Effect of Protein Supplementation on Physical Performance in Older People With Sarcopenia-A Randomized Controlled Trial

Objectives: To test the long-term effects of whey-enriched protein supplementation on muscle and physical performance. Design: A 12-month randomized controlled double blind trial with a 43-month of post-trial follow-up. Setting: Porvoo, Finland. Participants: A total of 218 older (>74 years of age) community-dwelling people with sarcopenia. Intervention: (1) Control with no supplementation; (2) isocaloric placebo; and (3) 20 g x 2 whey-enriched protein supplementation. All participants were given instructions on home-based exercise, dietary protein, and vitamin D supplementation of 20 mu g/d. Measurements: Physical performance was assessed by short physical performance battery and continuous summary physical performance scores. Hand grip strength and calf intracellular resistance based skeletal muscle index were measured by bioimpedance spectroscopy. The measurements were performed at 0, 6, and 12 months. The post-trial follow-up was performed by a postal questionnaire and national census record data. Results: The participants were older (75-96 years of age) and mostly women (68%). The test supplements had no significant effects on physical performance; the 12-month changes for short physical performance battery were -0.55, -.05, and 0.03 points in control, isocaloric, and protein groups (P = .17), respectively. The changes in continuous summary physical performance scores were similar between the intervention groups (P = .76). The hand grip strength decreased significantly in all intervention groups, and the 12-month changes in calf intracellular resistance-based skeletal muscle index were minor and there were no differences between the intervention groups. One-half of the patients (56%) in both supplement groups reported mild gastrointestinal adverse effects. Differences were found neither in the all-cause mortality nor physical functioning in the post-trial follow-up. Conclusions: The whey-enriched protein supplementation in combination with low intensity home-based physical exercise did not attenuate the deterioration of muscle and physical performance in community-dwelling older people with sarcopenia. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe

The associations of body mass index, bioimpedance spectroscopy-based calf intracellular resistance, single-frequency bioimpedance analysis and physical performance of older people

BACKGROUND: Bioimpedance skeletal muscle indices (SMI) are used as a surrogate for skeletal muscle mass, but their associations with physical functioning and obesity need further evaluation. AIMS: To compare the associations of body mass index (BMI), bioimpedance spectroscopy-based calf intracellular resistance (Cri-SMI), and single-frequency bioimpedance analysis (SF-SMI) indices with physical performance and the functioning of community-dwelling older people at risk of or already suffering from sarcopenia. METHODS: Pre-intervention measurements of the screened subjects and the participants of the Porvoo sarcopenia trial (N = 428) were taken. Cri-SMI, whole-body SF-SMI, and BMI were related to hand-grip strength, walking speed, short physical performance battery (SPPB), and the physical component of the RAND-36. RESULTS: Among the older people (aged 75-96), Cri-SMI correlated inversely with age (men r = - 0.113, p < 0.001; women r = - 0.287, p < 0.001), but positively with SPPB (r = 0.241, p < 0.001) and the physical component of the RAND-36 (r = 0.114, p = 0.024), whereas BMI was inversely associated with SPPB (r = - 0.133, p < 0.001) and RAND-36 (r = - 0.286, p < 0.001). After controlling for age, gender, and comorbidity, one unit of Cri-SMI (cm2/Ω) was associated with a 3.3-fold probability of good physical performance (SPPB ≥ 9 points, OR = 3.28, p < 0.001) and one unit of BMI (kg/m2) decreased the respective probability 4% (OR= 0.96, p = 0.065). Physical inactivity partly explained the negative association of BMI. When Cri-SMI and BMI were controlled for, a 1% difference in Cri-SMI was associated with a 0.7% (p < 0.001) higher probability of good performance, the respective figure being - 2.2% (p = 0.004) for BMI. The associations of SF-SMI with physical functioning indices were insignificant. CONCLUSIONS: Independent of each other, Cri-SMI was positively and BMI was inversely associated with the physical performance and functioning of community-dwelling older people who were at risk of or already suffering from sarcopenia. We found no association between SF-SMI and physical functioning.Peer reviewe

