutritional status, and physical performance measurements. Adverse health outcomes were collected (hospital readmission, institutionalization, and mortality). Univariate analyses and multivariate backward binary logistic regressions were used to determine predictive factors. RESULTS AND DISCUSSION In this study, 290 patients were admitted for OG conditions, and 122 patients were admitted due to HAD. In patients with OG conditions, lower Mini-Mental State Examination (MMSE) predicted institutionalization and mortality. Lower Mini Nutritional Assessment-Short Form predicted institutionalization, whereas lower Barthel Index and lower Tinetti-Performance-Oriented Mobility Assessment scores were associated with higher mortality. In patients with HAD, higher age-adjusted comorbidity index predicted hospital readmission and mortality, and lower Short Physical Performance Battery scores predicted institutionalization and mortality. Finally, lower MMSE scores, worse values in Older Americans Resources and Services Scale and male gender were associated with a higher risk of institutionalization. CONCLUSIONS Predictive factors for hospital readmission, institutionalization, and mortality in patients with OG conditions and HAD during GR were different. Some of those predictors, such as nutritional status and physical performance, are modifiable. Understanding predictive factors for adverse outcomes, and how these factors differ by admission diagnosis, improves our ability to identify patients most at risk. Early identification of these patients could assist with prevention efforts and lead to a reduction of negative outcomes.
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Affiliation(s)
- Miriam Urquiza
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Naiara Fernández
- Geriatric Department, Igurco Servicios Socio Sanitarios, Grupo IMQ, Bilbao, Spain
| | - Ismene Arrinda
- Geriatric Department, Igurco Servicios Socio Sanitarios, Grupo IMQ, Bilbao, Spain
| | - Ander Espin
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Julia García-García
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Ana Rodriguez-Larrad
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Jon Irazusta
- Department of Physiology, Faculty of Medicine and Nursing, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Clinical Nursing and Community Health Research Group, BioCruces Health Research Institute, Barakaldo, Bizkaia, Spain
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Meza-Valderrama D, Sánchez-Rodríguez D, Messaggi-Sartor M, Muñoz-Redondo E, Morgado-Pérez A, Tejero-Sánchez M, De Jaime-Gil E, Leiva-Banuelos N, Marco E. Supplementation with β-hydroxy-β-methylbutyrate after resistance training in post-acute care patients with sarcopenia: A randomized, double-blind placebo-controlled trial. Arch Gerontol Geriatr 2024; 119:105323. [PMID: 38171034 DOI: 10.1016/j.archger.2023.105323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES This study aimed to evaluate the efficacy of adding β-hydroxy-β- methylbutyrate (HMB) supplementation to a 12-week exercise-based rehabilitation program in older adults with sarcopenia after discharge from a post-acute geriatric rehabilitation unit. STUDY DESIGN A randomized, double-blind, placebo-controlled trial with two parallel groups. The intervention group received 3 g/day of Ca-HMB and participated in a 12- week resistance training program (3 sessions/week). The control group received a placebo and followed the same training program. MAIN OUTCOME MEASURES The primary outcomes were the improvements of handgrip strength and physical performance assessed through the Short Physical Performance Battery (SPPB) and 4-meter gait speed; and handgrip strength. All variables were assessed at baseline, post-intervention, and 1-year follow-up. RESULTS After completing the 12-week exercise program, the intervention group showed significant improvements in SPPB-Balance (1.3, 95 %CI 0.3 to 2.4) and total SPPB score (2.2, 95 %CI 0.4 to 4.0). Intra-group analysis demonstrated gains in the SPPB-Chair Stand (0.7 points, 95 %CI 0.0 to 1.4) and total SPPB score (2.1 points, 95 %CI 0.3 to 3.9) in the intervention group. Improvements in handgrip strength were observed in women (3.7 kg, 95 %CI: 0.2 to 7.3) at the end of the intervention, and persisted at the 1-year follow-up. CONCLUSIONS Our findings suggest that the supplementation of 3 g/day of Ca-HMB with resistance exercise may significantly enhance muscle strength and physical performance among older women with sarcopenia after recent hospitalization. Given this study's limitations, the intervention's effectiveness cannot be drawn, and further studies are needed.
