Fragilité de la personne âgée : un aperçu du rôle de la nutrition☆☆☆

Concept communément admis dans la communauté scientifique, la fragilité souffre encore aujourd’hui de l’absence de définition opérationnelle standardisée. Caractérisées par des réserves physiologiques amoindries ne permettant plus de faire face à des situations de stress, les personnes âgées fragiles sont exposées à un sur-risque d’événements de santé défavorables. Les données de la littérature disponibles aujourd’hui placent la nutrition au cœur du concept de fragilité à dominante physique : la perte de poids non intentionnelle est un critère de fragilité et les données d’étude d’observation soulignent que des apports protéino-énergétiques et en micronutriments inappropriés sont des facteurs de risque de fragilité. En revanche, une plus forte consommation de fruits et légumes, notamment dans le cadre d’un régime méditerranéen, semble être un élément protecteur. Aucun essai clinique ne permet d’apporter la preuve de ces constats à ce jour, et les efforts de recherche doivent se poursuivre pour répondre aux besoins spécifiques de la population âgée dans ce domaine

Association between IgM Anti-Herpes Simplex Virus and Plasma Amyloid-Beta Levels

OBJECTIVE: Herpes simplex virus (HSV) reactivation has been identified as a possible risk factor for Alzheimer's disease (AD) and plasma amyloid-beta (Aβ) levels might be considered as possible biomarkers of the risk of AD. The aim of our study was to investigate the association between anti-HSV antibodies and plasma Aβ levels. METHODS: The study sample consisted of 1222 subjects (73.9 y in mean) from the Three-City cohort. IgM and IgG anti-HSV antibodies were quantified using an ELISA kit, and plasma levels of Aβ(1-40) and Aβ(1-42) were measured using an xMAP-based assay technology. Cross-sectional analyses of the associations between anti-HSV antibodies and plasma Aβ levels were performed by multi-linear regression. RESULTS: After adjustment for study center, age, sex, education, and apolipoprotein E-e4 polymorphism, plasma Aβ(1-42) and Aβ(1-40) levels were specifically inversely associated with anti-HSV IgM levels (β = -20.7, P=0.001 and β = -92.4, P=0.007, respectively). In a sub-sample with information on CLU- and CR1-linked SNPs genotyping (n=754), additional adjustment for CR1 or CLU markers did not modify these associations (adjustment for CR1 rs6656401, β = -25.6, P=0.002 for Aβ(1-42) and β = -132.7, P=0.002 for Aβ(1-40;) adjustment for CLU rs2279590, β = -25.6, P=0.002 for Aβ(1-42) and β = -134.8, P=0.002 for Aβ(1-40)). No association between the plasma Aβ(1-42)-to-Aβ(1-40) ratio and anti-HSV IgM or IgG were evidenced. CONCLUSION: High anti-HSV IgM levels, markers of HSV reactivation, are associated with lower plasma Aβ(1-40) and Aβ(1-42) levels, which suggest a possible involvement of the virus in the alterations of the APP processing and potentially in the pathogenesis of AD in human

Obesity in French Inmates: Gender Differences and Relationship with Mood, Eating Behavior and Physical Activity

CONTEXT: Inmates, notably women, are at greater risk for obesity and metabolic complications than the general population according to several studies from high income countries. Data regarding French correctional institutions are lacking so far. To fill this gap, we have assessed in a sample from a French prison (33 females and 18 males) the gender-specific effect of incarceration on weight and body mass index (BMI) and examined their current metabolic status. Furthermore, to reveal the possible determinants of increased obesity, we analyzed emotional vulnerability, eating behavior and physical activity using self-reported questionnaires. RESULTS: In this sample, obesity (BMI≥30 kg/m2) was already frequent in women (18.2%) but rather scarce for men (11%) at prison entry. Incarceration worsened the rate of obesity in both genders (21.2% and 16.7% respectively). At the time of study, abdominal obesity estimated through waist circumference was particularly prevalent in women (69.7%) versus men (27.8%) and metabolic syndrome was detected in 33% of female against none in male inmates. Abdominal obesity was associated with female sex (p<0.03), low physical activity (p<0.05) and eating disorder (p = 0.07) in univariate analyses. Low physical activity remained significant as an explanatory factor of higher abdominal obesity in multivariate analysis. A marked difference between genders was found for practice of physical activity with a higher proportion of women compared to men being inactive (37.9% vs. 11.8%) and fewer women being very active (17.2% vs. 41.2%). CONCLUSION: This study revealed that a significant proportion of women of this correctional institution combined established obesity, a metabolic syndrome and very little practice of physical activity which put them at high risk of cardiovascular disease. Thus, obesity should be better surveyed and treated in prison, especially for female inmates. Increased physical activity, adapted to obese women, would be the first mean to decrease obesity and gender differences

Study protocol for a pragmatic cluster randomized controlled trial to improve dietary diversity and physical fitness among older people who live at home (the “ALAPAGE study”)

