Myoprotective whole foods, muscle health and sarcopenia in older adults

PURPOSE OF REVIEW

Sarcopenia increases in prevalence at older ages and may be exacerbated by poor diet. Whole foods rich in specific nutrients may be myoprotective and mitigate the risk of sarcopenia. Here we review recent evidence published from observational and intervention studies regarding myoprotective foods and explore their benefit for the prevention and/or treatment of sarcopenia in older adults.

RECENT FINDINGS

We found limited new evidence for the role of whole foods in sarcopenia and sarcopenia components (muscle mass, strength, physical performance). There was some evidence for higher consumption of protein-rich foods (milk and dairy) being beneficial for muscle strength in observational and intervention studies. Higher consumption of antioxidant-rich foods (fruit and vegetables) was associated with better physical performance and lower odds of sarcopenia in observational studies. Evidence for other protein- and antioxidant-rich foods were inconsistent or lacking. There remains a clear need for intervention studies designed to identify the role of whole foods for the treatment of sarcopenia.

SUMMARY

Although evidence for myoprotective roles of dairy, fruit and vegetables is emerging from observational studies, higher level evidence from intervention studies is needed for these foods to be recommended in diets of older adults to prevent and/or treat sarcopenia.

Determining the feasibility of characterising cellular senescence in human skeletal muscle and exploring associations with muscle morphology and physical function at different ages: findings from the MASS_Lifecourse Study

Cellular senescence may be associated with morphological changes in skeletal muscle and changes in physical function with age although there have been few human studies. We aimed to determine the feasibility of characterising cellular senescence in skeletal muscle and explored sex-specific associations between markers of cellular senescence, muscle morphology, and physical function in participants from the MASS_Lifecourse Study. Senescence markers (p16, TAF (Telomere-Associated DNA Damage Foci), HMGB1 (High Mobility Group Box 1), and Lamin B1) and morphological characteristics (fibre size, number, fibrosis, and centrally nucleated fibres) were assessed in muscle biopsies from 40 men and women (age range 47-84) using spatially-resolved methods (immunohistochemistry, immunofluorescence, and RNA and fluorescence in situ hybridisation). The associations between senescence, morphology, and physical function (muscle strength, mass, and physical performance) at different ages were explored. We found that most senescence markers and morphological characteristics were weakly associated with age in men but more strongly, although non-significantly, associated with age in women. Associations between senescence markers, morphology, and physical function were also stronger in women for HMGB1 and grip strength (r = 0.52); TAF, BMI, and muscle mass (r > 0.4); Lamin B1 and fibrosis (r =  - 0.5); fibre size and muscle mass (r ≥ 0.4); and gait speed (r =  - 0.5). However, these associations were non-significant. In conclusion, we have demonstrated that it is feasible to characterise cellular senescence in human skeletal muscle and to explore associations with morphology and physical function in women and men of different ages. The findings require replication in larger studies.

A silver bullet for ageing medicine?: clinical relevance of T-cell checkpoint receptors in normal human ageing

Immunosenescence describes dysregulation of the immune system with ageing manifested in both the innate and adaptive immunity, including changes in T-cell checkpoint signaling. Through complex and nuanced process, T-cells lose excitatory signaling pathways and upregulate their inhibitory signaling, leading to ineffective immune responses that contribute to the formation of the ageing phenotype. Here we expand on the expression, function, and clinical potential of targeting the T-cell checkpoint signaling in age and highlight interventions offering the most benefits to older adults' health. Notably, modifications in vaccination such as with mTOR inhibitors show immediate clinical relevance and good tolerability. Other proposed treatments, including therapies with monoclonal antibodies fail to show clinical efficacy or tolerability needed for implementation at present. Although T-cell co-signaling fits a valuable niche for translational scientists to manage immunosenescence, future study would benefit from the inclusion of older adults with multiple long-term conditions and polypharmacy, ensuring better applicability to actual patients seen in clinical settings.

The prevalence of sarcopenia in Parkinson's disease and related disorders- a systematic review

BACKGROUND

The prevalence of sarcopenia (reduced skeletal muscle strength and mass), Parkinson's disease (PD) and Parkinson's related disorders (PRD) all increase with age. They also share risk factors and pathogenetic features. An increased prevalence of sarcopenia in PD and PRD than the general population was thus postulated.

METHODS

Four databases were searched using predefined literature search strategies. Studies conducted in participants with PD or PRD reporting the prevalence of sarcopenia and those providing data to compute the prevalence were included. Pre-sarcopenia, probable/possible sarcopenia and confirmed sarcopenia were defined according to the main sarcopenia working groups. Risk of bias was assessed using the AXIS tool.

RESULTS

1978 studies were identified; 97 assessed in full; 14 met inclusion criteria. The median study quality score was 15/20. The range of probable sarcopenia was 23.9 to 66.7%, and it did not change after excluding PRD participants. The prevalence of confirmed sarcopenia in participants with any parkinsonian disorder ranged from 2 to 31.4%. Including just PD participants, the range was 10.9 to 31.4%. In studies with controls, sarcopenia was more prevalent in PD and PRD. There was a positive non-significant trend between severity of motor symptoms and prevalence of sarcopenia or components of sarcopenia. High heterogeneity precluded meta-analysis, therefore there was insufficient evidence to conclude whether sarcopenia is more prevalent in PD or PRD.

CONCLUSIONS

Probable and confirmed sarcopenia are common in PD and PRD and they may be associated with disease severity. This co-occurrence supports the value of screening for sarcopenia in parkinsonian populations.

Why are older adults living with the complexity of multiple long-term conditions, frailty and a recent deterioration in health under-served by research? A narrative synthesis review of the literature

Older adults living with the complexity of multiple long-term conditions (MLTC), frailty and a recent deterioration in health are under-served by research. As a result, current treatment guidelines are often based on data from studies of younger and less frail participants, and often single disease focused. The aims of this review were (i) to identify why older adults living with the complexity of MLTC, frailty and a recent deterioration in health are under-served by research and (ii) to identify strategies for increasing their recruitment and retention. Although a range of factors have been suggested to affect the participation of older adults with MLTC and frailty in research, this review shows that much less is known about the inclusion of older adults living with the complexity of MLTC, frailty and a recent deterioration in health. Researchers should focus on strategies that minimise participation burden for these patients, maintaining an adaptive and flexible approach, to increase their recruitment and retention. Future research should include qualitative interviews to provide further insights into how best to design and conduct research to suit the needs of this population group.

Hallmarks of ageing in human skeletal muscle and implications for understanding the pathophysiology of sarcopenia in women and men

Ageing is a complex biological process associated with increased morbidity and mortality. Nine classic, interdependent hallmarks of ageing have been proposed involving genetic and biochemical pathways that collectively influence ageing trajectories and susceptibility to pathology in humans. Ageing skeletal muscle undergoes profound morphological and physiological changes associated with loss of strength, mass, and function, a condition known as sarcopenia. The aetiology of sarcopenia is complex and whilst research in this area is growing rapidly, there is a relative paucity of human studies, particularly in older women. Here, we evaluate how the nine classic hallmarks of ageing: genomic instability, telomere attrition, epigenetic alterations, loss of proteostasis, deregulated nutrient sensing, mitochondrial dysfunction, cellular senescence, stem cell exhaustion, and altered intercellular communication contribute to skeletal muscle ageing and the pathophysiology of sarcopenia. We also highlight five novel hallmarks of particular significance to skeletal muscle ageing: inflammation, neural dysfunction, extracellular matrix dysfunction, reduced vascular perfusion, and ionic dyshomeostasis, and discuss how the classic and novel hallmarks are interconnected. Their clinical relevance and translational potential are also considered.

Attitudes and barriers to resistance exercise training for older adults living with multiple long-term conditions, frailty, and a recent deterioration in health: qualitative findings from the Lifestyle in Later Life - Older People's Medicine (LiLL-OPM) study

BACKGROUND

Many older adults live with the combination of multiple long-term conditions (MLTC) and frailty and are at increased risk of a deterioration in health requiring interaction with healthcare services. Low skeletal muscle strength is observed in individuals living with MLTC and is central to physical frailty. Resistance exercise (RE) is the best available treatment for improving muscle strength, but little is known about the attitudes and barriers to RE in this group of older adults. This study therefore aimed to explore the knowledge of and attitudes towards RE, as well as the barriers and enabling factors, in older adults living with MLTC, frailty and a recent deterioration in health.

METHODS

Fourteen participants aged 69-92 years (10 women) from the Lifestyle in Later Life - Older People's Medicine (LiLL-OPM) study were recruited from an Older People's Medicine Day Unit in Newcastle, UK. Participants were invited to take part in a semi-structured interview exploring their knowledge and attitudes as well as barriers and enabling factors to RE. Data were analysed using thematic analysis.

RESULTS

The analysis generated three themes (1) a lack of awareness and understanding of RE, (2) a self-perceived inability to perform RE; physical and psychological barriers and (3) willingness to perform RE under expert guidance. There was a general lack of awareness and understanding of RE, with most participants having never heard of the term and being unaware of its potential benefits. When RE was described, participants stated that they would be willing to try RE, but it was apparent that an individualised approach underpinned by expert guidance would be required to support engagement.

CONCLUSIONS

Older adults living with MLTC, frailty and a recent deterioration in health lack awareness and understanding of RE. Despite a range of barriers, this group appear willing to engage in RE if they are appropriately supported. There is a need to co-design and deliver effective strategies, including education, to raise awareness and understanding of RE, as well as promote engagement in RE, in this group of older adults.

