Efficacy of Nutritional Interventions as Stand-Alone or Synergistic Treatments with Exercise for the Management of Sarcopenia

Combined Nutrition with Exercise: Fueling the Fight Against Sarcopenia Through a Bibliometric Analysis and Review

Objective

This bibliometric analysis and review aimed to examine the current research status and trends in the combination of nutrition and exercise training for sarcopenia. Additionally, it sought to provide researchers with future research directions in this field.

Methods

Relevant publications were obtained from the Web of Science Core Collection (WoSCC) database, covering the period from January 1995 to October 2023. The collected publications were analyzed using CiteSpace, VOSviewer, Bibliometrix, and Review Manager.

Results

Out of the 2528 retrieved publications, the United States emerged as the leading contributor in terms of publication volume. The University of Texas System was identified as the most productive institution. Luc J C van Loon emerged as the most published author in this field. Analysis of keywords revealed recent hot topics and emerging areas of interest, such as "gut microbiota" and "mechanisms". Upon further evaluation, resistance training (RT) and protein supplementation were identified as the most commonly employed and effective methods.

Conclusion

RT and protein supplementation are widely recognized as effective strategies. Future research should focus on investigating the molecular aspects of sarcopenia. Moreover, the potential therapeutic role of gut microbiota in sarcopenia requires further comprehensive investigation in human subjects to establish its correlation.

Effectiveness of a combined lifestyle intervention for older people in long-term care: A randomized controlled trial

PURPOSE

Lifestyle medicine interventions combining physical, nutritional, and psychological components have been found effective in general older population. However, evidence from the long-term care (LTC) is scarce.

METHODS

We conducted a pragmatic, two-arm, parallel group, superiority randomized controlled trial. Residents living in a LTC facility for one or more years, able to discern and to express informed consent, and requiring nursing care were considered eligible. The three-months intervention combined bi-weekly physical exercise groups, a healthy diet, and weekly psychological wellbeing sessions. Patients of the control group were subjected to routine care. At the end of the study participants were assessed using Barthel Index, Katz Activities of Daily Living, and Tinetti scales.

RESULTS

A total of 54 patients with a mean age of 84 years took part to the study. Physical exercise and psychological wellbeing sessions were mostly attended by all the subjects of the intervention group. Both groups took less calories than planned in the diets; in addition, the intervention group showed a lower energy and carbohydrates intake than the control group. At the end of the study, the intervention group showed a significant improvement in the total scores of all the scales.

CONCLUSIONS

This intervention was effective in improving functionality in older people living in the LTC setting. Results were achieved in a short timeframe, likely due to synergistic interactions between components. However, a further exploration of underlying factors is needed, to better understand the barriers that hampered a complete intervention delivery in this context.

Blood Profiles of Community-Dwelling People with Sarcopenia: Analysis Based on the China Health and Retirement Longitudinal Study

INTRODUCTION

Routine blood factors can be economical and easily accessible candidates for sarcopenia screening and monitoring. The associations between sarcopenia and routine blood factors remain unclear. This study aimed to examine sarcopenia and blood factor associations based on a nation-wide cohort in China.

METHODS

A total of 1,307 participants and 17 routine blood indices were selected from two waves (year 2011 and year 2015) of the China Health and Retirement Longitudinal Study (CHARLS). The diagnosis of sarcopenia was based on the criteria proposed by the Asian Working Group for Sarcopenia (AWGS 2019). Generalized mixed-effects models were performed for association analyses. A logistic regression (LR) model was conducted to examine the predictive power of identifying significant blood factors for sarcopenia.

RESULTS

A higher sarcopenia risk was cross-sectionally associated with elevated blood concentrations of high-sensitivity C-reactive protein (hsCRP) (OR = 1.030, 95% CI [1.007, 1.053]), glycated hemoglobin (HbA1c) (OR = 1.407, 95% CI [1.126, 1.758]) and blood urea nitrogen (BUN) (OR = 1.044, 95% CI [1.002, 1.089]), and a decreased level of glucose (OR = 0.988, 95% CI [0.979, 0.997]). A higher baseline hsCRP value (OR = 1.034, 95% CI [1.029, 1.039]) and a greater over time change in hsCRP within 4 years (OR = 1.034, 95% CI [1.029, 1.039]) were associated with a higher sarcopenia risk. A higher BUN baseline value was related to a decreased sarcopenia risk over time (OR = 0.981, 95% CI [0.976, 0.986]), while a greater over time changes in BUN (OR = 1.034, 95% CI [1.029, 1.040]) and a smaller over time change in glucose (OR = 0.992, 95% CI [0.984, 0.999]) within 4 years were also related to a higher sarcopenia risk. LR based on significant blood factors (i.e., hsCRP, HbA1c, BUN, and glucose), and sarcopenia status in year 2015 yielded an area under the curve of 0.859 (95% CI: 0.836-0.882).

CONCLUSION

Routine blood factors involved in inflammation, protein metabolism, and glucose metabolism are significantly associated with sarcopenia. In clinical practice, plasma hsCRP, BUN, blood sugar levels, sex, age, marital status, height, and weight might be helpful for sarcopenia evaluation and monitoring.

