An exploratory study to determine the relationship between levels of habitual activity and nutritional status, functional status, dietary intake and fatigue in older adults.

Introduction: Scotland has an ageing population which has significant implications for health and social care services. Encouraging older people to engage in healthy lifestyle behaviours has the potential to maintain a person’s functional ability, increase healthy life years and thus has the potential to enable older people to live at home independently for longer. Recommendations for levels of activity have been produced for older adults but whether these are being achieved is currently unknown. Levels of activity are influenced by many factors including nutritional and functional status, dietary intake and fatigue but as yet the relationship between these parameters and habitual activity has not been established. Therefore the aims of this study were 1) to determine the relationship between levels of habitual activity and nutritional status, functional ability, dietary intake, and levels of fatigue in older adults and 2) to inform physical activity targets for the aging population. Methods: Older adults were recruited from a range of social and leisure facilities across central Scotland. Habitual activity was measured continuously for seven consecutive days using an activPALTM accelerometer. Nutritional status (BMI, waist circumference (WC), tricep skinfold and mid arm muscle circumference) was measured using ISAK methodology. Functional status (handgrip dynamometry, sit to stand (STS), six minute walk (6MW) and gait speed (m/s)) was measured along with dietary intake using a seven day unweighed diet diary. In addition levels of fatigue were measured using the Multi-dimensional Fatigue Inventory. Pearson’s correlation coefficient analysis was utilised to establish relationships between levels of habitual activity and markers of nutritional status, functional status and dietary intake. Spearman’s rho correlation analysis was utilised to establish the relationship between levels of habitual activity and levels of fatigue. Partial correlation analysis was used to establish the influence of age and gender on these relationships. Results: Forty four (21m, 23f) healthy older adults were recruited and completed the study. Participants were found to spend a mean±sd 551 ± 88 min in sedentary behaviour daily which equates to 61±10% awake time being sedentary. They took 8721 ± 3585 steps daily and spent 108±38 min stepping, 253±78 min standing and 1080±103 min sitting or lying each day. Percent time in sedentary behaviour was positively associated with BMI (r=.302, p=.049), WC (cm) (r=.302, p=.049), percent energy intake from fat (r=.535, p<.001) and saturated fat (r=.381, p=.011) and was negatively associated with 6MW (m) (r=-.445, p=.002) and % energy from non-milk extrinsic sugar (r=-.314, p=.038). Total weekly time in moderate intensity activity accumulated in blocks of at least 10 minutes was positively associated with 6MW (r=0.321, p=.041), daily protein intake (g) (r=.350, p=.025) and mean daily vitamin D intake (μg) (r=.404, p=.009) and was negatively associated with STS (r=-.321, p=.041). Age but not gender influenced the relationships. Conclusion: This is the first study to report objectively measured levels of sedentary behaviour where habitual activity was measured continuously over seven days and sedentary behaviour was considered during waking hours only in a Scottish older adult population. Recommendations for physical activity were not consistently met and there is therefore some indication that current recommendations for sedentary behaviour and physical activity should be reviewed. However activity cannot be considered in isolation as many factors influence this including nutritional status, functional status, dietary intake and levels of fatigue.sub_dnbsunpub1820_ethesesunpu

Effectiveness of nutritional and exercise interventions to improve body composition and muscle strength or function in sarcopenic obese older adults:A systematic review

Although sarcopenic obesity (SO) poses a major public health concern, a robust approach for\ud the optimization of body composition and strength/function in SO has not yet been\ud established. The purpose of this systematic review was to assess the effectiveness of\ud nutritional (focusing on energy and protein modulation) and exercise interventions, either\ud individually or combined, on body composition and strength/function in older adults with SO.\ud MEDLINE, the Cochrane Central Register of Controlled Trials, CINAHL and SPORTDiscus were\ud searched. Main inclusion criteria comprised sarcopenia as defined by the European Working\ud Group on Sarcopenia in Older People (EWGSOP) and obesity defined as % body fat .40%\ud (women) and .28% (men). Randomized controlled trials (RCTs), randomized controlled\ud crossover trials and controlled clinical trials with older adults (mean age .65 years) following\ud a nutritional regimen and/or an exercise training programwere considered. Out of 109 full text\ud articles identified, only two RCTs (61 participants) met the inclusion criteria. One study was a\ud nutritional intervention adding 15 g protein�Eday.1 (via cheese consumption) to the\ud participants' habitual diet. The second study was a high-speed circuit resistance training\ud intervention. Body composition did not change significantly in either of the studies. However,the exercise intervention improved significantly muscle strength and physical function.\ud Although this review was limited by the small number of eligible studies, it provides evidence\ud for the potential benefits of exercise and highlights the necessity for future research to develop\ud effective interventions including dietary and exercise regimens to combat sarcopenic obesity