The role of nutrition in the prevention of sarcopenia

Sarcopenia is a common skeletal muscle disorder characterized by a loss of muscle mass and impaired muscle function that is associated with poor health outcomes. Although nutrition is considered an important factor in the etiology of sarcopenia, the preventive potential of diet, specifically the extent to which differences in habitual patterns of diet and/or nutrient intakes impact risk of its development, is poorly understood. This narrative review considered research evidence on dietary patterns and nutrient intakes in mid- (<60 y) and young-older (60-70 y) adulthood to evaluate how they relate to age-related changes in muscle mass and function. A key finding was that current evidence on adult diet and sarcopenia risk in older age is limited and fragmented, with different outcomes reported across studies (for example, lean mass, strength) and few reporting links to incident diagnosed sarcopenia. As these outcomes are not interchangeable, it challenges collation of the evidence, leaving many gaps in understanding. There is also limited information about adult (<70 y) diet and few longitudinal studies with repeated dietary assessments to enable definition of cumulative exposures across adulthood. However, despite these limitations, findings from studies of dietary patterns already provide reasonably consistent messages about the benefits of diets of higher quality in earlier adulthood for later physical performance, although whole-diet intervention trials are urgently needed to understand their potential. In comparison, there is little evidence of benefits of higher intakes of individual nutrients in earlier adulthood for later muscle mass and function. Although these gaps need to be addressed in future research, there may already be sufficient data to promote messages about diet quality more widely - that healthier diets of higher quality across adulthood, with known benefits for a range of health outcomes, are also linked to the effective preservation of muscle mass and function.

Repurposing Drugs for Diabetes Mellitus as Potential Pharmacological Treatments for Sarcopenia - A Narrative Review

Sarcopenia, the age-related loss of muscle strength and mass or quality, is a common condition with major adverse consequences. Although the pathophysiology is incompletely understood, there are common mechanisms between sarcopenia and the phenomenon of accelerated ageing seen in diabetes mellitus. Drugs currently used to treat type 2 diabetes mellitus may have mechanisms of action that are relevant to the prevention and treatment of sarcopenia, for those with type 2 diabetes and those without diabetes. This review summarises shared pathophysiology between sarcopenia and diabetes mellitus, including the effects of advanced glycation end products, mitochondrial dysfunction, chronic inflammation and changes to the insulin signalling pathway. Cellular and animal models have generated intriguing, albeit mixed, evidence that supports possible beneficial effects on skeletal muscle function for some classes of drugs used to treat diabetes, including metformin and SGLT2 inhibitors. Most human observational and intervention evidence for the effects of these drugs has been derived from populations with type 2 diabetes mellitus, and there is a need for intervention studies for older people with, and at risk of, sarcopenia to further investigate the balance of benefit and risk in these target populations. Not all diabetes treatments will be safe to use in those without diabetes because of variable side effects across classes. However, some agents [including glucagon-like peptide (GLP)-1 receptor agonists and SGLT2 inhibitors] have already demonstrated benefits in populations without diabetes, and it is these agents, along with metformin, that hold out the most promise for further investigation in sarcopenia.

Recovery from Resistance Exercise in Older Adults: A Systematic Scoping Review

BACKGROUND

Resistance exercise is recommended for maintaining muscle mass and strength in older adults. However, little is known about exercise-induced muscle damage and recovery from resistance exercise in older adults. This may have implications for exercise prescription. This scoping review aimed to identify and provide a broad overview of the available literature, examine how this research has been conducted, and identify current knowledge gaps relating to exercise-induced muscle damage and recovery from resistance exercise in older adults.

METHODS

Studies were included if they included older adults aged 65 years and over, and reported any markers of exercise-induced muscle damage after performing a bout of resistance exercise. The following electronic databases were searched using a combination of MeSH terms and free text: MEDLINE, Scopus, Embase, SPORTDiscus and Web of Science. Additionally, reference lists of identified articles were screened for eligible studies. Data were extracted from eligible studies using a standardised form. Studies were collated and are reported by emergent theme or outcomes.

RESULTS

A total of 10,976 possible articles were identified and 27 original research articles were included. Findings are reported by theme; sex differences in recovery from resistance exercise, symptoms of exercise-induced muscle damage, and biological markers of muscle damage.

CONCLUSIONS

Despite the volume of available data, there is considerable variability in study protocols and inconsistency in findings reported. Across all measures of exercise-induced muscle damage, data in women are lacking when compared to males, and rectifying this discrepancy should be a focus of future studies. Current available data make it challenging to provide clear recommendations to those prescribing resistance exercise for older people.

New Horizons in cellular senescence for clinicians

Cellular senescence has emerged as a fundamental biological mechanism underpinning the ageing process and has been implicated in the pathogenesis of an increasing number of age-related conditions. Cellular senescence is a cell fate originally defined as an irreversible loss of replicative potential although it is now clear that it can be induced by a variety of mechanisms independent of replication and telomere attrition. The drivers include a persistent DNA damage response causing multiple alterations in cellular function. Senescent cells secrete a range of mediators that drive chronic inflammation and can convert other cells to the senescent state-the senescence-associated secretory phenotype. Much research to date has been conducted in animal models, but it is now clear that senescent cells accompany ageing in humans and their presence is an important driver of disease across systems. Proof-of-concept work suggests that preventing or reversing senescence may be a viable strategy to counteract human ageing and age-related disease. Possible interventions include exercise, nutrition and senolytics/senostatic drugs although there are a number of potential limitations to the use of senotherapeutics. These interventions are generally tested for single-organ conditions, but the real power of this approach is the potential to tackle multiple age-related conditions. The litmus test for this exciting new class of therapies, however, will be whether they can improve healthy life expectancy rather than merely extending lifespan. The outcomes measured in clinical studies need to reflect these aims if senotherapeutics are to gain the trust of clinicians, patients and the public.

Feasibility of engaging older adults living with multiple long-term conditions, frailty, and a recent deterioration in health in a study of lifestyle: protocol for the LiLL-OPM study

Community-dwelling older adults living with multiple long-term conditions (MLTC), frailty and a recent deterioration in health are underserved by research. This results in a limited evidence base for their care, including the potential benefits of lifestyle interventions such as structured exercise. The aims of the LiLL-OPM (Lifestyle in Later Life - Older People's Medicine) study are to determine if it is feasible to carry out a research project with these patients, describe their health and lifestyle, their attitudes to engaging in exercise and their experiences of taking part in the research. Older adults who are attending an Older People's Medicine Day Unit service in Newcastle, UK, and their informal carers will be invited to take part. The study will use mixed methods with semi-structured interviews and a health and lifestyle questionnaire, carried out in a way that is most convenient to participants, including in their own homes and with a flexible schedule of study visits. The findings from the feasibility study will provide invaluable data on how to design research, including the most suitable approaches to recruitment and data collection. This will improve the inclusion in research of older adults living with MLTC, frailty and a recent deterioration in health.

Simple approaches to characterising multiple long-term conditions (multimorbidity) and rates of emergency hospital admission: Findings from 495,465 UK Biobank participants

BACKGROUND

Numerous approaches are used to characterise multiple long-term conditions (MLTC), including counts and indices. Few studies have compared approaches within the same dataset. We aimed to characterise MLTC using simple approaches, and compare their prevalence estimates of MLTC and associations with emergency hospital admission in the UK Biobank.

METHODS

We used baseline data from 495,465 participants (age 38-73 years) to characterise MLTC using four approaches: Charlson index (CI), Byles index (BI), count of 43 conditions (CC) and count of body systems affected (BC). We defined MLTC as more than two conditions using CI, BI and CC, and more than two body systems using BC. We categorised scores (incorporating weightings for the indices) from each approach as 0, 1, 2 and 3+. We used linked hospital episode statistics and performed survival analyses to test associations with an endpoint of emergency hospital admission or death over 5 years.

RESULTS

The prevalence of MLTC was 44% (BC), 33% (CC), 6% (BI) and 2% (CI). Higher scores using all approaches were associated with greater outcome rates independent of sex and age group. For example, using CC, compared with score 0, score 2 had 1.95 (95% CI: 1.91, 1.99) and a score of 3+ had 3.12 (95% CI: 3.06, 3.18) times greater outcome rates. The discriminant value of all approaches was modest (C-statistics 0.60-0.63).

CONCLUSIONS

The counts classified a greater proportion as having MLTC than the indices, highlighting that prevalence estimates of MLTC vary depending on the approach. All approaches had strong statistical associations with emergency hospital admission but a modest ability to identify individuals at risk.

Assessment of Dietary Intake in Three Cohorts of Advanced Age in Two Countries: Methodology Challenges

OBJECTIVES

Dietary intake information is key to understanding nutrition-related outcomes. Intake changes with age and some older people are at increased risk of malnutrition. Application, difficulties, and advantages of the 24-hour multiple pass recall (24hr-MPR) dietary assessment method in three cohorts of advanced age in the United Kingdom (UK) and New Zealand (NZ) is described.

PARTICIPANTS

The Newcastle 85+ study (UK) recruited a single year birth cohort of people aged 85 years during 2006-7. LiLACS NZ recruited a 10-year birth cohort of Māori (indigenous New Zealanders) aged 80-90 years and a single year birth cohort of non-Māori aged 85 years in 2010.

MEASUREMENTS

Two 24hr-MPR were conducted on non-consecutive days by trained assessors. Pictorial resources and language were adapted for the New Zealand and Māori contexts. Detailed methods are described.