"We want more": perspectives of sarcopenic older women on the feasibility of high-intensity progressive resistance exercises and a whey-protein nutrition intervention

This qualitative study is nested within a 12-week pilot randomized-controlled, two-arm trial involving high-intensity progressive resistance training (PRT) or PRT with a multi-nutrient, whey-protein supplementation (PRT+WP) in sarcopenic older adults (trial registration no: TCTR20230703001). The aim was to investigate sarcopenic participants' perceptions and barriers to this multi-modal intervention strategy that may accelerate "real-world" implementation. Eighteen older adults (one man) with possible sarcopenia were invited to join the study, of whom 16 women were randomized to a thrice-weekly PRT (n = 8) program (80% of 1-repetitive maximum, six resistance band exercises) only or PRT plus daily weekday milk-based WP supplementation (PRT+WP, n = 8). Muscle strength (handgrip and 5-times sit-to-stand), mass (dual-energy X-ray absorptiometry), performance (Short Physical Performance Battery and stair ascent-descent), and nutrition status (Mini Nutritional Assessment) were assessed for changes. We randomly selected eight women for the semi-structured interview. Post-intervention, eight (50%) women were sarcopenia-free, six (38%) remained in possible sarcopenia, one (6%) improved to sarcopenia, and one (6%) deteriorated from possible to severe sarcopenia. There were no significant between-group differences, but significant within-group improvements (p < 0.05) were detected for handgrip strength (PRT+WP 5.0 kg, d = 0.93; PRT 6.1 kg, d = 0.55), 5-times sit-to-stand time (PRT 2.0 s, d = 1.04), nutrition score (PRT+WP 3.44, d = 0.52; PRT 1.80, d = 0.44), and stair ascent time (PRT+WP 0.97 s, d = 0.77; PRT 0.75 s, d = 0.97). Our thematic analyses identified four main themes, namely, (1) perceived benefits, (2) sustaining behavior changes, (3) challenges in participating, and (4) improved wellbeing. Participants expressed how they initially were skeptical and doubted that they could complete the exercises or tolerate the milk-based WP supplements. However, they reported positive experiences and benefits felt from strength gains, increased confidence, and better physical abilities. Participants were surprised by the zero adverse effects of WP supplements. The women wanted more nutritional information and structured, guided exercise programs and suggested a community-based implementation. In conclusion, our findings showed PRT was well received and may support reduced risks of sarcopenia. No added benefits were seen with the addition of WP supplementation, but a larger sample is required to address this question. Overall, older (previously sarcopenic) Malay women indicated that they want more multi-modal programs embedded in their community.

Potential of Food Protein-Derived Bioactive Peptides against Sarcopenia: A Comprehensive Review

Sarcopenia is an age-related progressive muscle disorder characterized by accelerated loss of muscle mass, strength, and function, which are important causes of physiological dysfunctions in the elderly. At present, the main alleviating method includes protein supplements to stimulate synthesis of muscle proteins. Food protein-derived peptides containing abundant branched-chain amino acids have a remarkable effect on the improvement of sarcopenia. Understanding the underlying molecular mechanism and clarifying the structure-activity relationship is essential for the mitigation of sarcopenia. This present review recaps the epidemiology, pathogenesis, diagnosis, and treatment of sarcopenia, which facilitates a comprehensive understanding of sarcopenia. Moreover, the latest research progress on food-derived antisarcopenic peptides is reviewed, including their antisarcopenic activity, molecular mechanism as well as structural characteristics. Food-derived bioactive peptides can indeed alleviate/mitigate sarcopenia. These antisarcopenic peptides play a pivotal role mainly by activating the PI3K/Akt/mTOR and MAPK pathways and inhibiting the ubiquitin-proteasome system and AMPK pathway, thus promoting the synthesis of muscle proteins and inhibiting their degradation. Antisarcopenic peptides alleviate sarcopenia via specific peptides, which may be absorbed into the circulation and exhibit their bioactivity in intact forms. The present review provides a theoretical reference for mitigation and prevention of sarcopenia by food protein-derived bioactive peptides.

Fatigue in older persons: the role of nutrition

Fatigue is defined as a symptom leading to the inability to continue functioning at the expected activity level. It is a highly prevalent symptom, challenging to frame into monodimensional pathophysiological mechanisms. As a result, fatigue is often underestimated in the clinical setting and is wrongly considered an unavoidable consequence of ageing. Several potential mechanisms responsible for fatigue have been proposed, including sleep patterns, autonomic nervous system abnormalities and biological complexity. Inflammation and mitochondrial dysfunction are among the most promising mechanisms through which malnutrition may cause fatigue. Not surprisingly, fatigue is highly prevalent in inflammatory conditions (e.g. COVID-19 infection). The nutritional status may also represent a critical factor in the development and presentation of fatigue, which may mimic the exhaustion of the individual's metabolic reserves. For example, the insufficient dietary intake of energy and proteins may determine the catabolism of body fat and muscles, disrupt the homeostatic balance and cause the onset of fatigue. It is necessary to conduct research on fatigue. By characterising its pathophysiological mechanisms, it will be possible to (1) support the design and development of targeted interventions, (2) improve the quality of life of many persons by acting on the symptom and (3) reduce the direct and indirect costs of a burdening condition typical of advancing age. In the present review, we provide an overview of the role that nutrition may play as a determinant of fatigue in older people, also in the context of the COVID-19 pandemic.

