Clinical determinants of resting metabolic rate in geriatric outpatients

Purpose: Accurate estimation of the energy requirements including resting metabolic rate (RMR) is important for optimal nutritional care, yet its clinical determinants are unknown. This study examined the associations between clinical determinants of the Comprehensive Geriatric Assessment (CGA) domains with RMR among geriatric outpatients. Materials & methods: Data were retrieved from cohorts of community-dwelling older adults (n = 84, 54 female) referring to geriatrics outpatient mobility clinics in both Amsterdam, The Netherlands and Melbourne, Australia. Determinants within domains of the CGA included diseases (number, type and severity of diseases, polypharmacy), nutrition (body weight, body mass index, absolute and relative skeletal muscle mass, fat-free mass and fat mass, risk of malnutrition), physical function (handgrip strength, Short Physical Performance Battery, Timed Up & Go), cognition (Mini-Mental State Examination), psychological wellbeing (Geriatric Depression Scale) and blood pressure. RMR was objectively measured using indirect calorimetry with a canopy hood. Association between the clinical determinants with standardized RMR (country and sex-specific z-score) were analysed with linear regression adjusted for age, sex and body weight. Results: Determinants within the nutritional domain were associated with RMR; body weight showed the strongest association with RMR. Significant associations between determinants within the nutritional domain with RMR disappeared after further adjustment for body weight. None of the other domains were associated with RMR. Conclusions: Body weight is the strongest clinical determinant of RMR and should be taken into account when estimating RMR in geriatric care

Lack of Knowledge Contrasts the Willingness to Counteract Sarcopenia Among Community-Dwelling Adults

OBJECTIVE: Sarcopenia is highly prevalent in older adults. Knowledge among community-dwelling adults is important for effective prevention and treatment of sarcopenia. This study aims to assess current knowledge about sarcopenia, investigate willingness for treatment and prevention, and awareness of muscle health. METHOD: Participants who attended health educational events completed a questionnaire on knowledge about sarcopenia. Self-perceived muscle health was assessed by visual analog scale. Objective muscle measures included muscle mass, handgrip strength, and gait speed. RESULTS: Included participants were 197 (median aged 67.9 years [interquartile range = 57.0-75.1]). Eighteen participants (9%) reported to know what sarcopenia is. Participants' self-perceived muscle health showed a low correlation with all objective muscle measures. 76% were willing, in case of sarcopenia diagnosis, to start treatment and 71% were willing to prevent sarcopenia. DISCUSSION: Knowledge about sarcopenia is limited while participants were willing to start treatment and prevention. Strategies to increase knowledge among community-dwelling adults are needed

Physical Activity and Nutrition INfluences in Ageing: Current Findings from the PANINI Project

Background: The ageing of the population is a global challenge and the period of life spent in good health, although increasing, is not keeping pace with lifespan. Consequently, understanding the important factors that contribute to healthy ageing and validating interventions and influencing policy to promote healthy ageing are vital research priorities. Method: The PANINI project is a collaboration of 20 partners across Europe examining the influence of physical activity and nutrition in ageing. Methods utilised encompass the biological to the social, from genetics to the influence of social context. For example, epigenetic, immunological, and psychological assessments, and nutritional and sports science-based interventions have been used among older adults, as well as mathematical modelling and epidemiology. The projects are multi-disciplinary and examine health outcomes in ageing from a range of perspectives. Results: The results discussed here are those emerging thus far in PANINI from 11 distinct programmes of research within PANINI as well as projects cross-cutting the network. New approaches, and the latest results are discussed. Conclusions: The PANINI project has been addressing the impact of physical activity and nutrition on healthy ageing from diverse but interlinked perspectives. It emphasises the importance of using standardized measures and the advantages of combining data to compare biomarkers and interventions across different settings and typologies of older adults. As the projects conclude, the current results and final data will form part of a shared dataset, which will be made open access for other researchers into ageing processes.On behalf of the PANINI Consortiu