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Affiliation(s)
- Delky Meza-Valderrama
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department, National Institute of Physical Medicine and Rehabilitation, Vía Centenario, 0819 Panamá City, Panamá; Sistema Nacional de Investigación- Secretaria Nacional de Ciencia e Investigación, Clayton Ciudad del Saber Edificio 205, 0819 Panamá City, Panamá.
| | - Dolores Sánchez-Rodríguez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Geriatrics Department, Brugmann University Hospital, Université Libre de Bruxelles, Place A.Van Gehuchten 4, 1020 Brussels, Belgium; WHO Collaborating Center for Public Health aspects of musculoskeletal health and ageing. Division of Public Health, Epidemiology and Health Economics, University of Liège, Pl. du Vingt Août 7, 4000, Liège, Belgium
| | - Monique Messaggi-Sartor
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Elena Muñoz-Redondo
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Andrea Morgado-Pérez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Marta Tejero-Sánchez
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain
| | - Elisabet De Jaime-Gil
- Geriatrics Department, Hospital del Mar - Centre Fòrum, Carrer de Llull 410, 08019, Barcelona, Catalonia, Spain
| | - Nuria Leiva-Banuelos
- Geriatrics Department, Hospital del Mar - Centre Fòrum, Carrer de Llull 410, 08019, Barcelona, Catalonia, Spain
| | - Ester Marco
- Rehabilitation Research Group, Hospital del Mar Medical Research Institute, Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain; Physical Medicine and Rehabilitation Department. Hospital del Mar - Centre Esperança. Sant Josep de la Muntanya 12, 08024 Barcelona, Catalonia, Spain; Faculty of Health and Life Sciences, Universitat Pompeu Fabra, Dr Aiguader Building (Mar Campus), Dr. Aiguader 80, 08003 Barcelona, Catalonia, Spain
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Verstraeten LMG, van Wijngaarden JP, Meskers CGM, Maier AB. High Sarcopenia Awareness Contrasts a Lack of Clinical Implementation Among Geriatric Rehabilitation Health Care Professionals in the Netherlands: EMPOWER-GR. J Geriatr Phys Ther 2024; 47:67-76. [PMID: 36827678 DOI: 10.1519/jpt.0000000000000379] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND PURPOSE Despite being associated with serious adverse outcomes, such as mortality, sarcopenia remains largely undiagnosed in older individuals. This study aimed to assess the awareness, practices, and barriers and enablers to clinical implementation of sarcopenia diagnosis and treatment among geriatric rehabilitation health care professionals in the Netherlands. METHODS As part of EMPOWER-GR, a cross-sectional survey among geriatric rehabilitation health care professionals working in the Netherlands was undertaken between September 23, 2020, and January 28, 2021. Professionals were recruited via a geriatric rehabilitation care provider, health care professional associations, professional networks of the research team, and social media. Descriptive statistics were used to assess the study outcomes. RESULTS AND DISCUSSION Of the 501 geriatric rehabilitation health care professionals, 12.2% were physicians, 23.0% physical therapist/occupational therapists, 30.3% dietitians, 19.6% nurses, and 11.0% health care assistants. The concept of sarcopenia was known by 83.8% of the participants, 92.5% correctly identified sarcopenia as low muscle mass and strength (and low physical performance), and 73.8% identified sarcopenia as very important in the management of older adults admitted for rehabilitation. Although 26.2% and 18.9% of the participants reported screening and diagnosing sarcopenia, respectively, in their current practice, only 3.0% adequately used the (revised) definition of the European Working Group on Sarcopenia in Older People. When sarcopenia has been diagnosed, 65.0% reported initiating treatment consisting of resistance exercise training (78.7%), food fortification/high-energy or protein diet (85.4%), and oral nutritional supplements (70.4%). Most important barriers to screening and diagnosis were lack of knowledge, access to tools, and equipment and time, while enablers were protocol implementation, access to training, and clear responsibilities. CONCLUSIONS Sarcopenia awareness is high among geriatric rehabilitation health care professionals in the Netherlands, but adequate screening and diagnosis is almost nonexistent in current clinical practice, which hampers interventions. Better knowledge, clear responsibilities, and access to tools and protocols, as well as prioritization, are needed for sarcopenia to be diagnosed and treated in geriatric rehabilitation in the Netherlands.
