A randomised controlled trial of twelve months protein supplementation on muscle mass and strength in elderly women

Background. Aging is associated with progressive loss of muscle (sarcopenia), which can lead to reduced muscle strength and an increased risk of falls. Sarcopenia exists in otherwise healthy elderly people and its aetiology is not fully understood. Many epidemiological studies have shown that high protein intake is associated with preserving muscle mass and strength in the elderly. To date there have been few randomized trials of sufficient duration and power to examine the effects of dietary protein supplement on muscle mass and strength in the elderly. The objective of this study was to examine the effectiveness of whey protein supplementation on preventing sarcopenia in elderly women.Methods. A population based, one-year randomized, double blind and placebo controlled trial of protein supplementation was conducted on 219 community-dwelling ambulant women aged 70 to 80 years. Participants in the protein supplement group (n=109) consumed a drink daily which contained 30 g of protein. The control group (n=110) consumed a drink with the same energy (kilojoules) but only contained 2 g of protein. Assessments were taken at baseline and one year. Body composition was assessed by anthropometry and whole body dual-energy x-ray absorptiometry. Peripheral quantitative computer tomography was used to assess calf muscle crosssectional area. Hand grip, ankle dorsiflexion, knee and hip strengths were assessed using an isokinetic dynamometer. Mobility was assessed by the ‘Timed Up and Go’ test. Standing balance was assessed by the Romberg test. Dietary intake was assessed by a 3-day weighed food record. Compliance with the dietary intervention was assessed by 24-hour urinary nitrogen and by counting the returned empty supplement containers. Serum insulin-like growth factor one (IGF-1) was also measured.Results. One-hundred and ninety-five participants aged 74±3 years completed the one year trial. There were no significant differences in baseline characteristics between the protein supplemented group (n=100) and control group (n=95). Compared to their baseline values, both groups significantly increased whole body lean mass (protein group: +1.6%, p<0.05; control group: +2.3%, p<0.05), appendicular lean mass (protein group: +1.3%, p<0.05; control group: +1.8%, p<0.05), body weight (protein group: +0.8%, p<0.05; control group: +1.5%, p<0.05) and knee strength (protein group: +31%, p< 0.05; control group: +36%, p<0.05) after one year. The total fat mass increased from baseline only in the control group (protein group: +0.7%, p=0.19; control group: +1.5%, p<0.05). There were however no significant differences between the two drink groups in any of the above mentioned parameters. Over one year serum IGF-1 increased significantly in the protein group but decreased in the control group (protein group: +7.6%, p = 0.006; control group: -1.0%, p = 0.005), and the changes were significantly different between two drink groups (p = 0.006). The protein supplement also showed a protective effect on preserving balance function at one year. The prevalence of ‘poor standing balance’ and ‘fall rates’ were significantly increased in the control group at one year.Conclusion. Muscle mass and strength increased equally in both drink groups. Although fat mass only increased in the control group at one year there was no statistically significant difference in the changes in fat mass between the two groups due to the wide variance in response. Protein supplementation resulted in an increased serum IGF-1 level at one year compared with the control group. These data are consistent with the concept that in this age group increased energy intake regardless of the macronutrient composition of the supplements improves muscle mass and function. It is possible that achieving this through increased protein rather than carbohydrate may prevent the increase in fat mass noted with the carbohydrate supplement for the control drink perhaps by an effect of the protein to increase serum IGF-1. The metabolic significance of this remains to be explored

Who knows what \u27healthy weight\u27 looks like?

Background: Obesity is a global epidemic. The World Health Organization (WHO) reports that worldwide obesity has nearly tripled since 1975. In 2016, more than 1.9 billion adults were overweight and had corresponding increases in well-recognised, associated chronic diseases. Aims: This study aimed to explore whether the general population is able to identify a healthy BMI and accurately perceive their own BMI using a visual scale. Method: A cross-sectional, population-based survey of 103 participants were shown a visual scale of computer-generated images representing different BMIs and asked to identify: (1) which images represented a healthy body weight; (2) which image best represented their body; and (3) whether they thought they were a healthy or unhealthy body size. Conclusion: Overweight participants were significantly less likely to correctly identify their own BMI on a visual scale (38.9 per cent,

A randomised trial deploying a simulation to investigate the impact of hospital discharge letters on patient care in general practice

