Intrinsic capacity and hospitalization among older adults: a nationally representative cross-sectional study

PURPOSE

Monitoring intrinsic capacity (IC) in community-dwelling older people can be potentially used to alert for adverse health outcomes. However, whether there is an association between IC and hospitalization has yet to be fully explored. This study aimed to investigate the association of the IC composite measure and its 5 domains with hospitalization in the previous year and length of hospital stay.

METHODS

We conducted cross-sectional analyses using data from a representative sample of community-dwelling adults (≥ 65 years). We assessed the IC domains (vitality, locomotor, cognitive, sensory, and psychological) using validated self-reported information and performance tests. We calculated standardized estimated scores (z scores) for IC composite measure and domains and conducted multivariate logistic and ordinal regressions. The primary outcomes were hospitalizations in the previous year and length of hospital stay.

RESULTS

In a sample of 5354 participants (mean age = 73 ± 6 years), we found that participants with high IC composite z scores were less likely to have experienced hospitalization in the previous year (OR = 0.51; 95% CI = 0.44-0.58). Among those who were hospitalized, high IC scores were associated with short stays (OR = 0.87; 95% CI = 0.80-0.95). Cognitive and psychological domains were associated with hospitalizations, and the locomotor domain was related to length of hospital stay. The vitality domain was associated with both outcomes.

CONCLUSION

IC as a composite measure was associated with previous hospitalizations and length of stay. IC can help clinicians identify older people prone to adverse outcomes, prompting preventive integrated care interventions.

Effect of Dietary Supplementation with Omega-3 Fatty Acid on the Generation of Regulatory T Lymphocytes and on Antioxidant Parameters and Markers of Oxidative Stress in the Liver Tissue of IL-10 Knockout Mice

INTRODUCTION

chronic low-grade inflammation, or inflammaging, emerges as a crucial element in the aging process and is associated with cardiovascular and neurological diseases, sarcopenia, and malnutrition. Evidence suggests that omega-3 fatty acids present a potential therapeutic agent in the prevention and treatment of inflammatory diseases, mitigating oxidative stress, and improving muscle mass, attributes that are particularly relevant in the context of aging. The objective of the present study was to evaluate the effectiveness of supplementation with omega-3 fish oil in improving the immune response and oxidative stress in knockout mice for interleukin IL-10 (IL-10-/-).

MATERIAL AND METHODS

female C57BL/6 wild-type (WT) and interleukin IL-10 knockout (IL-10-/-) mice were fed during 90 days with a standard diet (control groups), or they were fed/supplemented with 10% of the omega-3 polyunsaturated fatty acid diet (omega-3 groups). Muscle, liver, intestinal, and mesenteric lymph node tissue were collected for analysis.

RESULTS

the IL-10-/-+O3 group showed greater weight gain compared to the WT+O3 (p = 0.001) group. The IL-10-/-+O3 group exhibited a higher frequency of regulatory T cells than the IL-10-/- group (p = 0.001). It was found that animals in the IL-10-/-+O3 group had lower levels of steatosis when compared to the IL-10-/- group (p = 0.017). There was even greater vitamin E activity in the WT group compared to the IL-10-/-+O3 group (p = 0.001) and WT+O3 compared to IL-10-/-+O3 (p = 0.002), and when analyzing the marker of oxidative stress, MDA, an increase in lipid peroxidation was found in the IL-10-/-+O3 group when compared to the IL-10-/- group (p = 0.03). Muscle tissue histology showed decreased muscle fibers in the IL-10-/-+O3, IL-10-/-, and WT+O3 groups.

CONCLUSION

the findings show a decrease in inflammation, an increase in oxidative stress markers, and a decrease in antioxidant markers in the IL-10-/-+O3 group, suggesting that supplementation with omega-3 fish oil might be a potential intervention for inflammaging that characterizes the aging process and age-related diseases.

Comparison of total daily energy expenditure with dietary reference intakes values in a sample of urban, relatively active Brazilian adults: A doubly labeled water study

OBJECTIVE

This report aimed to describe the results of total daily energy expenditure (TDEE) assessed by doubly labeled water (DLW TDEE) and the adequacy of the dietary reference intakes (DRI) equations to estimate energy requirements (DRI ER).

METHODS

A cross-sectional and observational study in a convenience sample of 40 healthy Brazilian adults (≥20 years; 21 women) living in a tropical urban region. Basal metabolic rate (BMR) was measured by indirect calorimetry, DLW TDEE was compared with DRI ER using individual calculated physical activity level (PAL = DLW TDEE/BMR) in its estimation.

RESULTS

BMR (5043 ± 548 kJ/day in women and 6213 ± 656 kJ/day in men), DLW TDEE (8372 ± 1324 kJ/day and 11 453 ± 1834 kJ/day), and PAL (1.66 ± 0.17 and 1.85 ± 0.30, respectively) were significantly higher in men. The DRI ER significantly overestimated DLW TDEE by 13.7 ± 8.3% and 12.7 ± 10.7% in women and men, respectively.

CONCLUSION

In the present sample of relatively active urban Brazilian subjects, the DRI ER yielded inaccurate estimation of DLW TDEE. More data from low- and moderate-income countries are necessary to develop accurate estimates of TDEE.

Adequacy of the "pocket formulas" for measuring total energy expenditure in healthy women compared with the new DRI equation: A doubly labeled water study

OBJECTIVES

"Pocket formulas" are practical alternatives for calculating an individual's total energy expenditure (TEE). Typically, more sophisticated predictive equations are used, such as the new equations proposed in the Dietary Reference Intakes (DRI). Nevertheless, these new equations necessitate estimating physical activity levels (PALs). The aim of this study was to compare the use of pocket formulas (kcal/kg of body weight) with the new predictive equations for energy expenditure proposed by the DRI (2023) in healthy women and with the doubly labeled water (DLW) method to predict TEE.

METHODS

The TEEs of healthy adult women were measured by DLW and calculated using the pocket formulas (× 20, × 25, × 30, and × 35 kcal/kg of body weight) and the new DRI equation. PALs by triaxial accelerometers were also collected.

RESULTS

The study included 55 women. For the entire sample, the × 30 pocket formula had the lowest bias (-6%; limits of agreement [LOAs]: -39.8; 27.5; root mean square error: 373.4) and the highest precision (42%). The pocket formulas showed reasonable agreement in the different body mass index categories compared with the results found by the 2023 DRI proposal. For individuals with normal weight, the agreement was × 35 kcal/kg: bias (%) = -4.8; LoA = -41.5; 31.8, with overweight, it was × 30 kcal/kg: bias (%) = -2.2; LoA = -25.1; 20.6, and with obesity, it was × 30 kcal/kg: bias (%) = 4.2; LoA = -21.1; 29.4.

CONCLUSION

Pocket formulas provide a reasonable agreement with TEE in healthy, sedentary, or low-active adult women, which may be a more simplistic strategy when there is no PAL data for calculating the DRI equations.

The sensitivity and specificity of the WHO's ICOPE screening tool, and the prevalence of loss of intrinsic capacity in older adults: A scoping review

BACKGROUND

The World Health Organization has developed the Integrated Care for Older People (ICOPE) program, a public health strategy to maintain older adults' functional abilities and promote healthier aging. The approach comprises a 5-step pathway. Step 1 is the screening for impairment in functions, and Step 2 is an in-depth evaluation to confirm the presence and severity of functional impairment. These initial two steps are crucial to determine the subsequent plan of care (Step 3) and follow-up (Step 4). The fifth step encompasses actions to support families and caregivers and to engage communities. This review gathers data from the literature on the prevalence of positive screenings regarding intrinsic capacity detected by the program's first-step screening tool, and on currently available results regarding the instrument's sensitivity and specificity.

METHODS AND FINDINGS

Electronic searches were conducted in the PubMed, Cochrane, Embase, and SciElo databases, the medRxiv platform, and recent human aging scientific events, looking for research analyzing the ICOPE screening instrument. Studies reporting data on the prevalence of positive screenings for loss of intrinsic capacity using the proposed screening tool and/or findings on the instrument's sensitivity and specificity were included. A total of 7 publications with participants aged 50 years or more were selected. The prevalence of at least one impairment in intrinsic capacity detected by the instrument varied among the studies from 17.1 % to 94.3 %. Sensitivity ranged from 26.4 % to 100 % and specificity from 22 % to 96 %, depending on the setting and the assessed domain.

CONCLUSION

Currently available data are heterogeneous, and different results were found among the studies due to diverse settings and methodologies. The evidence on the ICOPE screening tool's performance in different populations is still scarce and reinforces the need for further research worldwide.

