Nutritional status and physical function in hospitalized older adults: effects of a 12-week resistance training program with leucine-enriched protein supplementation post-exercise immediately after discharge

La malnutrición y un estado físico deteriorado son características prevalentes en personas mayores de 70años hospitalizadas. Muchas veces estas personas mayores no son identificadas, lo cual impide unacorrecta recuperación tras el alta. La falta de tiempo, espacio y dinero en los hospitales hace que sea devital importancia encontrar técnicas sencillas, económicas y prácticas para el día a día de un hospital queayuden en la identificación de aquellos pacientes en riesgo de una o mas condiciones que afectan a suestado nutricional y/o condición física. En este sentido la presente Tesis Doctoral aporta nueva evidenciade gran interés para el uso de diferentes técnicas en la identificación de riesgo de malnutrición y/o unacondición física deteriorada en personas mayores de 70 años hospitalizadas.Los programas de intervención que aúnan nutrición y ejercicio físico son considerados como la mejoralternativa para acelerar la recuperación tras el alta hospitalaria. Una de las consecuencias de lahospitalización y de la mayoría de las condiciones relacionadas con la edad, es la perdida de masamuscular y fuerza muscular. El entrenamiento de fuerza es considerado el mayor el estímulo para unacorrecta recuperación de masa y fuerza muscular, y se ha sugerido que los efectos podrían ser mayoresjunto con suplementación proteica tras el ejercicio. La actual Tesis Doctoral apoya el entrenamiento defuerza como la estrategia mas efectiva para la recuperación de la condición física en personas mayores de70 años post hospitalizadas. Sin embargo, no aporta evidencia en cuanto a los beneficios adicionales de lasuplementación proteica

Association between Mediterranean Dietary Pattern and Breakfast Quality with Physical Fitness in School Children: The HIIT Project

Dietary habits have been linked with health in childhood. However, few studies have examined the association between healthy dietary patterns and physical fitness. Therefore, the aim of this study was to examine the associations of adherence to the Mediterranean dietary pattern (MDP) and breakfast quality with physical fitness in children. Further to this, we examined the role of physical activity in these associations. A total of 175 children (86 girls, 9.7 ± 0.3 years) participated. Adherence to MDP and breakfast quality were assessed by the KIDMED questionnaire and 24 h recall, respectively. Cardiorespiratory fitness, muscular strength, and speed–agility were assessed. Physical activity was evaluated by wrist-worn accelerometers. Greater adherence to the MDP was related with higher cardiorespiratory fitness, lower-limbs muscular strength, and speed–agility (all β ≥ 0.189, all p ≤ 0.02). No significant associations were observed between breakfast quality and physical fitness (all p > 0.05). However, all the significant associations disappeared after adjusting for physical activity (all p > 0.05). Our study sheds light on the relevance of adhering to the MDP over physical fitness in school children. However, there is no association between breakfast quality and physical fitness. Furthermore, physical activity seems to explain, at least partially, these findings.The HIIT project was supported by the Plan de Promoción de Grupos de Investigación of the Public University of Navarra. C.C.-S. is supported by the Spanish Ministry of Science and Innovation (FJC2018-037925-I). L.A. is supported by the Education Department of the Government of the Basque Country (PRE_2016_1_0057, PRE_2017_2_0224, PRE_2018_2_0057, PRE_2019_2_0004). M.A. is supported by a grant from the University of the Basque Country (PIF17/186). M.O. is supported by a grant from the Spanish Ministry of Economy and Competitiveness, grant number; BES-2017-080770

The Effect of a Family-Based Lifestyle Education Program on Dietary Habits, Hepatic Fat and Adiposity Markers in 8–12-Year-Old Children with Overweight/Obesity