RESULTS

In the Newcastle 85+ study, 805 (93%) participants consented to the 24-MPR, 95% of whom completed two 24hr-MPR; in LiLACS NZ, 218 (82%) consented and 203 (76%) Māori and 353 (90%) non-Māori completed two 24hr-MPR. Mean time to complete each 24hr-MPR was 22 minutes in the Newcastle 85+ study, and 45 minutes for Māori and 39 minutes for non-Māori in LiLACS NZ. Dietary assessment of participants residing in residential care and those requiring proxy respondents were successfully included in both studies. Most participants (83-94%) felt that data captured by the 24hr-MPR reflected their usual dietary intake.

CONCLUSIONS

Dietary assessment using 24hr-MPR was successful in capturing detailed dietary data including information on portion size and time of eating for over 1300 octogenarians in the UK and New Zealand (Māori and non- Māori). The 24hr-MPR is an acceptable method of dietary assessment in this age group.

Advanced glycation end products in skeletal muscle health and sarcopenia: A systematic review of observational studies

BACKGROUND

Advanced glycation end products (AGEs) and AGEs receptor (RAGE) may play a role in sarcopenia. This systematic review evaluated the associations between AGEs measured in tissues (skin) by autofluorescence (SAF) and/or circulation (blood, urine) and muscle health outcomes (strength, mass, function) and sarcopenia in observational studies.

METHODS

MEDLINE, Embase, Scopus and Web of Science were searched for studies reporting associations between AGEs and muscle-related outcomes in community-dwelling adults aged ≥ 30 years (until March 2022).

RESULTS

Fourteen cross-sectional and one prospective study were included in the narrative summary. SAF was negatively associated with muscle strength, mass, and physical functioning in adults aged ≥ 30 years (four studies), and muscle mass (three studies), strength, and sarcopenia (one study) in adults aged ≥ 65 years. Circulating AGEs were negatively associated with muscle strength and physical functioning (four studies) and predicted the risk of walking disability (one prospective study), and sarcopenia (one study) in older adults. The role of RAGE in muscle health was inconclusive.

CONCLUSIONS

SAF and circulating AGEs were negatively associated with muscle-related outcomes in adults aged ≥ 30 years in cross-sectional studies. This finding should be confirmed in well-designed prospective studies investigating sarcopenia, as AGEs represent a potentially modifiable target for intervention.

Immunosenescence profiles of lymphocyte compartments and multiple long-term conditions (multimorbidity) in very old adults: The Newcastle 85+ Study

Immunosenescence, a decline in immune system function, has been linked to several age-related diseases and ageing syndromes. Very old adults (aged ≥ 85 years) live with multiple long-term conditions (MLTC, also known as multimorbidity)-a complex phenomenon of poor health defined by either counts, indices, or patterns, but little is known about the relationship between an ageing immune system and MLTC in this age group. We utilised baseline data from the Newcastle 85+ Study to investigate the associations between previously defined immunosenescence profiles of lymphocyte compartments and MLTC counts and patterns (from 16 chronic diseases/ageing syndromes). Seven hundred and three participants had MLTC and complete data for all 16 conditions, a median and mean of 5 (range 2-11) and 62.2% had ≥ 5 conditions. Three distinct MLTC patterns emerged by clustering: Cluster 1 ('Low frequency cardiometabolic-cerebrovascular diseases', n = 209), Cluster 2 ('High ageing syndromes-arthritis', n = 240), and Cluster 3 ('Hypertensive-renal impairment', n = 254). Although having a more senescent phenotype, characterised by higher frequency of CD4 and CD8 senescence-like effector memory cells and lower CD4/CD8 ratio, was not associated with MLTC compared with less senescent phenotype, the results warrant further investigation, including whether immunosenescence drives change in MLTC and influences MLTC severity in late adulthood.

Advancing our understanding of skeletal muscle across the lifecourse: Protocol for the MASS_Lifecourse study and characteristics of the first 80 participants

INTRODUCTION

Sarcopenia, the age-related loss of skeletal muscle strength and mass, carries a significant burden for affected individuals. There has been little investigation of sarcopenia using experimental medicine techniques to study human muscle tissue in detail. The aim of the Muscle Ageing Sarcopenia Studies Lifecourse (MASS_Lifecourse) study is to recruit up to 160 participants, equally divided between females and males between ages 45 and 85 years for detailed phenotyping of skeletal muscle health. Here we describe the protocol for the study and the characteristics of the first 80 participants.

METHODS

We are recruiting participants from three sources in the north-east of England. Study fieldwork comprises a home visit (or videocall) for consent and assessment of health, cognition, lifestyle, and wellbeing. This is followed by a visit to a clinical research facility for assessment of sarcopenia status and collection of samples including a vastus lateralis muscle biopsy. We produced descriptive statistics for the first 80 participants, including expressing their grip strength relative to normative data in the form of Z-scores.

RESULTS

The first 80 participants (53.8 % female) covered the target ages, ranging from 48 to 84 years. They were regularly physically active, reported good physical function and had a prevalence of sarcopenia (including probable sarcopenia) of 11.3 % based on the revised European consensus. Their grip strength was similar to that in the general population, with a mean Z-score of 0.09 standard deviations (95 % CI: -1.64, 1.83) above that expected.

CONCLUSIONS

The MASS_Lifecourse study combines comprehensive health and lifestyle data with a range of biological samples including skeletal muscle. The findings from planned analyses should contribute to improvements in the diagnosis, treatment, and prevention of sarcopenia.

986 IMMUNOSENESCENCE PROFILES AND MULTIPLE LONG-TERM CONDITIONS IN VERY OLD ADULTS: THE NEWCASTLE 85+ STUDY

Introduction

Immunosenescence, a decline in immune system function, has been linked to several age-related diseases and geriatric syndromes, including cardiovascular diseases and frailty. Very old adults (aged ≥85 years) live with multiple long-term conditions (MLTC) or multimorbidity—a complex phenomenon of poor health defined by either counts (≥2 diseases), indices, or patterns. However, little is known about the relationship between immunosenescence and MLTC in this age group. We utilised baseline data from the Newcastle 85+ Study to investigate the association between previously defined immunosenescence profilesa and MLTC.

Method

We used data from 703 participants who had multimorbidity and complete data for 16 chronic diseases and geriatric syndromes (i.e. analytic sample). MLTC counts were derived from the number of conditions and categorised into &lt;median and ≥ median MLTC groups. We used the SPSS Two Step clustering with all 16 conditions to define MLTC patterns. Two immunosenescence profiles (‘Senescent-like phenotype’ and ‘Less senescent-like phenotype’) were defined previously from 13 lymphocyte compartments. We used multivariable regression analyses to investigate the association between immunosenescence profiles and MLTC counts, groups, and patterns.

Results

In the analytic sample only 6.8% participants had 2 conditions, whilst 79.1% had 3–7, and 14.1% had ≥8 conditions, a median of 5, and 62.2% were in ≥median MLTC group. Three distinct MLTC patterns emerged by clustering: ‘Low cardio-cerebro-metabolic diseases’ (n = 209), ‘High geriatric syndromes-arthritis’ (n = 240), and ‘Hypertensive-renal impairment’ pattern, (n = 254). Having ‘Senescent-like phenotype’ characterised by higher frequency of CD4 and CD8 senescence-like effector memory cells and lower CD4/CD8 ratio was not significantly associated with either MLTC counts, ≥median MLTC group, or patterns compared with ‘Less senescent phenotype’.

Conclusion

No cross-sectional associations between immunosenescence and MLTC were found in the very old. Further studies are needed to determine whether immunosenescence drives change in MLTC counts and patterns and influences MLTC burden in late adulthood.

1055 SIMPLE APPROACHES TO CHARACTERISING MULTIPLE LONG-TERM CONDITIONS (MULTIMORBIDITY) AND RATES OF HOSPITAL ADMISSION IN UK BIOBANK

Introduction

Multiple approaches are used to describe MLTC, including counts and indices (weighted counts). However, few studies have directly compared different approaches which would be helpful for the design of future MLTC studies. We therefore aimed to compare the prevalence of MLTC and association with emergency hospital admission characterised using different approaches within the same dataset.

Method

We used baseline data from 501,596 UK Biobank participants (age 37-73y) combined with linked hospital episode statistics to characterise MLTC using four approaches: count of body systems affected (CB); count of 43 conditions (CC); Byles index (BI); and Charlson comorbidity index (CCI). For each we performed survival analyses to test associations to a combined endpoint of first emergency admission or death over five years from baseline interview, adjusting for age and sex. We used Harrell’s C-index to compare the discriminant value of the four approaches for the combined endpoint.

Results

Prevalence of two or more positive responses (indicating the presence of MLTC) was 45% for CB, 33% for CC, 6% for BI and 2% for CCI. 95,812 (19%) participants had one or more emergency admission or died in the first five years. All four approaches were associated with greater rates of admission/death. For example, using CC, compared to those with zero conditions those with one had 1.42 (95% CI 1.39,1.45), those with two 1.94 (95% CI 1.90,1.98), and those with 3+ conditions had 3.11 (95% CI 3.05,3.17) times greater rates. The predictive value of the four approaches was modest (C-indices ranging from 0.60 to 0.63).

Conclusion

The counts classified a greater proportion of the sample as having MLTC than the indices, highlighting that prevalence estimates of MLTC may vary depending on the approach used. All approaches had strong statistical associations with admission, but only moderate ability to identify individual participants at risk.

684 LONG-TERM CONDITIONS, MULTIMORBIDITY, LIFESTYLE FACTORS AND GRIP STRENGTH CHANGE OVER 9 YEARS IN 44,315 UK BIOBANK PARTICIPANTS

Introduction

Weak grip strength is associated with a range of adverse health outcomes, and an accelerated decline in grip strength confers an even greater risk. To date there has been limited research into the factors associated with change in grip strength in mid-life. Using data from UK Biobank our aim was to investigate the associations of long-term conditions (LTCs), multimorbidity and lifestyle factors with patterns of change in grip strength.