Associations of coffee drinking with physical performance in the oldest-old community-dwelling men The Helsinki Businessmen Study (HBS)

Abstract Background: Habitual coffee drinking has been associated with lower risk of various chronic diseases linked to poor physical performance. Objective: We explored cross-sectional associations between coffee consumption and physical performance among oldest-old community-dwelling men in the Helsinki Businessmen Study (HBS). Methods: A random sample of HBS survivors (n = 126, mean age 87 years) attended a clinic visit in 2017/2018, including measurements of body composition, physical performance [Short Physical Performance Battery (SPPB)], and cognition. Coffee consumption was retrieved from 3-day food diaries. Results: Coffee consumption was positively associated with higher gait speed (p = 0.003), SPPB score (p = 0.035), and chair rise points (p = 0.043). Association of coffee with gait speed remained after adjustment for age, waist circumference, physical activity, pulse rate, and high-sensitivity C-reactive protein. Conclusion: Higher coffee consumption was independently associated with better physical performance reflected as faster gait speed in oldest-old men

Associations of sleep quality, quantity and nutrition in oldest-old men The Helsinki Businessmen Study (HBS)

Abstract Introduction: Sleep quality and quantity often decline as people age, which may negatively impact health. We examined how nutrition is associated with self-reported sleep quality and quantity in oldest-old community-dwelling men. Methods: In this cross-sectional analysis of the Helsinki Businessmen Study (HBS), a random sample of 130 surviving participants underwent a clinical examination in 2017–2018. Food and nutrient intakes were retrieved from 3-day food diaries in 126 men, and sleep quality and quantity were determined with a questionnaire. Nutritional status was assessed using Mini Nutritional Assessment Short Form (MNA-SF), General Health and Vitality were measured with RAND-36/SF-36 health-related quality of life instrument, and albumin and creatinine levels were analyzed from fasting serum samples. Results: Mean age of the survivors was 87 years (range 83–99). Self-reported sleep quality and quantity were highly correlated (p &lt; 0.001, η² = 0.693). Nutritional status (MNA-SF) (p = 0.006, η² = 0.076), vegetable intake (p = 0.030. η² = 0.041) and vitality (p = 0.008, η² = 0.101) were associated with better sleep quality and fish (p = 0.028, η² = 0.051) intake was associated with longer sleep duration. This association remained after adjusting for age, sleep quality, carbohydrate energy %, and albumin levels. Conclusion: Healthy nutrition may be an important contributor to sleep hygiene in oldest-old men

Esigerastenia ja gerastenia ennustavat kuolemanvaaraa jopa vahvemmin kuin monisairastavuus