Healthy lifestyle education programs are recommended for obesity prevention and treatment. However, there is no previous information on the effects of these programs on the reduction of hepatic fat percentage. The aims were (i) to examine the effectiveness of a 22-week family-based lifestyle education program on dietary habits, and (ii) to explore the associations of changes in dietary intake with percent hepatic fat reduction and adiposity in children with overweight/obesity. A total of 81 children with overweight/obesity (aged 10.6 ± 1.1 years, 53.1% girls) and their parents attended a 22-week family based healthy lifestyle and psychoeducational program accompanied with (intensive group) or without (control) an exercise program. Hepatic fat (magnetic resonance imaging), adiposity (dual energy X-ray absorptiometry) and dietary habits (two non-consecutive 24 h-recalls) were assessed before and after the intervention. Energy (p < 0.01) fat (p < 0.01) and added sugar (p < 0.03) intake were significantly reduced in both groups at the end of the program, while, in addition, carbohydrates intake (p < 0.04) was reduced exclusively in the control group, and simple sugar (p < 0.05) and cholesterol (p < 0.03) intake was reduced in the exercise group. Fruit (p < 0.03) and low-fat/skimmed dairy consumption (p < 0.02), the adherence to the Mediterranean Diet Quality Index for children and teenagers (KIDMED, p < 0.01) and breakfast quality index (p < 0.03) were significantly higher in both control and intervention groups after the intervention. Moreover, participants in the exercise group increased the adherence to the Dietary Approaches to Stop Hypertension (DASH) diet (p < 0.001), whereas the ratio of evening-morning energy intake was significantly lower exclusively in the control group after the program (p < 0.02). Changes in energy intake were significantly associated with changes in fat mass index (FMI) in the exercise group, whereas changes in sugar-sweetened beverages (SSB) consumption was associated with percent hepatic fat reduction (p < 0.05) in the control group. A 22-week family-based healthy lifestyle program seems to be effective on improving diet quality and health in children with overweight/obesity and these should focus on SSB avoidance and physical activity.The current project was supported by the Spanish Ministry of Industry and Competitiveness (DEP2016-78377-R), by European Regional Development Funds (ERDF) and by the University of the Basque Country (GIU14/21). This work was also supported by grants from Spanish Ministry of Economy and Competitiveness (RYC 2010-05957; RYC-2011-09011; BES-2017-080770), by the Education Department of the Government of the Basque Country (PRE_2016_1_0057, PRE_2017_2_0224, PRE_2018_2_0057, PRE_2019_2_0004) and by the University of the Basque Country (PIF17/186). This study has been partially funded by the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades and by ERDF, (ref. SOMM17/6107/UGR)

Malnutrition and Poor Physical Function Are Associated With Higher Comorbidity Index in Hospitalized Older Adults

BackgroundThe Charlson Comorbidity Index (CCI) is the most widely used method to measure comorbidity and predict mortality. There is no evidence whether malnutrition and/or poor physical function are associated with higher CCI in hospitalized patients. Therefore, this study aimed to (i) analyze the association between the CCI with nutritional status and with physical function of hospitalized older adults and (ii) examine the individual and combined associations of nutritional status and physical function of older inpatients with comorbidity risk. MethodsA total of 597 hospitalized older adults (84.3 +/- 6.8 years, 50.3% women) were assessed for CCI, nutritional status (the Mini Nutritional Assessment-Short Form [MNA-SF]), and physical function (handgrip strength and the Short Physical Performance Battery [SPPB]). ResultsBetter nutritional status (p < 0.05) and performance with handgrip strength and the SPPB were significantly associated with lower CCI scores among both men (p < 0.005) and women (p < 0.001). Patients with malnutrition or risk of malnutrition (OR: 2.165, 95% CI: 1.408-3.331, p < 0.001) as well as frailty (OR: 3.918, 95% CI: 2.326-6.600, p < 0.001) had significantly increased the risk for being at severe risk of comorbidity. Patients at risk of malnutrition or that are malnourished had higher CCI scores regardless of being fit or unfit according to handgrip strength (p for trend < 0.05), and patients classified as frail had higher CCI despite their nutritional status (p for trend < 0.001). ConclusionsThe current study reinforces the use of the MNA-SF and the SPPB in geriatric hospital patients as they might help to predict poor clinical outcomes and thus indirectly predict post-discharge mortality risk.This study was supported by the Basque Government (2016111138). MA was supported by a grant from the University of the Basque Country (PIF17/186) and IE was supported by a grant from the University of the Basque Country in collaboration with the University of Bordeaux (UBX) (PIFBUR16/07)