Bone-muscle crosstalk following exercise plus Ursolic acid by myomiR-133a/Cx43-Runx2 axis in aged type 2 diabetes rat models

Natural bioactive compound, Ursolic acid (UA), plus different types of exercise may exert the action on glycemic control, leading to clinical benefits in the prevention and treatment of aging/diabetes-associated complications. So, this study examined the effects of eight weeks combination of 250 mg of UA per day per kilogram of body weight of rat as well as resistance/endurance training on miR-133a expression across serum, bone marrow, skeletal muscle, and Connexin 43 (Cx43)-Runt-related transcription factor 2 (Runx2) signaling axis in high-fat diet and low-dose streptozotocin-induced T2D (here, HFD/STZ-induced T2D). The study was conducted on 56 male Wistar rats (427 ± 44 g, 21 months old), having HFD/STZ-induced T2D randomly assigned into 7 groups of 8 including (1) sedentary non-diabetic old rats (C); (2) sedentary type 2 diabetes animal model (D); (3) sedentary type 2 diabetes animal model + UA (DU); (4) endurance-trained type 2 diabetes animal model (DE); (5) resistance-trained type 2 diabetes animal model (DR); (6) endurance-trained type 2 diabetes animal model + UA (DEU); and (7) resistance-trained type 2 diabetes animal model + UA (DRU). Resistance training included a model of eight weeks of ladder resistance training at 60-80% maximal voluntary carrying capacity (MVCC) for five days/week. Treadmill endurance exercise protocol included eight weeks of repetitive bouts of low-/high-intensity training with 30%-40% and 60%-75% maximal running speed for five days/week, respectively. UA Supplementary groups were treated with 500 mg of UA per kg of high-fat diet per day. The results revealed significant supplement and exercise interaction effects for the BM miR-133a (p = 0.001), the bone marrow Runx2 (p = 0.002), but not the serum miR-133a (p = 0.517), the skeletal muscle miR-133a (p = 0.097) and the Cx43 (p = 0.632). In conclusion, only eight weeks of resistance-type exercise could affect miR-133a profile in muscles and osteoblast differentiation biomarker RUNX2 in aged T2D model of rats. 250 mg of UA per kilogram of body weight rat per day was administered orally, less than the sufficient dose for biological and physiological impacts on osteoblast differentiation biomarkers in aged T2D model of rats following eight weeks.

Osteosarcopenia in Patients with Chronic Obstructive Pulmonary Diseases: Which Pathophysiologic Implications for Rehabilitation?

Chronic obstructive pulmonary disease (COPD) is a burdensome condition affecting a growing number of people worldwide, frequently related to major comorbidities and functional impairment. In these patients, several factors might have a role in promoting both bone and muscle loss, including systemic inflammation, corticosteroid therapies, sedentary behaviours, deconditioning, malnutrition, smoking habits, and alcohol consumption. On the other hand, bone and muscle tissues share several linkages from functional, embryological, and biochemical points of view. Osteosarcopenia has been recently defined by the coexistence of osteoporosis and sarcopenia, but the precise mechanisms underpinning osteosarcopenia in patients with COPD are still unknown. In this scenario, a deeper understanding of the molecular basis of osteosarcopenia might guide clinicians in a personalized approach integrating skeletal muscle health with the pulmonary rehabilitation framework in COPD. Taken together, our results summarized the currently available evidence about the multilevel interactions between osteosarcopenia and COPD to pave the way for a comprehensive approach targeting the most common risk factors of these pathological conditions. Further studies are needed to clarify the role of modern clinical strategies and telemedicine solutions to optimize healthcare delivery in patients with COPD, including osteopenia, osteoporosis, and sarcopenia screening in these subjects.

Pharmacological, Nutritional, and Rehabilitative Interventions to Improve the Complex Management of Osteoporosis in Patients with Chronic Obstructive Pulmonary Disease: A Narrative Review

Osteoporosis is a highly prevalent condition affecting a growing number of patients affected by chronic obstructive pulmonary disease (COPD), with crucial implications for risk of fragility fractures, hospitalization, and mortality. Several risk factors have been identified to have a role in osteoporosis development in COPD patients, including corticosteroid therapy, systemic inflammation, smoke, physical activity levels, malnutrition, and sarcopenia. In this scenario, a personalized multitarget intervention focusing on the pathological mechanisms underpinning osteoporosis is mandatory to improve bone health in these frail patients. Specifically, physical exercise, nutritional approach, dietary supplements, and smoke cessation are the cornerstone of the lifestyle approach to osteoporosis in COPD patients, improving not only bone health but also physical performance and balance. On the other hand, pharmacological treatment should be considered for both the prevention and treatment of osteoporosis in patients at higher risk of fragility fractures. Despite these considerations, several barriers still affect the integration of a personalized approach to managing osteoporosis in COPD patients. However, digital innovation solutions and telemedicine might have a role in optimizing sustainable networking between hospital assistance and community settings to improve bone health and reduce sanitary costs of the long-term management of COPD patients with osteoporosis.