Objective To determine how the timing and length of hospital discharge letters impact on the number of ongoing patient problems identified by general practitioners (GPs). Trial design GPs were randomised into four groups. Each viewed a video monologue of an actor-patient as he might present to his GP following a hospital admission with 10 problems. GPs were provided with a medical record as well as a long or short discharge letter, which was available when the video was viewed or 1 week later. GPs indicated if they would prescribe, refer or order tests for the patient's problems. Methods Setting Primary care. Participants Practising Australian GPs. Intervention A short or long hospital discharge letter enumerating patient problems. Outcome measure Number of ongoing patient problems out of 10 identified for management by the GPs. Randomisation 1:1 randomisation. Blinding (masking) Single-blind. Results Numbers randomised 59 GPs. Recruitment GPs were recruited from a network of 102 GPs across Australia. Numbers analysed 59 GPs. Outcome GPs who received the long letter immediately were more satisfied with this information (p&lt;0.001). Those who received the letter immediately identified significantly more health problems (p=0.001). GPs who received a short, delayed discharge letter were less satisfied than those who received a longer delayed letter (p=0.03); however, both groups who received the delayed letter identified a similar number of health problems. GPs who were older, who practised in an inner regional area or who offered more patient sessions per week identified fewer health problems (p values &lt;0.01, &lt;0.05 and &lt;0.05, respectively). Harms Nil. Conclusions Receiving information during patient consultation, as well as GP characteristics, influences the number of patient problems addressed. Trial registration number ACTRN12614000403639

Video Consultation Use by Australian General Practitioners: Video Vignette Study

Background: There is unequal access to health care in Australia, particularly for the one-third of the population living in remote and rural areas. Video consultations delivered via the Internet present an opportunity to provide medical services to those who are underserviced, but this is not currently routine practice in Australia. There are advantages and shortcomings to using video consultations for diagnosis, and general practitioners (GPs) have varying opinions regarding their efficacy. Objective: The aim of this Internet-based study was to explore the attitudes of Australian GPs toward video consultation by using a range of patient scenarios presenting different clinical problems. Methods: Overall, 102 GPs were invited to view 6 video vignettes featuring patients presenting with acute and chronic illnesses. For each vignette, they were asked to offer a differential diagnosis and to complete a survey based on the theory of planned behavior documenting their views on the value of a video consultation.Results: A total of 47 GPs participated in the study. The participants were younger than Australian GPs based on national data, and more likely to be working in a larger practice. Most participants (72%-100%) agreed on the differential diagnosis in all video scenarios. Approximately one-third of the study participants were positive about video consultations, one-third were ambivalent, and one-third were against them. In all, 91% opposed conducting a video consultation for the patient with symptoms of an acute myocardial infarction. Inability to examine the patient was most frequently cited as the reason for not conducting a video consultation. Australian GPs who were favorably inclined toward video consultations were more likely to work in larger practices, and were more established GPs, especially in rural areas. The survey results also suggest that the deployment of video technology will need to focus on follow-up consultations. Conclusions: Patients with minor self-limiting illnesses and those with medical emergencies are unlikely to be offered access to a GP by video. The process of establishing video consultations as routine practice will need to be endorsed by senior members of the profession and funding organizations. Video consultation techniques will also need to be taught in medical schools

Management of behavioural change in patients presenting with a diagnosis of dementia: a video vignette study with Australian general practitioners

Objective: To test the impact of feedback on the proposed management of standardised patients presenting with behavioural change with a diagnosis of dementia in Australian primary care. Materials and methods: A video vignette study was performed with Australian general practitioners (GPs) in 2013. Participants viewed six pairs of matched videos depicting people presenting changed behaviour in the context of a dementia diagnosis in two phases. In both phases GPs indicated their diagnosis and management. After phase 1, GPs were offered feedback on management strategies for the patients depicted. Analyses focused on identification of change in management between the two phases of the study. Factors impacting on the intention to coordinate care for such patients were tested in a questionnaire based on the Theory of Planned Behaviour. Results: Forty-five GPs completed the study. There was significant improvement in the proposed management of three of the six scenarios after the intervention. Older GPs were more likely to refer appropriately (OR=1.11 (1.01 to 1.23), p=0.04.). Overall referral to support agencies was more likely after the intervention (OR=2.52 (1.53 to 4.14), p<0.001). Older GPs were less likely to intend to coordinate care for such patients (OR=0.89 (0.81 to 0.98) p=0.02). Participants who felt confident about their ability to coordinate care were more likely to do so (OR=3.79 (1.08 to 13.32) p=0.04).Conclusions: The intervention described in this study promoted multidisciplinary management of patients with behavioural problems with a diagnosis of dementia. Increasing practitioner confidence in their ability to coordinate care may increase the proportion of GPs who will respond to patients and carers in this context. Older GPs may benefit in particular

Who knows what ‘healthy weight’ looks like?