Effects of resistance training intervention along with leucine-enriched whey protein supplementation on sarcopenia and frailty in post-hospitalized older adults: preliminary findings of a randomized controlled trial

Resistance training and protein supplementation are expected to exert the greatest effect in counteracting muscle-wasting conditions. Myokines might play a key role, but this remains to be elucidated. The aim of this study (NCT03815201) was to examine the effects of a resistance training program with post-exercise leucine-enriched protein supplementation on sarcopenia and frailty status and on the plasma myokine concentrations of post-hospitalized older adults. A total of 41 participants were included in this 12-week resistance training intervention and randomized either to the placebo group or the protein group. Sarcopenia, frailty, body composition and blood-based myokines were measured at baseline and after 12 weeks. Both groups improved in terms of physical performance (p < 0.005) and frailty (p < 0.07) following the resistance training intervention, but without any difference between groups. Myokine concentrations did not change after the intervention in either group. Changes in myostatin concentrations were associated with greater improvements in appendicular skeletal muscle mass at the end of the intervention (p < 0.05). In conclusion, the implementation of resistance training programs after hospitalization in older adults should be prioritized to combat sarcopenia and frailty immediately. The results regarding myostatin should be taken as preliminary findings.This study was supported by the Basque Government (2016111138). M.A. was supported by a grant from the University of the Basque Country (PIF17/186). C.C.-S. is supported by the Spanish Ministry of Science and Innovation (FJC2018-037925-I). I.E. by a grant from the University of the Basque Country in collaboration with the university of Bordeaux (University of Bordeaux (UBX)) (PIFBUR16/07)

Effects of leucine-enriched whey protein supplementation on physical function in post-hospitalized older adults participating in 12-weeks of resistance training program: a randomized controlled trial

Age-related strength and muscle mass loss is further increased after acute periods of inactivity. To avoid this, resistance training has been proposed as an effective countermeasure, but the additional effect of a protein supplement is not so clear. The aim of this study was to examine the effect of a whey protein supplement enriched with leucine after resistance training on muscle mass and strength gains in a post-hospitalized elderly population. A total of 28 participants were included and allocated to either protein supplementation or placebo supplementation following resistance training for 12 weeks (2 days/week). Physical function (lower and upper body strength, aerobic capacity and the Short Physical Performance Battery (SPPB) test), mini nutritional assessment (MNA) and body composition (Dual X-ray Absorptiometry) were assessed at baseline and after 12 weeks of resistance training. Both groups showed improvements in physical function after the intervention (p 0.05). Muscle mass did not improve after resistance training in either group (p > 0.05). In conclusion, 12 weeks of resistance training are enough to improve physical function in a post-hospitalized elderly population with no further benefits for the protein-supplemented group.This study was supported by the Basque Government (2016111138), and the European Regional Development Funds (ERDF), the University of Granada Plan Propio de Investigación 2016 (Excellence Actions: Unit of Excellence on Exercise and Health [UCEES]) and the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades (ERDF: ref. SOMM17/6107/UGR). MA was supported by a grant from the University of the Basque Country (PIF17/186), IE by a grant from the University of the Basque Country in collaboration with the University of Bordeaux (Université of Bordeaux (UBX)) (PIFBUR16/07) and JRR by grants from the Spanish Ministry of Economy and Competitiveness (RYC 2010-05957; RYC-2011-09011 and BES-2014-068829).This work was also supported by grants from the Public University of Navarra, 'Plan de Promoción de Grupos de Investigación (2019)'

Determinants of Participation in a Post-Hospitalization Physical Exercise Program for Older Adults

