Self-Perception of Economic Means is Associated with Dietary Choices, Diet Quality and Physical Health in the Oldest Old Men from the Highest Socioeconomic Group

IntroductionSelf-perception of economic means may affect dietary choices, diet quality, and health behavior. We examined these associations in the oldest-old men from the highest socioeconomic class.MethodsThe participants in this cross-sectional analysis were the oldest- old home-dwelling men (n = 314, mean age 87 years, range 82-97 years) from the longitudinal Helsinki Businessmen Study cohort. They responded to a postal health and nutrition questionnaire, whereupon dietary intakes were assessed using 3-day food diaries and two diet quality indices. The questionnaire also included items about health, exercise, falls, and economic means.ResultsHigher self-perception of economic means was linearly associated with higher fish intake (p = 0.021), fruit and vegetable intakes (p = 0.027), use of alcohol (p = 0.003), overall diet quality according to IDQ (p = 0.008), self-perceived physical condition (p = 0.002) and inversely associated with body weight (p = 0.011), weight loss (p = 0.008), blood glucose levels (p = 0.020), and falls (p = 0.029).ConclusionSelf-perception of economic means was associated with dietary choices and physical health even among affluent older men. This information is important, because self-perception of economic means, however real, may affect health and nutrition behavior of older people.Peer reviewe

Ravitsemus, päivittäinen kävely ja resilienssi ovat yhteydessä fyysiseen toimintakykyyn vanhimmista vanhoilla miehillä

Peer reviewe

Sarcopenia Indicators as Predictors of Functional Decline and Need for Care among Older People.

OBJECTIVES: Sarcopenia is associated with poor health outcomes. We examined the relative roles of muscle mass, strength, physical performance and obesity as health predictors among older sarcopenic people. DESIGN AND PARTICIPANTS: This prospective study examined community-dwelling people aged 75+ (N=262). SETTING: Porvoo Sarcopenia and Nutrition Trial. MEASUREMENTS: We collected demographic data and medical history by postal questionnaire including RAND-36 at baseline and at four years and measured BMI, Short Physical Performace Battery (SPPB), hand-grip strength, cognition and two surrogate measures of muscle mass; the Single Frequency Skeletal Muscle Index (SF-SMI) and the Calf Intracellular Resistance Skeletal Muscle Index (CRi-SMI). RESULTS: Adjusted for age and gender, independent outdoors mobility was predicted positively by baseline physical functioning scores in RAND-36 (p<0.001), the SPPB (p<0.001), the two-minute step test (p<0.001), and grip strength (p=0.023), as well as CRi-SMI (p<0.001). However, the prediction was negative in BMI (p<0.001) and the Charlson co-morbidity Index (p= 0.004). Similar associations were found when the physical component RAND-36 was used as an outcome measure. The use of home care was predicted by high co-morbidity (p=0.057) and low scores in RAND-36 (p<0.001), SPPB (p<0.001) and the two-minute step test (p<0.001), and low CRi-SMI (p<0.001). CRi-SF was a more consistent predictor than SF-SMI, which was partly masked by BMI. Controlled for age, gender and comorbidity, a 10% difference in CRi-SMI was associated with a 4% higher probability (p=0.019) of independently living at home, whereas the respective figures for SF-SMI and BMI were -18% (p=0.098) and -14% (p=0.088). CONCLUSIONS: In contrast to SF-SMI, high CRi-SMI appeared to indicate good prognosis and less need of care, independently of BMI.Peer reviewe

Macronutrient composition and sarcopenia in the oldest-old men : The Helsinki Businessmen Study (HBS)

