•We analyzed 71 frailty tools for the inclusion of components/items associated with nutritional status.•Fifty-two tools (73 %) included at least one nutritional-related item and 22 (31 %) two or more ...items.•The assessment of nutritional status was mainly based on anthropometric measurements.•Methods for assessing nutritional status in the frailty context lack consistency.•The definition of nutritional items contributing to a possible operational definition of the nutritional frailty phenotype is needed.
Different methods have been proposed for the assessment of the nutritional status in frailty phenotypes. In the present narrative review article, we have summarized the number and specifications of nutritional items in existing frailty tools, in order to develop a possible means of assessment and operational definition of the nutritional frailty phenotype. In six different databases until December 2019, we searched for original articles regarding frailty tools (i.e., scales, indexes, scores, questionnaires, instruments, evaluations, screening, indicators), analyzing each tool regarding nutritional items. We identified 160 articles describing 71 frailty tools. Among the selected frailty tools, 54 were community-based (70 %), 17 hospital-based (22 %), 4 validated in long-term care institutions for older adults (LTCIOA) (5.1 %) and 2 validated in both community- and hospital-based settings, including LTCIOA (2.5 %). Fifty-two of these tools (73 %) included at least one nutritional item. Twenty-two (42 %) reported two or more nutritional items. The items were grouped in the following categories: A) anthropometric measurements, B) laboratory measurements, and C) other nutritional-related measurements. Anthropometric measurements stood out compared to all other items. Nutritional items are included in the majority of frailty tools, strengthening the concept that they may have a direct implication on an increased risk of adverse health-related outcomes in frail subjects. This supports the development of the concept of nutritional frailty as an independent frailty phenotype. Subsequent steps will be to assess the contribution of each nutritional item to a possible operational definition of nutritional frailty and define the items that may best identify this new frailty phenotype.
Introduction
Preventive nutritional management of frailty, a multidimensional intermediate status in the ageing process, may reduce the risk of adverse health‐related outcomes. We investigated the ...ability of a measure combining physical frailty with nutritional imbalance, defined as nutritional frailty, to predict all‐cause mortality over a period of up to 8 years.
Methods
We analysed data on 1,943 older adults from the population‐based ‘Salus in Apulia Study’. Physical frailty was operationalized using Cardiovascular Health Study criteria and cognitive frailty by combining physical frailty with cognitive impairment. A novel five‐item construct was built to assess the extent of nutritional imbalance identified with a machine learning algorithm. Cox models and Kaplan–Meier survival probability analyses of physical frailty, nutritional imbalance (two or more of the following: low body mass index, low skeletal muscle index, ≥2.3 g/day sodium intake, <3.35 g/day potassium intake and <9.9 g/day iron intake), cognitive frailty and the novel nutritional frailty phenotype (physical frailty plus nutritional imbalance) were applied to assess all‐cause mortality risk, adjusted for age, sex, education and multimorbidity.
Results
The overall prevalence of nutritional frailty was 4.52% (95% confidence interval, CI:3.55–5.44), being more frequent in males. Subjects with nutritional frailty were at higher risk for all‐cause mortality hazard ratio (HR):2.31; 95%CI:1.41–3.79 than those with physical frailty (HR:1.45,95% CI:1.0–2.02), nutritional imbalance (HR:1.39; 95%CI:1.05–1.83) and cognitive frailty (HR:1.06; 95%CI:0.56–2.01).
Conclusions
Efforts to identify, manage and prevent frailty should include the nutritional domain. The nutritional frailty phenotype may highlight major nutritional determinants that could drive survival and health trajectories in older adults.
The advancing age of the participants of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study was the incentive to investigate frailty as a major parameter of ageing. ...The aim of this study was to develop a multidimensional tool to measure frailty in an ageing, free-living study population. The "accumulation of deficits approach" was used to develop a frailty index (FI) to characterize a sub-sample (N = 815) of the EPIC-Potsdam (EPIC-P) study population regarding the aging phenomenon. The EPIC-P frailty index (EPIC-P-FI) included 32 variables from the following domains: health, physical ability, psychosocial and physiological aspects. P-values were calculated for the linear trend between sociodemographic and life style variables and the EPIC-P-FI was calculated using regression analysis adjusted for age. The relationship between the EPIC-P-FI and age was investigated using fractional polynomials. Some characteristics such as age, education, time spent watching TV, cycling and a biomarker of inflammation (C-reactive protein) were associated with frailty in men and women. Interestingly, living alone, having no partner and smoking status were only associated with frailty in men, and alcohol use and physical fitness (VO2max) only in women. The generated, multidimensional FI, adapted to the EPIC-P study, showed that this cohort is a valuable source for further exploration of factors that promote healthy ageing.
Nuts have been an indispensable component of the human diet for hundreds because of their unique nutrient composition and are thought to play a beneficial part in the prevention of cardiovascular ...diseases.
To evaluate the extent, validity and presence of evidence for studies investigating the impact of nuts intake on biomarkers of cardiovascular disease and cardiovascular events, we performed an umbrella review of all published meta-analyses synthesizing data from both observational studies and randomized controlled trials.
