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

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 <0.001, eta(2) = 0.693). Nutritional status (MNA-SF) (p = 0.006, eta(2) = 0.076), vegetable intake (p = 0.030. eta(2) = 0.041) and vitality (p = 0.008, eta(2) = 0.101) were associated with better sleep quality and fish (p = 0.028, eta(2) = 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. Key summary pointsAim To investigate associations of sleep quality and quantity and nutrition in oldest-old men. Findings Sleep quality was associated with nutritional status and vegetable intakes, whereas sleep quantity was linked to fish intake. Message Healthy nutrition may be an important contributor of sleep hygiene in oldest-old men.Peer reviewe

Happiness of the oldest-old men is associated with fruit and vegetable intakes

BackgroundPositive emotions and happiness may improve health and prolong life. Diet quality, Mediterranean dietary pattern, fruit and vegetable, chocolate, and fish consumption have been linked to positive affect, improved mood, and reduced risk of depression. We examined the associations between diet, nutrition, and perceived happiness in the oldest-old men.MethodsThe participants in this cross-sectional analysis were the oldest-old, home-dwelling men (n=338, mean age 88years, range 82-97years) from the longitudinal Helsinki Businessmen Study cohort. In 2016, a postal health and nutrition survey was performed. Happiness was evaluated using the Visual Analog Scale of Happiness (0-100mm). The nutrition survey included a 3-day food diary, Mediterranean Diet Adherence score, and Index of Diet Quality designed to measure adherence to Finnish dietary recommendations. The participants were divided into quartiles according to happiness scores, and diet quality scores, food intakes, and other indicators were compared between the happiness quartiles.ResultsHappiness was linearly associated with total fruit and vegetable intakes (p=0.002) and inversely associated with age (p=0.016), blood glucose levels (p=0.049), skipping lunch (p=0.023), reduced food intake (p=0.002), and weight loss (p=0.016).ConclusionsFruit and vegetable intakes indicated happiness in the oldest-old men while reduced food intakes and weight loss were inversely associated with happiness. Maintaining good nutrition and increasing fruit and vegetable consumption may be important for psychological health of older people.Peer reviewe

Major cardiovascular disease (CVD) risk factors in midlife and extreme longevity

Background The studies on the association of various midlife risk factors with reaching 90 years or more are scarce. We studied this association in a socioeconomically homogenous cohort of businessmen. Methods The study consists of men (n = 970) from the Helsinki Businessmen Study cohort (born 1919-1928). Five major cardiovascular disease (CVD) risk factors (smoking, BMI, blood pressure, serum lipids, fasting glucose), consumption of alcohol and coffee, self-rated health and self-rated fitness, were assessed in 1974, at an average age of 50 years. The number of major risk factors was tested as a risk burden. The Charlson Comorbidity Index and the RAND-36 (SF-36) Physical and Mental health summary scores were calculated from surveys in year 2000, at age of 73 years. Mortality dates were retrieved through 31 March 2018 from the Population Information System of Finland. Results 244 men survived to the age of 90 representing 25.2% of the study cohort. The survivors had less risk factor burden in midlife, and less morbidity and higher physical health summary score in 2000. Of those with five major risk factors only 7% survived up to 90 years, whereas 51% of those without any risk factors reached that age. Single risk factors reducing odds of reaching 90 years were smoking (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.34-0.67), glucose (0.66, 0.49-0.88), BMI (0.63, 0.46-0.86), and cholesterol (0.71, 0.53-0.96). Conclusion Lack of five major CVD risk factors in midlife strongly increased odds of reaching 90 years of age and also predicted factors related to successful ageing in late life.Peer reviewe

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

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.Peer reviewe

High Intake of Nonmilk Extrinsic Sugars Is Associated With Protein and Micronutrient Dilution in Home-Dwelling and Institutionalized Older People

Background: High dietary sugar intake may compromise protein and micronutrient intakes in people with low energy intakes. The results of micronutrient dilution studies in older people have been few and conflicting. We examined the nutritional status and nutrient intakes associated with nonmilk extrinsic sugars (NMES) intakes in older people representing a broad spectrum of both healthy and vulnerable older populations. Design and participants: This cross-sectional study combined five Finnish data sets covering homedwelling (n = 526) and institutionalized (n = 374) older people. Their nutritional status was assessed using Mini Nutritional Assessment (MNA) and nutrient intakes retrieved from 1- to 3-day food records. The participants were divided into quartiles corresponding to the proportions of energy received from NMES. Energy, nutrient, and fiber intakes were classified according to the NMES quartiles, and the participants were divided according to their places of residence (home, institution). Results: High NMES intakes were associated with older age, female sex, poor cognition, low MNA scores, immobility, and institutionalization. In all, 90% of the participants in the highest NMES quartile (Q4) were institutionalized. In the institutionalized individuals, low protein and micronutrient intakes were observed in both those with low energy intake (Q1) and in those with very high NMES intakes (Q4). In home-dwelling individuals, the nutrient intakes tended to decline linearly with increasing NMES intakes in protein and most micronutrients. Conclusions: Institutionalized older people consumed diets high in NMES, compared with those living at home, and their low energy and high NMES intakes were associated with low protein and micronutrient intakes. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe

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 cost effectiveness of personalized dietary advice to increase protein intake in older adults with lower habitual protein intake : a randomized controlled trial

Purpose To examine the cost effectiveness of dietary advice to increase protein intake on 6-month change in physical functioning among older adults. Methods In this multicenter randomized controlled trial, 276 community-dwelling older adults with a habitual protein intake = 1.2 g/kg aBW/d (PROT, n = 96), Intervention 2; similar advice and in addition advice to consume protein (en)rich(ed) foods within half an hour after usual physical activity (PROT + TIMING, n = 89), or continue the habitual diet with no advice (CON, n = 91). Primary outcome was 6-month change in 400-m walk time. Secondary outcomes were 6-month change in physical performance, leg extension strength, grip strength, body composition, self-reported mobility limitations and quality of life. We evaluated cost effectiveness from a societal perspective. Results Compared to CON, a positive effect on walk time was observed for PROT; - 12.4 s (95%CI, - 21.8 to - 2.9), and for PROT + TIMING; - 4.9 s (95%CI, - 14.5 to 4.7). Leg extension strength significantly increased in PROT (+ 32.6 N (95%CI, 10.6-54.5)) and PROT + TIMING (+ 24.3 N (95%CI, 0.2-48.5)) compared to CON. No significant intervention effects were observed for the other secondary outcomes. From a societal perspective, PROT was cost effective compared to CON. Conclusion Dietary advice to increase protein intake to >= 1.2 g/kg aBW/d improved 400-m walk time and leg strength among older adults with a lower habitual protein intake. From a societal perspective, PROT was considered cost-effective compared to CON. These findings support the need for re-evaluating the protein RDA of 0.8 g/kg BW/d for older adults.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) : The Helsinki Businessmen Study

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.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