Association between Dietary Practice and Gait Speed in Community-Dwelling Older Adults with Overweight and Obesity: A Cross-Sectional Study

: Slow gait speed is associated with poorer clinical outcomes and higher rates of functional limitation and mortality in older adults, especially when combined with overweight or obesity. Aging is also associated with nutritional deficits. The aim of our study was to assess the potential association between dietary practice and gait speed performance in community-dwelling older adults with overweight and obesity. Participants underwent body composition measurement with the Tanita MC-780MA Bioimpedance Analyzer (BIA). Dietary patterns were assessed with the Mini Nutritional Assessment (MNA) questionnaire, and a dietary adequacy (DA) score system was constructed. The four-meter gait speed test was performed in order to assess gait speed. Of 222 participants, aged 67.6 ± 6.6 years, with a body mass index (BMI) of 31.9 ± 4.5 kg/m2, 34.7% had reduced gait speed and lower DA compared to those with normal gait speed (2.99 ± 1.12 vs. 3.37 ± 1.07; p < 0.05). The DA score of participants with slower gait speed was more likely to fall below the median than that of participants with normal gait speed (70.1% vs. 51.7%; p < 0.05). Participants with slower gait speed were more likely to be nutritionally at risk of low DA (22.1% vs. 10.3%; p < 0.05). Logistic regression analysis, after adjustment for confounders, showed that the risk of having a slow gait speed was 75% lower among those with a higher DA score (OR = 0.25; 95% CI = 0.11-0.53). Older adults with overweight or obesity in community dwellings might need to be supported with nutritional interventions that can improve their gait speed

Personalized Nutritional Strategies to Reduce Knee Osteoarthritis Severity and Ameliorate Sarcopenic Obesity Indices: A Practical Guide in an Orthopedic Setting

Knee osteoarthritis (KOA) is one of the most common joint diseases, especially in individuals with obesity. Another condition within this population, and which presents frequently, is sarcopenic obesity (SO), defined as an increase in body fat and a decrease in muscle mass and strength. The current paper aims to describe recent nutritional strategies which can generally improve KOA clinical severity and, at the same time, ameliorate SO indices. Searches were carried out in the PubMed and Science Direct databases and data were summarized using a narrative approach. Certain key findings have been revealed. Firstly, the screening and identification of SO in patients with KOA is important, and to this end, simple physical performance tests and anthropometric measures are available in the literature. Secondly, adherence to a Mediterranean diet and the achievement of significant body weight loss by means of low-calorie diets (LCDs) remain the cornerstone nutritional treatment in this population. Thirdly, supplementation with certain micronutrients such as vitamin D, essential and non-essential amino acids, as well as whey protein, also appear to be beneficial. In conclusion, in the current review, we presented a detailed flowchart of three different nutritional tracks that can be adopted to improve both KOA and SO based on joint disease clinical severity

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Do routine clinic visits prevent de-stabilization in patients awaiting coronary revascularization?

We examined retrospectively the usefulness of routine clinic visits in preventing adverse cardiac events in 115 patients awaiting coronary surgery or angioplasty. Mean waiting time from angiography to revascularization was 126 days. A total of 126 visits were made by 80 patients. No deaths occurred, but one patient, despite three visits, suffered myocardial infarction at 316 days post-angiography. Eight patients required admission for unstable angina, five having been on the waiting list for less than 5 weeks. The mean number of clinic visits, number of diseased vessels and proportion on triple anti-ischaemic therapy were similar in the patients suffering such events and those remaining stable. In conclusion, the inherent unpredictability of coronary disease greatly limits the role of interim clinic visits in the prevention of adverse cardiac events in patients awaiting revascularization

Exploring the effectiveness of a 1.5-Year weight management intervention for adults with obesity

Background & aim: Obesity is a growing healthcare problem in Arabic-speaking countries although the effectiveness of the lifestyle modification program for weight management in this region is still lacking. Accordingly, this study aimed to assess long-term outcomes following an adapted lifestyle modification program based on cognitive behavioral therapy for obesity (CBT-OB) in Lebanon. Methods: Forty-five adult participants with obesity were recruited consecutively at the Outpatient Clinic of the Department of Nutrition and Dietetics at Beirut Arab University (Lebanon). Patients were offered an individualized form of CBT-OB lasting 18 months comprising two phases (a weight loss phase of 6 months and a weight-maintenance phase of 12 months). Results: Twenty-five patients completed the treatment, with a mean weight loss of −11.58% after 6 months (−11.46% in the intention-to-treat analysis) and −8.84% after 18 months (−9.51% in the intention-to-treat analysis). Weight loss was associated with improvement in Health-Related Quality of Life (HRQoL) at six-month follow-up and in glycated hemoglobin (HbA1c) and body composition patterns at 18-month follow-up. Conclusion: Our findings provide evidence supporting the use of CBT-OB for obesity as a standard in ‘real-world’ clinical setting in Lebanon. Future studies are needed on larger samples and other populations in Arab-speaking countries

Lifetime Weight Cycling and Central Fat Distribution in Females With Obesity: A Brief Report