Background: Older patients often experience a decline in physical function and cognitive status after hospitalization. Although interventions involving physical exercise are effective in improving functional performance, participation in physical exercise interventions among older individuals is low. We aimed to identify factors that contribute to exercise refusal among post-hospitalized older patients. Methods: A cross-sectional study of recruitment data from a randomized controlled trial was conducted involving 495 hospitalized people >= 70 years old. Sociodemographic and clinical data were obtained from the Basque Public Health System database. We determined physical function with the Short Physical Performance Battery (SPPB), nutritional status with the Mini-Nutritional Assessment, frailty according to the Fried phenotype criteria, and cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ). Student's t, Mann-Whitney U, or chi-squared tests were applied for bivariate analysis. Parameters significantly associated with participation were introduced in a logistic multivariate regression model. Results: Among the analyzed patients, 88.8% declined participation in the physical exercise program. Multivariate regression revealed that older age (OR: 1.13; 95% CI: 1.07-1.19), poor nutritional status (OR: 0.81; 95% CI: 0.69-0.95), and reduced home accessibility (OR: 0.27; 95% CI: 0.08-0.94) were predictors of participation refusal. Moreover, patients who declined participation had worse performance on the SPPB (P < 0.05) and its tests of balance, leg strength, and walking speed (P < 0.05). No differences were found between groups in other variables. Conclusions: This study confirms low participation of older adults in a post-hospitalization physical exercise program. Non-participation was associated with increased age, poor nutritional status, and reduced home accessibility. Our findings support the need for intervention design that accounts for these factors to increase older patient participation in beneficial exercise programs.The study was funded by the Department of Education, Language Policy and Culture (2016111138) and a Programme Contract of the Department of Health, both departments of the Government of the Basque Country, which provided financial support during the research. The funders had no role in the study design, data collection and analysis and interpretation or writing the manuscript

Prevention of diabetes in overweight/obese children through a family based intervention program including supervised exercise (PREDIKID project): study protocol for a randomized controlled trial

Background: The global pandemic of obesity has led to an increased risk for prediabetes and type-2 diabetes (T2D). The aims of the current project are: (1) to evaluate the effect of a 22-week family based intervention program, including supervised exercise, on insulin resistance syndrome (IRS) risk in children with a high risk of developing T2D and (2) to identify the profile of microRNA in circulating exosomes and in peripheral blood mononuclear cells in children with a high risk of developing T2D and its response to a multidisciplinary intervention program including exercise. Methods: A total of 84 children, aged 8-12 years, with a high risk of T2D will be included and randomly assigned to control (N = 42) or intervention (N = 42) groups. The control group will receive a family based lifestyle education and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week, 90 min per session including warm-up, moderate to vigorous aerobic activities, and strength exercises). The following measurements will be evaluated at baseline prior to randomization and after the intervention: fasting insulin, glucose and hemoglobin A1c; body composition (dual-energy X-ray absorptiometry); ectopic fat (magnetic resonance imaging); microRNA expression in circulating exosomes and in peripheral blood mononuclear cells (MiSeq; Illumina); cardiorespiratory fitness (cardiopulmonary exercise testing); dietary habits and physical activity (accelerometry). Discussion: Prevention and identification of children with a high risk of developing T2D could help to improve their cardiovascular health and to reduce the comorbidities associated with obesity.The Spanish Ministry of Industry and Competitiveness (DEP2016-78377-R), by “Fondos Estructurales de la Unión Europea (FEDER), Una manera de hacer Europa.” and by the University of the Basque Country (GIU14/21). This work was also supported by grants from Spanish Ministry of Economy and Competitiveness (RYC-2010-05957; RYC- 2011-09011), Spanish Ministry of Education, Culture and Sports (FPU14/ 03329) and by the Education, Linguistic Policy and Culture Department of the Government of the Basque Country (PRE_2016_1_0057)

Association of Breakfast Quality and Energy Density with Cardiometabolic Risk Factors in Overweight/Obese Children: Role of Physical Activity