Ten years of a geriatric oncology service at a public university cancer centre in Brazil

The implementation of a geriatric oncology service is challenging in both high-income and low-and-middle-income countries. The Octavio Frias de Oliveira Institute of Cancer of Sao Paulo (ICESP) is a tertiary healthcare complex of the Clinics Hospital of the University of Sao Paulo Medical School and is considered a model of excellence in oncology in Latin America. The objective of this manuscript is to describe 10 years of the geriatric oncology service at ICESP and the challenges for its implementation. We performed a narrative description of the ICESP's geriatric oncology service and a general retrospective descriptive analysis of data collected from routine structured medical records of patients referred to the service from 2011 to 2021. This article highlights the different settings in which the service operates (outpatient, pre-operative and hospital follow-up). In this period, 1,700 patients were assessed for preoperative evaluation (median age 83.9, SD 4.95), 468 patients were evaluated for therapeutic decision (median age 79.4, SD 7.38), 968 in general geriatric oncology care outpatient clinics from 2012 to 2021 (median age 78.7, SD 7.91) and 1,391 inpatient evaluations. In the past 10 years, our geriatric oncology team has grown exponentially and changed its characteristics in order to adjust them to the hospital demands, raising awareness among the oncology teams about the benefit of using geriatric assessment and promoting multidisciplinary discussions.

Sleep quality is a predictor of muscle mass, strength, quality of life, anxiety and depression in older adults with obesity

We aimed to investigate associations between sleep quality with selected quantitative and qualitative parameters of health in older individuals with obesity. Cross-sectional assessment (n = 95 men/women; ≥ 65 years; BMI ≥ 30 kg/m²) of sleep quality, body composition, handgrip strength, quality-of-life, anxiety/depression. Mean PSQI score was 6.3. Poor sleepers (n = 49) presented lower appendicular lean mass (ALM) (16.2 vs 17.8 kg; p = 0.0273), ALM/BMI (0.47 vs 0.53 kg/BMI; p = 0.0085), fat mass (48.6 vs 46.6%; p = 0.0464), handgrip strength (19.7 vs 22.0 kgf; p = 0.0542) and handgrip/BMI (0.57 vs 0.66 kgf/BMI; p = 0.0242) than good sleepers. They also had higher anxiety (8.6 vs 5.6; p = 0.0100) and depression (4.8 vs 3.2; p = 0.0197) scores, worse health-related quality-of-life and lower scores in mental (62.8 vs 73.0; p = 0.0223) and physical (52.9 vs 67.3; p = 0.0015) domains. Adjusted models showed that PSQI was negatively associated with ALM (β = - 0.13, 95% CI - 0.25; - 0.01) and health-related quality of life on physical (β = - 2.76, 95% CI - 3.82; - 1.70) and mental (β = - 2.25, 95% CI - 3.38; - 1.12) domains, and positively associated with anxiety (β = 0.57; 95% CI 0.26; 0.87) and depression (β = 0.31; 95% CI 0.13; 0.49). Poor sleep quality associates with impaired selected quantitative and qualitative parameters of health. Additionally, sleep quality was shown as an independent predictor of ALM, health-related quality-of-life, anxiety and depression in older individuals with obesity.

Mirtazapine versus Megestrol in the Treatment of Anorexia-Cachexia Syndrome in Patients with Advanced Cancer: A Randomized, Double-Blind, Controlled Phase II Clinical Trial

This study compared mirtazapine with megestrol in the management of cancer-related anorexia-cachexia syndrome in patients with advanced cancer. A randomized, double-blind, controlled clinical trial involving patients with advanced cancer and anorexia-cachexia syndrome was performed. Participants received mirtazapine 30 mg/day or megestrol 320 mg/day for eight weeks. The primary endpoint was the effect of mirtazapine on weight gain and the secondary endpoints were its effect on appetite, muscle strength, physical performance, body composition, adverse events, and medication adherence. Linear regression model with mixed effects was applied and a significance level of 5% was adopted. Fifty-two patients were randomized. Mean age was 65.8 ± 8.4 years. There was weight gain in 52% of the participants in the megestrol group and in 38% in the mirtazapine group after four weeks (p = 0.040). Appetite improved in 92% of the participants in the megestrol group and in 56% in the mirtazapine group after eight weeks (p = 0.007). In the sub-analysis by sex, women showed improvement in appetite (p < 0.001) and weight gain (p < 0.005) in the mirtazapine group, which was not observed in men. Mirtazapine appears to be inferior to megestrol in weight and appetite improvement. However, there may be a difference in the therapeutic response between sexes.

Intrinsic labelling of common beans with 2H2O to enable estimates of protein digestibility

BACKGROUND

The use of plant protein intrinsically labelled with stable isotopes provides an innovative solution to assess the efficiency of protein intake by humans. Here, the incorporation of 2H has been applied to intrinsically labelled plant protein in the common bean. This study aimed to evaluate which is the best phenological phase of seed maturation to incorporate the heavy hydrogen isotope 2H into seed amino acids. Common beans (Phaseolus vulgaris L.) were grown in pots, then, after 50 days sowing, 2H2O dissolved in irrigation water was applied, then again at an interval of either 3, 6, 9, and 12 days.

RESULTS

Applications of 2H2O at 6, 9, and 12 days after the first application, in the full-flowering stage, were the best treatments for enriching protein-bound amino acids in the bean seed with 2H.

CONCLUSION

All treatments resulted in enrichment above 500 ppm, so the treatments (quantity and timing of 2H2O addition) were deemed successful for enriching bean seeds. This makes the intrinsically labelled seeds suitable for preparing test meals to assess the digestion and essential amino acid absorption of common bean amino acids in human subjects.

Use of the activPAL® triaxial accelerometer to estimate total energy expenditure in low-income women: differences between body mass index classifications

Objective

This study aimed to assess the agreement between the total energy expenditure (TEE) estimated by the activPAL® triaxial accelerometers (ACC) and the TEE measured by the doubly labeled water method (DLW), as well as to assess if these values differ between the classifications of body mass index (BMI).

Materials and methods

This is a cross-sectional study. Low-income adult women (19-45y) with BMI ≥ 18.5 kg/m2 were included. Accelerometry data (activPAL® ) were collected over 7 consecutive days, which were used to calculate TEE-ACC and compared with DLW data. The Bland-Altman method, concordance correlation coefficient and root mean square error were used to assess agreement between methods.

Results

The sample consisted of 55 women with a mean age of 31 ± 5 years. The agreement between TEE-ACC and TEE-DLW showed a bias of -142.5 kcal (-7.1%). Among the BMI classifications, participants with normal weight show a bias of -417.1 kcal (-21.0%), participants with overweight, -87.5 kcal (-3.9%) and participants with obesity, 97.5 kcal (4.3%). Furthermore, the bias between the methods showed a significant and positive correlation with the body weight (r = 0.49; p < 0.01).

Conclusion

The TEE-ACC estimates from activPAL® were reasonably accurate when compared to the TEE-DLW, especially in women with overweight and obesity, being much less accurate in individuals with normal weight.

Body fat, cardiovascular risk factors and polymorphism in the FTO gene: randomized clinical trial and different physical exercise for adolescents

OBJECTIVE

To investigate the effects of different physical exercise programs and polymorphisms of the FTO (fat mass and obesity-associated gene) on body composition and cardiovascular risk factors in adolescents with overweight and obesity.

METHODS

A randomized, parallel, double-blind clinical trial consisting of the adolescent overweight from the state public network, in a simple representative random sample, who participated in an aerobic exercise or weight training intervention for 10 weeks. Anthropometry, body composition, biochemical markers, sexual maturation, and rs9939609 polymorphism in the FTO gene were assessed. 347 adolescents had their characterization of nutritional status. 72 individuals with overweight and obesity were invited to participate. 39 remained for the start of the program and were randomly allocated to both types of intervention. In the end, 26 subjects participated in the intervention programs, with 12 and 14 in the aerobic and weight training programs, respectively.

RESULTS

Heterozygous and homozygous bearers of risk allele A participating in the aerobic program showed improvements in glycemia (p = 0.002) and total cholesterol (p = 0.023) and a reduction in body fat mass (p = 0.041). The weight training program reduced glycemia in patients with the risk allele A (p = 0.027). Cameron's stage four sexual maturation participants were 2.1 times more likely to improve their body fat (CI = 1.31-3.39).

CONCLUSION

Aerobic exercises produced exclusively a significant decrease in fat mass and total cholesterol in patients with risk allele A. Distinct physical exercise programs may cause diverse changes in risk variables related to the health of adolescents.