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Affiliation(s)
- Laure M G Verstraeten
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | | | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Center for Healthy Longevity, @AgeSingapore, National University Health System, Singapore
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Takano H, Kamada Y, Ichikawa M, Yoshida S. Prospective observational study of nutritional status and oral supplement utilization in users of an elderly daycare service, employing a web-based Mini Nutritional Assessment Form (MNA plus). Front Nutr 2024; 11:1375592. [PMID: 38505267 PMCID: PMC10948603 DOI: 10.3389/fnut.2024.1375592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/22/2024] [Indexed: 03/21/2024] Open
Abstract
Introduction Seniors are vulnerable to frailty, a condition linked to falls, fractures, hospitalizations, and sarcopenia. Even with regular meals, senior daycare users are at risk for malnutrition. Methods This study assessed malnutrition risk in daycare users, using the web-based Mini Nutritional Assessment Form (MNA®-SF). Individuals identified as malnourished or at risk were examined for changes in nutritional status with and without oral nutritional supplementation (ONS). Results Of 507 subjects, 138 (27.2%) were malnourished or at risk. Discontinuation rates were 20.0% (7/35) for the ONS group and 40.0% (10/25) for the regular care (RC) group. Among 29 patients with measurable weight change after six months, 19 (ONS group) and 10 (RC group) participated. The ONS group exhibited significant increases in body weight (+1.4 ± 2.9 kg, p < 0.01), body mass index (BMI) (+0.6 ± 0.9 kg/m2, p < 0.01), calf circumference (+3.2 ± 0.2 cm, p < 0.01), and grip strength (+1.2 ± 1.9 kg, p = 0.069). Conversely, the RC group showed no significant increases in body weight (+1.0 ± 1.9 kg, p = 0.146), BMI (+0.4 ± 0.8 kg/m2, p = 0.176), or grip strength (-0.7 ± 1.7 kg, p = 0.327), with decreased grip strength and calf circumference (-0.8 ± 0.9 cm, p < 0.05). In the ONS group, 52.6% (10/19) consumed over 400 kcal/day of ONS, and 84.2% maintained this intake for three months. Malnutrition is prevalent among daycare users. Conclusion ONS influences weight, BMI, and calf circumference, potentially reducing discontinuation rates. Clinical trial registration https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049767, UMIN000043580.
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Affiliation(s)
- Hiroki Takano
- Nestlé Health Science Company, Nestlé Japan Ltd., Tokyo, Japan
| | - Yukikazu Kamada
- Nestlé Health Science Company, Nestlé Japan Ltd., Tokyo, Japan
| | - Masaki Ichikawa
- Nestlé Health Science Company, Nestlé Japan Ltd., Tokyo, Japan
| | - Sadao Yoshida
- Department of Rehabilitation, Chuzan Hospital, Okinawa, Japan
- Department of Health and Nutrition, Okinawa University, Okinawa, Japan
- Faculty of Health Sciences, Kinjo University, Hakusan, Ishikawa, Japan
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Verstraeten LM, Mashni A, van Wijngaarden JP, Meskers CG, Maier AB. Sarcopenia knowledge of geriatric rehabilitation patients is low while they are willing to start sarcopenia treatment: EMPOWER-GR. J Cachexia Sarcopenia Muscle 2024; 15:352-360. [PMID: 38124340 PMCID: PMC10834324 DOI: 10.1002/jcsm.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/08/2023] [Accepted: 10/18/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sarcopenia is prevalent in 20-50% of geriatric rehabilitation inpatients and is associated with functional dependence and mortality. The aim is to assess knowledge of geriatric rehabilitation inpatients on sarcopenia and their willingness and perceived barriers to start treatment. METHODS Enhancing Muscle POWER in Geriatric Rehabilitation (EMPOWER-GR) is an observational cohort of geriatric rehabilitation inpatients in Amsterdam, the Netherlands. Knowledge of sarcopenia, willingness and perceived barriers to treatment were assessed with a survey among inpatients. Importance of and self-perceived muscle health were rated using a visual analogue scale from 0 to 10. Descriptive statistics were used. RESULTS Inpatients' (n = 157, 59.9% female) mean age was 80.5 years (SD 7.3). Sarcopenia (European Working Group on Sarcopenia in Older People 2) prevalence was 21.7%. Five inpatients (3.2%) had heard of sarcopenia and had knowledge of its definition. Median muscle health was rated as 6 (interquartile range: 4-7). After explanation of treatment options, 67.1% were willing to start resistance exercise training (RET), 61.1% a high-protein diet and 55.7% oral nutritional supplements (ONS). Inpatients with sarcopenia were less willing (51.6%) to start a high-protein diet compared with inpatients without sarcopenia (77.8%) (P = 0.002); there was no difference for RET and ONS. Most reported barriers to treatment were ONS dislike (17.0%), too many other health issues (13.6%), doubts about treatment effectiveness/importance (12.9%) and RET intensity/difficulty (10.2%). CONCLUSIONS Knowledge of sarcopenia was low, while the majority of inpatients showed willingness to start treatment. A dislike of ONS, RET difficulty and too many other health issues may reduce willingness to start treatment. Education is important to increase sarcopenia-related health issues in geriatric rehabilitation inpatients.