The effects of synbiotic and/or vitamin D supplementation on gut-muscle axis in overweight and obese women: a study protocol for a double-blind, randomized, placebo-controlled trial

BACKGROUND

Sarcopenia refers to an age-related loss of skeletal muscle content, strength, and function, leading to a decrease in mobility. Obesity may exacerbate age-related complications such as sarcopenia through inflammatory pathways. In addition, intestinal dysbiosis has been proposed as an emerging contributor to sarcopenia due to the stimulation of the immune system and elevated barrier permeability of the intestine. Targeting microbiome with synbiotic and vitamin D supplementation may modulate the microbiome followed by the enhancement of sarcopenia indices. Thus, the present study aims to evaluate the effect of synbiotic supplementation with or without vitamin D on the intestinal microbiome and its relationship with strength, muscle function, and body composition in middle-aged overweight and obese women.

METHODS

This multi-factorial, double-blind, randomized controlled trial will be conducted on 88 participants in eight weeks. The participants will be allocated into four groups receiving vitamin D placebo (weekly) and synbiotic placebo (daily), vitamin D and synbiotic placebo, vitamin D placebo and symbiotic, and vitamin D and synbiotic. Intestinal microbiome assessment will be done by DNA isolation and real-time polymerase chain reaction (PCR). In addition, anthropometric indices, body composition, muscle strength, and physical performance will be evaluated by standard methods. All measurements will be made at the beginning and end of the study.

DISCUSSION

The previous studies showed that probiotics were involved in reducing inflammation, insulin sensitivity, modulation of atrophy markers such as atherogen-1, and decreasing reactive oxygen indices. In addition, vitamin D was found to improve the intestinal microbiome and facilitate muscle anabolism. The present protocol is novel as it aims to investigate the impact of the co-supplementation of synbiotic and vitamin D on the gut microbiome and sarcopenia indices.

TRIAL REGISTRATION

This trial has been registered in the Iranian Registry of Clinical Trials (IRCT20090822002365N25, date of registration: March 2021).

Prevalence of Long COVID-19 Symptoms After Hospital Discharge in Frail and Robust Patients

Background

A motley postacute symptomatology may develop after COVID-19, irrespective of the acute disease severity, age, and comorbidities. Frail individuals have reduced physiological reserves and manifested a worse COVID-19 course, during the acute setting. However, it is still unknown, whether frailty may subtend some long COVID-19 manifestations. We explored the prevalence of long COVID-19 disturbs in COVID-19 survivals.

Methods

This was an observational study. Patients aged 65 years or older were followed-up 1, 3, and 6 months after hospitalization for COVID-19 pneumonia.

Results

A total of 382 patients were enrolled. Frail patients were more malnourished (median Mini Nutritional Assessment Short Form score 8 vs. 9, p = 0.001), at higher risk of sarcopenia [median Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F) score 3 vs. 1.5, p = 0.003], and manifested a worse physical performance [median Short Physical Performance Battery (SPPB) score 10 vs. 11, p = 0.0007] than robust individuals, after hospital discharge following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. Frailty was significantly associated with: (i) confusion, as a presenting symptom of COVID-19 [odds ratio (OR) 77.84, 95% CI 4.23–1432.49, p = 0.003]; (ii) malnutrition (MNA-SF: adjusted B –5.63, 95% CI –8.39 to –2.87, p < 0.001), risk of sarcopenia (SARC-F: adjusted B 9.11, 95% CI 3.10–15.13, p = 0.003), impaired muscle performance (SPPB: B –3.47, 95% CI –6.33 to –0.61, p = 0.02), complaints in mobility (adjusted OR 1674200.27, 95% CI 4.52–619924741831.25, p = 0.03), in self-care (adjusted OR 553305.56, 95% CI 376.37–813413358.35, p < 0.001), and in performing usual activities of daily living (OR 71.57, 95% CI 2.87–1782.53, p = 0.009) at 1-month follow-up; (iii) dyspnea [modified Medical Research Council (mMRC): B 4.83, 95% CI 1.32–8.33, p = 0.007] and risk of sarcopenia (SARC-F: B 7.12, 95% CI 2.17–12.07, p = 0.005) at 3-month follow-up; and (iv) difficulties in self-care (OR 2746.89, 95% CI 6.44–1172310.83, p = 0.01) at the 6-month follow-up. In a subgroup of patients (78 individuals), the prevalence of frailty increased at the 1-month follow-up compared to baseline (p = 0.009).

Conclusion

The precocious identification of frail COVID-19 survivors, who manifest more motor and respiratory complaints during the follow-up, could improve the long-term management of these COVID-19 sequelae.

Interprofessional Treatment of Malnutrition and Sarcopenia by Dietitians and Physiotherapists: Exploring Attitudes, Interprofessional Identity, Facilitators, Barriers, and Occurrence

Purpose

Malnutrition and sarcopenia require dietetic and physiotherapy interventions. In this study, we aimed to compare interprofessional identity of dietitians and physiotherapists, as well as attitudes towards, facilitators and barriers for, and occurrence of interprofessional treatment of malnutrition and sarcopenia by both professions.

Methods

A cross-sectional online survey was distributed from December 4, 2021 until January 31, 2022 through an international online network platform for professionals (LinkedIn). Practitioners working as dietitian or physiotherapist in a healthcare setting were eligible for participation. Outcome measures concerned perceptions regarding shared problem domains, interprofessional treatment, attitudes towards interprofessional treatment, interprofessional identity, facilitators, and barriers. A Chi²-test, Mann–Whitney U-test, and Spearman’s Rho correlation were calculated.