Multicompartment body composition analysis in older adults: a cross-sectional study

BACKGROUND

During aging, changes occur in the proportions of muscle, fat, and bone. Body composition (BC) alterations have a great impact on health, quality of life, and functional capacity. Several equations to predict BC using anthropometric measurements have been developed from a bi-compartmental (2-C) approach that determines only fat mass (FM) and fat-free mass (FFM). However, these models have several limitations, when considering constant density, progressive bone demineralization, and changes in the hydration of the FFM, as typical changes during senescence. Thus, the main purpose of this study was to propose and validate a new multi-compartmental anthropometric model to predict fat, bone, and musculature components in older adults of both sexes.

METHODS

This cross-sectional study included 100 older adults of both sexes. To determine the dependent variables (fat mass [FM], bone mineral content [BMC], and appendicular lean soft tissue [ALST]) whole total and regional dual-energy X-ray absorptiometry (DXA) body scans were performed. Twenty-nine anthropometric measures and sex were appointed as independent variables. Models were developed through multivariate linear regression. Finally, the predicted residual error sum of squares (PRESS) statistic was used to measure the effectiveness of the predicted value for each dependent variable.

RESULTS

An equation was developed to simultaneously predict FM, BMC, and ALST from only four variables: weight, half-arm span (HAS), triceps skinfold (TriSK), and sex. This model showed high coefficients of determination and low estimation errors (FM: R²_adj: 0.83 and SEE: 3.16; BMC: R²_adj: 0.61 and SEE: 0.30; ALST: R²_adj: 0.85 and SEE: 1.65).

CONCLUSION

The equations provide a reliable, practical, and low-cost instrument to monitor changes in body components during the aging process. The internal cross-validation method PRESS presented sufficient reliability in the model as an inexpensive alternative for clinical field use.

Acute Muscle Mass Loss Predicts Long-Term Fatigue, Myalgia, and Health Care Costs in COVID-19 Survivors

OBJECTIVE

We examined the impact of loss of skeletal muscle mass in post-acute sequelae of SARS-CoV-2 infection, hospital readmission rate, self-perception of health, and health care costs in a cohort of COVID-19 survivors.

DESIGN

Prospective observational study.

SETTING AND PARTICIPANTS

Tertiary Clinical Hospital. Eighty COVID-19 survivors age 59 ± 14 years were prospectively assessed.

METHODS

Handgrip strength and vastus lateralis muscle cross-sectional area were evaluated at hospital admission, discharge, and 6 months after discharge. Post-acute sequelae of SARS-CoV-2 were evaluated 6 months after discharge (main outcome). Also, health care costs, hospital readmission rate, and self-perception of health were evaluated 2 and 6 months after hospital discharge. To examine whether the magnitude of muscle mass loss impacts the outcomes, we ranked patients according to relative vastus lateralis muscle cross-sectional area reduction during hospital stay into either "high muscle loss" (-18 ± 11%) or "low muscle loss" (-4 ± 2%) group, based on median values.

RESULTS

High muscle loss group showed greater prevalence of fatigue (76% vs 46%, P = .0337) and myalgia (66% vs 36%, P = .0388), and lower muscle mass (-8% vs 3%, P < .0001) than low muscle loss group 6 months after discharge. No between-group difference was observed for hospital readmission and self-perceived health (P > .05). High muscle loss group demonstrated greater total COVID-19-related health care costs 2 ($77,283.87 vs. $3057.14, P = .0223, respectively) and 6 months ($90,001.35 vs $12, 913.27, P = .0210, respectively) after discharge vs low muscle loss group. Muscle mass loss was shown to be a predictor of total COVID-19-related health care costs at 2 (adjusted β = $10, 070.81, P < .0001) and 6 months after discharge (adjusted β = $9885.63, P < .0001).

CONCLUSIONS AND IMPLICATIONS

COVID-19 survivors experiencing high muscle mass loss during hospital stay fail to fully recover muscle health. In addition, greater muscle loss was associated with a higher frequency of post-acute sequelae of SARS-CoV-2 and greater total COVID-19-related health care costs 2 and 6 months after discharge. Altogether, these data suggest that the loss of muscle mass resulting from COVID-19 hospitalization may incur in an economical burden to health care systems.

Self-management strategies and multicomponent training to mitigate the effects of the interruption of physical exercise programmes in the pandemic context on functionality, sedentary behaviour, physical capacity, mental health, body composition and quality of life in older adults: a blinded randomized controlled study protocol

Background

Considering the confinement recommended by the World Health Organization due to the pandemic caused by COVID-19, many community physical exercise programmes for older adults have had their activities cancelled. In this context, proposing strategies to recover the possible adverse effects of the confinement period is pertinent. The use of self-management strategies associated with regular physical activity reduces sedentary behaviour and improves physical capacity in older adults. Thus, the purpose of this study was to describe a multicomponent training programme combined with a self-management strategy protocol to mitigate the effects of interruptions in physical exercise programmes on functionality, physical capacity, mental health, body composition and quality of life in older adults.

Methods

This will be a blinded, randomized and controlled clinical trial performed in São Carlos, SP, Brazil. Eighty older adults will be divided into two groups: multicomponent training (Multi) and multicomponent training + self-management strategies (Multi+SM). The intervention will be performed over 16 weeks on three alternate days of every week, with 50-min sessions. The assessment of physical capacity will be performed before the interruption of physical exercise programmes (T0: initial assessment, March 2020), preintervention (T1: immediately after the return of the exercise programme) and postintervention (T2). The assessments of physical activity level, quality of life, mental health, functionality and body composition will be performed at T1 and T2.

Discussion

The results from this MC+SM protocol will allow us to contribute clinical support to evaluate the variables analysed and to guide future public health policies with the aim of minimizing the possible deleterious effects arising from the physical exercise interruption periods caused by epidemics and pandemics.

Trial registration

RBR-10zs97gk. Prospectively registered in Brazilian Registry of Clinical Trials (ReBEC) on 17 June 2021. Registry name: Use of self-management strategies combined with multicomponent training to mitigate the effects of social distancing due to COVID-19 on capacity, physical capacity, mental health and quality of life in older adults - A blind, randomized and controlled clinical trial.

Association between classic and specific bioimpedance vector analysis and sarcopenia in older adults: a cross-sectional study

Background

To verify (1) the association between classic and specific bioelectrical impedance vector analysis (BIVA) with body composition, hydration, and physical performance in older adults with and without sarcopenia; (2) which BIVA most accurately distinguishes sarcopenia.

Methods

A sample of 94 older adults with and without sarcopenia (29 men and 65 women, 60–85 years) was evaluated. The classic and specific BIVA procedures, Dual energy X-ray absorptiometry (DXA), and deuterium dilution were performed. Sarcopenia was defined by muscle weakness and low skeletal muscle index, while severity was indicated by low physical performance.

Results

The BIVA's potential to monitor hydration and muscle mass loss in older adults seems feasible. Classic and specific BIVA were able to distinguish sarcopenia in women (p < 0.001), but not in men. When the sarcopenia criteria were individually analyzed, both classic and specific BIVA were able to distinguish low skeletal muscle index in women, while only classic BIVA did for men. For the criterion of slow physical performance, only the classic BIVA showed severity differences for women. The vectors of adults without sarcopenia of both sexes tended to be positioned in the left region of the ellipses, revealing a predominance of soft tissues.

Conclusions

Classic BIVA has a distinct sarcopenic association with body composition, hydration, and physical performance in older adults, while specific BIVA was similar between groups. Both BIVAs are sensible to detect female morphological changes (skeletal muscle index) but not for functional (handgrip, 6-min walk test) sarcopenia criteria. These procedures are promising tools for monitoring sarcopenia risks during aging.

Randomised Controlled Trial of Fish Oil Supplementation on Responsiveness to Resistance Exercise Training in Sarcopenic Older Women

This study aims to investigate the effects of fish oil supplementation on the muscle adaptive response to resistance exercise training, physical performance and serum levels of inflammatory cytokines in sarcopenic older women. A randomised, double-blind, placebo-controlled trial is performed with thirty-four sarcopenic women (2010 European Consensus of Sarcopenia), aged ≥ 65 years. The participants are allocated into the following two groups: Exercise and Fish Oil (EFO) and Exercise and Placebo (EP). Both groups undertook a resistance exercise programme over 14 weeks. All participants are instructed to ingest 4 g/day of food supplements; the EP group received sunflower oil capsules, and the EFO group, fish oil capsules. The cross-sectional area (CSA) of the quadriceps muscle is calculated using magnetic resonance imaging (MRI). The strength of the lower limbs is measured using isokinetic dynamometry. Both groups show improvements in CSA and strength after the intervention. Changes in EFO are significantly greater compared with EP for muscle strength (peak torque, 19.46 Nm and 5.74 Nm, respectively, p < 0.001). CSA increased after the intervention in both groups (EFO; 6.11% and EP; 2.91%), although there is no significant difference between the groups (p = 0.23). There are no significant intra-group, inter-group or time differences in any of the cytokines measured. The use of fish oil supplementation potentiates the neuromuscular response to the anabolic stimulus from training, increasing muscle strength and physical performance in sarcopenic older women.