Methods

We used data from 44,315 UK Biobank participants with grip strength measured at baseline (2006–10) and a subsequent study visit around nine years later. At baseline, participants’ LTCs were self-reported and categorised against a hierarchy. Multimorbidity was characterised by the number of LTC categories present (0, 1, 2 and 3+). Lifestyle factors (body mass index (BMI), smoking, diet and physical activity) were also assessed. Change in grip strength was grouped into four patterns: decline, stable low, stable high or reference (no change or increase) and used as the outcome in multinomial logistic regression models.

Results

Most LTC categories were associated with adverse patterns of change in grip strength (stable low and/or decline): for example, musculoskeletal/trauma conditions were associated with an increased risk of the stable low pattern (Relative Risk Ratio [RRR] = 1.63; 95% Confidence Interval [CI] 1.49–1.79). Multimorbidity and lifestyle factors had independent associations with grip strength change: those with 3+ categories of LTCs were more likely to experience decline in grip strength (RRR = 1.18;95% CI 1.08–1.28) compared to those with no LTCs. Low physical activity was associated with adverse patterns of grip strength, while raised BMI had divergent associations (both the decline and stable high patterns of grip strength change).

Conclusion

Individuals living with multimorbidity and those with lifestyle risk factors such as low physical activity are at increased risk of loss of strength over time.

Resistance exercise as a treatment for sarcopenia: prescription and delivery

Sarcopenia is a generalised skeletal muscle disorder characterised by reduced muscle strength and mass and associated with a range of negative health outcomes. Currently, resistance exercise (RE) is recommended as the first-line treatment for counteracting the deleterious consequences of sarcopenia in older adults. However, whilst there is considerable evidence demonstrating that RE is an effective intervention for improving muscle strength and function in healthy older adults, much less is known about its benefits in older people living with sarcopenia. Furthermore, evidence for its optimal prescription and delivery is very limited and any potential benefits of RE are unlikely to be realised in the absence of an appropriate exercise dose. We provide a summary of the underlying principles of effective RE prescription (specificity, overload and progression) and discuss the main variables (training frequency, exercise selection, exercise intensity, exercise volume and rest periods) that can be manipulated when designing RE programmes. Following this, we propose that an RE programme that consists of two exercise sessions per week and involves a combination of upper- and lower-body exercises performed with a relatively high degree of effort for 1–3 sets of 6–12 repetitions is appropriate as a treatment for sarcopenia. The principles of RE prescription outlined here and the proposed RE programme presented in this paper provide a useful resource for clinicians and exercise practitioners treating older adults with sarcopenia and will also be of value to researchers for standardising approaches to RE interventions in future sarcopenia studies.

Recovery from resistance exercise in older adults: a protocol for a scoping review

Introduction

Resistance exercise has been shown to improve muscle health in older adults and is recommended as a front-line treatment for many health conditions, including sarcopenia and frailty. However, despite considerable research detailing the potential benefits of resistance exercise programmes, little is known about how older adults recover from individual exercise sessions. This scoping review will examine the current evidence surrounding the acute post-exercise effects of resistance exercise and the exercise recovery process in older adults to inform future research and exercise prescription guidelines for older adults.

Methods and analysis

The methodological framework of Arksey and O’Malley (2005) will be applied for this scoping review. A systematic search of five online databases and the hand-searching of reference lists of identified articles will be used to identify relevant papers. Studies that aim to measure exercise-induced muscle damage or exercise recovery following a resistance exercise session in participants aged 65 years and over will be included. Qualitative and quantitative data from relevant studies will be presented in a tabular format. Results will be summarised in narrative format. Key findings will be discussed concerning resistance exercise prescription in older adults.

Dissemination

This review will be used to direct further research surrounding the exercise recovery process from resistance exercise in older adults and will also aid in designing specific exercise prescription guidelines for an older population. Findings will be relevant to researchers, clinicians, health workers and policy-makers and disseminated through publications and presentations.

Long-term conditions, multimorbidity, lifestyle factors and change in grip strength over 9 years of follow-up: Findings from 44,315 UK biobank participants

Background

Weak grip strength is associated with a range of adverse health outcomes and an accelerated decline in grip strength confers an even greater risk. The factors associated with change in grip strength in mid-life remain to be fully determined.

Methods

We used data from 44,315 UK Biobank participants who had grip strength measured at baseline (2006-10) and a subsequent visit approximately nine years later. At baseline, participants’ long-term conditions (LTCs) were categorised against a hierarchy, with multimorbidity characterised by the number of LTC categories. Lifestyle factors were assessed. Change in grip strength was grouped into four patterns: decline, stable low, stable high or reference (no change or increase) and used as the outcome in multinomial logistic regression.

Results

Most LTC categories were associated with adverse patterns of change in grip strength (stable low and/or decline): for example, musculoskeletal/trauma conditions were associated with an increased risk of the stable low pattern (Relative Risk Ratio [RRR] = 1.63; 95% confidence interval [CI]: 1.49-1.79). Multimorbidity and lifestyle factors had independent associations with grip strength change. Those with 3+ categories of LTCs were more likely to experience decline in grip strength (RRR = 1.18; 95% CI: 1.08-1.28) compared to those with none. Low physical activity was associated with adverse patterns of grip strength, while raised body mass index (BMI) had divergent associations.

Conclusions

Individuals living with multimorbidity and those with lifestyle risk factors such as low physical activity are at increased risk of low muscle strength and the loss of strength over time.

Older Adults' Knowledge and Perceptions of Whole Foods as an Exercise Recovery Strategy

Resistance exercise is a widely advocated treatment for improving muscle strength and performance in older adults. Maximizing the benefit of resistance exercise by ensuring optimal recovery is an important aim and studies are now seeking interventions to expedite exercise recovery in older people. A recovery strategy that has acquired considerable interest is the consumption of protein, and more recently, the consumption of protein-rich whole foods. This study aimed to understand the perspectives of community-dwelling older adults, and determine their knowledge of exercise recovery strategies, their preferences for recovery strategies, and their attitudes toward using whole foods, such as milk as a post-exercise recovery aid. Two hundred ninety-one older adults (74 ± 4 years) were recruited to complete a self-administered online survey. A mixed methods approach was used to gather in-depth data from the cohort. Participants were asked to complete a combination of free-text (open-ended) and multiple-choice questions. Content analysis was conducted on responses to open-ended questions through a systematic classification process of coding. The most common recovery strategies reported were heat treatment, rest, and massage. Nutrition was rarely cited as a recovery strategy. Less than 2% of respondents mentioned nutrition, of these, only half mentioned a protein source. Forty-nine percent expressed negative opinions toward recovery supplements (e.g., “waste of money”) compared to 7% expressing positive opinions. Whole foods such as milk, meat, fish, and fruit, were deemed to be a more acceptable recovery strategy than supplements by 80% of respondents. Those that found whole foods to be equally as acceptable (18%), cited efficacy as their main concern, and those that declared whole foods less acceptable (2%) had no common reason. Despite the high acceptability of whole foods, only 35% were aware that these foods could aid recovery. When asked about milk specifically, the majority of older adults (73%) said this would, or might, be an acceptable exercise recovery strategy. Those that found milk an unacceptable recovery strategy (27%) often cited disliking milk or an allergy/intolerance. In conclusion, whilst whole foods represented an acceptable recovery intervention for older adults, the majority were unaware of the potential benefits of nutrition for post-exercise recovery.

Prevalence and factors associated with poor performance in the 5-chair stand test: findings from the Cognitive Function and Ageing Study II and proposed Newcastle protocol for use in the assessment of sarcopenia

BACKGROUND

Poor performance in the 5-chair stand test (5-CST) indicates reduced lower limb muscle strength. The 5-CST has been recommended for use in the initial assessment of sarcopenia, the accelerated loss of muscle strength and mass. In order to facilitate the use of the 5-CST in sarcopenia assessment, our aims were to (i) describe the prevalence and factors associated with poor performance in the 5-CST, (ii) examine the relationship between the 5-CST and gait speed, and (iii) propose a protocol for using the 5-CST.

METHODS

The population-based study Cognitive Function and Ageing Study II recruited people aged 65 years and over from defined geographical localities in Cambridgeshire, Newcastle, and Nottingham. The study collected data for assessment of functional ability during home visits, including the 5-CST and gait speed. We used multinomial logistic regression to assess the associations between factors including the SARC-F questionnaire and the category of 5-CST performance: fast (<12 s), intermediate (12-15 s), slow (>15 s), or unable, with slow/unable classed as poor performance. We reviewed previous studies on the protocol used to carry out the 5-CST.

RESULTS

A total of 7190 participants aged 65+ from the three diverse localities of Cognitive Function and Ageing Study II were included (54.1% female). The proportion of those with poor performance in the 5-CST increased with age, from 34.3% at age 65-69 to 89.7% at age 90+. Factors independently associated with poor performance included positive responses to the SARC-F questionnaire, physical inactivity, depression, impaired cognition, and multimorbidity (all P < 0.005). Most people with poor performance also had slow gait speed (57.8%) or were unable to complete the gait speed test (18.4%). We found variation in the 5-CST protocol used, for example, timing until a participant stood up for the fifth time or until they sat down afterwards.

CONCLUSIONS

Poor performance in the 5-CST is increasingly common with age and is associated with a cluster of other factors that characterize risk for poor ageing such as physical inactivity, impaired cognition, and multimorbidity. We recommend a low threshold for performing the 5-CST in clinical settings and provide a protocol for its use.