Results

Data from 53 physiotherapists and 48 dietitians were included. Malnutrition is considered a shared problem domain by both professions (U = 1248.000; p = 0.858). While sarcopenia is treated by both professions (U = 1260.000; p = 0.927), physiotherapists consider sarcopenia more often a shared problem domain compared to dietitians (U = 1003.000; p = 0.044). Attitudes towards interprofessional treatment were mostly positive (73%, n = 35 and 87%, n = 46 respectively). Interprofessional identity of dietitians was lower compared to physiotherapists (median = 4.0 versus median = 4.3 respectively; U = 875.000, p = 0.007). This was explained by lower interprofessional belonging (median = 4.0 versus median = 4.8 respectively; U = 771.000, p < 0.001) and lower interprofessional commitment (median = 4.0 versus median = 4.3 respectively; U = 942.500, p = 0.023). Interprofessional identity was correlated with efficient means of communication (r = 0.30, p = 0.003) and bureaucracy (r = −0.21, p = 0.034). Other barriers reported included available time, financial compensation, interprofessional knowledge, and obtaining extra care. Most reported facilitators concerned role clarity, clarity of expertise, and willingness of others to collaborate.

Conclusion

Dietitians and physiotherapists have different interprofessional identities, but both are advocates of interprofessional treatment. Both professions mostly treat malnutrition and sarcopenia individually and have different perceptions regarding sarcopenia as shared problem domain. Facilitators were mainly related to clarity and commitment while barriers were mainly related to resources.

A Cross-Sectional Study on the Relationship between Oral Function and Sarcopenia in Japanese Patients with Regular Dental Maintenance

We aimed to clarify the relationship between oral function assessments regarding oral hypofunction and sarcopenia in patients who had completed treatment for organic dental problems, including oral pain, removable denture fit, and tooth loss. This cross-sectional study included 269 patients aged ≥65 years (mean age 74.9 ± 6.50 years, 133 men, 136 women) who visited a dental clinic between June 2019 and March 2021. We evaluated oral function and sarcopenia and analyzed their relationship using the Jonckheere–Terpstra test, Mantel–Haenszel trend test, and Poisson regression analysis. We diagnosed 132 (49.07%) patients with oral hypofunction, 30 (11.2%) with sarcopenia, and 24 (8.9%) with severe sarcopenia. The number of oral hypofunction items (prevalence rate ratio [PRR] = 1.39, 95%Wald = 0.11 to 0.56) was significantly associated with sarcopenia. For each of the items, tongue-lip motor function [ta] (PRR = 0.80, 95%Wald = −0.44 to −0.02)] [ka] (PRR = 0.76, 95%Wald = −0.53 to −0.03) and tongue pressure (PRR = 0.95, 95%Wald = −0.09 to −0.02) showed a significant association with sarcopenia. However, no significant association was found for other variables. Dentists should not only treat organic dental problems but also consider the relationship between oral function and sarcopenia.

Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review

Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.

Nutritional Factors Related to Muscle Weakness 1 Year after Total Hip Arthroplasty: A Case-Control Study

OBJECTIVES

Prolonged muscle weakness after total hip arthroplasty (THA) remains a problem. Despite increasing physical activity up to 3 years after surgery, muscle strength was decreased to 80-90% of the healthy side 2 years after THA. The objective of the present study was to identify the nutritional factors related to muscle weakness 1 year after THA.

METHODS

Persons who underwent THA were divided into 2 groups according to the cutoff point of knee extensor strength that represents functional limitation: a normal-strength group of 71 persons and a muscle weakness group of 91 persons. The investigators assessed lower limb isometric strength, the 10-m timed gait test, and daily intakes of energy and nutrients from preoperative to 1 year after THA. The differences in nutrient intakes between the 2 groups (normal-strength group and muscle weakness group) were examined by multiple logistic regression analysis.

RESULTS

There was a significant difference between the groups in energy intake. Daily protein intake was related to knee extension strength gain above the cutoff point 1 year after THA.

CONCLUSIONS AND IMPLICATIONS

The present study suggested that to prevent prolonged muscle weakness after THA, a sufficient protein intake as well as an exercise intervention may be needed even half a year or after.

Sarcopenia screening strategies in older people: a cost effectiveness analysis in Iran

Background and objectives

Sarcopenia is an important age-related disease which can lead to an increased risk of mortality, falls, fractures, and poor quality of life. So, timely detection can be effective in reducing the burden of disease. The aim of this study was to identify the most cost-effective strategy for sarcopenia screening in Iran.

Materials and methods

We constructed a Markov transition model over a life-time horizon based on natural history. Compared strategies included Sarcopenia scoring assessment models (SarSA-Mod), European working group on sarcopenia in older people (EWGSOP), Mini sarcopenia risk assessment (MSRA) and SARC-F. Parameters values were extracted from primary data and the literature, and the costs and Quality-adjusted life years (QALYs) were calculated for each strategy. Sensitivity analysis of uncertain parameters was also performed to determine the robustness of the model. Analysis was performed using 2020 version of TreeAge Pro software.