Abstract Background: Multimorbidity and frailty phenotype are common among people aged 75 and older, but there is little data on their independent contributions to prognosis. Methods: In the Helsinki Businessmen Study, men born 1919–1934 were followed up from the 1960s. In 2011, multimorbidity, prefrailty and frailty phenotype were assessed in 528 home-living men (median age 82, interquartile range 80–86 years). Seven-year mortality was retrieved from the national register, and prognostic factors were analysed using Cox regression. Results: The following groups were identified: group I: robust without multimorbidity (n = 135; 25% dead); group II: only prefrailty (n = 177; 44% dead); group III: only frailty (n = 27; 70% dead); group IV: only multimorbidity (n = 59; 37% dead); group V: multimorbidity + prefrailty (n = 107; 56% dead); group VI: multimorbidity + frailty (n = 23; 83% dead). In an adjusted model including disability, hazard ratios (with 95% confidence interval) with group I as reference were: II: 2.01 (95% CI 1.26–3.20); III: 3.68 (1.88–7.20); IV: 1.81 (1.00–3.28); V: 2.63 (1.61–4.28); VI: 4.83 (2.47–9.45). Conclusions: Prefrailty and frailty phenotype predicted mortality similarly — or better — than multimorbidity and may thus provide extra prognostic value in older men.Tiivistelmä Lähtökohdat: Monisairastavuus ja gerastenia ovat yleisiä yli 75-vuotiailla, mutta niiden itsenäisestä ennustemerkityksestä on vähän tietoa. Menetelmät: Helsingin Johtajatutkimuksessa seurataan 1919–1934 syntyneitä miehiä. Vuonna 2011 määritettiin monisairastavuus sekä esigerastenian ja gerastenian fenotyyppi 528:lta kotona asuvalta mieheltä (iän mediaani 82 v). Väestörekisterikeskuksesta saatiin 7 vuoden kuolleisuus, ja ennustemerkitys analysoitiin Coxin monimuuttujamallilla. Tulokset: Miehillä, joilla ei ollut monisairastavuutta, esigerasteniaa tai gerasteniaa (n = 135), 7 vuoden kuolleisuus oli 25 %, pelkän esigerastenian fenotyyppisillä (n = 177) 44 % (riskisuhde 2,01; 95 %:n LV 1,26–3,20) ja pelkän gerastenian fenotyyppisillä (n = 27) 70 % (3,68; 1,88–7,20). Pelkästään monisairaiden (n = 59) kuolleisuus oli 37 % (1,81; 1,00–3,28), monisairaiden esigerasteenisten (n = 107) 56 % (2,63; 1,61–4,28) ja monisairaiden gerasteenisten (n = 23) 83 % (4,83; 2,47–9,45). Riskisuhteet ensimmäiseen ryhmään verrattuna laskettiin vakioidussa mallissa, joka sisälsi toiminnanvajeen. Päätelmät: Esigerastenian ja gerastenian kliiniset fenotyypit ennustivat yli 75-vuotiaiden kotona asuvien miesten 7 vuoden kuolleisuutta yhtä hyvin tai paremmin kuin monisairastavuus. Fenotyypin määrittäminen antaa kliinistä lisäarvoa ennustearvioon

Association of plasma gelsolin with frailty phenotype and mortality among octogenarian community-dwelling men:a cohort study

Abstract Background: Biomarkers are needed for frailty, a common phenotype often associated with muscle loss in older people. Plasma gelsolin (pGSN) is a protein largely synthesized and secreted by skeletal muscle. Aims: To investigate whether pGSN could be a biomarker of the frailty phenotype and predict mortality. Methods: A homogenous cohort of males (born 1919–1934, baseline n = 3490) has been followed since the 1960s. In 2010/11, frailty phenotypes by modified Fried criteria were assessed. pGSN was measured in a convenience subset (n = 469, mean age 83) and re-measured in survivors (n = 127) in 2017. Mortality through December 31, 2018 was retrieved from national registers. Regression models were used for analyses. Results: Of 469 males, 152 (32.4%) were robust, 284 (60.6%) prefrail, and 33 (7.0%) frail in 2010/11. There was a graded (p = 0.018) association between pGSN (mean 58.1 ug/mL, SD 9.3) and frailty. After multivariable adjustment, higher pGSN levels were associated with lower odds of having contemporaneous phenotypic prefrailty (OR per 1 SD 0.73, 95% CI 0.58–0.92) and frailty (OR per 1 SD 0.70, 95% CI 0.44–1.11). By 2018, 179 males (38.2%) had died, and higher baseline pGSN predicted a lower 7-year mortality rate (HR per 1 SD 0.85, 95% CI 0.72–1.00). pGSN concentrations in 2010/11 and 2017 were correlated (n = 127, r = 0.34, p &lt; 0.001). Discussion: Higher baseline pGSN concentrations were associated with a persistently robust phenotype and lower mortality rate over 7 years in a cohort of octogenarian males with high socioeconomic status and may be a promising laboratory biomarker for the development of a frailty phenotype

Phenotypic frailty and multimorbidity are independent 18-year mortality risk indicators in older men

