Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

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

Peridotite clinopyroxene chemistry reflects mantle processes rather than continental versus oceanic settings.

Comparison of 360 trace element analyses of clinopyroxenes from peridotites indicates that clinopyroxene composition cannot discriminate between suboceanic and subcontinental mantle. Clinopyroxenes from abyssal and fore-arc peridotites have the lowest incompatible element concentrations and record melting and basalt extraction as the dominant process. Clinopyroxenes from continental peridotite massifs partially overlap the composition of clinopyroxenes from abyssal peridotites and, in general, behave as a less depleted component in the chemical variation trends defined by the latter. In the peridotite massifs, subsolidus re-equilibration involving phase transitions (spinel to plagioclase facies) may cause significant element variations in clinopyroxene (e.g. Sr and Eu/Eu* decrease, REE, Ti increase). Metasomatic processes cause only comparatively minor trace element variations. Clinopyroxenes from mantle xenoliths in OIB and continental alkali basalts have the highest incompatible trace element concentrations and the largest compositional variations, They primarily record metasomatic enrichment processes, which are similar in suboceanic and subcontinental mantle. These processes induced the highest incompatible element enrichment in the clinopyroxenes from the most refractory peridotites, supporting the chromatographic nature of infiltration metasomatism. This enrichment, however, does not affect Ti, which is in the same concentration range in clinopyroxenes from both xenoliths and abyssal peridotites. The apparent Ti immobility may be due to several causes, such as reduced Ti solubility in hydrous fluids, fractionation of Ti-rich phases from percolating silicate melts, reaction with carbonatite melts formerly equilibrated with amphibole-peridotite. In general, clinopyroxene geochemistry does not allow a clear distinction between different metasomatic agents. The similarity between the geochemical characteristics of xenoliths from continental and oceanic environments supports previous results that the compositions of the pre-metasomatic lithosphere and of the asthenosphere, from where metasomatic agents derive, do not differ in the two environments

Accelerated surgery versus standard care in hip fracture (HIP ATTACK) : an international, randomised, controlled trial

Background: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. Methods: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). Findings: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4\u20139) in the accelerated-surgery group and 24 h (10\u201342) in the standard-care group (p<0\ub70001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0\ub791 (95% CI 0\ub772 to 1\ub714) and absolute risk reduction (ARR) of 1% ( 121 to 3; p=0\ub740). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0\ub797 (0\ub783 to 1\ub713) and an ARR of 1% ( 122 to 4; p=0\ub771). Interpretation: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. Funding: Canadian Institutes of Health Research