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Affiliation(s)
- Laure M.G. Verstraeten
- Department of Human Movement Sciences@AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciencesvan der Boechorststraat 7Amsterdam1081 BTThe Netherlands
| | - Amir Mashni
- Department of Human Movement Sciences@AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciencesvan der Boechorststraat 7Amsterdam1081 BTThe Netherlands
| | | | - Carel G.M. Meskers
- Department of Rehabilitation MedicineAmsterdam University Medical Centre, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Andrea B. Maier
- Department of Human Movement Sciences@AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciencesvan der Boechorststraat 7Amsterdam1081 BTThe Netherlands
- Department of Medicine and Aged Care@AgeMelbourne, The Royal Melbourne Hospital, The University of MelbourneParkvilleVictoriaAustralia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Centre for Healthy Longevity@AgeSingapore, National University Health SystemSingapore
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Lee H, Chung HS, Kim YJ, Choi MK, Roh YK, Yu JM, Oh CM, Kim J, Moon S. Association between body composition and the risk of mortality in the obese population in the United States. Front Endocrinol (Lausanne) 2023; 14:1257902. [PMID: 38089609 PMCID: PMC10711108 DOI: 10.3389/fendo.2023.1257902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
Background Recent studies have presented the concept of the obesity paradox, suggesting that individuals with obesity have a lower risk of death than those without obesity. This paradox may arise because body mass index (BMI) alone is insufficient to understand body composition accurately. This study investigated the relationship between fat and muscle mass and the risk of mortality in individuals with overweight/obesity. Methods We used data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2006 and 2011 to 2018, which were linked to mortality information obtained from the National Death Index. Multiple Cox regression analyses were performed to estimate mortality risk. Subgroup analysis was conducted using propensity score-matched (PSM) data for age, sex, and race/ethnicity. Results This study included 16,555 participants who were overweight/obese (BMI≥25 kg/m2). An increase in appendicular skeletal muscle mass index was associated with a lower mortality risk (hazard ratio [HR]: 0.856; 95% confidence interval [CI]: 0.802-0.915). This finding was consistent with the subgroup analysis of the PSM data. Contrastingly, a high fat mass index was associated with an increased risk of mortality. Sarcopenic overweight/obesity was significantly associated with high mortality compared to obesity without sarcopenia (HR: 1.612, 95%CI: 1.328-1.957). This elevated risk was significant in both age- and sex-based subgroups. This finding was consistent with the subgroup analysis using PSM data. Conclusion In contrast to the obesity paradox, a simple increase in BMI does not protect against mortality. Instead, low body fat and high muscle mass reduce mortality risk.