PubMed (between 1966 and April 2016) was searched for systematic reviews and meta-analyses. Methodological quality was assessed by applying the AMSTAR score (0-11 points), and the meta-evidence by applying NutriGrade, our recently developed scoring system (0-10 points).
In total, 14 meta-analyses were included in the umbrella review. Only 4 out of 14 reported an AMSTAR score ≥8 (high methodological quality), whereas NutriGrade meta-evidence score varied between 2 (very low meta-evidence) and 7.9 (moderate meta-evidence). There is consistent evidence from intervention trials, reporting significant reductions for total cholesterol, and from observational studies that higher intakes of nuts were associated with reduced risk of cardiovascular disease and hypertension. On the other side no effect could be observed for stroke, HDL-cholesterol, and blood pressure in the normal range.
In summary, the present umbrella review showed that nuts intake was associated with reduced risk of cardiovascular disease and hypertension, and lower levels of total cholesterol. The observed evidence is limited by the moderate methodological quality and very low to moderate quality of evidence.
Intestinal microbiota is related to obesity and serum lipid levels, both risk factors for chronic diseases constituting a challenge for public health. We investigated how a diet rich in whole grain ...(WG) products and red meat (RM) influences microbiota. During a 10-week crossover intervention study, 20 healthy adults consumed two isocaloric diets, one rich in WG products and one high in RM. Repeatedly data on microbiota were assessed by 16S rRNA based denaturing gradient gel electrophoresis (DGGE). A blood sample and anthropometric data were collected. Mixed models and logistic regression were used to investigate effects. Microbiota showed interindividual variability. However, dietary interventions modified microbiota appearance: 8 bands changed in at least 4 participants during the interventions. One of the bands appearing after WG and one increasing after RM remained significant in regression models and were identified as Collinsella aerofaciens and Clostridium sp. The WG intervention lowered obesity parameters, while the RM diet increased serum levels of uric acid and creatinine. The study showed that diet is a component of major relevance regarding its influence on intestinal microbiota and that WG has an important role for health. The results could guide investigations of diet and microbiota in observational prospective cohort studies. Trial registration: ClinicalTrials.gov NCT01449383.
Summary People at older ages are at increased risk for developing stress-related diseases associated with chronically elevated cortisol secretion. However, the main factors contributing to such ...endocrine alterations in this age group are still largely unknown. This cross-sectional study examined patterns of long-term integrated cortisol secretion, as assessed in hair, in a sample of 654 participants in middle and old adulthood (mean age: 65.8 years; range: 47–82 years) from the German cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC) study in Potsdam. Hair cortisol concentrations (HCC) were determined from the first scalp-near 3 cm hair segment and several sociodemographic, lifestyle, anthropometric, disease-related, and psychological parameters were assessed. In simple linear regressions, HCC were found to increase with participants’ age and to be higher in men compared to women. HCC also showed positive associations with waist-to-hip ratio, waist circumference, smoking, prevalent type 2 diabetes mellitus, mental health, daytime sleeping, and being unemployed or retired—as well as a negative association with diastolic blood pressure. After full mutual adjustment, only age and smoking remained independent predictors of HCC. The association between prevalent type 2 diabetes mellitus and HCC was attenuated but still persisted independently in women. Similar, a positive relationship between HCC and alcohol consumption was found in women. The current results confirm previous evidence of positive associations of HCC with age, sex, alcohol consumption, and type 2 diabetes mellitus and add new knowledge on factors—such as smoking—that may contribute to elevated cortisol levels in people at older ages.
Gaussian graphical models (GGMs) are exploratory methods that can be applied to construct networks of food intake. Such networks were constructed for meal-structured data, elucidating how foods are ...consumed in relation to each other at meal level. Meal-specific networks were compared with habitual dietary networks using data from an EPIC-Potsdam sub-cohort study. Three 24-hour dietary recalls were collected cross-sectionally from 815 adults in 2010-2012. Food intake was averaged to obtain the habitual intake. GGMs were applied to four main meals and habitual intakes of 39 food groups to generate meal-specific and habitual dietary networks, respectively. Communities and centrality were detected in the dietary networks to facilitate interpretation. The breakfast network revealed five communities of food groups with other vegetables, sauces, bread, margarine, and sugar & confectionery as central food groups. The lunch and afternoon snacks networks showed higher variability in food consumption and six communities were detected in each of these meal networks. Among the central food groups detected in both of these meal networks were potatoes, red meat, other vegetables, and bread. Two dinner networks were identified with five communities and other vegetables as a central food group. Partial correlations at meals were stronger than on the habitual level. The meal-specific dietary networks were only partly reflected in the habitual dietary network with a decreasing percentage: 64.3% for dinner, 50.0% for breakfast, 36.2% for lunch, and 33.3% for afternoon snack. The method of GGM yielded dietary networks that describe combinations of foods at the respective meals. Analysing food consumption on the habitual level did not exactly reflect meal level intake. Therefore, interpretation of habitual networks should be done carefully. Meal networks can help understand dietary habits, however, GGMs warrant validation in other populations.