Background : Diet and physical activity are key components of healthy aging. Current interventions that promote healthy eating and physical activity among the elderly have limitations and evidence of French interventions’ effectiveness is lacking. We aim to assess (i) the effectiveness of a combined diet/physical activity intervention (the “ALAPAGE” program) on older peoples’ eating behaviors, physical activity and fitness levels, quality of life, and feelings of loneliness; (ii) the intervention’s process and (iii) its cost effectiveness. Methods : We performed a pragmatic cluster randomized controlled trial with two parallel arms (2:1 ratio) among people ≥60 years old who live at home in southeastern France. A cluster consists of 10 people participating in a “workshop” (i.e., a collective intervention conducted at a local organization). We aim to include 45 workshops randomized into two groups: the intervention group (including 30 workshops) in the ALAPAGE program; and the waiting-list control group (including 15 workshops). Participants (expected total sample size: 450) will be recruited through both local organizations’ usual practices and an innovative active recruitment strategy that targets hard-to-reach people. We developed the ALAPAGE program based on existing workshops, combining a participatory and a theory-based approach. It includes a 7-week period with weekly collective sessions supported by a dietician and/or an adapted physical activity professional, followed by a 12-week period of post-session activities without professional supervision. Primary outcomes are dietary diversity (calculated using two 24-hour diet recalls and one Food Frequency Questionnaire) and lower-limb muscle strength (assessed by the 30-second chair stand test from the Senior Fitness Test battery). Secondary outcomes include consumption frequencies of main food groups and water/hot drinks, other physical fitness measures, overall level of physical activity, quality of life, and feelings of loneliness. Outcomes are assessed before the intervention, at 6 weeks and 3 months later. The process evaluation assesses the fidelity, dose, and reach of the intervention as its causal mechanisms (quantitative and qualitative data). Discussion : This study aims to improve healthy aging while limiting social inequalities. We developed and evaluated the ALAPAGE program in partnership with major healthy aging organizations, providing a unique opportunity to expand its reach

Dietary Supplements: Which Place between Food and Drugs?

Healthy dietary habits and food choices, a part of lifestyle, are recognized as major environmental factors for the prevention of non-communicable chronic diseases over the life course; their modifiable features promise a reduced socio-economic global burden load in aging societies [...

Mediterranean diet and cognitive decline: what role for omega-3 polyunsaturated fatty acids?

The Mediterranean diet is characterized by a high consumption of fruits, vegetables, legumes, cereals, and olive oil as the main source of added fat, a moderate consumption of fish and wine, and a low consumption of meat and dairy products as a source of saturated fat. Several epidemiological studies have shown that higher adherence to a Mediterranean diet was associated with slower cognitive decline in older persons. This protective effect might be mediated by omega-3 poly-unsaturated fatty acids (n-3 PUFA). We investigated this hypothesis in 1050 participants in the 3City study from Bordeaux. After multivariable adjustment including apolipoprotein E (ApoE) genotype, plasma docosahexaenoic acid and total n-3 PUFA were positively associated with a score of adherence to a Mediterranean diet. Plasma eicosapentaenoic acid was positively associated with adherence only in ApoE4 non-carriers. These data suggest that the protective effect of the Mediterranean diet on cognitive functions might be partly mediated by higher plasma n-3 PUFA

Mediterranean diet and cognitive decline: what role for omega-3 polyunsaturated fatty acids?

The Mediterranean diet is characterized by a high consumption of fruits, vegetables, legumes, cereals, and olive oil as the main source of added fat, a moderate consumption of fish and wine, and a low consumption of meat and dairy products as a source of saturated fat. Several epidemiological studies have shown that higher adherence to a Mediterranean diet was associated with slower cognitive decline in older persons. This protective effect might be mediated by omega-3 poly-unsaturated fatty acids (n-3 PUFA). We investigated this hypothesis in 1050 participants in the 3City study from Bordeaux. After multivariable adjustment including apolipoprotein E (ApoE) genotype, plasma docosahexaenoic acid and total n-3 PUFA were positively associated with a score of adherence to a Mediterranean diet. Plasma eicosapentaenoic acid was positively associated with adherence only in ApoE4 non-carriers. These data suggest that the protective effect of the Mediterranean diet on cognitive functions might be partly mediated by higher plasma n-3 PUFA

Mediterranean diet and cognitive function in older adults.

International audiencePURPOSE OF REVIEW: The effectiveness of the Mediterranean diet in reducing the prevalence of cardiovascular and chronic diseases has been largely evidenced. Although nutrition constitutes an interesting approach in preventing age-related brain disorders, the association between the Mediterranean-style diet and cognitive functions has been very occasionally explored. RECENT FINDINGS: Results are provided from only two recent prospective cohorts of older Americans and French individuals (> or =65 years) on the relationship of Mediterranean diet to cognitive functions. A high adherence to the Mediterranean diet has been associated with slower cognitive decline, with reduced risk of mild cognitive impairment conversion to Alzheimer's disease and with reduced risk of Alzheimer's disease. SUMMARY: The possibility that the Mediterranean diet may affect not only the risk for Alzheimer's disease, but also the evolution of cognitive performances a long time before the clinical diagnosis of dementia and subsequent disease course constitutes major promising results. Replication of these results in other populations seems necessary to allow their generalization and to propose the Mediterranean diet as a potential preventive approach against cognitive decline or dementia in addition to its expected benefits against many other unfavorable outcomes in a public health perspective