Abstract Purpose: Multimorbidity, prefrailty, and frailty are frequent in ageing populations, but their independent relationships to long-term prognosis in home-dwelling older people are not well recognised. Methods: In the Helsinki Businessmen Study (HBS) men with high socioeconomic status (born 1919–1934, n = 3490) have been followed-up from midlife. In 2000, multimorbidity (≥ 2 conditions), phenotypic prefrailty and frailty were determined in 1365 home-dwelling men with median age of 73 years). Disability was assessed as a possible confounder. 18-year mortality follow-up was established from registers and Cox regression used for analyses. Results: Of the men, 433 (31.7%) were nonfrail and without multimorbidity at baseline (reference group), 500 (36.6%) and 82 (6.0%) men had prefrailty or frailty, respectively, without multimorbidity, 84 (6.2%) men had multimorbidity only, and 201 (14.7%) and 65 (4.8%) men had prefrailty or frailty together with multimorbidity. Only 30 (2.2%) and 86 (6.3%) showed signs of ADL or mobility disability. In the fully adjusted analyses (including ADL disability, mental and cognitive status) of 18-year mortality, frailty without multimorbidity (hazard ratio 1.62, 95% confidence interval 1.13–2.31) was associated with similar mortality risk than multimorbidity without frailty (1.55, 1.17–2.06). The presence of both frailty and multimorbidity indicated a strong mortality risk (2.93, 2.10–4.07). Conclusion: Although multimorbidity is generally considered a substantial health problem, our long-term observational study emphasises that phenotypic frailty alone, independently of disability, may be associated with a similar risk, and a combination of multimorbidity and frailty is an especially strong predictor of mortality

Effectiveness and cost-effectiveness of personalised dietary advice aiming at increasing protein intake on physical functioning in community-dwelling older adults with lower habitual protein intake : rationale and design of the PROMISS randomised controlled trial

Introduction Short-term metabolic and observational studies suggest that protein intake above the recommended dietary allowance of 0.83 g/kg body weight (BW)/day may support preservation of lean body mass and physical function in old age, but evidence from randomised controlled trials is inconclusive. Methods and analysis The PRevention Of Malnutrition In Senior Subjects in the EU (PROMISS) trial examines the effect of personalised dietary advice aiming at increasing protein intake with or without advice regarding timing of protein intake to close proximity of usual physical activity, on change in physical functioning after 6 months among community-dwelling older adults (>= 65 years) with a habitual protein intake of Discussion The PROMISS trial will provide evidence whether increasing protein intake, and additionally optimising the timing of protein intake, has a positive effect on the course of physical functioning after 6 months among community-dwelling older adults with a habitual protein intake of Ethics and dissemination The study has been approved by the Ethics Committee of the Helsinki University Central Hospital, Finland (ID of the approval: HUS/1530/2018) and The Medical Ethical Committee of the Amsterdam UMC, location VUmc, Amsterdam, the Netherlands (ID of the approval: 2018.399). All participants provided written informed consent prior to being enrolled onto the study. Results will be submitted for publication in peer-reviewed journals and will be made available to stakeholders (ie, older adults, healthcare professionals and industry).Peer reviewe

Dietary fat intake and quality in long-term care residents in two cohorts assessed 10 years apart

Abstract Purpose: To describe and compare detailed dietary fat intake, fat quality and associative factors between two measuring points 10 years apart of residents living in long-term care facilities, and to reflect how fat composition and fat quality corresponds to current nutrition recommendations. Methods: In 2007 long-term care residents (n = 374) of 25 assisted-living facilities and nursing homes and in 2017–18 long-term care residents (n = 486) of 17 respective facilities in Helsinki metropolitan area were recruited for this study. Information on the residents’ heights, demographic information and use of calcium and vitamin D supplementation were retrieved from medical records. Residents’ clinical assessment included Clinical Dementia Rating (CDR), the Mini Nutritional Assessment (MNA) and questionnaire related to nutrition care. Participants’ energy and fat intake were determined from 1--2-day food diaries kept by the ward nurses, and fat quality indicators calculated. Results: Age, gender distribution, MNA score or body mass index did not differ between the two cohorts. Residents’ cognitive status, subjective health and mobility were poorer in 2017 compared to 2007. Total fat and saturated fatty acid (SFA) intakes were higher and fat quality indicators lower in the 2017 cohort residents than in the 2007 cohort residents. Sugar intake, male gender, eating independently, eating larger amounts and not having dry mouth predicted higher SFA intake in the 2017 cohort. Conclusions: The fat quality in long-term care residents in our study worsened in spite of official recommendations between the two measurement points