Poor physical function in elderly women in low-level aged care is related to muscle strength rather than to measures of sarcopenia

Comparison of the effect of respiratory muscle strength on dynamic and static balance assessment between sarcopenia and non-sarcopenia groups

[Purpose] We compared differences in the association between respiratory muscle strength and static and dynamic balance in sarcopenia and non-sarcopenia groups, for fall risk assessment. [Participants and Methods] The study included 37 participants aged ≥65 years, who were certified to receive long-term care. Inspiratory and expiratory muscle strength, hand grip strength, Timed Up and Go Test scores, and one-leg standing task scores were recorded. Pearson's correlation coefficients and multiple regression analysis were used for data analysis. [Results] Only the expiratory muscle and hand grip strength were correlated in the sarcopenia group. Expiratory and inspiratory muscle strength was correlated with both one-leg standing task scores and hand grip strength, and inspiratory muscle strength was correlated with the Timed Up and Go Test scores in the non-sarcopenia group. Multiple regression analysis revealed that expiratory muscle strength was an explanatory variable for the one-leg standing task and inspiratory muscle strength for the Timed Up and Go Test in the non-sarcopenia group. [Conclusion] Combined evaluation of expiratory muscle strength and the Timed Up and Go Test scores may be useful to assess the fall risk.

Association between ankle torque and performance-based tests, self-reported pain, and physical function in patients with knee osteoarthritis

Objectives

This study aimed to investigate the association between ankle torque and performance-based tests, self-reported pain, and physical function in patients with knee osteoarthritis (OA).

Patients and methods

The cross-sectional study was conducted with 39 individuals (24 females, 15 males; mean age: 57.3±6.2 years; range, 40 to 65 years) with knee OA between January 2014 and July 2015. Ankle torque was determined using an isokinetic dynamometer. The 40-m fast-paced walk test and a stair climb test were used to assess functional performance. Self-reported pain and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pearson's correlation coefficients were calculated to test correlations between the dependent variables (40-m fast-paced walk test, stair climb test, WOMAC pain and physical function domains, sex, age, body mass index, and radiologic evidence of OA) and the independent variables (mean plantar flexor torque and dorsiflexor peak torque). A multiple linear regression analysis was applied to quantify the association between the dependent and independent variables.

Results

Dorsiflexor and plantar flexor peak torques in the concentric and eccentric modes were negatively correlated with the 40-m fast-paced walk and stair climb tests (r=-0.33 to -0.51, p≤0.05). A negative correlation was found between concentric plantar flexor torque and the WOMAC physical function score (r=-0.35, p=0.03). No correlation was found between ankle torques and the WOMAC pain score (p>0.05). The multiple linear regression analysis showed that the eccentric plantar flexor and dorsiflexor torques were significantly associated with the stair climb test (β=-0.001, 95% confidence interval [CI]: -0.001 to 0.000, p=0.03, and β=-0.002, 95% CI: -0.004 to 0.000, p=0.05, respectively). No significant associations were found between concentric plantar flexor and dorsiflexor torques and the stair climb test (p>0.05). No significant associations were found between the ankle torques and the 40-m fast-paced walk test and WOMAC physical function (p>0.05).

Conclusion

Ankle torque plays an important role in functional performance. Thus, ankle torque deficit, especially eccentric plantar flexor and dorsiflexor torques, may exert a negative influence on stair climbing performance in patients with knee osteoarthritis.

Can the balance evaluation systems test be used to identify system-specific postural control impairments in older adults with chronic neck pain?

Background

Older adults with chronic neck pain (CNP) demonstrate impaired postural control. The Balance Evaluation Systems Test (BESTest) is used to assess systems underlying postural control impairments, but its use in CNP has not been reported. This study assessed whether the BESTest can identify postural control impairments in CNP as well as the level of BESTest item difficulty by Rasch analysis.

Materials and methods

This cross-sectional study recruited thirty young adults (YOUNG) aged 20–40 years and eighty older adults aged 60 years or older [without neck pain (OLD) = 60, with chronic neck pain (CNP) = 20]. Questionnaires were administered to collect demographic data, intensity of neck pain (VAS), patient’s self-rated neck pain and disability (NDI), and balance confidence in daily activities (ABC). The BESTest was used to assess postural control.