The relationship between total energy expenditure and physical activity level in women living in an impoverished Brazilian urban area

OBJECTIVE

This study aimed to describe how strong is the relationship between TEE and PAL in women living in an impoverished Brazilian urban area.

METHODS

Anthropometric, hormonal (insulin, TSH, FT₄ , and FT₃ ), body composition (deuterium), TEE (doubly labeled water) and PAL (metabolic equivalent task [MET]-7-day triaxial accelerometer, ActivPAL®) data were collected from 55 women (mean age: 31y, mean BMI: 27.4 kg/m² ). Adjusted-TEE models were calculated incorporating the residuals of anthropometric, hormonal, and body composition variables in the TEE, to assess the relation between MET and adjusted-TEE, through three different analyzes: linear regression, nonlinear regression and change-point regression.

RESULTS

Most participants (89.1%, n = 49) were classified as low-active. There was no association between crude TEE and MET.h/d (R²  = 0.05; p = 0.09). There was a positive, although weak, linear relationship between adjusted-TEE and MET.h/d (β = 2705.26 kcal; 95% CI: 436.25; 4974.27; adj-R²  = 0.08). A change point of this relationship was identified in the MET.h/d value of 1.53 (SD = 0.02; adj-R² = 0.13). The association between adjusted-TEE and MET.h/d before the change point (β = 5101.46 kcal; 95%CI: 978.84; 9224.08; adj-R²  = 0.11) was stronger than the association in the full linear model, nevertheless, it was still weak. This association stop existing when it is assessed in individuals after the change point (β = -6609.92 kcal; 95%CI: -16773.24; 3553.40; adj-R²  = 0.08).

CONCLUSIONS

These results suggest that the relationship between TEE and PAL is weak and it is not completely linear in women living in an impoverished Brazilian urban area.

Can Social Resources Explain the Limitations in the Activities of Daily Living of Older Adults Classified by the Phenotype of Physical Frailty?

The objective is to investigate the mediating roles of living alone and personal network in the relationship between physical frailty and activities of daily living (ADL) limitations among older adults. 2271 individuals were classified as vulnerable (pre-frail or frail) or robust. Mediating variables were living alone and personal network. Katz Index and Lawton-Brody scale were used to assess ADL. Mediating effects were analyzed with beta coefficients from linear regression models using the bootstrapping method. Mediation analysis showed significant mediating effects of living alone (β = .011; 95% CI = .004; .018) and personal network (β = .005; 95% CI = .001; .010) on the relationship between physical frailty and basic ADL limitations. Mediation effects of living alone and personal network on the relationship between physical frailty and instrumental ADL limitations were β = -.074 (95% CI=-.101; -.046) and β = -.044 (95% CI = -.076; -.020), respectively. Physically vulnerable older adults who lived alone or had poor personal network were more dependent on basic and instrumental ADL.

Weight-loss in obese dogs promotes important shifts in fecal microbiota profile to the extent of resembling microbiota of lean dogs

BACKGROUND

Among the undesirable changes associated with obesity, one possibility recently raised is dysbiosis of the intestinal microbiota. Studies have shown changes in microbiota in obese rats and humans, but there are still few studies that characterize and compare the fecal microbiota of lean, obese and dogs after weight loss. Thus, this study aimed to evaluate the effects of a weight loss program (WLP) in fecal microbiota of dogs in addition to comparing them with those of lean dogs. Twenty female dogs of different breeds, aged between 1 and 9 years were selected. They were equally divided into two groups: Obese group (OG), with body condition score (BCS) 8 or 9/9, and body fat percentage greater than 30%, determined by the deuterium isotope dilution method, and lean group (LG) with BCS 5/9, and maximum body fat of 15%. Weight loss group (WLG) was composed by OG after loss of 20% of their current body weight. Fecal samples were collected from the three experimental groups. Total DNA was extracted from the feces and these were sequenced by the Illumina methodology. The observed abundances were evaluated using a generalized linear model, considering binomial distribution and using the logit link function in SAS (p < 0.05).

RESULTS

The WLP modulated the microorganisms of the gastrointestinal tract, so that, WLG and LG had microbial composition with greater biodiversity than OG, and intestinal uniformity of the microbiota (Pielou's evenness index) was higher in OG than WLG dogs (P = 0.0493) and LG (P = 0.0101). In addition, WLG had values of relative frequency more similar to LG than to OG.

CONCLUSION

The fecal microbiota of the studied groups differs from each other. The weight loss program can help to reverse the changes observed in obese dogs.

Effect of chocolate on older patients with cancer in palliative care: a randomised controlled study

Background

Older advanced stage cancer patients, with changes in nutritional status, represent an important demand for palliative care. The aim was to determine the effects of 4 weeks of chocolate consumption on the nutritional status of older cancer patients in palliative care.

Methods

Older cancer patients in palliative care with ambulatory (n = 46) monitoring were randomized to control (CG, n = 15), intervention with 55% cocoa chocolate (IG1, n = 16) and intervention with white chocolate (IG2, n = 15) groups and evaluated before and after 4 weeks for nutritional status (primary outcome), evaluated by the Mini Nutritional Assessment tool (MNA). Food consumption, anthropometry, body composition, laboratory parameters and quality of life (QL) with the European Organization for the Research and Treatment of Cancer instrument were also evaluated.

Results

IG1 progressed with increased screening (estimated difference [95% CI]: − 1.3 [− 2.2;-0.4], p < 0.01), and nutritional (estimated difference [95% CI]: − 1.3 [− 2.5;-0.1], p = 0.04) scores on the MNA, with no change in anthropometry and body composition. Regarding antioxidant capacity, reduced glutathione levels increased (estimated difference [95% CI]: − 0.8 [− 1.6;-0.02], p = 0.04) and malondealdehyde levels decreased in IG2 (estimated difference [95% CI]:+ 4.9 [+ 0.7;+ 9.1], p = 0.02). Regarding QL, functionality improved in IG1, with higher score in the functional domain (estimated difference [95% CI]:-7.0 [− 13.3;-0.7], p = 0.03).

Conclusions

The consumption of chocolate with a greater cocoa content may contribute to the improvement of the nutritional status and functionality among older cancer patients in palliative care. The consumption of white chocolate was associated with improved oxidative stress.

Trial registration

A randomized clinical trial (ClinicalTrials.gov NCT04367493).

The effect of frailty on the 24-hour blood pressure pattern in the very elderly

Frailty plays a crucial role in the management of hypertension in the very elderly and has a strong association with cardiovascular diseases. Nevertheless, its influence on the 24-hour blood pressure pattern, including elevated asleep systolic blood pressure (BP) and the lack of BP fall during sleep (non-dipping) has not been explored in a population above 80 years. Patients older than 80 years were classified into frail or robust subtypes by the five item frailty phenotype criteria. All participants were submitted to office blood pressure measurements and ambulatory BP monitoring over a 24-hour period. Nocturnal dipping was defined as nighttime BP fall ≥10%. Thirty-eight frail and 36 non-frail individuals (mean age 85.3 ± 3.7 years; 67% females) were analyzed. Awake systolic and diastolic BP were similar for frail and robust individuals. Frail patients had higher systolic BP during sleep (128 ± 15 mm Hg vs. 122 ±13 mm Hg p = .04) and reduced systolic BP fall [1 (-4.5 - 5)% vs. 6.8 (2.1 - 12.8)% p < .01]. Frailty was independently associated with higher risk of non-dipping (OR 12.4; CI 1.79 - 85.9) and reduced nighttime systolic BP fall (-6.1%; CI -9.6 - -2.6%). In conclusions, frailty has a substantial influence on nighttime BP values and pattern in patients older than 80 years.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Acute effects of different types of exercise on the blood pressure of hypertensive older women: a randomized study

BACKGROUND

The magnitude and duration of the hypotensive effect of exercise may be influence by the type of exercise performed. The aim of the present study was to compare systolic (SBP) and diastolic (DBP) blood pressure for 24 hours after a single session of continuous aerobic (CA), interval aerobic (IA), resistance (RE) exercise and control (C), among hypertensive older women under treatment.