There is a general belief that having breakfast is an important healthy lifestyle factor; however, there is scarce evidence on the influence of breakfast quality and energy density on cardiometabolic risk in children, as well as on the role of physical activity in this association. The aims of this paper were (i) to examine the associations of breakfast quality and energy density from both solids and beverages with cardiometabolic risk factors, and (ii) to explore whether physical activity levels may attenuate these relationships in children with overweight/obesity from two projects carried out in the north and south of Spain. Breakfast consumption, breakfast quality index (BQI) score, BEDs/BEDb (24 h-recalls and the KIDMED questionnaire), and physical activity (PA; accelerometry) were assessed, in 203 children aged 8–12 years who were overweight or obese. We measured body composition (Dual X-ray Absorptiometry), uric acid, blood pressure, lipid profile, gamma-glutamyl-transferase (GGT), glucose, and insulin, and calculated the HOMA and metabolic syndrome z-score. The BQI score was inversely associated with serum uric acid independently of a set of relevant confounders β = -0.172, ρ = 0.028), but the relationship was attenuated after further controlling for total PA (ρ < 0.07). BEDs was positively associated with total and HDL cholesterol, and systolic blood pressure regardless of confounders (all ρ < 0.05), while BEDb was positively associated with HOMA in either active/inactive children (all ρ < 0.03). In conclusion, higher breakfast quality and lower breakfast energy density should be promoted in overweight/obesity children to improve their cardiometabolic health.EFIGRO and ActiveBrains projects were supported by the Spanish Ministry of Industry and Competitiveness (DEP2016-78377-R and DEP2013-47540) by “Fondos Estructurales de la Unión Europea (FEDER), Una manera de hacer Europa”. The EFIGRO project was also supported by the University of the Basque Country (GIU14/21). LA was supported by a grant from the Education Department of the Government of Basque Country (PRE_2016_1_0057 and PRE_2017_2_0224), MM is supported by a grant from the Spanish Ministry of Education, Culture, and Sport (FPU14/03329) and EST17/00210, MO was supported by a grant from the Spanish Ministry of Science, Innovation, and Universities (BES-2017-080770), whereas MA was supported by a grant from the University of the Basque Country (PIF 17/186). JRR, FBO, and CC-S were also supported by grants from the Spanish Ministry of Economy and Competitiveness (RYC 2010-05957; RYC-2011-09011 and BES-2014-068829)

E ects of Leucine-Enriched Whey Protein Supplementation on Physical Function in Post-Hospitalized Older Adults Participating in 12-Weeks of Resistance Training Program: A Randomized Controlled Trial

Age-related strength and muscle mass loss is further increased after acute periods of inactivity. To avoid this, resistance training has been proposed as an effective countermeasure, but the additional effect of a protein supplement is not so clear. The aim of this study was to examine the effect of a whey protein supplement enriched with leucine after resistance training on muscle mass and strength gains in a post-hospitalized elderly population. A total of 28 participants were included and allocated to either protein supplementation or placebo supplementation following resistance training for 12 weeks (2 days/week). Physical function (lower and upper body strength, aerobic capacity and the Short Physical Performance Battery (SPPB) test), mini nutritional assessment (MNA) and body composition (Dual X-ray Absorptiometry) were assessed at baseline and after 12 weeks of resistance training. Both groups showed improvements in physical function after the intervention (p 0.05). Muscle mass did not improve after resistance training in either group (p > 0.05). In conclusion, 12 weeks of resistance training are enough to improve physical function in a post-hospitalized elderly population with no further benefits for the protein-supplemented group.This study was supported by the Basque Government (2016111138), and the European Regional Development Funds (ERDF), the University of Granada Plan Propio de Investigación 2016 (Excellence Actions: Unit of Excellence on Exercise and Health [UCEES]) and the Junta de Andalucía, Consejería de Conocimiento, Investigación y Universidades (ERDF: ref. SOMM17/6107/UGR). This work was also supported by grants from the Public University of Navarra, “Plan de Promoción de Grupos de Investigación (2019)”