Results

The CNP group showed the lowest ABC scores. Compared to the YOUNG group, the BESTest score was significantly lower in the OLD group, while the CNP group showed the lowest score, suggesting that balance control deteriorated from the normal aging process and further declined in the CNP group, especially in biomechanical constraints, transitions–anticipatory postural adjustment, and reactive postural response (p < 0.05). Using scores from these three sections, the BESTest was accurate at the cutoff score of 48.5 out of 51 for differentiating the older adults whose daily life are affected by neck problems (using the NDI as a reference) with a high AUC (0.79), sensitivity (72%), and specificity (69%). The Rasch analysis revealed that the Timed Up and Go with dual task test was the most difficult BESTest item for all groups, whereas 14 items showed more difficulty for the CNP group.

Conclusion

The BESTest can be used to identify postural control impairments in CNP patients, even those with moderate pain and mild disability with a high level of physical functioning. The combined score of biomechanical constraints, transitions–anticipatory postural adjustment, and reactive postural response domains was suggested for the detection of older adults whose daily lives are affected by neck problems. This will also help clinicians consider the management of neck pain to prevent falls in CNP.

Prevalence and risk factors of stroke-related sarcopenia at the subacute stage: A case control study

Purpose

To investigate the prevalence and risk factors of stroke-related sarcopenia (SRS) in hospitalized patients receiving rehabilitation treatment.

Methods

Approximately, 259 patients with stroke that satisfied the inclusion and exclusion criteria were consecutively recruited between June 2020 and July 2022. The epidemiologic data, history, clinical data, and measured data of the skeletal muscle index were collected. The patients were divided into the sarcopenia and non-sarcopenia group for comparison and analysis with the univariate and multivariate analysis.

Results

SRS was presented in 121 (46.7%) patients with a mean age of 59.6 ± 9.7 years, including 42 women and 79 men. Multivariate logistic regression analysis revealed the following parameters to be significant (p < 0.05) risk factors for SRS: college degree or above (OR, 2.1, 95% CI, 1.1–4.1), ICU stay (OR, 1.7, 95% CI, 1.06–2.8), pneumonia (OR, 1.9, 9% CI, 1.1–3.6), walking ability (OR, 2.6, 95% CI, 1.5–4.6), cognitive impairment (OR, 1.8, 95%, 1.1–2.9), aphasia (OR, 2.1, 95% CI, 1.2–3.5), nasogastric feeding (OR, 3.7, 95%, 1.9–7.3), age (OR, 1.04, 95% CI, 1–1.1), and creatine kinase (OR, 1.1, 95% CI,0.9–1.2).

Conclusions

Older age, light weight, severer clinical conditions, cognitive impairment, and significantly decreased levels of albumin, RAG, creatinine, uric acid, red blood cell count, hemoglobin, prealbumin, iron, and creatine kinase are more significantly present in patients with SRS compared with those without SRS.

Relationship Between Sarcopenia and Cardiovascular Diseases in the Elderly: An Overview

With the advent of population aging, aging-related diseases have become a challenge for governments worldwide. Sarcopenia has defined as a clinical syndrome associated with age-related loss such as skeletal muscle mass, strength, function, and physical performance. It is commonly seen in elderly patients with chronic diseases. Changes in lean mass are common critical determinants in the pathophysiology and progression of cardiovascular diseases (CVDs). Sarcopenia may be one of the most important causes of poor physical function and decreased cardiopulmonary function in elderly patients with CVDs. Sarcopenia may induce CVDs through common pathogenic pathways such as malnutrition, physical inactivity, insulin resistance, inflammation; these mechanisms interact. In this study, we aimed to investigate the relationship between sarcopenia and CVDs in the elderly. Further research is urgently needed to understand better the relationship, pathophysiology, clinical presentation, diagnostic criteria, and mechanisms of sarcopenia and CVDs, which may shed light on potential interventions to improve clinical outcomes and provide greater insight into the disorders above.

Does skeletal muscle morphology or functional performance better explain variance in fast gait speed in older adults?

BACKGROUND

Fast gait speed is being increasingly recognized as an important clinical tool in older adults. However, the underlying muscular and functional contributors to fast gait speed performance remain poorly understood.

AIM

We sought to determine predictors of fast gait speed in older adults. We hypothesized that lower-extremity skeletal muscle size and quality would be strong predictors.