Older People Living in the Community - Nutritional Needs, Barriers and Interventions: a Literature Review

Crown Copyright 2009 Limited extracts from the text may be produced provided the source is acknowledged. For more extensive reproduction, please contact the Queens Printers of Scotland, Admail, ADM 4058, Edinburgh EH1 1NG. Email: [email protected] 1. This literature review focuses on the nutritional needs of older adults living in the community, the barriers to them meeting their nutritional needs and interventions which may be successful in improving nutritional intake. Good nutrition plays a vital role in the wellbeing and health of older people but also helps delay and reduce the risk of developing disease. Aims 2. The aims of the review are to: - Identify the nutritional needs of older people living in the community and barriers to them meeting their nutritional requirements. - Identify effective dietary and other interventions, including interventions to improve food access for older people (including cooking clubs, delivered meals/food etc) and use of supplements (of which vitamin D may be one), to improve health outcomes (including nutritional status) of this population group.sch_dieAlibhai, S.M.H., Greenwood C. and Payette H. (2005) An approach to the management of unintentional weight loss in elderly people. Canadian Medical Association Journal. 172 (6):773-780. Alzheimer Scotland http://www.alzscot.org/pages/statistics.htm accessed 28.11.08. Armstrong, J., Sherriff, A., Wrieden, W.L., Brogan, Y., and Barton, K.L. (2009) Deriving and interpreting dietary patterns in the Scottish diet: further analysis of the Scottish health survey and expenditure and food survey. Food Standards Agency Scotland. Available from URL: http://www.foodbase.org.uk/results.php?f_report_id=318 (Accessed 29.10.09) Audit Scotland (2004) Commissioning community care services for older people. Audit Scotland. Baldwin, C. and Weekes C.E. (2007) Dietary advice for illness-related malnutrition in adults. Cochrane Database of Systematic Reviews Issue 1. Art. No.: CD002008. DOI: 10.1002/14651858.CD002008.pub3. Bannerman, E., Reilly, J.J., MacLennan, W.J., Kirk, T. and Pender, F. (1997) Evaluation of validity of British anthropometric reference data for assessing nutritional state of elderly people in Edinburgh. BMJ 315:338-341. Bartali, B., Semba, R.D., Frongillo E.A., Varadhan, R., Ricks, M.O., Blaum, C.S., Ferrucci, L., Guralnik, J.M., ,and Fried, L,P. (2006) Low micronutrient levels as a predictor of incident disability in older women. Archives of Internal Medicine. 166(21):2335-40. Baumgartner, R.N., Koehler, K.M., Gallagher, D., Romero, L., Heymsfield, S.B., Ross, R.R., Garry, P.J., and Lindeman, R.D. (1998) Epidemiology of sarcopenia among the elderly in New Mexico. American Journal of Epidemiology. 147(8): 755- 63. Beck, M. and Ovesen, L. (1998) At which body mass index and degree of weight loss should hospitalized elderly patients be considered at nutritional risk? Clinical Nutrition. 17 (5) 195-198. Beswick, A.D., Rees, K., Ayis, S., Gooberman-Hill, R., Horwood, J. and Ebrahim, S (2008) Complex interventions to improve physical function and maintain independent living in the elderly people. A systematic review and meta analysis. The Lancet. 371(9614):725 - 735. Boyce, J.M. and Shone, G.R.(2006) Effects of ageing on smell and taste. Postgraduate Medical Journal. 82(966):239-41. 48 Broadwin, J., Goodman-Gruen, D. and Slymen, D. (2001) Ability of fat and fat-free mass percentages to predict functional disability in older men and women. Journal of the American Geriatrics Society. 49(12):1641-5. Brownie, S. (2006) Why are elderly individuals at risk of nutritional deficiency? International Journal Of Nursing Practice. 12(2)110-118. Caroline Walker Trust (2004) Eating well for older people: Practical and nutritional guidelines for food in residential and nursing homes and for community meals. (Second Edition) Abbots Langley: The Caroline Walker Trust. Cesari, M., Pahor, M., Bartali, B., Cherubini, A., Penninx, B.W., Williams, G.R., Atkinson, H., Martin, A., Guralnik, J.M. and Ferrucci, L. (2004) Antioxidants and physical performance in elderly persons: the Invecchiare in Chianti (InCHIANTI) study. American Journal of Clinical Nutrition. 79(2):289-94. Chin, A., Paw, M., de Jong, N., Schouten, E. G., van Staveren, W. A., and Kok, F. J. (2002) Physical exercise or micronutrient supplementation for the wellbeing of the frail elderly? A randomised controlled trial. British Journal of Sports Medicine. 36(2)126-131. 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Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