METHODS

The study was conducted on 30 women aged 67.5±5.2 years participating in all sessions applied in random order. After each session, blood pressure was obtained by an oscillometric device and they were submitted to 24-hour ambulatory blood pressure monitoring.

RESULTS

Immediately after the sessions, a lower SBP value was observed in groups CA and IA compared to groups C and RE. During the 24 hours after sessions, there was a greater reduction of SBP after IA than after other types of exercise, with the reduction after RE being greater than after CA and C (P<0.01). In wakefulness period, the reduction of SBP after IA was more intensive, and, during sleep, IA and RE promoted greater reductions of SBP, with reduction of DBP only after RE (P<0.01).

CONCLUSIONS

Immediately after the exercise sessions there was a fall in SBP only after aerobic exercises. However, aerobic exercise in the interval mode and RE were more effective in reducing BP over a period of 24 hours.

Evaluation of Dietary Comsumption in Independents Community-Dwelling Older Adults With and Without Sarcopenia

Objectives

To characterize and compare the food consumption of independent community-dwelling older adults with and without sarcopenia.

Methods

Descriptive cross-sectional study, conducted with data from 50 community-dwelling older adults receiving care in secondary level of health in a city in southeastern Brazil, during 2017. The following tests were used to diagnose sarcopenia: dual X-ray absorptiometry, hand grip strength and walk speed. Data from intake was obtained by three 24-hour Multiple Pass Recall and the consumption variation was adjusted in the Multiple Source Method Program. The consumption of macronutrientes and micronutrientes was compared between the

groups without sarcopenia and those with pre-sarcopenia/sarcopenia. The means were measures of average consumption, nutrients inadequacy and consumption ranges. The results are expressed as descriptive data, presented as media, standard deviation and absolute and relative frequency. A significance level adopted was P &lt; 0.05.

Results

Lowest intake of animal protein (g) was identified in men with pre-sarcopenia/sarcopenia compared with those without sarcopenia (P &lt; 0.05). In women, those with pre-sarcopenia/sarcopenia had more intake of carbohydrate (%) and less intake of protein (g), animal protein (g) and saturated fat acids (%) (P &lt; 0.05). The vitamin D, vitamin E and calcium medium consumption was lower than the Estimated Average Requirement in all groups of the study, with high consumption inadequacy (&gt;75%) for those nutrients.

Conclusions

The lowest intake by the elderly with sarcopenia and the high inadequacy of important nutrients for muscle mass preservation and strength by both groups of elderly could contribute for the development of this condition.

Funding Sources

Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq.

A multidimensional approach to frailty compared with physical phenotype in older Brazilian adults: data from the FIBRA-BR study

BACKGROUND

Frailty is a predictor of negative health outcomes in older adults. The physical frailty phenotype is an often used form for its operationalization. Some authors have pointed out limitations regarding the unidimensionality of the physical phenotype, introducing other dimensions in the approach to frailty. This study aimed to create a multidimensional model to evaluate frailty in older Brazilian adults and to compare the dimensions of the model created among the categories of the physical frailty phenotype.

METHODS

A cross-sectional study was conducted using data from 3569 participants (73.7 ± 6.6 years) from a multicenter and multidisciplinary survey (FIBRA-BR). A three-dimensional model was developed: physical dimension (poor self-rated health, vision impairment, hearing impairment, urinary incontinence, fecal incontinence, and sleeping disorder), social dimension (living alone, not having someone who could help when needed, not visiting others, and not receiving visitors), and psychological dimension (depressive symptoms, concern about falls, feelings of sadness, and memory problems). The five criteria of the phenotype created by Fried and colleagues were used to evaluate the physical frailty phenotype. The proposed multidimensional frailty model was analyzed using factorial analysis. Pearson's chi-square test was used to analyze the associations between each variable of the multidimensional frailty model and the physical phenotype categories. Analysis of variance compared the multidimensional dimensions scores among the three categories of the physical frailty phenotype.

RESULTS

The factorial analysis confirmed a model with three factors, composed of 12 variables, which explained 38.6% of the variability of the model data. The self-rated health variable was transferred to the psychological dimension and living alone variable to the physical dimension. The vision impairment and hearing impairment variables were dropped from the physical dimension. The variables significantly associated with the physical phenotype were self-rated health, urinary incontinence, visiting others, receiving visitors, depressive symptoms, concern about falls, feelings of sadness, and memory problems. A statistically significant difference in mean scores for physical, social, and psychological dimensions among three physical phenotype categories was observed (p < 0.001).

CONCLUSIONS

These results confirm the applicability of our frailty model and suggest the need for a multidimensional approach to providing appropriate and comprehensive care for older adults.

Serum metabolomics analysis reveals that weight loss in obese dogs results in a similar metabolic profile to dogs in ideal body condition

INTRODUCTION

The study of metabolic profile can be an important tool to better understand, at a systemic level, metabolic alterations caused by different pathological conditions, such as obesity. Furthermore, it allows the discovery of metabolic biomarkers, which may help to diagnose alterations caused by obesity.

OBJECTIVE

To investigate the metabolic profile of blood serum of obese dogs, control dogs, and dogs that were subjected to a weight loss program.

METHODS

Ten obese adult spayed female dogs were included, and their body composition was determined by the deuterium isotope dilution method. The dogs were subjected to a weight loss program and formed a new experimental group after losing 20% of the initial body weight. A third experimental group was composed of ten lean adult spayed female dogs. The metabolic profile of blood serum was evaluated through nuclear magnetic resonance (NMR). Principal Component Analyses (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA) models were constructed using Pareto scaling pre-processing. Pathway analysis was also performed using the MetaboAnalist online tool.

RESULTS

The PCA shows that the control and after weight loss groups presented a trend to negative PC1, indicating similarities between these two groups. In contrast, obese animals presented a tendency to appear on negative PC2 indicating a different metabolic profile. The OPLS-DA analysis of the serum indicated that healthy groups presented higher content of glucose, while animals that lost weight had higher levels of cholesterol and lactate than the control group. On the other hand, the analysis showed that lipid content, cholesterol, and branched-chain amino acids were highest in obese animals. Variable Influence on Projection (VIP) analysis demonstrated that Lactate is the most important metabolite for the OPLS-DA model and Hierarchical Cluster Analysis (HCA) corroborated the similarity between the control group and the obese after weight loss groups. Moreover, the pathway analysis indicated the most important metabolic pathways related to this dataset.

CONCLUSIONS

The metabolomic assessment based on NMR of blood serum differed between obese dogs and animals in optimal body condition. Moreover, the weight loss resulted in metabolic profiles similar to those observed in lean animals.

Total Energy Expenditure and Functional Status in Older Adults: A Doubly Labelled Water Study

OBJECTIVES

Higher total energy expenditure in free living conditions, regardless of any activity, has been strongly associated with a lower risk of mortality in healthy older adults. Also, a good performance in physical and functional tests is a marker of good functional prognosis. However, it is not yet clear what is the association between total energy expenditure and the performance in physical and functional tests. The objective of this study was to verify the association between the total energy expenditure of older adults measured by doubly labelled water and the performance in functional tests.

DESIGN

Cross-sectional study.

SETTINGS AND PARTICIPANTS

Fifty-six older people were recruited from health services linked to the participating institutions.

MEASUREMENTS

Socio-demographic, anthropometric and clinical characteristics were assessed through the application of a structured questionnaire. Body composition was evaluated by isotopic dilution of deuterium oxide and functional status was assessed by the gait speed test, 6-minute walk test and handgrip strength. Total energy expenditure (GET) was assessed using the doubly labelled water method and the physical activity profile was verified using an activity monitor based on accelerometery.

RESULTS

The results showed that the highest total energy expenditure correlated with the best performance in the gait speed tests (r = 0.266; p = 0.047), 6-minute walk test (r = 0.424; p = 0.001) and maximum handgrip strength (r = 0.478; p = 0.000). Multivariate regression analysis in a model adjusted for sex and fat-free mass revealed an association between total energy expenditure and the 6-minute walk test (ß = 1.790; t = 2.080; p = 0.044) and the number of sedentary events ( ß = 6.389; t = 2.147; p = 0.038).

CONCLUSION

The results of this study suggest that, in clinical practice, older individuals with lower gait speed, worse performance in the 6-minute walk test and lower handgrip strength, may have lower total energy expenditure, being the stimulus for its increase important for the prevention of possible problems related to low energy expenditure.