METHODS

Ninety community-dwelling older adults (33 men, 57 women; mean ± SD age = 74 ± 6 years) participated. B-mode ultrasonography was used to capture images of the vastus lateralis, rectus femoris, and gastrocnemius in the transverse plane. Each participant performed 30-second chair stand, heel-rise, functional reach, and grip strength tests. Fast gait speed was measured using the NIH Toolbox 4-Meter Walk Test. ImageJ software was used to quantify cross-sectional area (CSA), subcutaneous tissue thickness, and echo intensity. Two separate stepwise regression analyses were performed, one using muscle morphology variables as independent variables, and another including the functional outcomes.

RESULTS

The ultrasound variables exhibited weak-to-moderate correlations with fast gait speed (|r| range = 0.168-0.416). The initial regression analysis indicated that the combination of medial gastrocnemius CSA and subcutaneous tissue thickness explained 22.8% of the variance in fast gait speed. The secondary analysis indicated that 30-second chair stand, heel-rise, and grip strength performance explained 45.5% of the variance.

CONCLUSION

While medial gastrocnemius morphology is important, measures of upper and lower-extremity muscle function are better predictors of fast gait speed. These results highlight a dissociation between skeletal muscle morphology and fast gait speed.

Factors associated with appendicular skeletal muscle mass among male Chinese patients with stable chronic obstructive pulmonary disease: A hospital-based cross-sectional study

Limbs muscle wasting is a common disorder in patients with chronic obstructive pulmonary disease (COPD) that limits daily activities and exercise intolerance, especially in males. The present study aimed to estimate the prevalence of appendicular skeletal muscle mass (ASM) in male patients with stable COPD. In addition, factors associated with parameters of ASM were also investigated.We recruited 116 male patients with stable COPD from the outpatient clinic between September 2016 and December 2017. For each patient, we obtained demographic characteristics and measured post-bronchodilator forced expiratory volume in 1 second, symptoms, exacerbations history, and ASM. ASM was defined as the sum of the muscle masses of the 4 limbs.Appendicular skeletal muscle mass index (ASMI) in male patients with stable COPD was 8.2 ± 0.9 kg/m, and the prevalence of low skeletal muscle mass was 7.8% (9 of 116 patients). Multiple linear-regression analysis showed that body mass index, occupation, fat-free mass index, and the modified medical research council scale were significantly correlated with ASMI. Compared with nonexercise group, lower limb muscle mass and ASM were significantly improved in physical exercise group.Underweight, retirement, fat-free mass depletion, and severe dyspnea are all risk factors for ASM in male patients with stable COPD. Our findings also justify the importance of exercise training in improving ASM.

Russian translation and validation of SarQoL® – quality of life questionnaire for patients with sarcopenia

The aim is to carry out language adaptation and validation on the Russian sample of a special SarQoL questionnaire, designed to assess the quality of life of elderly people with sarcopenia. Material and methods. 100 patients over 65 years, mean age 74.0±6.5 years, observed on an outpatient basis were included. 50 from them had sarcopenia and 50 participants were without it. The diagnosis of sarcopenia was based on criteria developed by the European working group on sarcopenia (EWGSOP, 2010). The validation procedure was carried out in accordance with the Protocol. Results and discussion. There was a significant decrease in the overall quality of life according to SarQoL questionnaire in patients with sarcopenia compared with the control group without sarcopenia (50.65±14.23 and 75.10±14.46, respectively; p<0.001). High internal consistency of the SarQoL (Cronbach's á coefficient 0.924) was revealed. A significant positive correlation of domains with the overall SarQoL index in the range from r=0.37, p=0.0083 to r=0.92, p<0.001 was established. Moderate correlations of SarQoL with some domains SF-36 and the EQ-5D questionnaires were revealed. High internal consistency (ICC) of 0.935 (95% CI 0.91-0.96) was found. Conclusion. The Russian version of the SarQoL questionnaire is valid, consistent and reliable and can be used to assess the quality of life in older patients with sarcopenia.

Relation between functional mobility and dynapenia in institutionalized frail elderly

Objective

To investigate the relation between functional mobility and dynapenia in institutionalized frail elderly.