DNA methylation-based classification of sinonasal tumors

The diagnosis of sinonasal tumors is challenging due to a heterogeneous spectrum of various differential diagnoses as well as poorly defined, disputed entities such as sinonasal undifferentiated carcinomas (SNUCs). In this study, we apply a machine learning algorithm based on DNA methylation patterns to classify sinonasal tumors with clinical-grade reliability. We further show that sinonasal tumors with SNUC morphology are not as undifferentiated as their current terminology suggests but rather reassigned to four distinct molecular classes defined by epigenetic, mutational and proteomic profiles. This includes two classes with neuroendocrine differentiation, characterized by IDH2 or SMARCA4/ARID1A mutations with an overall favorable clinical course, one class composed of highly aggressive SMARCB1-deficient carcinomas and another class with tumors that represent potentially previously misclassified adenoid cystic carcinomas. Our findings can aid in improving the diagnostic classification of sinonasal tumors and could help to change the current perception of SNUCs

DNA methylation-based classification of sinonasal tumors

The diagnosis of sinonasal tumors is challenging due to a heterogeneous spectrum of various differential diagnoses as well as poorly defined, disputed entities such as sinonasal undifferentiated carcinomas (SNUCs). In this study, we apply a machine learning algorithm based on DNA methylation patterns to classify sinonasal tumors with clinical-grade reliability. We further show that sinonasal tumors with SNUC morphology are not as undifferentiated as their current terminology suggests but rather reassigned to four distinct molecular classes defined by epigenetic, mutational and proteomic profiles. This includes two classes with neuroendocrine differentiation, characterized by IDH2 or SMARCA4/ARID1A mutations with an overall favorable clinical course, one class composed of highly aggressive SMARCB1-deficient carcinomas and another class with tumors that represent potentially previously misclassified adenoid cystic carcinomas. Our findings can aid in improving the diagnostic classification of sinonasal tumors and could help to change the current perception of SNUCs

Erratum to: A multi-stage genome-wide association study of uterine fibroids in African Americans

The article "A multi-stage genome-wide association study of uterine fibroids in African Americans", written by Jacklyn N. Hellwege, was originally published Online First without open access. After publication in volume 136, issue 10, page 1363-1373 the author decided to opt for Open Choice and to make the article an open access publication. Therefore, the copyright of the article has been changed t

The drivers of heuristic optimization in insect object manufacture and use

Insects have small brains and heuristics or ‘rules of thumb’ are proposed here to be a good model for how insects optimize the objects they make and use. Generally, heuristics are thought to increase the speed of decision making by reducing the computational resources needed for making decisions. By corollary, heuristic decisions are also deemed to impose a compromise in decision accuracy. Using examples from object optimization behavior in insects, we will argue that heuristics do not inevitably imply a lower computational burden or lower decision accuracy. We also show that heuristic optimization may be driven by certain features of the optimization problem itself: the properties of the object being optimized, the biology of the insect, and the properties of the function being optimized. We also delineate the structural conditions under which heuristic optimization may achieve accuracy equivalent to or better than more fine-grained and onerous optimization methods