25 Sarcopenia, Long-Term Conditions, and Multimorbidity From Mid-Life to Later Life: Findings From 499,046 UK Biobank Participants

Introduction

Sarcopenia, the loss of muscle strength and mass, predicts adverse outcomes and becomes common with age. There is recognition that sarcopenia may occur at younger ages in those with long-term conditions (LTCs) as well as those with multimorbidity (the presence of two or more LTCs), but their relationships have been little explored. Our aims were to describe the prevalence of sarcopenia in UK Biobank, a large sample of men and women aged 40–70 years, and to explore relationships with different categories of LTCs and multimorbidity.

Methods

We used data from 499,046 participants in the baseline of UK Biobank. Our main outcome was probable sarcopenia based on maximum grip strength below sex-specific cut-points. Participants’ LTCs were recorded during an interview and categorised against a hierarchy. We used logistic regression to examine the independent associations between each category of LTCs and probable sarcopenia, including adjustment for age, sex, and body mass index. We also examined the association with multimorbidity.

Results

Probable sarcopenia had an overall prevalence of 5.3% and increased with age. The categories with the strongest associations with probable sarcopenia were musculoskeletal/trauma (OR 2.17 [95% CI: 2.11, 2.23]), endocrine/diabetes (OR 1.49 [95% CI: 1.45, 1.55]), and neurological/psychiatric (OR 1.39 [95% CI: 1.34, 1.43]) LTCs. Almost half of the sample (44.5%) had multimorbidity and they were at nearly twice the odds of probable sarcopenia (OR 1.96 [95% CI: 1.91, 2.02]) compared to those without.

Conclusions

We have shown an overall prevalence of 5.3% of probable sarcopenia at ages 40–70 in UK Biobank. The risk of probable sarcopenia was higher in those with some categories of LTCs, suggesting that these groups may stand to benefit from assessment of sarcopenia, during mid-life as well as old age.

31 Physical Activity, Muscle Strength and Quantity: Preliminary Findings From the Mass_Lifecourse Cohort

Introduction

We established the MASS_Lifecourse study to investigate changes in skeletal muscle between ages 45–85. Reduced physical activity (PA) is a key factor linked to the development of sarcopenia. Our aim was the describe the amount and patterns of PA and sedentary behaviour (SB), and relationships with muscle strength and quantity, among MASS_Lifecourse participants.

Method

Participants wore a triaxial accelerometer on their dominant wrist for seven days. Recordings were analysed to calculate time in moderate-vigorous PA (MVPA) with time not in MVPA classified as SB based on wrist position. Muscle strength was measured with a Jamar grip dynamometer and the 5 chair-stand test. Muscle quantity was assessed using appendicular lean muscle mass from dual-energy X-ray absorptiometry. Physical performance was assessed by gait speed.

Results

68 participants (31 male) aged 47–84 (mean 65) participated in the present study. Median daily MVPA was 19.1 (IQR 7.1, 36.6) minutes and was lower with age. The mean sedentary time per day was 767.1 minutes per day and increased with age. The pattern of MVPA across the day changed with age: the oldest group (75–84 years) achieved a lower morning activity peak followed by an earlier decline whilst the younger groups were more consistently active throughout the day. Participants were more active than population reference data from the Active Lives Survey. Time spent in MVPA was positively associated with muscle strength and physical performance, whereas SB was negatively associated. Muscle quantity was not associated with PA or SB.

Conclusions

Participants in the MASS_Lifecourse study are more active than the general population but still show age-related declines in physical activity and strength. Future work in the cohort aims to elucidate mechanisms underlying the age-related loss of muscle strength and quantity.

Contribution of protein intake and its interaction with physical activity to transitions between disability states and to death in very old adults: the Newcastle 85+ Study

INTRODUCTION

Growth in the number of very old (≥ 85 years) adults will likely lead to increased prevalence of disability. Our aim was to determine the contribution of protein intake, and the interaction between protein intake and physical activity (PA), to the transition between disability states and to death in the very old using the Newcastle 85+ Study.

METHODS

The analytic sample comprised of 717 older adults aged 85 years at baseline and living in the community. Protein intake was estimated with 2 × 24-h multiple pass recalls (24 h-MPR) at baseline. Disability was measured as difficulty performing 17 activities of daily living (ADL) at baseline, at 18, 36, and 60 months, and defined as having difficulties in one or more ADL. The contribution of protein intake [g/kg adjusted body weight/day (g/kg aBW/d)] to transition probabilities to and from disability, and to death over 5 years was examined by multi-state models adjusted for key health covariates.

RESULTS

Participants were expected to spend 0.8 years (95% CI 0.6-1.0) disability-free and 2.8 years (95% CI 2.6-2.9) with disability between the ages 85 and 90 years. One unit increase in protein intake (g/kg aBW/d) halved the likelihood of incident disability (HR 0.44, 95% CI 0.24-0.83) but not for other transitions. Similar reductions in disability incidence were also found in individuals with protein intake ≥ 0.8 (HR 0.50, 95% CI 0.31-0.80) and ≥ 1 g/kg aBW/d (HR 0.49, 95% CI 0.33-0.73). Participants with high PA and protein intake ≥ 1 g/kg aBW/d were less likely to transition from disability-free to disability than those within the same PA level but with protein intake < 1 g/kg aBW/d (HR 0.45, 95% CI 0.28-0.72).

CONCLUSION

Higher protein intake, especially in combination with higher physical activity, may delay the incidence of disability in very old adults.

Immunosenescence profiles are not associated with muscle strength, physical performance and sarcopenia risk in very old adults: The Newcastle 85+ Study

Decline in immune system function (immunosenescence) has been implicated in several age-related disorders. However, little is known about whether alteration in T-cell senescence, a process underlying immunological ageing, is related to muscle health in very old adults (aged ≥85 years). Utilising data from the Newcastle 85+ Study, we aimed to (a) derive and characterise immunosenescence profiles by clustering 13 baseline immunosenescence-related biomarkers of lymphocyte compartments in 657 participants; (b) explore the association between the profiles and 5-year change in muscle strength (grip strength) and physical performance (Timed Up-and-Go test), and (c) determine whether immunosenescence profiles predict 3-year incident sarcopenia. Two distinct clusters were identified; Cluster 1 ('Senescent-like phenotype', n = 421), and Cluster 2 ('Less senescent-like phenotype', n = 236) in individuals with complete biomarker data. Although Cluster 1 was characterised by T-cell senescence (e.g., higher frequency of CD4 and CD8 senescence-like effector memory cells), and elements of the immune risk profile (lower CD4/CD8 ratio, CMV+), it was not associated with change in muscle function over time, or with prevalent or incident sarcopenia. Future studies will determine whether more in-depth characterisation or change in T-cell phenotypes predict the decline in muscle health in late adulthood.

Feasibility and acceptability of a milk and resistance exercise intervention to improve muscle function in community-dwelling older adults (MIlkMAN): Pilot study

Background

Dietary protein supplementation combined with resistance exercise (RE) may counteract declines in muscle strength, mass, and function (sarcopenia), but the role of whole foods rich in protein, such as milk, is less well understood. In the MIlkMAN study, we aimed to examine the feasibility and acceptability of milk+RE as an intervention for muscle function in community-dwelling older adults, and provide exploratory pilot data for future substantive research in population at risk of sarcopenia.

Methods

In a parallel groups design, 30 older adults (71.7±3.6 years; 12 women) were randomised into three groups: WM (whole milk 3.6% fat)+RE, SM (skimmed milk 0.3% fat)+RE, and C (isocaloric carbohydrate drink)+RE. RE was performed twice-weekly over 6 weeks in a community gym, followed by the consumption of 500 ml of milk (~20 g protein) or carbohydrate drink immediately after exercise and a further 500 ml at home within the following 4–5 hours. The feasibility and acceptability of the study was determined by calculating recruitment and attendance rates, compliance with the intervention, rating participants’ experiences, and recording adverse health events.

Results

The response rate was 49% (out of 400 invitations sent), and the recruitment rate was 73.2% (30 participants recruited out of 41 screened for eligibility). Twenty-nine participants completed the intervention—an attendance rate of 97.1%; 89.7% rated their experience as ‘excellent’/very good’. Compliance with taking the drinks was 97.1% (WM), 98.3% (SM), and 95.0% (C); 93.1% rated their drink intake as ‘easy’/’very easy’ with no adverse effects. Collection of exploratory pilot data to inform future trials was successful. Mean change in grip strength, 5-chair rises, and gait speed were 0.9±3.4 kg, 1.8±2.2 s, 0.1±0.1 m/s, respectively with no differences between the groups.

Conclusions

This community-based milk+RE intervention was feasible and acceptable to older adults. The study successfully collected pilot data for future substantive research.

The feasibility of muscle mitochondrial respiratory chain phenotyping across the cognitive spectrum in Parkinson's disease

INTRODUCTION

There has been little work on the relationship between sarcopenia, a progressive skeletal muscle disorder, and age-related neurodegenerative diseases such as Parkinson's disease (PD).

OBJECTIVES

We aimed to determine: 1) the feasibility of characterizing skeletal muscle across a range of cognitive function in PD; 2) if muscle mitochondrial respiratory chain (MRC) function and content are preserved in older adults with PD.

METHODS

Sarcopenia was defined using handgrip strength, chair rise and bioimpedance analysis. MRC function was assessed using phosphorous magnetic resonance spectroscopy (MRS) by estimating τ_1/2 PCr (s) (phosphocreatine half-time recovery) in the calf muscles following a bout of aerobic exercise. Biopsy of the vastus lateralis muscle was performed, and MRC content assessed by fluorescent immunohistochemistry for porin and components of MRC Complexes I and IV.