Validity of Nutritional Screening Tools for Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

Objectives The aim of this systematic review was to summarize the validity of nutritional screening tools to detect the risk of malnutrition in community-dwelling older adults. Design A systematic review and meta-analysis. The protocol for this systematic review was registered in the PROSPERO database (CRD42017072703). Setting and participants A literature search was performed in PubMed, EMBASE, CINAHL, and Cochrane using the combined terms “malnutrition,” “aged,” “community-dwelling,” and “screening.” The time frame of the literature reviewed was from January 1, 2001, to May 18, 2018. Older community-dwellers were defined as follows: individuals with a mean/median age of >65 years who were community-dwellers or attended hospital outpatient clinics and day hospitals. All nutritional screening tools that were validated in community-dwelling older adults against a reference standard to detect the risk of malnutrition, or with malnutrition, were included. Measures Meta-analyses were performed on the diagnostic accuracy of identified nutritional screening tools validated against the Mini Nutritional Assessment-Long Form (MNA-LF). The symmetric hierarchical summary receiver operating characteristic models were used to estimate test performance. Results Of 7713 articles, 35 articles were included in the systematic review, and 9 articles were included in the meta-analysis. Seventeen nutritional screening tools and 10 reference standards were identified. The meta-analyses showed average sensitivities and specificities of 0.95 (95% confidence interval [CI] 0.75–0.99) and 0.95 (95% CI 0.85–0.99) for the Mini Nutritional Assessment-Short Form (MNA-SF; cutoff point ≤11), 0.85 (95% CI 0.80–0.89) and 0.87 (95% CI 0.86–0.89) for the MNA-SF-V1 (MNA-SF using body mass index, cutoff point ≤11), 0.85 (95% CI 0.77–0.89) and 0.84 (95% CI 0.79–0.87) for the MNA-SF-V2 (MNA-SF using calf circumference instead of body mass, cutoff point ≤11), respectively, using MNA-LF as the reference standard. Conclusions and Implications The MNA-SF, MNA-SF-V1, and MNA-SF-V2 showed good sensitivity and specificity to detect community-dwelling older adults at risk of malnutrition validated against the MNA-LF. Clinicians should consider the use of the cutoff point ≤11 on the MNA-SF, MNA-SF-V1, and MNA-SF-V2 to identify community-dwelling older adults at risk of malnutrition

Handgrip strength cannot be assumed a proxy for overall muscle strength

Objectives: Dynapenia, low muscle strength, is predictive for negative health outcomes and is usually expressed as handgrip strength (HGS). Whether HGS can be a proxy for overall muscle strength and whether this depends on age and health status is controversial. This study assessed the agreement between HGS and knee extension strength (KES) in populations differing in age and health status. Design: Data were retrieved from 5 cohorts. Setting and Participants: Community, geriatric outpatient clinics, and a hospital. Five cohorts (960 individuals, 49.8% male) encompassing healthy young and older individuals, geriatric outpatients, and older individuals post hip fracture were included. Measures: HGS and KES were measured according to the protocol of each cohort. Pearson correlation was performed to analyze the association between HGS and KES, stratified by sex. HGS and KES were standardized into sex-specific z scores. The agreement between standardized HGS and standardized KES at population level and individual level were assessed by intraclass correlation coefficients (ICC) and Bland-Altman analysis. Results: Pearson correlation coefficients were low in healthy young (male: 0.36 to 0.45, female: 0.45) and healthy older individuals (male: 0.35 to 0.37, female: 0.44), and moderate in geriatric outpatients (male and female: 0.54) and older individuals post hip fracture (male: 0.44, female: 0.57) (P<.05, except for male older individuals post hip fracture [P¼.07]). Intraclass correlation coefficient values were poor to moderate in all populations (ie, healthy young individuals [0.41, 0.45], healthy older individuals [0.37, 0.41, 0.44], geriatric outpatients [0.54], and older individuals post hip fracture [0.54]). Bland-Altman analysis showed that within the same population of age and health status, agreement between HGS and KES varied on individual level