Background & aim: Sarcopenia is associated with increased risk for several adverse health outcomes including frailty, disability, loss of independence, and mortality. We examined cross-sectional associations between sarcopenia and detailed dietary macronutrient composition in community-living oldest-old men (mean age 87). Methods: Participants were invited to a clinic visit in 2017/2018 including assessments of sarcopenia status using European Working Group on Sarcopenia in Older People's 2 (EWGSOP2) criteria and detailed macronutrient, vitamin D and food intakes retrieved from 3-day food diaries. Results: Of the 126 participants, 48 had probable sarcopenia and 27 sarcopenia. Sarcopenia was associated with lower energy (p = 0.020), total protein (p = 0.019), plant (p = 0.008) and fish proteins (p = 0.041), total fat (p = 0.015), monounsaturated fatty acids (MUFA) (p = 0.011), polyunsaturated fatty acids (p = 0.002), vitamin D intakes (p = 0.005) and, of fat quality indicators, MUFA: saturated fatty acid-ratio (p = 0.042). Conclusion: These findings suggest that sufficient energy and protein intakes, but also fat quality may be important along with healthy dietary patterns for prevention of sarcopenia in the oldest-old.Peer reviewe

Associations of protein source, distribution and healthy dietary pattern with appendicular lean mass in oldest-old men : the Helsinki Businessmen Study (HBS)

Key summary pointsAim To investigate how food and dietary intakes, protein daily distribution and source were associated with appendicular lean mass (ALM)/m(2) in the oldest-old community-dwelling men. Findings ALM/m(2) was associated with total protein intake, source and distribution as well as fruit and vegetable intakes. Message Not only protein intake, but also source and distribution as well as healthy overall diet characterized by abundant amounts of fruits and vegetables were important in maintaining muscle mass in the oldest-old men in our study. Purpose We explored how food and dietary intakes, protein daily distribution and source are associated with appendicular lean mass (ALM)/m(2) of the oldest-old community-dwelling men. Methods Cross-sectional analyses of Helsinki Businessmen Study (HBS, mean age 87 years) participants who came to clinic visit in 2017/2018. Nutritional status, physical performance and fasting blood samples were measured. Food and dietary intakes were retrieved from 3-day food diaries. Body composition was measured and appendicular lean mass (ALM) per m(2) was dichotomized as ALM/m(2) = 7 kg/m(2). Differences between lower and higher ALM were analyzed using t test or Mann-Whitney U test. Analysis of covariance was used to investigate independent associations with ALM/m(2). Results Random sample of 130 participants took part in the medical examinations, 126 returned food diaries, and 102 underwent DXA-scan. ALM/m(2) was associated with total protein (p = 0.033), animal protein (p = 0.043) and meat protein (p = 0.033) intakes. Protein distribution between daily meals differed at lunch; those with higher ALM/m(2) ate more protein (p = .047) at lunch. Consumption of fruits, vegetables (p = 0.022) and meat (p = 0.006) was associated with ALM/m(2). Conclusion Protein intake, source and distribution as well fruit and vegetable intakes were associated with higher ALM in oldest-old men. Study registration The study is registered with ClinicalTrials.gov identifier: NCT02526082.Peer reviewe

Status of Geriatrics in 22 Countries

The aim of this article is to describe the current status of geriatrics and position of geriatricians in 22 countries of three continents, and to portray their attitudes towards and resources allocated to geriatrics. An electronic survey was delivered to a convenience sample of 22 geriatricians in leading positions of their countries. The time required in post graduation specialist training to become a geriatrician varied from one year (subspecialty in the USA) to six years (independent specialty in Belgium). The number in the population aged 80+ per geriatrician varied from 450 (Austria) to 25,000 (Turkey). Of respondents, 55% reported that geriatrics is not a popular specialty in their country. Acute geriatric wards, rehabilitation and outpatient clinics were the most common working places for geriatricians. Nearly half of the respondents had an opinion that older patients who were acutely ill, were receiving subacute rehabilitation or had dementia should be cared for by geriatricians whereas half of the respondents would place geriatricians also in charge of nursing home and orthogeriatric patients. The biggest problems affecting older people's clinical care in their countries were: lack of geriatric knowledge, lack of geriatricians, and attitudes towards older people. Half of respondents thought that older people's health promotion and comprehensive geriatric assessment were not well implemented in their countries, although a majority felt that they could promote good geriatric care in their present position as a geriatrician. The position of geriatric, geriatricians' training and contents of work has wide international variety.Peer reviewe

Psychological well-being is associated with better nutrient intakes in heterogeneous older populations

Non peer reviewe

The sarcopenia and physical frailty in older people : multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans