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Affiliation(s)
- Heeso Lee
- Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hye Soo Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Yoon Jung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Min Kyu Choi
- Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Yong Kyun Roh
- Department of Family Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Jae Myung Yu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Chang-Myung Oh
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Joon Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Shinje Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
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An K, Wu Z, Qiu Y, Pan M, Zhang L, An Z, Li S. Shared decision making in sarcopenia treatment. Front Public Health 2023; 11:1296112. [PMID: 38074732 PMCID: PMC10710138 DOI: 10.3389/fpubh.2023.1296112] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
The implementation of shared decision making (SDM) in management of sarcopenia is still in its nascent stage, especially compared to other areas of medical research. Accumulating evidence has highlighted the importance of SDM in older adults care. The current study overviews general SDM practices and explores the potential advantages and dilemmas of incorporating these concepts into sarcopenia management. We present common patient decision aids available for sarcopenia management and propose future research directions. SDM can be effectively integrated into daily practice with the aid of structured techniques, such as the "seek, help, assess, reach, evaluate" approach, "making good decisions in collaboration" questions, "benefits, risks, alternatives, doing nothing" tool, or "multifocal approach to sharing in shared decision making." Such techniques fully consider patient values and preferences, thereby enhancing adherence to and satisfaction with the intervention measures. Additionally, we review the barriers to and potential solutions to SDM implementation. Further studies are required to investigate measurement and outcomes, coordination and cooperation, and digital technology, such as remote SDM. The study concludes that sarcopenia management must go beyond the single dimension of "Paternalism" choice. Integrating SDM into clinical practice offers promising opportunities to improve patient care, with patient-centered care and partnership of care approaches positively impacting treatment outcomes.
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Affiliation(s)
- Kang An
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zengxiang Wu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Qiu
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mengjia Pan
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lin Zhang
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenmei An
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shuangqing Li
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Unsal P, Guner M, Ozsurekci C, Balli N, Bas AO, Ozturk Y, Dikmeer A, Burkuk S, Koca M, Balci C, Dogu BB, Cankurtaran M, Halil M. Prevalence of nutrition disorders and nutrition-related conditions in older patients with Alzheimer's disease. Nutr Clin Pract 2023; 38:1142-1153. [PMID: 37076942 DOI: 10.1002/ncp.10995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 02/26/2023] [Accepted: 03/19/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUNDS Alzheimer's disease is frequently encountered with nutrition-related conditions such as malnutrition, sarcopenia, frailty, overnutrition, and micronutrient abnormalities in older patients. In this study, we aimed to evaluate the prevalence of nutrition disorders and nutrition-related conditions in the same patient group. METHODS A total of 253 older patients with Alzheimer's disease underwent comprehensive geriatric assessment, which included nutrition-related disorders, malnutrition via the Mini Nutritional Assessment-Short Form (MNA-SF), frailty via the Clinical Frailty Scale (CFS), and sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People-2 criteria. RESULTS The patients' mean age was 79.8 ± 6.5 years, and 58.1% were women. In our patients, 64.8% had malnutrition or were at risk of malnutrition; 38.3% had sarcopenia; 19.8% were prefrail; and 80.2% were frail. Malnutrition, frailty, and sarcopenia prevalence increased as the Alzheimer's disease stage progressed. Malnutrition was found to be significantly related with frailty scores via CFS (odds ratio [OR], 1.397; P = 0.0049) and muscle mass via fat-free mass index (FFMI) (OR, 0.793; P = 0.001). In logistic regression analysis, age, MNA-SF, and CFS were included in the model to detect the independent correlates of probable and confirmed sarcopenia. CFS was independently associated with probable and confirmed sarcopenia (OR, 1.822; P = 0.013; OR, 2.671; P = 0.001, respectively). Frailty was similarly related with FFMI (OR, 0.836; P = 0.031). Obesity was independently related with FFMI (OR, 0.688; P < 0.001). CONCLUSION In conclusion, nutrition disorders and nutrition-related conditions can present concurrently in patients with all stages of Alzheimer's disease; therefore, these frequent problems should be screened and diagnosed accordingly.
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Affiliation(s)
- Pelin Unsal
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Merve Guner
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cemile Ozsurekci
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nisa Balli
- Department of Clinical Pharmacy, Hacettepe University Faculty of Pharmacy, Ankara, Turkey
| | - Arzu Okyar Bas
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Ozturk
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ayse Dikmeer
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Suna Burkuk
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Koca
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Cafer Balci
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Burcu Balam Dogu
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Cankurtaran
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Halil
- Department of Internal Medicine, Division of Geriatric Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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11
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Yoshida S, Shiraishi R, Nakayama Y, Taira Y. Can Nutrition Contribute to a Reduction in Sarcopenia, Frailty, and Comorbidities in a Super-Aged Society? Nutrients 2023; 15:2991. [PMID: 37447315 DOI: 10.3390/nu15132991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Many countries are facing the advent of super-aging societies, where sarcopenia and frailty will become pertinent problems. The prevalence of comorbidities is a major problem in countries with aged populations as elderly people suffer from various diseases, such as diabetes, heart failure, chronic kidney disease and dementia. All of these diseases are associated with sarcopenia and frailty, and they frequently cause falls, fractures, and a decline in activities of daily living. Fractures in the elderly people are associated with bone fragility, which is influenced by diabetes and chronic kidney disease. Nutritional support for chronic disease patients and sarcopenic individuals with adequate energy and protein intake, vitamin D supplementation, blood glucose level management for individuals with diabetes, obesity prevention, nutritional education for healthy individuals, and the enlightenment of society could be crucial to solve the health-related problems in super-aging societies.