Association of Plant Protein Intake with Change in Physical Performance in Chinese Community-Dwelling Older Adults

(1) Background: Dietary protein intake might be beneficial in optimizing physical performance, yet whether this is dependent on protein source and sex is unclear. We examined the association between dietary protein intake and change in physical performance among Chinese community-dwelling older adults. (2) Methods: This prospective study included older Chinese adults (≥65 years) in Hong Kong. Total, plant and animal protein intakes at baseline were assessed using a food frequency questionnaire. Physical performance at baseline and 4-year follow-up were assessed by the time to complete a 6-m walking test. Adjusted linear regression examined the association between total, plant and animal protein intakes (g/kg of body weight (BW)) and 4-year change in physical performance. (3) Results: 3133 participants (49.8% males) aged 71.8 ± 4.9 years were included. In males, total, plant and animal protein intakes were not associated with a change in physical performance. In females, higher plant protein intake was associated with less decline in physical performance (β 0.723, SE 0.288, p = 0.012). No associations were observed for total animal protein intakes. (4) Conclusion: In Chinese community-dwelling older adults, total and animal protein intakes were not associated with a 4-year change in physical performance. Higher plant protein intake was associated with less decline in physical performance in females

Healthy Diet for Healthy Aging

Extending healthspan is a major public health challenge. Diet is one of the modifiable factors for preventing age-related diseases and preserving overall good health status during aging. Optimizing individuals&rsquo; intrinsic capacity, including domains in cognition, psychological, sensory function, vitality, and locomotion, has been proposed as a model of healthy aging by the World Health Organization. To better understand the relationships between a healthy diet and healthy aging, this review summarizes the recent epidemiologic and clinical data for dietary patterns that have been shown to play a role in (domains of) healthy aging. Regardless of priori or posteriori dietary patterns, it appears that dietary patterns centered on plant-based foods have a beneficial role in (domains of) healthy aging. Our review identified a knowledge gap in dietary patterns and multidimensional concepts of healthy aging. More epidemiological studies should consider intrinsic capacity as an outcome measure to further our understanding of a healthy diet and multidimensional concepts of healthy aging. When a sufficient number of epidemiological studies is available, evidence can be synthesized and clinical trials can be designed to evaluate a healthy diet as a strategy for healthy aging to further our progress in translating evidence to practice and promoting healthy aging

A Nutritionally Complete Oral Nutritional Supplement Powder Improved Nutritional Outcomes in Free-Living Adults at Risk of Malnutrition: A Randomized Controlled Trial

Background: This randomized controlled trial investigated the effectiveness of an oral nutritional supplement (ONS) on nutrition-related outcomes over 12 weeks in Chinese adults with or at risk of malnutrition. Methods: 88 Chinese adults &ge;18 years living independently in Hong Kong with Mini Nutritional Assessment-Short Form (MNA-SF) score &le;11 were randomly assigned to (1) 2 servings/day of nutritionally complete ONS powder made with water (Fresubin&reg; Powder (Fresubin Kabi Deutschland GmbH, Bad Homburg, Germany), 600 kcal, 22.4 g protein) for 12 weeks (intervention group) or (2) no treatment (control group). The primary outcome was increase in body weight (BW) over 12 weeks. Secondary outcomes included improvement in body mass index (BMI), mid-arm circumference (MAC), calf circumference, MNA-SF score, quality of life, self-rated health, frailty, and diet quality. Results: The intervention group showed a significantly higher mean increase in BW compared with the control group (1.381 kg, intervention vs control, p &lt; 0.001). The intervention group also showed significantly higher mean increases in BMI, MAC, calf circumference, intake of energy, protein, vitamin D, and calcium compared with the control group. No group differences in the changes of other outcomes were observed. Conclusions: For Chinese free-living adults at risk of malnutrition, daily consumption of a nutritionally complete ONS powder improved nutritional outcomes compared with the control group