Methods

A descriptive, correlational study involving 26 institutionalized elderly men and women, mean age 82.3±6 years. The instruments employed were the Mini Mental State Examination, the Geriatric Depression Scale, the International Physical Activity Questionnaire, the Timed Up and Go test, a handgrip dynamometer and a portable dynamometer for large muscle groups (shoulder, elbow and hip flexors, knee extensors and ankle dorsiflexors).

Results

Significant negative correlation between functional mobility levels assessed by the Timed Up and Go test and dynapenia was observed in all muscle groups evaluated, particularly in knee extensors (r -0.65).

Conclusion

A significant negative correlation between muscle strength, particularly knee extensor strength, and functional mobility was found in institutionalized elderly. Data presented indicate that the higher the muscle strength, the shorter the execution time, and this could demonstrate better performance in this functional mobility test.

ACE and UCP2 gene polymorphisms and their association with baseline and exercise-related changes in the functional performance of older adults

Maintaining high levels of physical function is an important aspect of successful ageing. While muscle mass and strength contribute to functional performance in older adults, little is known about the possible genetic basis for the heterogeneity of physical function in older adults and in how older adults respond to exercise. Two genes that have possible roles in determining levels of muscle mass, strength and function in young and older adults are angiotensin-converting enzyme (ACE) and mitochondrial uncoupling protein 2 (UCP2). This study examined whether polymorphisms in these two individual genes were associated with baseline functional performance levels and/or the training-related changes following exercise in previously untrained older adults. Five-eight Caucasian older adults (mean age 69.8 years) with no recent history of resistance training enrolled in a 12 week program of resistance, balance and cardiovascular exercises aimed at improving functional performance. Performance in 6 functional tasks was recorded at baseline and after 12 weeks. Genomic DNA was assayed for the ACE intron 16 insertion/deletion (I/D) and the UCP2 G-866A polymorphism. Baseline differences among genotype groups were tested using analysis of variance. Genotype differences in absolute and relative changes in physical function among the exercisers were tested using a general linear model, adjusting for age and gender. The genotype frequencies for each of the studied polymorphisms conformed to the Hardy-Weinberg equilibrium. The ACE I/D genotype was significantly associated with mean baseline measures of handgrip strength (II 30.9 ± 3.01 v. ID 31.7 ± 1.48 v. DD 29.3 ± 2.18 kg, p < 0.001), 8ft Up and Go time (II 6.45 ± 0.48 v. ID/DD 4.41 ± 0.19 s, p < 0.001) and 6 min walk distance (II 458 ± 28.7 v. ID/DD 546 ± 12.1m, p = 0.008). The UCP2 G-866A genotype was also associated with baseline 8ft Up and Go time (GG 5.45 ± 0.35 v. GA 4.47 ± 0.26 v. AA 3.89 ± 0.71 s, p = 0.045). After 12 weeks of training, a significant difference between UCP2 G-886A genotype groups for change in 8ft Up and Go time was detected (GG −0.68 ± 0.17 v. GA −0.10 ± 0.14 v. AA +0.05 ± 0.31 s, p = 0.023). While several interesting and possibly consistent associations with older adults’ baseline functional performance were found for the ACE and UCP2 polymorphisms, we found no strong evidence of genetic associations with exercise responses in this study. The relative equivalence of some of these training-response findings to the literature may have reflected the current study’s focus on physical function rather than just strength, the relatively high levels of baseline function for some genotype groups as well as the greater statistical power for detecting baseline differences than the training-related changes.

The significance of body mass index in calculating the cut-off points for low muscle mass in the elderly: methodological issues

OBJECTIVES

Cut-off points (COPs) for appendicular lean mass (ALM) index, essential to define low muscle mass (LMM) in the elderly, have never been officially defined for Poland. The aim of the study was to establish them. Additionally, the significance of body mass index (BMI) for correctly defining the COPs in a young, healthy reference group was assessed.

METHODS

The study was composed of reference group (n = 1113) and the elderly group (n = 200). In all subjects, body composition was assessed by bioimpedance analysis, and ALM index was calculated. Next, COPs (kg/m(2)) were set up for the whole reference group and for particular subgroups with different BMIs separately. They were used to diagnose sarcopenia in the elderly.

RESULTS

COP for all young females was 5.37 (COP-F), while it was equal to 5.52 (COP-F2) when only those with a recommended BMI (18.50-24.99 kg/m(2)) were taken into consideration. For males, it was 7.32 and 7.29, respectively. Only 7% of elderly females had LMM based on COP-F and 15% had LMM based on COP-F2 (P < 0.05); for males, the percentages were 18% and 16%, respectively.