Seroprevalence of SARS-CoV-2 infection among residents and workers of long-term care facilities in Ribeirão Preto, Brazil: an epidemiological survey

OBJECTIVE: Residents and workers in long-term care facilities (LTCF) for older adults share the same space, and residents are more susceptible to COVID-19 complications. The aim of this study was to determine the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies as an indication of previous infection of both residents and workers in LTCFs, as well as associated factors. METHODS: This epidemiological survey was conducted in Ribeirão Preto, Brazil, a medium-sized city. Stratified sampling was performed, with data collected on demographics, health, LTCF protective measures, activities of daily living, and cognition. A serological test was carried out on all selected individuals. RESULTS: The mean resident and worker ages were 80.62 (SD, 9.66) and 37.41 (SD, 12.42) years, respectively. The serological test was positive in 13.33% of the residents, who had 2.91 (SD, 1.28) chronic diseases and used 5.65 (SD, 2.79) medications. Dementia screening was negative in only 11.1%, and only 20% were independent in activities of daily living. The serological test results were positive in 25.93% of the workers, although SARS-CoV-2 had been previously detected in only 6.9%. The LTCF did not perform systematic screening of worker respiratory symptoms. CONCLUSIONS: There was a higher seroprevalence of SARS-CoV-2 among LTCF workers than residents. Systematic screening of worker symptoms before each shift was not regularly performed. The high prevalence of cognitive changes among LTCF residents can impede adherence to personal protection measures.

Impact of the severity of dementia due to Alzheimer's disease on the gustatory sensitivity of older persons

OBJECTIVE

To evaluate the association between the severity of dementia and taste recognition abilities in older persons with Alzheimer's disease (AD).

METHODS

Anthropometric measurements were performed and body mass index was used to determine the nutritional status. The taste strips were used to test gustatory functions of the five basic tastes (sweet, salty, sour, bitter and umami).

RESULTS

A total of 30 healthy younger subjects, 30 healthy older subjects, 37 with mild stage AD and 23 with moderate stage AD were recruited. The older subjects with moderate AD showed a significant reduction of taste, less recognition of bitter and salty taste (score: 10.6 ± 2.6; 2.6 ± 0.9; 1.7 ± 1.5) when compared to older people without cognitive impairment (score: 13.3 ± 1.8; 3.4 ± 0.9; 3.2 ± 0.9), and less recognition of sweet taste (score: 2.9 ± 1.2) when compared to subjects with mild stage AD (score: 3.6 ± 0.8). Impaired recognition of salty taste was detected since the early stages of AD. Among the factors that possibly influence gustatory function, a significant correlation was detected between taste ability and age, medication intake, mini-mental state examination and the nutritional status.

CONCLUSION

The severity of dementia is directly associated with greater impairment of taste sensitivity, especially among older subjects with moderate stage disease.

Estimating total daily energy requirements in community-dwelling older adults: validity of previous predictive equations and modeling of a new approach

BACKGROUND/OBJECTIVES

Accurate estimation of energy requirements is crucial for health maintenance and prevention of malnutrition in older adults. This study aimed to assess the accuracy of predictive equations for estimating energy requirements in older adults and to test the validity of new predictive equations for this age group.

SUBJECTS/METHODS

This is a cross-sectional study including 38 Brazilian community-dwelling older adults aged 60-84 years, who had their total energy expenditure measured by doubly labeled water (TEE_DLW). The energy expenditure was compared to the Institute of Medicine (Dietary Reference Intake (DRI)) and Vinken et al. previous predictive equations and three predictive models developed in a modeling sample. The agreement was assessed using intra-class correlation coefficient, Bland-Altman plots, and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured energy expenditure.

RESULTS

The mean (standard deviation) TEE_DLW was 2656.7 (405.6) kcal/day for men and 2168.9 (376.9) for women. Vinken et al. and both DRI equations presented moderate to good degree of agreement, while the developed models vary from fair to very good agreement in comparison to DLW. The accuracy rate was the same for both DRI equations and Vinken et al. equation (60.53%). The new equations developed in this study had accuracy in predicting TEE for Brazilian older adults varying from 43.11% to 73.68%.

CONCLUSIONS

The results corroborate the use of previous predictive equations for estimating energy requirements in Brazilian older adults. Further studies have the potential to explore the use of the developed models to assess energy needs in this population.

NUTRITIONAL STATUS IN CHILDREN WITH CANCER: COMPARISON OF DEUTERIUM OXIDE DILUTION WITH BIOELECTRIC IMPEDANCE ANALYSIS AND ANTHROPOMETRY

Objective:

To explore changes in the nutritional status of pediatric cancer patients before and after chemotherapy and evaluate the correlation between deuterium oxide dilution, bioelectric impedance analysis, and anthropometry for assessment of body composition.

Methods:

This study included 14 children (aged 5.6 to 13.6 years) and classified them as having hematologic or solid tumors. They had their body composition analyzed according to deuterium oxide, bioelectric impedance, and anthropometric measurements before the first chemotherapy cycle and after three and six months of therapy.

Results:

The patients in the hematologic tumor group had an increase in weight, height, body mass index, waist, hip, and arm circumference, subscapular skinfold thickness, and fat mass with the isotope dilution technique during chemotherapy. In the solid tumor group, the children showed a reduction in fat-free mass when assessed by bioimpedance analysis. We found a positive correlation between the triceps skinfold thickness and fat mass determined by bioimpedance analysis and deuterium oxide. The arm muscle circumference correlated with the fat-free mass estimated by bioimpedance analysis and deuterium oxide.

Conclusions:

Patients with hematologic tumors had an increase in body weight, height, and fat mass, which was not identified in the solid tumor group. The positive correlation between anthropometry (triceps skinfold thickness and arm muscle circumference), deuterium oxide dilution, and bioelectric impedance analysis shows the applicability of anthropometry in clinical practice.

Estimating resting energy expenditure from dual-energy X-ray absorptiometry: A cross-sectional study in healthy young adults

OBJECTIVE

To qualify a 3C approach model of dual-energy X-ray absorptiometry (DXA) to estimate multicomponent resting energy expenditure (REE) referenced by indirect calorimetry (IC).

METHODS

A sample of 155 college students, of both sexes (18-30 years old) was evaluated. Anthropometric measures, REE by IC, and whole-body DXA-scans were performed. The REE for each body component was determined after transforming the components from the molecular (DXA) to the organ tissue level. Bland-Altman and proportional bias analyses were used to verify agreement between REE measured (REE_IC ) and estimated (REE_DXA ).

RESULTS

Statistically significant differences were found for all sex comparisons (P < .001), except for age (P = .950). Differences from the final sex-specific models' were not found between REE_IC and REE_DXA (P > .05). Men also presented greater expenditure (P < .001) in each component, except for adipose tissue. The plots confirmed the validity of the model for both sexes, with low difference values between the measured and estimated REE. The mean of the differences of REE_IC and REE_DXA showed heteroscedasticity of the data for men (P = .004). The same error tendency was not evident for women (P = .333).

CONCLUSIONS

This 3C model, estimating REE from a multicomponent approach, allows a new application of DXA as tool for understanding intraindividual differences in terms of the mass of metabolically active tissue. Sex and populational differences should be taken in account. Consequently, we present qualified sex-specific DXA models that can be applied in different contexts such as health and sports, besides considering interpersonal differences in terms of energy expenditure.

Taurine Supplementation Increases Post-Exercise Lipid Oxidation at Moderate Intensity in Fasted Healthy Males

Based on the fact that taurine can increase lipid metabolism, the objective of the present study was to evaluate the effects of different doses of acute taurine supplementation on lipid oxidation levels in healthy young men after a single bout of fasting aerobic exercise. A double-blind, acute, and crossover study design was conducted. Seventeen men (age 24.8 ± 4.07y; BMI: 23.9 ± 2.57 kg/m²) participated in the present study. Different doses of taurine (TAU) (3 g or 6 g) or placebo were supplemented 90 min before a single bout of fasting aerobic exercise (on a treadmill at 60% of VO₂ max). The subjects performed three trials, and each one was separated by seven days. Blood samples were collected at baseline and after the exercise protocol of each test to analyze plasma levels of glycerol and taurine. Lipid and carbohydrate oxidation were determined immediately after exercise for 15 min by indirect calorimetry. We observed that TAU supplementation (6 g) increased lipid oxidation (38%) and reduced the respiratory coefficient (4%) when compared to the placebo (p < 0.05). However, no differences in lipid oxidation were observed between the different doses of taurine (3 g and 6 g). For glycerol concentrations, there were no differences between trials. Six grams of TAU supplementation 90 min before a single bout of aerobic exercise in a fasted state was sufficient to increase the lipid oxidation post-exercise in healthy young men.