Appropriate interventions might improve the prevention of essential hypertension. This requires a comprehensive view of modifiable lifestyle factors (MLFs) distribution and effect. To determine how ...six MLFs (general adiposity, abdominal adiposity, alcohol consumption, smoking, diet, physical inactivity) for risk of hypertension are distributed and how their combinations affect the risk, a prospective study cohort of 11,923 healthy participants from the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study was used. Of these, 1,635 developed hypertension during a mean follow-up of 10.3 years. Mutually exclusive combinations, clustering and interactions of MLFs were then investigated stratifying by sex, Hazard Ratios (HRs) and Population Attributable Risks (PARs%) were calculated. General adiposity alone was sufficient to increase the risk of hypertension (HR = 1.86, PAR% 3.36), and in this cohort it played a major role in enhancing the risk of hypertension, together with smoking and physical inactivity. MLFs had a different impact and a different modulation of risk in women and men, and they showed a remarkable tendency to occur in specific patterns with higher prevalence than expected. This indication can help to promote a holistic approach through multifactorial preventive strategies addressing more than a factor at a time. For prevention of hypertension addressing adiposity together with smoking, promoting at the same time physical activity should be the first choice.
Purpose
To examine the association of red meat and whole-grain bread consumption with plasma levels of biomarkers related to glucose metabolism, oxidative stress, inflammation and obesity.
Methods
...Our cross-sectional study was based on 2,198 men and women who were selected as a sub-cohort for an investigation of biological predictors of diabetes and cardiovascular diseases from the European Prospective Investigation into Cancer and Nutrition-Potsdam study. Circulating levels of glycated hemoglobin, adiponectin, hs-CRP, gamma-glutamyltransferase, alanine-aminotransferase, fetuin-A, HDL-cholesterol and triglycerides were measured from random blood samples. Diet and lifestyle data were assessed by questionnaires, and anthropometric data were measured.
Results
After multivariable adjustment, higher consumption of whole-grain bread was significantly (
P
trend <0.05) associated with lower levels of GGT, ALT and hs-CRP, whereas higher consumption of red meat was significantly associated with higher levels of GGT and hs-CRP when adjusted for potential confounding factors related to lifestyle and diet. Further adjustment for body mass index and waist circumference attenuated the association between red meat and hs-CRP (
P
= 0.19).
Conclusions
The results of this study suggest that high consumption of whole-grain bread is related to lower levels of GGT, ALT and hs-CRP, whereas high consumption of red meat is associated with higher circulating levels of GGT and hs-CRP.
Plasma Fetuin-A Levels and the Risk of Type 2 Diabetes
Norbert Stefan 1 ,
Andreas Fritsche 1 ,
Cornelia Weikert 2 ,
Heiner Boeing 2 ,
Hans-Georg Joost 3 ,
Hans-Ulrich Häring 1 and
Matthias B. Schulze ...2 4
1 Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry,
University of Tübingen, Tübingen, Germany
2 Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
3 Department of Pharmacology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
4 Public Health Nutrition Unit, Technische Universität München, Freising, Germany
Corresponding author: Matthias B. Schulze, matthias.schulze{at}wzw.tum.de
Abstract
OBJECTIVE— The liver-secreted protein fetuin-A induces insulin resistance in animals, and circulating fetuin-A is elevated in insulin
resistance and fatty liver in humans. We investigated whether plasma fetuin-A levels predict the incidence of type 2 diabetes
in a large prospective, population-based study.
RESEARCH DESIGN AND METHODS— A case-cohort study within the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study comprising
27,548 subjects was designed. We randomly selected a subcohort of 2,500 individuals of whom 2,164 were diabetes free at baseline
and had anamnestic, anthropometrical, and metabolic data for analysis. Of the 849 incident diabetic case subjects identified
in the full cohort during 7 years of follow-up, 703 remained for analyses after similar exclusions.
RESULTS— Plasma fetuin-A levels were positively associated with diabetes risk after adjustment for age (relative risk RR for extreme
quintiles 1.75 95% CI 1.32–2.31; RR for 10 μg/ml 1.04 1.03–1.06). The association remained significant after adjustment
for sex, BMI, waist circumference, and lifestyle risk factors (RR for 10 μg/ml 1.03 1.01–1.06). Adjustment for glucose,
triglycerides, HDL cholesterol, A1C, γ-glutamyltransferase, or high-sensitivity C-reactive protein or mutual adjustment for
these biomarkers did not appreciably change this result (RR for 10 μg/ml full adjusted model 1.05 1.02–1.07). Furthermore,
fetuin-A was associated with increased diabetes risk particularly in individuals with elevated plasma glucose.
CONCLUSIONS— Our data suggest that fetuin-A is an independent risk factor of type 2 diabetes.
Footnotes
Published ahead of print at http://diabetes.diabetesjournals.org on 15 July 2008.
Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work
is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore
be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
Accepted June 30, 2008.
Received April 22, 2008.
DIABETES
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