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Affiliation(s)
- Sadao Yoshida
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
- Department of Health and Nutrition, Okinawa University, 555 Kokuba, Naha 902-8521, Okinawa, Japan
- Faculty of Health Sciences, Kinjo University, 1200 Kasama-machi, Hakusan 924-8511, Ishikawa, Japan
| | - Ryo Shiraishi
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
| | - Yuki Nakayama
- Department of Rehabilitation, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
| | - Yasuko Taira
- Faculty of Nutrition, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa 904-2151, Okinawa, Japan
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12
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Barazzoni R, Cederholm T, Zanetti M, Gortan Cappellari G. Defining and diagnosing sarcopenia: Is the glass now half full? Metabolism 2023; 143:155558. [PMID: 37031950 DOI: 10.1016/j.metabol.2023.155558] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
Low muscle mass and function exert a substantial negative impact on quality of life, health and ultimately survival, but their definition, identification and combination to define sarcopenia have suffered from lack of universal consensus. Methodological issues have also contributed to incomplete agreement, as different approaches, techniques and potential surrogate measures inevitably lead to partly different conclusions. As a consequence: 1) awareness of sarcopenia and implementation of diagnostic procedures in clinical practice have been limited; 2) patient identification and evaluation of therapeutic strategies is largely incomplete. Significant progress has however recently occurred after major diagnostic algorithms have been developed, with common features and promising perspectives for growing consensus. At the same time, the need for further refinement of the sarcopenia concept has emerged, to address its increasingly recognized clinical heterogeneity. This includes potential differential underlying mechanisms and clinical features for age- and disease-driven sarcopenia, and the emerging challenge of sarcopenia in persons with obesity. Here, we will review existing algorithms to diagnose sarcopenia, and major open methodological issues to assess skeletal muscle mass and function under different clinical conditions, in order to highlight similarities and differences. Potential for consensus on sarcopenia diagnosis as well as emerging new challenges will be discussed.
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Affiliation(s)
- Rocco Barazzoni
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.
| | - Tommy Cederholm
- Uppsala University and Karolinska University Hospital, Stockholm, Sweden
| | - Michela Zanetti
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
| | - Gianluca Gortan Cappellari
- Internal Medicine, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy
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13
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Szklarzewska S, Mottale R, Engelman E, De Breucker S, Preiser JC. Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis. Clin Nutr 2023; 42:309-336. [PMID: 36731161 DOI: 10.1016/j.clnu.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical. TRIALS gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios. RESULTS We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination. CONCLUSION Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.
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Affiliation(s)
- Sylwia Szklarzewska
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Raphael Mottale
- Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sandra De Breucker
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Medical Direction, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Association of a modified laboratory frailty index with adverse outcomes in geriatric rehabilitation inpatients: RESORT. Mech Ageing Dev 2022; 203:111648. [PMID: 35219637 DOI: 10.1016/j.mad.2022.111648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
A higher number of laboratory measurements is associated with mortality in patients admitted to hospital, but is not part of the frailty index based on laboratory tests (FILab). This study aimed to modify the FI-Lab (mFI-Lab) by accounting for the number of laboratory measurements and compare its validity to predict institutionalization and mortality at three-month post-discharge with the clinical frailty scale (CFS) in geriatric rehabilitation inpatients. In 1819 patients (median age 83.3 [77.6-88.3], 56.6% female), a higher FI-Lab was not associated with institutionalization but a higher risk of mortality. A higher mFI-Lab was associated with lower odds of institutionalization but a higher risk of mortality. A higher CFS was associated with institutionalization and higher mortality. The Akaike information criterion value was lowest for the CFS, followed by the mFI-Lab and the FI-Lab. The CFS is better than the mFI-Lab predicting short-term adverse outcomes in geriatric rehabilitation inpatients. When using laboratory data to estimate frailty, the mFI-Lab rather than the FI-Lab should be used.