Frailty syndrome in Brazilian older people: a population based study

This article aims to categorize elderly non-frail (NF), pre-frail (PF) and frail (FF) as to fast and slow gait speed. Compare NF, PF and FF, and analyze associations between fast or slow gait speed with clinical, functional and mental factors. 5,501 elderly (65 years or over; to the Frailty in Brazilian Older People Study), classified as NF, PF and FF (Fried´s frailty phenotype) and, in relation to fast gait speed (≥ 0.8m/s) and slow (< 0.8m/s). Age, sex, body mass index, muscular strength, advanced, instrumental and basic activities of daily living, falls, fear of falling and depressive symptoms were evaluated. Logistic regression analysis investigated associations between variables. The proportion of the slow elderly increased with fragility (NF = 12.39%, PF = 37.56%, FF = 88.83%, p < 0.01). Be woman, performance in activities of daily living, muscle strength and fall were associated with fragility syndrome. The association between frailty and adverse health outcomes reinforces its primacy as an indicator of the functional health of the elderly. Functional capacity, muscular strength, and falls should be evaluated considering their potential for reversibility.

Energy Expenditure in Older Adults Who Are Frail: A Doubly Labeled Water Study

BACKGROUND AND PURPOSE

Frailty is a common and important geriatric syndrome, distinct from any single chronic disease, and an independent predictor of mortality. It is characterized by age-associated decline in physiological reserve and function across multiple systems, culminating in a vicious cycle of altered energy expenditure. The total energy expenditure (TEE) of an individual includes the resting metabolic rate (RMR), the thermic effect of feeding, and the energy expenditure in physical activity (PAEE). The investigation of the energy expenditure of older adults who are frail is essential for better understanding the syndrome. Therefore, we compared the RMR, the PAEE, the physical activity level (PAL), and the TEE of older adults who were frail with those who were not frail.

METHODS

A cross-sectional study was conducted with 26 community-dwelling older adults (66-86 years of age). Older adults in the frail and nonfrail groups were matched for age and gender, and the matched pairs were randomly selected to continue the study. The RMR was measured by indirect calorimetry. The TEE was obtained by the multipoint, doubly labeled water method. After collecting a baseline urine sample, each participant received an oral dose of doubly labeled water composed of deuterium oxide and oxygen-18 (H2O). Subsequently, urine samples were collected on the 1st, 2nd, 3rd, 7th, 12th, 13th, and 14th days after the baseline collection and analyzed by mass spectrometry.

RESULTS AND DISCUSSION

The older adults who were frail presented significantly lower PAEE (1453.7 [1561.9] vs 3336.1 [1829.3] kj/d, P < .01), PAL (1.4 [0.3] vs 1.9 [0.6], P = .04), and TEE (7919.0 [2151.9] vs 10442.4 [2148.0] kj/d, P < .01) than the older adults who were nonfrail. There was no difference in their RMRs (5673.3 [1569.2] vs 6062.0 [1891.7] kj/d, P = .57). Frailty has been associated with a smaller lean body mass and with a disease-related hypermetabolic state, which might explain the lack of difference in the RMR. The PAL of the older adults who were frail was below the recommended level for older adults and determined a lower PAEE and TEE when compared with older adults who were not frail.

CONCLUSION

This study showed that low energy expenditure in physical activity is a main component of frailty. The PAL of the older adults who were frail was far below the recommended level for older adults.

Older Adult Cancer Patients Under Palliative Care With a Prognosis of 30 Days or More: Clinical and Nutritional Changes

Objective: The aim of this study was to characterize nutritional status, body composition, oxidative stress, and inflammatory activity and to determine the possible associations between nutritional status and clinical variables in advanced cancer patients.Method: This was a cross-sectional study of 46 elderly cancer patients under palliative care with a prognosis of 30 days or more. Nutritional status, food intake, anthropometry, body composition (deuterium oxide method), metabolic profile, inflammation damage (C-reactive protein), oxidative damage (8-hydroxy-2'-deoxyguanosine), and symptom intensity were evaluated.Results: Among elderly cancer patients, 36.9% were malnourished or at risk of malnutrition. Systemic inflammation was detected, with a correlation between worse nutritional status and higher C-reactive protein levels (p < 0.01, r= -0.57), while lower lean mass (p < 0.01, r = 0.62) and higher fat mass percentages (p < 0.01, r = 0.62) correlated with higher levels of 8-hydroxy-2'-deoxyguanosine. Furthermore, daily energy (n = 25; 57.4%) and protein intake (n = 24; 52.2%) were lower than recommended in more than half the patients. The most prevalent symptoms were anxiety, impairment of well-being, drowsiness, tiredness, and lack of appetite.Conclusions: Despite preserved functionality, patients already had clinical and laboratory changes that, together with inadequate food intake, risk of malnutrition, systemic inflammation, and the presence of uncontrolled symptoms, alerted to the importance of an early and comprehensive palliative approach.

Diagnostic Accuracy of the Short Physical Performance Battery for Detecting Frailty in Older People

BACKGROUND

The Short Physical Performance Battery (SPPB) is widely used to predict negative health-related outcomes in older adults. However, the cutoff point for the detection of the frailty syndrome is not yet conclusive.

OBJECTIVE

The aim of this study was to determine the diagnostic value of the SPPB for detecting frailty in community-dwelling older adults.

DESIGN

This was a population-based cross-sectional study focusing on households in urban areas. A total of 744 people who were 65 years old or older participated in this study.

METHODS

Frailty was determined by the presence of 3 or more of the following components: unintentional weight loss, self-reported fatigue, weakness, low level of physical activity, and slowness. Diagnostic accuracy measures of the SPPB cutoff points were calculated for the identification of frailty (individuals who were frail) and the frailty process (individuals who were considered to be prefrail and frail). Receiver operating characteristic curves were constructed. Odds ratios for frailty and the frailty process and respective CIs were calculated on the basis of the best cutoff points. A bootstrap analysis was conducted to confirm the internal validity of the findings.

RESULTS

The best cutoff point for the determination of frailty was ≤  8 points (sensitivity = 79.7%; specificity = 73.8%; Youden J statistic = 0.53; positive likelihood ratio = 3.05; area under the curve = 0.85). The best cutoff point for the determination of the frailty process was ≤  10 points (sensitivity = 75.5%; specificity = 52.8%; Youden J statistic = 0.28; positive likelihood ratio = 1.59; area under the curve = 0.76). The adjusted odds of being frail and being in the frailty process were 7.44 (95% CI = 3.90-14.19) and 2.33 (95% CI = 1.65-3.30), respectively.

LIMITATIONS

External validation using separate data was not performed, and the cross-sectional design does not allow SPPB predictive capacity to be established.

CONCLUSIONS

The SPPB might be used as a screening tool to detect frailty syndrome in community-dwelling older adults, but the cutoff points should be tested in another sample as a further validation step.

Mood, lifestyle and cardiovascular risk factors among older caregivers of patients with Alzheimer's disease dementia: a case-control study

BACKGROUND

Caregivers may have a higher risk of cardiovascular diseases and have high rates of anxiety and depression.

AIMS

The objective of this study was to evaluate mood, lifestyle and the presence of cardiovascular risk factors in older women caregivers of patients with Alzheimer´s disease (AD) dementia compared to non-caregivers living in the neighborhood.

METHODS

Paired case-control (1:1). Volunteers responded to a questionnaire with information about physical and leisure activities, smoking, alcohol use, and daily hours of care. Blood pressure (BP) was measured on 5 days with the Home Blood Pressure Monitoring (HBPM) system, and mood was assessed with the Geriatric Depression Scale (GDS) and Mini International Neuropsychiatric Interview (MINI). Laboratory testing for cardiovascular risk factors was performed.

RESULTS

Sixty-two volunteers were evaluated. Total cholesterol levels were higher among caregivers, with an odds ratio (OR) of 3.57 (95% CI 1.2-11, p = 0.03). There was no difference in BP. A positive screening for depression was obtained for 58% of caregivers and for 16% of control subjects (OR = 6.62, 95% CI 1.9-22.6, p < 0.01). The MINI revealed that 38.7% of caregivers had an actual depressive episode as compared to 9.7% of controls (9.7%) (OR = 5.42, 95% CI 1.3-22.7, p = 0.02); 35.5% of caregivers and 6% of controls had a diagnosis of anxiety disorder (OR = 4.79, 95% CI 1.2-19.1, p = 0.03).

DISCUSSION

The cardiovascular risk markers and lifestyle were similar in caregivers and non-caregivers, but there was a higher prevalence of depression and anxiety among caregivers.