RESULTS

Nine participants (78% male; mean age 79.9; PD duration 3.3 years) were recruited. Four had cognitive impairment. Six participants had probable sarcopenia. Eight participants completed MRS and had mean (SD) τ_1/2 PCr of 37.8 (7.6) seconds, suggesting preserved mitochondrial function. Muscle biopsies were obtained in all and the procedure was well tolerated. Porin Z-score, a proxy for mitochondrial mass, was lower than expected compared to controls (0-89% of fibres with low porin). There was a small amount of Complex I (0.16-4.59%) and Complex IV (0-3.79%) deficiency.

CONCLUSIONS

Detailed phenotyping, muscle biopsy and imaging was feasible and acceptable across a spectrum of cognitive function in PD. Sarcopenia was relatively common and may be associated with lower mitochondrial mass and low levels of MRC deficiency.

Study of the Older Adults' Motivators and Barriers Engaging in a Nutrition and Resistance Exercise Intervention for Sarcopenia: An Embedded Qualitative Project in the MIlkMAN Pilot Study

Objectives: The present study aimed to investigate motivators and barriers to older adults engaging in a nutrition and resistance exercise (RE) intervention for sarcopenia. Methods: We conducted a content analysis of structured interviews with 29 community-dwelling older adults (aged 65–80 years) completing the MIlk Intervention Muscle AgeiNg (MIlkMAN) study. Results: Content analysis revealed that self-perceived improved health, knowledge acquisition in nutrition and exercise, social well-being, professional support in a fun environment, and positive reported outcomes were motivators for engagement in the intervention. Peer encouragement, social bonds, and their retention were motivators to continuing engagement after study completion, especially in widowed women. Barriers to maintenance included affordability, environmental factors, and concerns over negative health outcomes. Discussion: Nutrition and RE interventions for sarcopenia should focus on knowledge acquisition about their health benefits, being enjoyable, and offering social opportunities that have the potential to last beyond the study duration to promote and maintain positive health behaviors.

Milk for Skeletal Muscle Health and Sarcopenia in Older Adults: A Narrative Review

Skeletal muscle aging manifests as a decline in muscle quantity and quality that accelerates with aging, increasing the risk of sarcopenia. Sarcopenia is characterized by a loss of muscle strength and mass, and contributes to adverse health outcomes in older adults. Intervention studies have shown that sarcopenia may be treated by higher protein intake in combination with resistance exercise (RE). In comparison, less is known about the role of whole protein-containing foods in preventing or treating sarcopenia. Liquid milk contains multiple nutrients and bioactive components that may be beneficial for muscle, including proteins for muscle anabolism that, alone or with RE, may have myoprotective properties. However, there is a lack of evidence about the role of milk and its effects on muscle aging. This narrative review considers evidence from three observational and eight intervention studies that used milk or fortified milk, with or without exercise, as an intervention to promote muscle health and function in older adults (aged 50–99 years). The observational studies showed no association between higher habitual milk consumption and muscle-related outcomes. The results of intervention studies using fortified milk in relation to elements of sarcopenia were also negative, with further inconclusive results from the studies using a combination of (fortified) milk and exercise. Although milk contains nutrients that may be myoprotective, current evidence does not show beneficial effects of milk on muscle health in older adults. This could be due to high habitual protein intakes (>1.0 g/kg BW/d) in study participants, differences in the type of milk (low-fat vs whole) and timing of milk consumption, length of interventions, as well as differences in the sarcopenia status of participants in trials. Adequately powered intervention studies of individuals likely to benefit are needed to test the effectiveness of a whole food approach, including milk, for healthy muscle aging.

Sarcopenia, long-term conditions, and multimorbidity: findings from UK Biobank participants

BACKGROUND

Sarcopenia, the loss of muscle strength and mass, predicts adverse outcomes and becomes common with age. There is recognition that sarcopenia may occur at younger ages in those with long-term conditions (LTCs) as well as those with multimorbidity (the presence of two or more LTCs), but their relationships have been little explored. Our aims were to describe the prevalence of sarcopenia in UK Biobank, a large sample of men and women aged 40-70 years, and to explore relationships with different categories of LTCs and multimorbidity.

METHODS

We used data from 499 046 participants in the baseline of UK Biobank. Our main outcome was probable sarcopenia based on maximum grip strength below sex-specific cut-points. Participants' LTCs were recorded during an interview and categorized against a hierarchy. We used logistic regression to examine the independent associations between each category of LTCs and probable sarcopenia, including adjustment for age, sex, and body mass index. We also examined the association with multimorbidity.

RESULTS

Probable sarcopenia had an overall prevalence of 5.3% and increased with age. The categories with the strongest associations with probable sarcopenia were musculoskeletal/trauma [OR 2.17 (95% CI: 2.11, 2.23)], endocrine/diabetes [OR 1.49 (95% CI: 1.45, 1.55)], and neurological/psychiatric [OR 1.39 (95% CI: 1.34, 1.43)] LTCs. Almost half of the sample (44.5%) had multimorbidity, and they were at nearly twice the odds of probable sarcopenia [OR 1.96 (95% CI: 1.91, 2.02)] compared with those without.

CONCLUSIONS

We have shown an overall prevalence of 5.3% of probable sarcopenia at ages 40-70 in UK Biobank. The risk of probable sarcopenia was higher in those with some categories of LTCs, suggesting that these groups may stand to benefit from assessment of sarcopenia, during mid-life as well as old age.

Nutrition and Muscle Strength, As the Key Component of Sarcopenia: An Overview of Current Evidence

Much has been achieved by recent research to increase understanding of the links between nutrition and muscle health. Focusing on muscle strength as the key component of sarcopenia, the aim of this overview was to evaluate its links to nutrition, both to variation in habitual diets in older populations, as well as considering supplementation effects in trials. A main message from the reviewed studies is that while many provide suggestive evidence of benefits of higher nutrient intakes and diets of higher quality, findings are inconsistent, and data on muscle strength are often lacking. To assess the potential of optimising diets as a strategy to promote and maintain muscle strength, gaps in current evidence need to be addressed. These include the need for (i) better understanding of individual differences in responsiveness to dietary change, and the need for targeted nutritional support; (ii) clearer distinction between protective and therapeutic actions of diet; and (iii) definition of the role of dietary patterns and their influence on muscle strength, to allow effects of changes in food consumption to be evaluated—particularly when combined with physical activity. Development of this evidence is needed to enable translation into appropriate dietary recommendations for older populations.

Protein intake and transitions between frailty states and to death in very old adults: the Newcastle 85+ study

Objectives

To examine the association of protein intake with frailty progression in very old adults.

Design

The Newcastle 85+ study, a prospective longitudinal study of people aged 85 years old in Northeast England and followed over 5 years.

Setting and Participants

668 community-dwelling older adults (59% women) at baseline, with complete dietary assessment and Fried frailty status (FFS).

Measures

Dietary intake was estimated with 2 × 24-h multiple pass recalls at baseline. FFS was based on five criteria: shrinking, physical endurance/energy, low physical activity, weakness and slow walking speed and was available at baseline and 1.5, 3 and 5 years. The contribution of protein intake (g/kg adjusted body weight/day [g/kg aBW/d]) to transitions to and from FFS (robust, pre-frail and frail) and to death over 5 years was examined by multi-state models.

Results

Increase in one unit of protein intake (g/kg aBW/d) decreased the likelihood of transitioning from pre-frail to frail after adjusting for age, sex, education and multimorbidity (hazard ratios [HR]: 0.44, 95% confidence interval [CI]: 0.25–0.77) but not for the other transitions. Reductions in incident frailty were equally present in individuals with protein intake ≥0.8 (HR: 0.60, 95% CI: 0.43–0.84) and ≥1 g/kg aBW/d (HR: 0.63, 95% CI: 0.44–0.90) from 85 to 90 years. This relationship was attenuated after adjustment for energy intake, but the direction of the association remained the same (e.g. g/kg aBW/d model: HR: 0.71, 95% CI: 0.36–1.41).

Conclusion

High protein intake, partly mediated by energy intake, may delay incident frailty in very old adults. Frailty prevention strategies in this age group should consider adequate provision of protein and energy.

Chromosome Instability and Mosaic Aneuploidy in Neurodegenerative and Neurodevelopmental Disorders

Evidence from multiple laboratories has accumulated to show that mosaic neuronal aneuploidy and consequent apoptosis characterizes and may underlie neuronal loss in many neurodegenerative diseases, particularly Alzheimer’s disease and frontotemporal dementia. Furthermore, several neurodevelopmental disorders, including Seckel syndrome, ataxia telangiectasia, Nijmegen breakage syndrome, Niemann–Pick type C, and Down syndrome, have been shown to also exhibit mosaic aneuploidy in neurons in the brain and in other cells throughout the body. Together, these results indicate that both neurodegenerative and neurodevelopmental disorders with apparently different pathogenic causes share a cell cycle defect that leads to mosaic aneuploidy in many cell types. When such mosaic aneuploidy arises in neurons in the brain, it promotes apoptosis and may at least partly underlie the cognitive deficits that characterize the neurological symptoms of these disorders. These findings have implications for both diagnosis and treatment/prevention.