Background The "Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies" (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. Methods SPRINTT RCT recruited older adults (>= 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3-9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0-1.2 g/kg body weight, energy intake of 25-30 kcal/kg of body weight/day, and serum vitamin D concentration >= 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. Results Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. Conclusion The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations. Aim To describe the methods and feasibility of the nutritional intervention carried out within the SPRINTT Randomized cotrolled trial. We also illustrate how nutrition interventionists identified participants at risk of malnutrition and the lessons learnt from the nutrition intervention. Findings SPRINTT nutrition intervention was well-received by the majority of the participants. It was mainly carried out using tailored nutrition counselling, but also other means of delivering the intervention were successfully used. Compared with a standard nutrition prescription, an individualized protocol to diagnose malnutrition and follow-up by tailored nutrition counselling helped achieve nutritional targets more effectively in spite of diversity of population in nutritional habits and in some cases reluctance to accept changes. Message The SPRINTT nutrition intervention was feasible and allowed flexibility to the varying needs and cultural differences of this heterogeneous population of frail, older Europeans. It may serve as a model to educate and improve nutrition among community-dwelling older people at risk of mobility limitations.Peer reviewe

Relationship between frailty, nutrition, body composition, quality of life, and gender in institutionalized older people

Our aim was to explore the relationship between frailty, nutrition, body composition, and how gender modifies this relationship among long-term care facility residents. We further investigated how body composition correlates with health-related quality of life (HRQoL) in both genders. In all, 549 residents (> 65 years of age) were recruited from 17 long-term care facilities for this cross-sectional study. Demographic information, diagnoses, use of medications, and nutritional supplements were retrieved from medical records. Participants' frailty status, cognition, nutritional status, HRQoL, and body composition were determined. Energy, protein, and fat intakes were retrieved from 1- to 2-day food diaries. The final sample consisted of 300 residents (77% women, mean age 83 years). The majority of participants, 62% of women and 63% of men, were identified as frail. Frail participants in both genders showed lower body mass index (p = 0.0013), muscle mass (MM) (p < 0.001), poorer nutritional status (p = 0.0012), cognition (p = 0.0021), and lower HRQoL (p < 0.001) than did prefrail participants. Women had higher fat mass, whereas men exhibited higher MM. The HRQoL correlated with the MM in both women, r = 0.48 [95% CI 0.38, 0.57] and men r = 0.49 [95% CI 0.38, 0.58]. Interventions aimed at strengthening and retaining MM of long-term residents may also support their HRQoL.Peer reviewe

The short-term effect of dark chocolate flavanols on cognition in older adults: A randomized controlled trial (FlaSeCo)

Background Cocoa flavanols in the diet have had positive effects on cognition, blood lipid levels, and glucose metabolism. Methods Cognitively healthy older adults aged 65–75 years were recruited for an eight-week randomized, double-blind controlled trial to investigate the effectiveness of cocoa flavanols on cognitive functions. At baseline, nutrient and polyphenol intakes from diet were assessed with three-day food diaries. The intervention group received 50 g dark chocolate containing 410 mg of flavanols per day, and the control group 50 g dark chocolate containing 86 mg of flavanols per day, for eight weeks. Cognition was assessed with Verbal Fluency (VF) and the Trail Making Test (TMT) A and B as the main outcome measures. Changes in blood lipids and glucose were also measured. Results The older adults participating numbered 100 (63% women), mean 69 y (range 65 to 74). They were highly educated with a mean 14.9 years of education (SD 3.6). No differences in changes in cognition were seen between groups. The mean change (± SEs) in the time to complete the TMT A and B in the intervention group was −4.6 s (−7.1 to −2.1) and −16.1 s (−29.1 to −3.1), and in the controls −4.4 s (−7.0 to −1.9) and −12.5 s (−22.8 to −2.1)(TMT A p = 0.93; TMT B p = 0.66). No difference was apparent in the changes in blood lipids, glucose levels, or body weight between the groups. Conclusions The healthy older adults showed no effect from the eight-week intake of dark chocolate flavanols on cognition.Peer reviewe