Results

All four screening strategies increased life time QALYs. After removing dominated strategy, the incremental cost per QALY gained for sarcopenia screening varied from $1875.67 for EWGSOP to $1898.33 for MSRA. Our base-case analysis showed that the most cost-effective strategy was EWGSOP and 2nd best was SarSA-Mod with $43,414.3 and $42,663.3 net monetary benefits given one GDP per capita ($5520.311) as willingness to pay, respectively. Sensitivity analysis of model parameters also showed robustness of results.

Conclusions

The results of the study, as the first economic evaluation of sarcopenia screening, showed that the EWGSOP strategy is more cost-effective than other strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10511-7.

A Narrative Review of Gut-Muscle Axis and Sarcopenia: The Potential Role of Gut Microbiota

Sarcopenia is a multifactorial disease related to aging, chronic inflammation, insufficient nutrition, and physical inactivity. Previous studies have suggested that there is a relationship between sarcopenia and gut microbiota,namely, the gut-muscle axis. The present review highlights that the gut microbiota can affect muscle mass and muscle function from inflammation and immunity,substance and energy metabolism, endocrine and insulin sensitivity, etc., directly or indirectly establishing a connection with sarcopenia, thereby realizing the “gut-muscle axis”.

Healthy Aging-Nutrition Matters: Start Early and Screen Often

The amount of time spent in poor health at the end of life is increasing. This narrative review summarizes consistent evidence indicating that healthy dietary patterns and maintenance of a healthy weight in the years leading to old age are associated with broad prevention of all the archetypal diseases and impairments associated with aging including: noncommunicable diseases, sarcopenia, cognitive decline and dementia, osteoporosis, age-related macular degeneration, diabetic retinopathy, hearing loss, obstructive sleep apnea, urinary incontinence, and constipation. In addition, randomized clinical trials show that disease-specific nutrition interventions can attenuate progression-and in some cases effectively treat-many established aging-associated conditions. However, middle-aged and older adults are vulnerable to unhealthy dietary patterns, and typically consume diets with inadequate servings of healthy food groups and essential nutrients, along with an abundance of energy-dense but nutrient-weak foods that contribute to obesity. However, based on menu examples, diets that are nutrient-dense, plant-based, and with a moderately low glycemic load are better equipped to meet the nutritional needs of many older adults than current recommendations in US Dietary Guidelines. These summary findings indicate that healthy nutrition is more important for healthy aging than generally recognized. Improved public health messaging about nutrition and aging, combined with routine screening and medical referrals for age-related conditions that can be treated with a nutrition prescription, should form core components of a national nutrition roadmap to reduce the epidemic of unhealthy aging.

Improvement of nutritional status enhances cognitive and physical functions in older adults with orthostatic hypotension

OBJECTIVES

Malnutrition may be an important risk factor for orthostatic hypotension (OH). The aim of this study was to investigate the relationship between malnutrition and OH, and the effect of nutritional improvement on cognitive functions and gait-balance parameters in patients with OH.

METHODS

A total of 692 patients were included in the study. The Head-up Tilt Table Test and Mini Nutritional Assessment (MNA) were implemented for participants. Patients underwent a comprehensive geriatric assessment, including a neurocognitive evaluation and physical performance. After 6 mo, the participants who had OH were reevaluated.

RESULTS

Women comprised 64.8% of the patients and the mean age was 74.98 ± 7.68 y. The frequencies of OH, malnutrition, and risk of malnutrition were 31.9%, 7.4%, and 13.3%, respectively. The rates of dementia, hypertension, sarcopenia, frailty, and a history of falls in the past year were higher in the OH-positive group. OH was associated with malnutrition (odds ratio: 2.48; confidence interval, 1.35‒4.54; P = 0.003) and risk of malnutrition (odds ratio: 1.64; CI, 1.03‒2.62; P = 0.035) in contrast with normal nutritional status. A higher MNA score during the follow-up period resulted in improved cognitive and gait-balance scores when confounding factors were adjusted (P < 0.05). Patients with OH whose MNA score improved during the follow up also had a significant decrease in the number of falls (P = 0.034).

CONCLUSIONS

Optimization of nutritional status may improve global cognition and gait-balance functions, and prevent falls in older people with OH.

Dietary Patterns and Muscle Mass, Muscle Strength, and Physical Performance in the Elderly: A 3-Year Cohort Study

OBJECTIVES

Nutritional support effectively prevents and treats sarcopenia; however, the influence of overall dietary patterns on sarcopenia parameters is less investigated. This study aimed to determine the association between adherence to Mediterranean-style diet (MD), Dietary Approaches to Stop Hypertension (DASH), Japanese Food Guide Spinning Top (JFG-ST), and modified JFG-ST (mJFG-ST) and muscle mass, muscle strength, and physical performance in community-dwelling Japanese elderly.

DESIGN AND SETTINGS

This prospective cohort study recruited individuals aged over 60 years from a community college in Nagoya, Japan.

PARTICIPANTS AND MEASUREMENTS

A total of 666 participants were followed up annually from 2014 to 2017. Demographic data, anthropometric measurements, and sarcopenia parameters including walking speed (WS), hand grip strength in the dominant hand (HGS), and skeletal mass index (SMI) were recorded. Self-recall dietary intake was assessed using a validated food frequency questionnaire comprising 29 food groups. Adherence to MD, DASH, JFG-ST, and mJFG-ST was determined by tertiles.