Weight cycling (WC) is a common phenomenon in patients with obesity, however, its consequence on body composition has not yet been fully understood. Therefore, we aimed to determine whether multiple WC can negatively affect the latter, especially in terms of body fat distribution in female adults seeking treatment that are overweight or obese. Body composition was obtained using a segmental body composition analyser (MC-780MA, Tanita Corp., Tokyo, Japan) in 125 adult females who had been referred to the Department of Nutrition and Dietetics at the Beirut Arab University (Lebanon). WC was defined as intentional weight loss of ≥3 kg followed by involuntary weight regain of ≥3 kg, and participants were categorized as WC if they had experienced ≥2 cycles. Ninety of the 125 participants met the criteria for WC and displayed a higher total and trunk fat mass than those without WC. This was confirmed through linear regression analysis, showing that multiple WC were associated with increased fat mass (FM) by nearly 4.2 kg (β = 4.23, 95%CI: 0.81–7.65, p = 0.016)–2.4 kg in the trunk region (β = 2.35, 95%CI: 0.786–3.917, p = 0.004) when compared to the non-WC group, after adjusting for age and fat-free mass. In conclusion, multiple WC is associated with increased body fat, especially in the central region. Future studies are needed to examine the impact of this fat distribution on health outcomes in this phenotype of patients

The impact of sarcopenic obesity on health-related quality of life of treatment-seeking patients with obesity

Background: There is a paucity of studies on health-related quality of life (HRQoL) and sarcopenic obesity (SO). Objective: This study aimed to assess the potential association between SO and impaired HRQoL. Methods: The ORWELL 97 questionnaire was used to assess HRQoL and body composition was measured using a bioimpedance analyser (Tanita BC-418) in 130 patients with obesity, referred to the Nutritional and Weight Management outpatient clinic of Beirut Arab University in Lebanon. Participants were then categorized on the basis of the absence or presence of SO. Results: Sixty-four of the 130 participants met the criteria for SO (49.2%) and displayed significantly higher total ORWELL 97 scores than those in the group without SO (64.00 vs. 41.00, p=0.001), indica-tive of poorer HRQoL. Linear regression analysis showed that SO was associated with an increase in ORWELL 97 scores by nearly 24 units (β=24.35, 95% CI=11.45-37.26; p<0.0001). Moreover, the logis-tic regression analysis showed that SO increased the odds of clinically significant impairment of HRQoL (ORWELL 97 score ≥74.25) by nearly seven-fold (OR=7.37, 95% CI=1.92-28.39; p=0.004). Conclusion: Our findings show that the presence of SO was associated with increased impairment of HRQoL that reaches clinical significance when compared to obesity only. Future studies are needed to clarify whether this may influence clinical outcomes. If this is shown to be the case, weight management programs should incorporate additional strategies to improve HRQoL in individuals with SO

The relationship between sarcopenic obesity, weight-loss and maintenance outcomes during obesity management: Are additional strategies required?

The lack of long-term maintenance of the weight loss achieved during weight-management programs is the major cause of failure in obesity treatments. The identification of factors related to this outcome has clinical implications. Therefore, we aimed to assess the relationship between sarcopenic obesity (SO) and the weight-loss percentage (WL%). The WL% was measured at the six-month follow-up and after more than 12 months, in 46 adult participants with obesity, during an individualized weight-management program where participants were categorized as having or not having SO at the baseline. At the six-month follow-up, participants with SO did not display a significant difference in terms of WL%, when compared to those without SO (−10.49 ± 5.75% vs. −12.73 ± 4.30%; p = 0.148). However, after a longer term (i.e., >12 months), the WL% appeared to be significantly lower in the former (SO vs. non-SO) (−7.34 ± 6.29% vs. −11.43 ± 4.31%; p = 0.024). In fact, partial correlation analysis revealed a relationship between SO at the baseline and a lower WL% after more than 12 months (ρ = −0.425, p = 0.009), after controlling for age, sex, and body mass index (BMI). Participants with SO appeared to face more difficulties in maintaining the achieved WL over a longer term (>12 months follow-up) by comparison with their counterparts (i.e., non-SO). Should this finding be replicated in larger-sample studies, new strategies should be adopted for these patients in order to improve this clinical outcome, especially during the weight-maintenance phase

Association Between Reduced Daily Steps and Sarcopenic Obesity in Treatment-Seeking Adults With Obesity

Objectives: Understanding the condition that describes the coexistence of obesity and sarcopenia, termed sarcopenic obesity (SO), is becoming a scientific and clinical priority. In this study, we aimed to assess the prevalence of SO in treatment-seeking adults with obesity and investigate any potential association between SO and a sedentary lifestyle, expressed in terms of daily steps. Methods: In this cross-sectional, prospective observational study, body composition and daily steps measurements were obtained using a segmental body composition analyser (Tanita BC-418) and an Omron HJ-320 pedometer, respectively, in 111 adults of both genders with obesity (body mass index; BMI ≥ 30 kg/m2), referred to the Outpatient Clinic in the Department of Nutrition and Dietetics at Beirut Arab University (BAU) in Lebanon. The participants were then categorized according to the presence of absence of SO, defined as an appendicular lean mass divided by body weight (ALM/weight) × 100%) of less than 23.40 and 29.60 in females and males, respectively. Results: Fifty-five of the 111 participants with obesity, with a mean age of 39.62 ± 16.55 years and a mean BMI of 38.05 ± 5.33 kg/m2 met the criteria for SO and displayed a significantly higher prevalence of inactivity (<5,000 daily steps), i.e., nearly double (54.5% vs. 32.1%; p = 0.017) and they had a lower mean number of daily steps than those in the group without SO (5,279 ± 2,641 vs. 6,732 ± 2,989; p = 0.008). Linear regression analysis showed that SO is associated with a lower number of daily steps by 1,421 (β = −1421.4; −2508.9, −333.9; p = 0.011) after adjusting for age, gender employment and the presence of cardiometabolic disease. Conclusion: Sarcopenic obesity affects nearly 50% of treatment-seeking adults with obesity. Moreover, it seems to be associated with a lower number of daily steps and a sedentary lifestyle. Future studies are needed to clarify whether this may influence clinical outcomes. If this is shown to be the case, weight management programmes should incorporate additional physical activity strategies in this population