Milk and resistance exercise intervention to improve muscle function in community-dwelling older adults at risk of sarcopenia (MIlkMAN): protocol for a pilot study

INTRODUCTION

Sarcopenia is a progressive muscle disorder characterised by decline in skeletal muscle mass, strength and function leading to adverse health outcomes, including falls, frailty, poor quality of life and death. It occurs more commonly in older people and can be accelerated by poor diet and low physical activity. Intervention studies incorporating higher dietary protein intakes or protein supplementation combined with resistance exercise (RE) have been shown to limit muscle function decline. However, less is known about the role of whole foods in reducing the risk of sarcopenia. Milk is a source of high-quality nutrients, which may be beneficial for skeletal muscle. This pilot study examines the feasibility and acceptability of milk consumption with RE to improve muscle function in community-dwelling older adults at risk of sarcopenia.

METHODS AND ANALYSIS

30 older adults aged ≥65 years will be randomly allocated to three groups: 'whole milk+RE', 'skimmed milk+RE' or 'control drink+RE'. Assessments will take place in participants' homes, including screening (milk allergies, grip strength, walking speed), baseline and postintervention health and function. All participants will undertake a structured RE intervention twice a week for 6 weeks at a local gym, followed by the consumption of 500 mL of whole or skimmed milk (each ~20 g of protein) or an isocaloric control drink and another 500 mL at home. Participants' views about the study will be assessed using standardised open-ended questions. The primary outcomes include feasibility and acceptability of the intervention with recruitment, retention and intervention response rates. Analyses will include descriptive statistics, exploration of qualitative themes and intervention fidelity.

ETHICS AND DISSEMINATION

Outputs include pilot data to support funding applications; public involvement events; presentation at conferences and peer-reviewed publication.

TRIAL REGISTRATION NUMBER

ISRCTN13398279; Pre-results.

Mediterranean diet adherence and cognitive function in older UK adults: the European Prospective Investigation into Cancer and Nutrition-Norfolk (EPIC-Norfolk) Study

BACKGROUND

In Mediterranean countries, adherence to a traditional Mediterranean dietary pattern (MedDiet) is associated with better cognitive function and reduced dementia risk. It is unclear if similar benefits exist in non-Mediterranean regions.

OBJECTIVES

The aims of this study were to examine associations between MedDiet adherence and cognitive function in an older UK population and to investigate whether associations differed between individuals with high compared with low cardiovascular disease (CVD) risk.

METHODS

We conducted an analysis in 8009 older individuals with dietary data at Health Check 1 (1993-1997) and cognitive function data at Health Check 3 (2006-2011) of the European Prospective Investigation into Cancer and Nutrition-Norfolk (EPIC-Norfolk). Associations were explored between MedDiet adherence and global and domain-specific cognitive test scores and risk of poor cognitive performance in the entire cohort, and when stratified according to CVD risk status.

RESULTS

Higher MedDiet adherence defined by the Pyramid MedDiet score was associated with better global cognition (β ± SE = -0.012 ± 0.002; P < 0.001), verbal episodic memory (β ± SE = -0.009 ± 0.002; P < 0.001), and simple processing speed (β ± SE = -0.002 ± 0.001; P = 0.013). Lower risk of poor verbal episodic memory (OR: 0.784; 95% CI: 0.641, 0.959; P = 0.018), complex processing speed (OR: 0.739; 95% CI: 0.601, 0.907; P = 0.004), and prospective memory (OR: 0.841; 95% CI: 0.724, 0.977; P = 0.023) was also observed for the highest compared with the lowest Pyramid MedDiet tertiles. The effect of a 1-point increase in Pyramid score on global cognitive function was equivalent to 1.7 fewer years of cognitive aging. MedDiet adherence defined by the Mediterranean Diet Adherence Screener (MEDAS) score (mapped through the use of both binary and continuous scoring) showed similar, albeit less consistent, associations. In stratified analyses, associations were evident in individuals at higher CVD risk only (P < 0.05).

CONCLUSIONS

Higher adherence to the MedDiet is associated with better cognitive function and lower risk of poor cognition in older UK adults. This evidence underpins the development of interventions to enhance MedDiet adherence, particularly in individuals at higher CVD risk, aiming to reduce the risk of age-related cognitive decline in non-Mediterranean populations.

Elevated Total Homocysteine in All Participants and Plasma Vitamin B12 Concentrations in Women Are Associated With All-Cause and Cardiovascular Mortality in the Very Old: The Newcastle 85+ Study

Background

Folate and vitamin B12 are keys to the correct functioning of one-carbon (1-C) metabolism. The current evidence on associations between 1-C metabolism biomarkers and mortality is inconclusive and generally based on younger or institutionalized populations. This study aimed to determine the associations between biomarkers of 1-C metabolism and all-cause and cardiovascular (CVD) mortality in the very old.

Methods

The Newcastle 85+ Study is a prospective longitudinal study of participants aged 85 at recruitment living in Northeast England. Baseline red blood cell folate (RBC folate), plasma vitamin B12, and total homocysteine (tHcy) concentrations were available for 752-766 participants. Associations between biomarkers of 1-C metabolism and all-cause and CVD mortality for up to 9 years were assessed by Cox proportional hazard models and confirmed by restricted cubic splines.

Results

Participants with higher tHcy concentrations had higher risk of death from any cause (hazard ratio [HR] [×10 μmol/L]: 1.24, 95% confidence interval [CI]: 1.10-1.41) and cardiovascular diseases (HR [×10 μmol/L]: 1.23, 95% CI: 1.04-1.45) than those with lower concentrations; and women with higher plasma vitamin B12 concentrations had increased risk of all-cause and cardiovascular mortality (HR [×100 pmol/L]: 1.10, 95% CI: 1.04-1.16) after adjustment for key sociodemographic, lifestyle, and health confounders.

Conclusion

Higher concentrations of tHcy in all participants and plasma vitamin B12 in women were associated with increased risk of all-cause and CVD mortality in the very old. This confirms findings for tHcy in younger populations but the adverse relationships between elevated plasma vitamin B12 concentrations and mortality in this setting are novel and require further investigation.

Factors associated with change in self-reported physical activity in the very old: The Newcastle 85+ study

BACKGROUND

Higher physical activity (PA) has been linked to better health and functioning. Trajectories of PA and associated factors have been studied in older adults aged ≥65, but less is known about influences on PA change in the very old (aged ≥85).

OBJECTIVE

To investigate factors associated with self-reported PA and PA change over time in very old adults.

METHODS

845 participants in the Newcastle 85+ Study were followed for health and functioning at 1.5-, 3-, and 5-year follow-up (wave 2 to 4). PA scores (range 0-18) and PA levels (low (PA scores 0-1), medium (2-6) and high (7-18)) were determined using a purpose-designed PA questionnaire. We used linear mixed models (LMM) to investigate factors associated with 5-year change in PA scores.

RESULTS

Overall, men had higher mean PA scores than women (up to 2.27 points). The highest proportion of participants (42-48%) had medium levels of PA across the waves. Although most experienced decline-stability in moderate and increases in high PA levels were also observed. The fully adjusted LMM revealed a curvilinear annual decline in PA scores of 0.52 (0.13) (β (SE), p<0.001), which decelerated by 0.07 (0.02) points (p<0.01) over time. The factors associated with low PA scores at baseline were female gender, higher waist-hip ratio, and no alcohol intake. Better self-rated and cognitive health and having fewer diseases were associated with higher PA scores. None were associated with the rate of change in PA over time.

CONCLUSION

We observed a curvilinear trend and deceleration in PA scores decline in the very old. Men and those in better health and who drank alcohol were more physically active at baseline. None of the factors were associated with the rate of PA decline. Investigating those who maintain or increase levels of PA may inform interventions for at risk groups with PA decline.

Dietary Patterns, Skeletal Muscle Health, and Sarcopenia in Older Adults

In recent decades, the significance of diet and dietary patterns (DPs) for skeletal muscle health has been gaining attention in ageing and nutritional research. Sarcopenia, a muscle disease characterised by low muscle strength, mass, and function is associated with an increased risk of functional decline, frailty, hospitalization, and death. The prevalence of sarcopenia increases with age and leads to high personal, social, and economic costs. Finding adequate nutritional measures to maintain muscle health, preserve function, and independence for the growing population of older adults would have important scientific and societal implications. Two main approaches have been employed to study the role of diet/DPs as a modifiable lifestyle factor in sarcopenia. An a priori or hypothesis-driven approach examines the adherence to pre-defined dietary indices such as the Mediterranean diet (MED) and Healthy Eating Index (HEI)—measures of diet quality—in relation to muscle health outcomes. A posteriori or data-driven approaches have used statistical tools—dimension reduction methods or clustering—to study DP-muscle health relationships. Both approaches recognise the importance of the whole diet and potential cumulative, synergistic, and antagonistic effects of foods and nutrients on ageing muscle. In this review, we have aimed to (i) summarise nutritional epidemiology evidence from four recent systematic reviews with updates from new primary studies about the role of DPs in muscle health, sarcopenia, and its components; (ii) hypothesise about the potential mechanisms of ‘myoprotective’ diets, with the MED as an example, and (iii) discuss the challenges facing nutritional epidemiology to produce the higher level evidence needed to understand the relationships between whole diets and healthy muscle ageing.

Effects of dietary patterns and low protein intake on sarcopenia risk in the very old: The Newcastle 85+ study

Background

Sarcopenia, a progressive age-related loss of skeletal muscle mass and strength, leads to disability, falls, and hospitalisation. Individual variation in sarcopenia onset may be partly explained by lifestyle factors such as physical activity and diet. Healthy dietary patterns (DPs) have been linked to better physical functioning in older adults, but their role in sarcopenia in the very old (aged ≥85) is unknown.

Aims

To investigate the association between DPs and the risk of sarcopenia over 3 years, and to determine whether protein intake influences this relationship in community-dwelling older adults from the Newcastle 85 + Study.