CONCLUSIONS

Older women caregivers of patients with AD have more mental health symptoms and disorders and need to be treated.

Salt Preference is Linked to Hypertension and not to Aging

Background

Seasoning is one of the recommended strategies to reduce salt in foods. However, only a few studies have studied salt preference changes using seasoning.

Objectives

The aim of this study was to compare preference for salty bread, and if seasoning can change preference in hypertensive and normotensive, young and older outpatients.

Methods

Outpatients (n = 118) were classified in four groups: older hypertensive subjects (OH) (n = 32), young hypertensive (YH) (n = 25); older normotensive individuals (ON) (n = 28), and young normotensive (YN) (n = 33). First, volunteers random tasted bread samples with three different salt concentrations. After two weeks, they tasted the same types of breads, with seasoning added in all. Blood pressure (BP), 24-hour urinary sodium and potassium excretion (UNaV, UKV) were measured twice. Analysis: Fisher exact test, McNamer’s test and ANCOVA. Statistical significance: p < 0.05.

Results

Systolic BP, UNaV, and UKV were greater in HO and HY and they had a higher preference for saltier samples than normotensive groups (HO: 71.9%, HY: 56% vs. NO: 25%, NY; 6%, p<0.01). With oregano, hypertensive individuals preferred smaller concentrations of salt, with reduced choice for saltier samples (HO: 71.9% to 21.9%, and HY: 56% to 16%, p = 0.02), NO preferred the lowest salt concentration sample (53.6% vs. 14.3%, p < 0.01), and NY further increased the preference for the lowest one (63.6% vs. 39.4%, p = 0.03).

Conclusions

Older and younger hypertensive individuals prefer and consume more salt than normotensive ones, and the seasoned bread induced all groups to choose food with less salt. Salt preference is linked to hypertension and not to aging in outpatients.

Declínio da velocidade da marcha e desfechos de saúde em idosos: dados da Rede Fibra

RESUMO A velocidade da marcha (VM) tem sido considerada um marcador de saúde em idosos capaz de predizer desfechos adversos de saúde, mas a compreensão de fatores associados a ela ainda é limitada e controversa. O objetivo deste trabalho é identificar desfechos adversos de saúde relacionados ao declínio da velocidade de marcha em idosos comunitários. Trata-se de estudo transversal e multicêntrico, que avaliou o autorrelato de doenças crônicas e de hospitalização no último ano, polifarmácia e velocidade de marcha. Utilizou-se análise de regressão logística para estimar os efeitos de cada variável independente na chance de os idosos apresentarem declínio na velocidade de marcha inferior (VM<0,8m/s) (α=0,05). Participaram da pesquisa 5.501 idosos. A menor velocidade da marcha mostrou-se associada a portadores de doenças cardíacas (OR=2,06; IC: 1,67-2,54), respiratórias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) e/ou depressão (OR=2,51; IC: 2,10-3,14), hospitalizados no último ano (OR=1,51; IC: 1,21-1,85) e polifarmácia (OR=2,14; IC: 1,80-2,54). Assim, os resultados indicaram que idosos com velocidade de marcha menor que 0,8m/s apresentam maior risco de eventos adversos de saúde. Dessa forma, sugere-se que a velocidade de marcha não seja negligenciada na avaliação de idosos comunitários, inclusive na atenção básica.

Comparison of body composition analysis methods among centenary women: Seeking simpler methods

OBJECTIVES

The aim of this study was to evaluate the most commonly used body composition tools in clinical practice, such as anthropometry and electrical bioimpedance, and compare it with deuterium oxide.

METHODS

An exploratory cross-sectional study was conducted on women aged 100 years or above at home. Body composition was determined by measuring skinfolds (Jackson and Pollock and Durnin and Womersley equations), by bioimpedance, and by the deuterium oxide method.

RESULTS

Body mass index values were lower than 22 kg/m2 in 64% of the subjects. When the various methods used were compared with deuterium oxide, there was better agreement for the determination of fat mass than lean mass. For fat mass, agreement was better when using bioimpedance (Lin's coefficient = 0.70), whereas for lean mass, agreement was better using the Durnin and Womersley equation (Lin's coefficient = 0.51).

CONCLUSION

It is possible to use bioimpedance and skinfolds to evaluate fat mass and lean mass, respectively, in centenarians.

Influence of Energy Balance on the Rate of Weight Loss Throughout One Year of Roux-en-Y Gastric Bypass: a Doubly Labeled Water Study

OBJECTIVE

To investigate the influence of changes in energy balance and body composition on the rate of weight loss throughout 1 year of Roux-en-Y gastric bypass.

METHODS

Variables were collected pre-, 6, and 12 months (M) post-surgery from 18 women (BMI ≥ 40 and ≤ 50 kg m^-2, 20 to 45 years). Total energy expenditure (TEE_m), fat-free mass (FFM), and fat mass (FM) were measured by doubly labeled water. Self-reported energy intake (EI_sr) was obtained from three non-consecutive food diaries. Metabolic adaptation was assessed via deviations from TEE predictive equation, and the calculated energy intake (EI_c) via the sum of TEE and change in body stores.

RESULTS

BMI significantly decreased (mean ± SD) from 45 ± 2 kg m^-2 to 32 ± 3 kg m^-2 at 6 M, and to 30 ± 3 kg m^-2 at 12 M after surgery. The TEE_m reduced significantly at both time points when compared with pre-surgery (6 M: - 612 ± 317 kcal day^-1; 12 M: - 447 ± 516 kcal day^-1). At 6 M, a metabolic adaptation was observed and the energy balance was - 1151 ± 195 kcal day^-1, while at 12 M it was - 332 ± 158 kcal day^-1. Changes in the values of TEE_m were associated with changes in body weight at 12 M post-surgery. A significant underreporting was observed for EI_sr (1057 ± 385 kcal day^-1) vs. EI_c (2083 ± 309 kcal day^-1) at 12 M post-operative.

CONCLUSION

The higher rate of weight loss at 6 M post-surgery was a response to energy imbalance, which was caused by high restriction in energy intake even with the presence of metabolic adaptation at this time. The EI_sr was not sufficiently accurate to assess the energy consumption of this population.

REGISTRATION OF CLINICAL TRIALS (OBSERVATIONAL STUDY)

Brazilian Clinical Trials Registry: RBR-8k5jsj. Universal Trial Number: U1111-1206-0858.

Maximum Walking Speed Can Improve the Diagnostic Value of Frailty among Community-Dwelling Older Adults a Cross-Sectional Study

This study investigates the diagnostic accuracy of the combination of usual walking speed (UWS) and maximum walking speed (MWS) to identify frailty in community-dwelling older adults. A population-based study with 758 participants aged 65 and older was conducted. Frailty syndrome was determined using the Fried phenotype. UWS and MWS were evaluated in a 4.6-meter path. Both measures were categorized using the 1.0 m/s cut points, and participants were categorized into three groups: those with "very good", "good" and "insufficient" walking reserve capacity (WRC). Of all participants, 9% were identified as frail and 47% as prefrail. The "insufficient" WRC presented a low sensitivity of 0.55, high specificity of 0.91 and moderately useful likelihood ratios (LR+ 6.57, LR- 0.48) to identify frailty. Based on Fagan's nomogram, an elder's corresponding post-test probability of being frail with an "insufficient" WRC would be around 40%, which substantially increased the diagnostic accuracy of frailty.

Prevalence and factors associated with sarcopenia and dynapenia in elderly people

Objectives

There is little information about the risk factors for sarcopenia and dynapenia. This study aimed to assess the prevalence of sarcopenia and dynapenia and to verify which risk factors are associated with the elderly population.

Methods

A total of 387 elderly people were evaluated. We used a questionnaire to identify socio-demographic and behavioral aspects. For physical performance, we used the Short Physical Performance Battery. Using the European Working Group of Sarcopenia in Older People consensus, we defined sarcopenia that includes the occurrence of low muscle mass, added to low muscle strength or low physical performance. Dynapenia was defined using handgrip strength.

Results

Sarcopenia and dynapenia were identified in 15.3% and 38.2% of the elderly people, respectively; 15.8% of women and 14.2% of men had sarcopenia, and 52.4% of women and 13.5% of men had dynapenia. Sarcopenia was associated with the increase in aging, white race, smoking, and risk of malnutrition. Dynapenia is more likely to occur in women and hospitalized patients.

Conclusion

Sarcopenia had a greater association with the risk factors evaluated here, mainly with smoking and nutritional status. On the other hand, dynapenia was different, having a greater association with hospital intervention.