CONCLUSIONS

COPs for LMM for Poland are 5.52 kg/m(2) (females) and 7.29 kg/m(2) (males). The reference group BMI is an important factor in establishing COPs for low muscle mass.

The impact of low muscle mass definition on the prevalence of sarcopenia in older Australians

Background. Sarcopenia is the presence of low muscle mass and low muscle function. The aim of this study was to establish cutoffs for low muscle mass using three published methods and to compare the prevalence of sarcopenia in older Australians. Methods. Gender specific cutoffs levels were identified for low muscle mass using three different methods. Low grip strength was determined using established cutoffs of <30 kg for men and <20 kg for women to estimate the prevalence of sarcopenia. Results. Gender specific cutoffs levels for low muscle mass identified were (a) <6.89 kg/m² for men and <4.32 kg/m² for women, <2 standard deviation (SD) of a young reference population; (b) <7.36 kg/m² for men and <5.81 kg/m² for women from the lowest 20% percentile of the older group; and (c) <−2.15 for men and <−1.42 for women from the lowest 20% of the residuals of linear regressions of appendicular skeletal mass, adjusted for fat mass and height. Prevalence of sarcopenia in older (65 years and older) people by these three methods for men was 2.5%, 6.2%, and 6.4% and for women 0.3%, 9.3%, and 8.5%, respectively. Conclusions. Sarcopenia is common but consensus on the best method to confirm low muscle mass is required.

Sarcopenia and its relationship with osteoarthritis: risk factor or direct consequence?

PURPOSE

The aim of this review is to evaluate the clinical role of sarcopenia in patients affected by osteoarthritis (OA) of major joints.

METHODS

An online database research was performed, in order to retrieve all articles investigating the relationship between sarcopenia and OA. No peer-reviewed journal was excluded. Papers in English, French, Spanish and Italian language were considered. After consulting the full-text article, five studies have been included in the review.

RESULTS

Of the five studies included, four are prospective studies and only one is a cross-sectional study which retrieved data retrospectively. A total of 4,231 patients, presenting a mean age of 62.0 years, were studied. Three studies evaluated only female subjects. Weight, height and body mass index were reported in all the articles. Knee OA has been assessed using the Kellgren-Lawrence grading system and the American college of rheumatology criteria. Alterations of the lean body mass on body weight ratio have been reported to be as a significant predictive parameter in two studies. Relationship between radiographic OA and an increase in the leg lean mass has been observed in one study.

CONCLUSIONS

We cannot support neither the thesis of a direct effect of sarcopenia on OA development nor the opposite relation, because the up-to-date literature lacks basic science studies concerning these topics. The absence of clinical studies regarding measurements and tools to compare sarcopenia and OA do not allow to definitely clarify this relationship.

Operational definitions of sarcopenia and their associations with 5-year changes in falls risk in community-dwelling middle-aged and older adults

Sarcopenia may be diagnosed in the clinic using operational definitions based on low muscle mass or function. This prospective, population-based study revealed that sex-specific associations may exist between operational definitions of sarcopenia and falls in community-dwelling middle-aged and older adults.

INTRODUCTION

The objective of this study is to verify associations between sarcopenia and falls risk and to determine changes in sarcopenia prevalence over 5 years in middle-aged and older men and women according to different anthropometric and performance-based operational definitions.

METHODS

N = 681 volunteers (48% female; mean ± SD age 61.4 ± 7.0 years) participated in baseline and follow-up assessments (mean 5.1 ± 0.5 years later). Appendicular lean mass (ALM) was assessed by dual-energy X-ray absorptiometry, hand grip (HGS) and lower-limb (LLS) strength were assessed by dynamometry, and falls risk was determined using the physiological profile assessment. Anthropometric definitions (ALM/height squared [ALM-H], ALM/weight × 100 and a residuals method [ALM-R]) and performance-based definitions (HGS, LLS and upper- and lower-limb muscle quality [LMQ]) of sarcopenia were examined. The lowest 20% of the sex-specific distribution for each definition at baseline was classified as sarcopenia.