RESULTS

At baseline, the mean age of all participants (56.5% women) was 69.4±4.4 years. WS, HGS, and SMI were 1.4±0.2 (m/s), 28.9±8.1 (kg), and 6.7±1.0 (kg/m2), respectively. In longitudinal analysis, participants with higher JFG-ST adherence scores were more likely to have higher SMI (Q3 vs. Q1: mean difference, 0.048; p=0.04) after adjustment, and its benefits were more evident in men (Q2 vs. Q1: mean difference, 0.098; p=0.047; Q3 vs. Q1: mean difference, 0.091; p=0.017) than in women. WS and HGS were not associated with any type of dietary pattern.

CONCLUSIONS

Adherence to JFG-ST was positively associated with SMI in Japanese community-dwelling elderly adults aged over 60 years, specifically in men. The country-specific dietary recommendations are required to be developed for sarcopenia prevention.

Protein Intake, Protein Mealtime Distribution and Seafood Consumption in Elderly Norwegians: Associations with Physical Function and Strength

Protein intake is considered important in the maintenance of muscle health in ageing. However, both the source and mealtime distribution of protein might affect the intake of protein and its effect on muscle protein synthesis. In this study, protein intake, mealtime distribution of protein, and seafood consumption were assessed in 92 older adults (aged 65+), and associations with physical performance (Short Physical Performance Battery (SPPB)), grip strength and gait speed were assessed in a multiple linear regression analysis. The participants had a mean age of 73 ± 8.9 years. Mean protein intake was 1.1 g/kg body weight. Protein intake was well distributed, with coefficient of variance between meals (CV meals) 0.6 ± 0.3. However, dinner had the highest protein intake. No associations were found between the nutrition factors and physical performance or strength; however, this result might have been caused by a ceiling effect in the chosen test batteries, as the mean score on SPPB was 10.3 ± 2.7, and 48.9% of the participants reached the top score of 12 points. Mean grip strength was 44.4 ± 9.4 kg (men) and 26.2 ± 6.8 kg (women). Mean gait speed was 1.0 ± 0.3 m/s. The interaction analysis suggests that there might be gender differences in the effect of seafood consumption on gait speed.

Are body fat and inflammatory markers independently associated with age-related muscle changes?

BACKGROUND & AIMS

A growing number of studies have shown that body fat and inflammation are associated with age-related changes in body muscle composition. However, most of these studies did not control for potential confounders. The aim was to determine whether there is an association between body fat and inflammatory cytokines with muscle mass/strength decline in community-dwelling older adults.

METHODS

Anthropometric, physical and functionality variables were collected. Nutritional status was assessed by the MNA form. Dynapenia was assessed with handgrip strength on the dominant hand using a dynamometer. Sarcopenia was determined using adapted criteria from the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Inflammatory cytokines were evaluated in plasma using a multiplex assay. Associations to muscle mass/strength decline were analyzed using a multinominal logistic regression, adjusted for potential confounders.

RESULTS

We recruited a convenience sample of 311 adults aged 60 years or older. Most of subjects were sufficiently active females with a median age of 68 years (interquartile range [IQR], 64-74 years), whereas about a half (46.3%) were at risk of malnutrition. The prevalence of dynapenia was 38.3%, whereas sarcopenia was 13.2%. After controlling for potential confounders, we found that relative fat mass index is independently associated with sarcopenia. Loss of strength was independently associated only with female sex, lower physical activity, worse nutrition and IL-10/TNF-α ratio, whereas female sex, an insufficiently active lifestyle and relative fat mass index were the key determinants of sarcopenia.

CONCLUSIONS

These findings highlight the importance of physical activity and healthy diet as effective interventions to prevent muscle mass/strength decline, and points to IL-10/TNF-α ratio and body fat as independently associated factors for dynapenia and sarcopenia, respectively.

Risk factors for 5-year mortality in a cohort of elderly patients with sarcopenia

BACKGROUND

The association between multiple risk factors and the mortality of sarcopenic patients has not been studied. This study's aim is to report the prevalence of sarcopenia among a sample of Italian hospitalized older adults, describe the physical function, body fat composition, cognitive, inflammatory and nutritional status of sarcopenic compared with non-sarcopenic subjects, and determine the risk factors associated with mortality in sarcopenic patients.

METHOD

A total of 462 patients were enrolled and followed up for a period of 5 years. Sarcopenia was diagnosed according to the EWGSOP2 criteria. Factors associated with sarcopenia were identified with linear regression analysis. Logistic regression was applied to explore the association between the risk factors and mortality in sarcopenic subjects. Survival analyses and predictors of mortality were identified using Kaplan-Meier and Cox regression.

RESULTS

The prevalence of sarcopenia was 33.5%. Linear regression showed that sarcopenia was associated with Barthel index (B -9.63, p0.004), BMI (B -3.19, p<0.001) and android fat (B 1.85, p0.004). Of these factors, only the number of co-morbidities (OR 1.394 C95% 1.023-1.862 p 0.025) and MMSE scores (OR 0.857 C95% 0.79-0.930 p <0.001) were associated with mortality in sarcopenia. Kaplan-Meier and the log-rank tests showed the negative prognostic effect of low BMI (p0.007), albumin (p<0.001) and Barthel index (p 0.018). The Cox regression showed that mortality hazard is reduced with BMI >24.9 (HR 0.287 C95% 0.095-0.866 p 0.027).