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15
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Yoshida S, Nakayama Y, Nakayama J, Chijiiwa N, Ogawa T. Assessment of sarcopenia and malnutrition using estimated GFR ratio (eGFRcys/eGFR) in hospitalised adult patients. Clin Nutr ESPEN 2022; 48:456-463. [DOI: 10.1016/j.clnesp.2021.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/09/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022]
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16
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Ho HE, Yeh CJ, Wei JCC, Chu WM, Lee MC. Multimorbidity patterns and their relationships with incident disability and frailty among older adults in Taiwan: a 16-year, population-based cohort study. Arch Gerontol Geriatr 2022; 101:104688. [DOI: 10.1016/j.archger.2022.104688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/15/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
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17
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Daly RM, Iuliano S, Fyfe JJ, Scott D, Kirk B, Thompson MQ, Dent E, Fetterplace K, Wright ORL, Lynch GS, Zanker J, Yu S, Kurrle S, Visvanathan R, Maier AB. Screening, Diagnosis and Management of Sarcopenia and Frailty in Hospitalized Older Adults: Recommendations from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR) Expert Working Group. J Nutr Health Aging 2022; 26:637-651. [PMID: 35718874 DOI: 10.1007/s12603-022-1801-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sarcopenia and frailty are highly prevalent conditions in older hospitalized patients, which are associated with a myriad of adverse clinical outcomes. This paper, prepared by a multidisciplinary expert working group from the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR), provides an up-to-date overview of current evidence and recommendations based on a narrative review of the literature for the screening, diagnosis, and management of sarcopenia and frailty in older patients within the hospital setting. It also includes suggestions on potential pathways to implement change to encourage widespread adoption of these evidence-informed recommendations within hospital settings. The expert working group concluded there was insufficient evidence to support any specific screening tool for sarcopenia and recommends an assessment of probable sarcopenia/sarcopenia using established criteria for all older (≥65 years) hospitalized patients or in younger patients with conditions (e.g., comorbidities) that may increase their risk of sarcopenia. Diagnosis of probable sarcopenia should be based on an assessment of low muscle strength (grip strength or five times sit-to-stand) with sarcopenia diagnosis including low muscle mass quantified from dual energy X-ray absorptiometry, bioelectrical impedance analysis or in the absence of diagnostic devices, calf circumference as a proxy measure. Severe sarcopenia is represented by the addition of impaired physical performance (slow gait speed). All patients with probable sarcopenia or sarcopenia should be investigated for causes (e.g., chronic/acute disease or malnutrition), and treated accordingly. For frailty, it is recommended that all hospitalized patients aged 70 years and older be screened using a validated tool [Clinical Frailty Scale (CFS), Hospital Frailty Risk Score, the FRAIL scale or the Frailty Index]. Patients screened as positive for frailty should undergo further clinical assessment using the Frailty Phenotype, Frailty Index or information collected from a Comprehensive Geriatric Assessment (CGA). All patients identified as frail should receive follow up by a health practitioner(s) for an individualized care plan. To treat older hospitalized patients with probable sarcopenia, sarcopenia, or frailty, it is recommended that a structured and supervised multi-component exercise program incorporating elements of resistance (muscle strengthening), challenging balance, and functional mobility training be prescribed as early as possible combined with nutritional support to optimize energy and protein intake and correct any deficiencies. There is insufficient evidence to recommend pharmacological agents for the treatment of sarcopenia or frailty. Finally, to facilitate integration of these recommendations into hospital settings organization-wide approaches are needed, with the Spread and Sustain framework recommended to facilitate organizational culture change, with the help of 'champions' to drive these changes. A multidisciplinary team approach incorporating awareness and education initiatives for healthcare professionals is recommended to ensure that screening, diagnosis and management approaches for sarcopenia and frailty are embedded and sustained within hospital settings. Finally, patients and caregivers' education should be integrated into the care pathway to facilitate adherence to prescribed management approaches for sarcopenia and frailty.
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Affiliation(s)
- R M Daly
- Professor Robin M. Daly, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Highway, Burwood, Melbourne, Victoria, Australia 3125, Phone: +61 3 9244 6040, , ORCID ID: 0000-0002-9897-1598
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