RESULTS

Sarcopenia prevalence increased after 5 years for all operational definitions except ALM-H (men: -4.0%; women: -5.5%). Men classified with sarcopenia according to anthropometric definitions, and women classified with sarcopenia according to performance-based definitions, had significant increases in falls risk over 5 years (all P < 0.05) compared to individuals without sarcopenia. Significant sex interactions were observed for ALM-R, LLS and LMQ (all P < 0.05) definitions.

CONCLUSIONS

Sarcopenia prevalence generally increases at a higher rate when assessed using performance-based definitions. Sarcopenia is associated with increases in falls risk over 5 years in community-dwelling middle-aged and older adults, but sex-specific differences may exist according to different anthropometric or performance-based definitions.

A cross-sectional study of loss of muscle mass corresponding to sarcopenia in healthy Chinese men and women: reference values, prevalence, and association with bone mass

A cross-sectional survey was conducted in Shanghai, eastern China, to evaluate the prevalence of loss of muscle mass corresponding to sarcopenia in Chinese men and women and compare the results with the prevalence in other populations. We also analyzed the differences between men and women, and assessed the effect of lean mass and fat mass of different regions on bone mass. A total of 1766 men and 1778 women aged 18-96 years participated in this study. Bone mineral density of spine and femur, and lean mass and fat mass of several body regions were measured by dual-energy X-ray absorptiometry. Class 1 and class 2 sarcopenia were defined as the appendicular lean mass (ALM) index (ALM/height(2)) 1 and 2 standard deviations below the sex-specific means for young adults. Mean values for ALM index were 7.93 for men and 6.04 kg/m(2) for women, aged 18-40 years. The reference values for classes 1 and 2 sarcopenia were 7.01 and 6.08 kg/m(2) in men and 5.42 and 4.79 kg/m(2) in women. The prevalence of sarcopenia was 4.8% in women and 13.2% in men aged 70 years and older, which is lower than that in Caucasian populations, but the same as that in Japanese and Koreans in Asia. Men demonstrated greater declines in muscle mass with aging than women, partly due to the protective effect of fat mass on lean mass in women. Leg lean mass was the strongest factor on femur bone mass; however, trunk lean mass was the strongest factor on spine bone mass. Maintaining a healthy weight is important for the elderly in order to avoid osteoporosis and sarcopenia.

Effectiveness of exercise and protein supplementation intervention on body composition, functional fitness, and oxidative stress among elderly Malays with sarcopenia

Sarcopenia, characterized as muscle loss that occurs with aging, is a major health problem in an aging population, due to its implications on mobility, quality of life, and fall risk. Protein supplementation could improve the physical fitness by increasing protein anabolism, and exercise has a documented evidence of positive effect on functional status among the elderly. However, the combined effect of both protein supplementation and exercise has not been investigated among sarcopenic elderly in the Asian population. Thus, this study aimed to determine the effectiveness of exercise intervention and protein supplementation either alone or in combination for 12 weeks, on body composition, functional fitness, and oxidative stress among elderly Malays with sarcopenia. Sixty five sarcopenic elderly Malays aged 60–74 years were assigned to the control group, exercise group (ExG), protein supplementation group (PrG), or the combination of exercise and protein supplementation group. A significant interaction effect between body weight and body mass index (BMI) was observed, with the PrG (−2.1% body weight, −1.8% BMI) showing the highest reductions. Further, there was a decrease in % body fat (−4.5%) and an increase in fat-free mass (kg) (+5.7%) in the ExG after 12 weeks (P < 0.05). The highest increments in lower and upper body strength were observed in the PrG (73.2%) and ExG (47.6%), respectively. In addition, the ExG showed a reduction in superoxide dismutase (SOD) levels, and both interventions did not alter either lipid or protein oxidation. In conclusion, the exercise program was found to improve muscle strength and body composition, while protein supplementation reduced body weight and increased upper body strength, among sarcopenic elderly in Malaysia.

Immunological and nutritional factors in elderly people in low-level care and their association with mortality

Background

This study examines associations between markers of nutritional status and lymphocyte subsets and seeks to determine if lymphocyte profile is predictive of survival in elderly Australians residing in aged care facilities. Aged yet still ambulatory subjects (n = 88, 73% female) living in low-level care and requiring minimal assistance were studied for 143 weeks. At baseline when participants were aged (mean ± SD) 86.0 ± 5.9 years, dietary intake was determined by 3-day weighed food record, body composition was assessed by dual energy X-ray absorptiometry (DXA) and a venous blood sample was taken.