CONCLUSION

Sarcopenia is associated with low physical function and BMI but higher android fat. Low Barthel, BMI and albumin can significantly decrease the survival rate in sarcopenic patients. Whereas BMI >24.9 is associated with lower mortality hazard.

The Effects of Timing of a Leucine-Enriched Amino Acid Supplement on Body Composition and Physical Function in Stroke Patients: A Randomized Controlled Trial

The combination of exercise and nutritional intervention is widely used for stroke patients, as well as frail or sarcopenic older persons. As previously shown, supplemental branched chain amino acids (BCAAs) or protein to gain muscle mass has usually been given just after exercise. This study investigated the effect of the timing of supplemental BCAAs with exercise intervention on physical function in stroke patients. The participants were randomly assigned to two groups based on the timing of supplementation: breakfast (n = 23) and post-exercise (n = 23). The supplement in the breakfast group was provided at 08:00 with breakfast, and in the post-exercise group it was provided just after the exercise session in the afternoon at 14:00-18:00. In both groups, the exercise intervention was performed with two sessions a day for two months. The main effects were observed in body fat mass (p = 0.02, confidence interval (CI): 13.2-17.7), leg press strength (p = 0.04, CI: 94.5-124.5), and Berg balance scale (p = 0.03, CI: 41.6-52.6), but no interaction with intake timing was observed. Although the effect of the timing of supplementation on skeletal muscle mass was similar in both groups, BCAA intake with breakfast was effective for improving physical performance and decreasing body fat mass. The results suggest that a combination of BCAA intake with breakfast and an exercise program was effective for promoting rehabilitation of post-stroke patients.

A 3-year prospective cohort study of dietary patterns and frailty risk among community-dwelling older adults

BACKGROUND & AIMS

The association between dietary patterns and frailty is less investigated in Asia. We aimed to investigate the prospective associations between dietary patterns and frailty index (FI) in community-dwelling Japanese older adults aged 60 years or older.

METHODS

A 3-year cohort collected the data on sociodemographic information, lifestyle behaviors, comorbidities, medication history, depression status, nutrition, and physical function from 2014 to 2017. Five dietary patterns including "Mediterranean-style," "sugar and fat," "salt and pickles," "noodle and alcohol," and "protein-rich" dietary patterns were identified using principal component analysis from 20 food groups obtained using a validated food frequency questionnaire. A 54-item FI was constructed on the basis of a deficit accumulation model. This project aimed to investigate the longitudinal association between dietary pattern and frailty trajectories with annual measurements over a 3-year period using a generalized estimating equation.

RESULT

After excluding 108 participants with incomplete data at baseline, 666 participants (56.5% female, 69.4 ± 4.4 years) were included for longitudinal analysis. Our results demonstrated that adherence score to "sugar and fat" dietary pattern" (Q4 vs. Q1: mean difference [0.017], 95% CI [0.006 to 0.029]) and "salt and pickles" dietary pattern (Q3 vs. Q1: mean difference [0.010], 95% CI [0.001 to 0.020]; Q4 vs. Q1: mean difference [0.014], 95% CI [0.003 to 0.025]) were positively associated with change in FI. Adherence score to a "protein-rich" dietary pattern was negatively associated with change in FI (Q4 vs. Q1: mean difference [-0.013], 95% CI [-0.025 to -0.002]).

CONCLUSIONS

"Salt and pickles" dietary pattern and "sugar and fat" dietary pattern were positively associated with frailty. In contrast, "protein-rich" dietary pattern was negatively associated with frailty.

Dietary Protein Supplementation Helps in Muscle Thickness Regain after Abdominal Wall Reconstruction for Incisional Hernia

A modern approach to incisional hernia is oriented toward midline restoration to re-establish abdominal wall physiology and to restore muscular strength. A high-protein diet has been demonstrated to improve muscle function and mass. The aim of this prospective study was to evaluate the effect of a high-protein diet on abdominal muscle remodeling in patients submitted to abdominal wall reconstruction (AWR). Forty-five patients submitted to elective AWR were prospectively divided into two groups depending on pre- and postoperative daily protein assumption: Group A patients were submitted to a standard 2300 kcal diet with 103 g of protein intake (males) and 1800 kcal diet with 80 g of protein intake (females) starting one month before surgery and lasting for three months postoperatively; Group B patients were submitted to the same dietary regimen plus 34 g of purified proteins daily. Patients underwent ultrasound scan preoperatively and three and six months after surgery, to evaluate the widest thickness of the rectus abdominis muscle on the transverse umbilical line. Three patients reporting hernia recurrence were excluded. No significant difference among the two groups in muscle thickness growth after surgery was observed at three months after surgery, even if a favorable trend in Group B was noted (10% vs 19%, P = not significant). At six months after surgery, Group B patients showed a significant difference in muscle thickening (13% vs 32%, P < 0.05). The study demonstrates a positive effect of a protein diet on the rectus abdominis muscle thickening after AWR. Further studies are needed.

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.