Methods

The analytic sample consisted of 757 participants (61.2% women) who had dietary assessment at baseline. After two-step clustering with 30 food groups to derive DPs, we used logistic regression to determine the risk of prevalent and incident sarcopenia across DPs in all participants, and in those with low (<1 g/kg adjusted body weight/day [g/kg aBW/d]) and good protein intake (≥1 g/kg aBW/d).

Results

We identified three DPs (DP1: ‘Low Red Meat’, DP2: ‘Traditional British’ and DP3: ‘Low Butter’) that varied by unsaturated fat spreads/oils, butter, red meat, gravy and potato consumption. Compared with participants in DP3, those in DP2 had an increased risk of prevalent (OR = 2.42, 95% CI: 1.15–5.09, p = 0.02) but not 3-year incident sarcopenia (OR = 1.67, 0.59–4.67, p = 0.33) adjusted for socio-demographic, anthropometry, health and lifestyle factors. Furthermore, DP2 was associated with an increased risk of prevalent sarcopenia at baseline (OR = 2.14, 1.01–4.53, p = 0.05) and 3-year follow-up (OR = 5.45, 1.81–16.39, p = 0.003) after adjustment for key covariates in participants with good protein intake.

Conclusion

A DP high in foods characteristic of a traditional British diet (butter, red meat, gravy and potato) was associated with an increased risk of sarcopenia even when overall protein intake was good. The results need to be replicated in other cohorts of the very old to understand the role of DPs in sarcopenia onset and management.

Prevalence and determinants of low protein intake in very old adults: insights from the Newcastle 85+ Study

PURPOSE

The very old (aged ≥ 85 years), fastest growing age group in most western societies, are at especially high risk of muscle mass and strength loss. The amount, sources and timing of protein intake may play important roles in the aetiology and management of sarcopenia. This study investigated the prevalence and determinants of low protein intake in 722 very old adults participating in the Newcastle 85+ Study.

METHODS

Protein intake was estimated with 2 × 24-h multiple pass recalls (24 h-MPR) and contribution (%) of food groups to protein intake was calculated. Low protein intake was defined as intake < 0.8 g of protein per adjusted body weight per day. A backward stepwise multivariate linear regression model was used to explore socioeconomic, health and lifestyle predictors of protein intake.

RESULTS

Twenty-eight percent (n = 199) of the community-living very old in the Newcastle 85+ Study had low protein intake. Low protein intake was less likely when participants had a higher percent contribution of meat and meat products to total protein intake (OR 0.97, 95% CI 0.95, 1.00) but more likely with a higher percent contribution of cereal and cereal products and non-alcoholic beverages. Morning eating occasions contributed more to total protein intake in the low than in the adequate protein intake group (p < 0.001). Being a woman (p < 0.001), having higher energy intake (p < 0.001) and higher tooth count (p = 0.047) was associated with higher protein intake in adjusted models.

CONCLUSION

This study provides novel evidence on the prevalence of low protein intake, diurnal protein intake patterns and food group contributors to protein intake in the very old.

Low protein intake, muscle strength and physical performance in the very old: The Newcastle 85+ Study

BACKGROUND

Low protein intake has been linked to reduced muscle strength and physical performance in older adults but little is known about how it may affect muscle health and subsequent functional decline in the very old (aged 85+), who are at enhanced risk of malnutrition and loss of muscle mass and strength.

AIMS

To investigate the associations between low protein intake, defined as the intake of <1 g protein/kg adjusted body weight/day (<1 g/kg aBW/d) and decline in muscle strength and physical performance in the very old.

METHODS

The analytic sample consisted of 722 community-dwelling participants (60% women) from the Newcastle 85+ Study who had protein intake at baseline. Participants were followed-up for change in grip strength (GS) and Timed Up-and-Go (TUG) test over 5 years (baseline, 18, 36, and 60 months). We used mixed models to determine the effects of low protein intake on muscle strength and physical performance in all participants, and also stratified by sex.

RESULTS

At baseline, 390 (54%) participants (261 women, p < 0.001) reported low protein intake, and these differed from participants with good intake (≥1 g/kg aBW/d) on several measures of health and function. In the model adjusted for protein intake, consuming <1 g/kg aBW/d of protein was associated with a 1.62 kg lower GS (p = 0.008) in all participants, and especially in women (β (SE) = -0.83 (0.41), p = 0.05) after adjusting for key baseline covariates (anthropometry, multimorbidity, arthritis in hands, cognitive status and physical activity). The rate of decline in GS over 5 years was not associated with protein intake. Women, but not men, with low protein intake had worse baseline TUG (β (SE) = 0.04 (0.02), p = 0.03) compared with those with good protein intake in the fully adjusted model, but the rate of decline in TUG was not affected by daily protein status.

CONCLUSIONS

Intake of <1 g protein/kg aBW/d may negatively affect muscle strength and physical performance in late life, especially in older women, independently of important covariates. More research is needed in the very old to define the optimal protein intake for maintenance of muscle health and function.

Protein Intake and Disability Trajectories in Very Old Adults: The Newcastle 85+ Study

Objectives

To determine whether protein intake is associated with better disability trajectories in the oldest adults (≥85) and whether muscle mass and muscle strength would partially mediate this.

Design

Prospective cohort study.

Setting

Newcastle‐upon‐Tyne and North Tyneside, United Kingdom.

Participants

Community‐dwelling older adults aged 85 at baseline (N=722).

Methods

Protein intake was estimated using two 24‐hour multiple‐pass recalls at baseline. Disability was measured as difficulty performing 17 activities of daily living at baseline and 18, 36, and 60 months. Trajectories were derived using mortality‐adjusted group‐based trajectory modelling. The effect of protein intake (g/kg of adjusted body weight (aBW)/d) on disability trajectories was examined using multinomial logistic regression.

Results

Participants had 4 distinct disability trajectories (between the ages of 85 and 90: constant very low (AT1), mild (AT2), moderate (AT3), and severe (AT4). Each unit increase in protein (g) per kg of aBW/d was associated with greater odds of AT1 (odds ratio (OR=7.97, 95% confidence interval (CI)=1.96–32.43, p = .004) and AT2 (OR=3.28, 95% CI=1.09–9.87, p = .03) than of AT4 over 5 years in models adjusted for selected covariates. Participants with protein intake of 1.0 g/kg aBW/d or more were more likely to belong to AT1 (OR=3.65, 95% CI=1.59–8.38, p = .009) and AT2 (OR=2.12, 95% CI=1.16–3.90, p = .01) than to AT4.

Conclusion

Higher protein intake, especially 1.0 g/kg aBW/d or more, was associated with better disability trajectories in the oldest adults. These findings will inform new dietary strategies to support active, healthy ageing. J Am Geriatr Soc 67:50–56, 2019.

Mitochondrial respiratory chain function and content are preserved in the skeletal muscle of active very old men and women

Introduction

The loss of mitochondrial function and content have been implicated in sarcopenia although they have been little studied in the very old, the group in which sarcopenia is most common. In this pilot study, our aim was to determine if mitochondrial respiratory chain function and content are preserved among healthy 85-year-olds.

Methods

We recruited 19 participants (11 female) through their general practitioner and assessed their medical history, functional status and self-reported physical activity. We identified sarcopenia using grip strength, Timed Up-and-Go and bioimpedance analysis. We assessed mitochondrial respiratory chain function using phosphorous magnetic resonance spectroscopy, estimating τ_1/2 PCr, the recovery half-time of phosphocreatine in the calf muscles following a bout of aerobic exercise. We performed a biopsy of the vastus lateralis muscle and assessed mitochondrial respiratory chain content by measuring levels of subunits of complex I and IV of the respiratory chain, expressed as Z-scores relative to that in young controls.

Results

Participants had a median (IQR) of 2 (1,3) long-term conditions, reported regular aerobic physical activity, and one participant (5.3%) had sarcopenia. Sixteen participants completed the magnetic resonance protocol and the mean (SD) τ_1/2 PCr of 35.6 (11.3) seconds was in keeping with preserved mitochondrial function. Seven participants underwent muscle biopsy and the mean fibre Z-scores were −0.7 (0.7) and −0.2 (0.4) for complexes I and IV, respectively, suggesting preserved content of mitochondrial respiratory chain enzymes.

Conclusion

Muscle mitochondrial respiratory chain function and content are preserved in a sample of active, well-functioning 85-year-olds, among whom sarcopenia was uncommon. The results from this study will help inform future work examining the association between muscle mitochondrial deficiency and sarcopenia.

Factors Associated With Physical Performance Measures in a Multiethnic Cohort of Older Adults

Objective: To explore the association between ethnicity, sociodemographic, health, and lifestyle factors, and physical performance (PP) in ethnically diverse community-dwelling older adults from one geographic area. Method: We used multivariable linear regression to identify factors associated with upper (grip strength [GS], arm curls [AC]) and lower (chair stands [CS]) body strength and mobility (gait speed [GSp]) in 577 older adults (mean age 74 ± 8; 104 African American, 142 Afro-Caribbean, 123 Hispanic, and 208 European American) from South Florida. Results: Worse mental health was negatively associated with CS in African Americans and AC in Hispanics. Older age and higher body mass index (BMI) was associated with slower GSp in all except in Hispanics. Higher physical activity was associated with higher upper body strength in Hispanics and better mobility in African Americans and Afro-Caribbeans, but not in European Americans. Conclusion: Studies with large multiethnic cohorts are needed to further our understanding of ethnic differences in PP, which will help in tailoring interventions and recognizing unmet needs for health and social services.