Results

At baseline assessment, study participants were consuming nutrient-poor diets and most had symptoms of chronic disease. Although overweight, 40% exhibited sarcopenia. Markers of nutritional status did not relate closely to immune cell numbers (absolute or relative), which on average were within the normal range. Men had lower numbers of CD3⁺CD4⁺ cells (CD4⁺ T cells), a higher proportion of CD3⁻ CD16^± CD56^± (natural killer (NK) cells) and a higher ratio of NK: CD4⁺ T cells than women (all P < 0.05). The main age-related changes evident were decreased T cells, particularly low CD4⁺ T cell counts, and increased numbers of CD19⁺ (B-cell) and NK cells. During the 143 week duration of follow-up, about one quarter of the study participants died, with death more likely in men than women (P < 0.01). Poor survival was predicted by the presence of decreased numbers of CD4⁺ T cells (hazard ratio (HR) 0.919, P < 0.01) and expanded numbers of NK cells (HR 1.085, P < 0.05) in the blood, and therefore the presence of a high NK: CD4⁺ T cell ratio (HR 30.521, P < 0.01).

Conclusions

The NK: CD4⁺ T cell ratio may potentially have clinical utility for predicting longevity in elderly populations. Further studies are needed in other elderly populations to confirm this finding.

Fat Modulates the Relationship between Sarcopenia and Physical Function in Nonobese Older Adults

It is intuitive to think that sarcopenia should be associated with declines in physical function though recent evidence questions this assertion. This study investigated the relationship between absolute and relative sarcopenia, with physical performance in 202 nonobese (mean BMI = 26.6 kg/ht²) community-dwelling older (mean age = 73.8 ± 5.9 years) adults. While absolute sarcopenia (appendicular skeletal mass (ASM)/ht²) was either not associated, or weakly associated with physical performance, relative sarcopenia (ASM/kg) demonstrated moderate (r = 0.31 to r = 0.51, P < 0.01) relationships with performance outcomes in both males and females. Knee extension strength (r = 0.27) and leg extension power (r = 0.41) were both related to absolute sarcopenia (P < 0.001) in females and not in males. Strength and power were associated with relative sarcopenia in both sexes (from r = 0.47 to r = 0.67, P < 0.001). The ratio of lean mass to total body mass, that is, relative sarcopenia, is an important consideration relative to physical function in older adults even in the absence of obesity. Stratifying these individuals into equal tertiles of total body fat revealed a trend of diminished regression coefficients across each incrementally higher fat grouping for performance measures, providing further evidence that total body fat modulates the relationship between sarcopenia and physical function.

Weight loss in elderly women in low-level care and its association with transfer to high-level care and mortality

Background

The purpose of this study was to determine whether unintentional weight loss in older women predicts an imminent transition out of low-level care (either to higher-level care or by mortality).

Methods

Fifty-three Australian women, ambulatory while living in low-level care and requiring minimal assistance, were studied. At baseline, when the women were aged (mean ± standard deviation) 86.2 ± 5.3 years, body composition was assessed by dual energy X-ray absorptiometry, dietary intake was determined by a three-day weighed food record, a venous blood sample was taken, and both muscle strength and physical functioning were measured. The women were then followed up for 143 weeks to record the composite outcome of transfer to high-level care or mortality.

Results

During follow-up, unintended loss of body weight occurred in 60% of the women, with a mean weight loss of −4.6 ± 3.6 kg. Seven women (13.2%) died, and seven needed transfer to high-level care. At baseline, those who subsequently lost weight had a higher body mass index (P < 0.01) because they were shorter (P < 0.05) but not heavier than the other women. Analysis of their dietary pattern revealed a lower dietary energy (P < 0.05) and protein intake (P < 0.01). The women who lost weight also had lower hip abductor strength (P < 0.01), took longer to stand and walk (P < 0.05), and showed a slower walking speed (P < 0.01). Their plasma C-reactive protein was higher (P < 0.05) and their serum albumin was lower (P < 0.01) than women who did not lose weight. Nonintentional weight loss was a significant predictor of death or transfer to high care (hazards ratio 0.095, P = 0.02).

Conclusion

Weight loss in older women predicts adverse outcomes, so should be closely monitored.