This study aimed to explore whether the general population can identify a healthy BMI and accurately perceive their own BMI using a visual scale. Overweight people were much less likely to identify their own BMI correctly and were also most likely to incorrectly think that they are a healthy size

Differences in the health, mental health and health-promoting behaviours of rural versus urban cancer survivors in Australia

Purpose People affected by cancer who live in rural Australia experience inferior survival compared to their urban counterparts. This study determines whether self-reported physical and mental health, as well as health-promoting behaviours, also differ between rural and urban Australian adults with a history of cancer. Methods Weighted, representative population data were collected via the South Australian Monitoring and Surveillance System between 1 January 2010 and 1 June 2015. Data for participants with a history of cancer (n = 4295) were analysed with adjustment for survey year, gender, age group, education, income, family structure, work status, country of birth and area-level relative socioeconomic disadvantage (SEIFA). Results Cancer risk factors and co-morbid physical and mental health issues were prevalent among cancer survivors regardless of residential location. In unadjusted analyses, rural survivors were more likely than urban survivors to be obese and be physically inactive. They were equally likely to experience other co-morbidities (diabetes, chronic obstructive pulmonary disease, cardiovascular disease, arthritis or osteoporosis). With adjustment for SEIFA, rural/urban differences in obesity and physical activity disappeared. Rural survivors were more likely to have trust in their communities, less likely to report high/very high distress, but equally likely to report a mental health condition, both with and without adjustment for SEIFA. Conclusions There is a need for deeper understanding of the impact of relative socioeconomic disadvantage on health (particularly physical activity and obesity) in rural settings and the development of accessible and culturally appropriate interventions to address rural cancer survivors’ specific needs and risk factors

Calcium Intake in Elderly Australian Women Is Inadequate

The role of calcium in the prevention of bone loss in later life has been well established but little data exist on the adequacy of calcium intakes in elderly Australian women. The aim of this study was to compare the dietary intake including calcium of elderly Australian women with the Australian dietary recommendation, and to investigate the prevalence of calcium supplement use in this population. Community-dwelling women aged 70–80 years were randomly recruited using the Electoral Roll for a 2-year protein intervention study in Western Australia. Dietary intake was assessed at baseline by a 3-day weighed food record and analysed for energy, calcium and other nutrients. A total of 218 women were included in the analysis. Mean energy intake was 7,140 ± 1,518 kJ/day and protein provided 19 ± 4% of energy. Mean dietary calcium intake was 852 ± 298 mg/day, which is below Australian recommendations. Less than one quarter of women reported taking calcium supplements and only 3% reported taking vitamin D supplements. Calcium supplements by average provided calcium 122 ± 427 mg/day and when this was taken into account, total calcium intake increased to 955 ± 504 mg/day, which remained 13% lower than the Estimated Average Requirement (EAR, 1,100 mg/day) for women of this age group. The women taking calcium supplements had a higher calcium intake (1501 ± 573 mg) compared with the women on diet alone (813 ± 347 mg). The results of this study indicate that the majority of elderly women were not meeting their calcium requirements from diet alone. In order to achieve the recommended dietary calcium intake, better strategies for promoting increased calcium, from both diet and calcium supplements appears to be needed

Who uses the internet as a source of nutrition and dietary information? An Australian population perspective

Background: The Internet contains a plethora of nutrition information. Health organizations are increasingly using the Internet to deliver population-wide health information and interventions. Effective interventions identify their target population and their needs; however, little is known about use of the Internet as a source of nutrition information. Objective: The aim was to assess the change in prevalence and demographic characteristics of Western Australian adults accessing the Internet as a source of nutrition information and identify specific information needs. Methods: Data were pooled from the Western Australian Department of Health’s 3-yearly Nutrition Monitoring Survey Series telephone survey between 1995 and 2012 of 7044 participants aged 18 to 64 years. Outcome variables were the main sources of nutrition information used in the last year and yes/no responses to 4 suggestions to what would make it easier to eat a healthy diet. Sociodemographic variables were collected. Results: The proportion of respondents using the Internet for nutrition information increased from <1% in 1995-2001 to 9.1% in 2004 and 33.7% in 2012. Compared to 2004, logistic regression showed that the odds of using the Internet for this information increased significantly in 2009 (OR 2.84, 95% CI 2.07-3.88) and 2012 (OR 5.20, 95% CI 3.86-7.02, P<.001). Respondents using the Internet as a source were more likely to be female (OR 1.30, 95% CI 1.05-1.60, P=.02), live in a metropolitan area (OR 1.26, 95% CI 1.03-1.54, P=.03), born in countries other than Australia/UK/Ireland (OR 1.41, 95% CI 1.07-1.85, P=.02), more educated (university: OR 2.46, 95% CI 1.77-3.42, P<.001), and were less likely to be older (55-64 years: OR 0.38, 95% CI 0.25-0.57, P<.001). The majority of respondents agreed the following information would assist them to make healthier choices: more ways to prepare healthy foods (72.0%, 95% CI 70.7-73.3), quicker ways to prepare healthy foods (79.0%, 95% CI 77.8-80.1), how to choose healthy foods (68.8%, 95% CI 67.5-70.1), and knowing more about cooking (54.7%, 95% CI 53.3-56.1). Those using the Internet for nutrition information were more likely than nonusers to want to know quicker ways to prepare healthy foods (83.0% vs 78.1%, P=.005) and information on choosing healthy foods (76.3% vs 67.3%, P<.001)