Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats to physical performance, independence, and quality of life. Nutritional supplementation could ...positively influence aspects of sarcopenia and thereby prevent mobility disability.
To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of sarcopenia.
A multicenter, randomized, controlled, double-blind, 2 parallel-group trial among 380 sarcopenic primarily independent-living older adults with Short Physical Performance Battery (SPPB; 0–12) scores between 4 and 9, and a low skeletal muscle mass index. The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an iso-caloric control product to consume twice daily for 13 weeks. Primary outcomes of handgrip strength and SPPB score, and secondary outcomes of chair-stand test, gait speed, balance score, and appendicular muscle mass (by DXA) were measured at baseline, week 7, and week 13 of the intervention.
Handgrip strength and SPPB improved in both groups without significant between-group differences. The active group improved more in the chair-stand test compared with the control group, between-group effect (95% confidence interval): −1.01 seconds (−1.77 to −0.19), P = .018. The active group gained more appendicular muscle mass than the control group, between-group effect: 0.17 kg (0.004–0.338), P = .045.
This 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic older adults. This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. These results warrant further investigations into the role of a specific nutritional supplement as part of a multimodal approach to prevent adverse outcomes among older adults at risk for disability.
Anticholinergic drugs put elderly patients at a higher risk for falls, cognitive decline, and delirium as well as peripheral adverse reactions like dry mouth or constipation. Prescribers are often ...unaware of the drug-based anticholinergic burden (ACB) of their patients. This study aimed to develop an anticholinergic burden score for drugs licensed in Germany to be used by clinicians at prescribing level.
A systematic literature search in pubmed assessed previously published ACB tools. Quantitative grading scores were extracted, reduced to drugs available in Germany, and reevaluated by expert discussion. Drugs were scored as having no, weak, moderate, or strong anticholinergic effects. Further drugs were identified in clinical routine and included as well.
The literature search identified 692 different drugs, with 548 drugs available in Germany. After exclusion of drugs due to no systemic effect or scoring of drug combinations (n = 67) and evaluation of 26 additional identified drugs in clinical routine, 504 drugs were scored. Of those, 356 drugs were categorised as having no, 104 drugs were scored as weak, 18 as moderate and 29 as having strong anticholinergic effects.
The newly created ACB score for drugs authorized in Germany can be used in daily clinical practice to reduce potentially inappropriate medications for elderly patients. Further clinical studies investigating its effect on reducing anticholinergic side effects are necessary for validation.
Summary
The causes of sarcopenia are multidimensional. The loss of fast-twitch muscle fibres exceeds the loss of slow-twitch muscle fibres and ends as a clinical relevant loss of muscle power. On a ...sub-cellular level, age associated changes in the mitochondria lead to functional decline of the muscle. The reduction of motor units causes muscle fibre atrophy and loss of muscle strength. Low levels of anabolic hormones and the imbalance of pro- and anti-inflammatory cytokines are responsible for changes in body composition of older adults. Reduced levels of physical activity, vitamin D and protein are highly associated with muscle loss. Sarcopenia causes loss of independence and high medical and nursing needs resulting in great economic healthcare burden.
Although resistance exercise interventions have been shown to be beneficial in prefrail or frail older adults it remains unclear whether there are residual effects when the training is followed by a ...period of detraining. The aim of this study was to establish the sustainability of a muscle power or muscle strength training effect in prefrail older adults following training and detraining.
69 prefrail community-dwelling older adults, aged 65-94 years were randomly assigned into three groups: muscle strength training (ST), muscle power training (PT) or controls. The exercise interventions were performed for 60 minutes, twice a week over 12 weeks. Physical function (Short Physical Performance Battery=SPPB), muscle power (sit-to-stand transfer=STS), self-reported function (SF-LLFDI) and appendicular lean mass (aLM) were measured at baseline and at 12, 24 and 36 weeks after the start of the intervention.
For the SPPB, significant intervention effects were found at 12 weeks in both exercise groups (ST: p = 0.0047; PT: p = 0.0043). There were no statistically significant effects at 24 and 36 weeks. In the ST group, the SPPB declined continuously after stop of exercising whereas the PT group and controls remained unchanged. No effects were found for muscle power, SF-LLFDI and aLM.
The results showed that both intervention types are equally effective at 12 weeks but did not result in statistically significant residual effects when the training is followed by a period of detraining. The unchanged SPPB score at 24 and 36 weeks in the PT group indicates that muscle power training might be more beneficial than muscle strength training. However, more research is needed on the residual effects of both interventions. Taken the drop-out rates (PT: 33%, ST: 21%) into account, muscle power training should also be used more carefully in prefrail older adults.
This trial has been registered with clinicaltrials.gov (NCT00783159)
Sarcopenia – Endocrinological and Neurological Aspects Stangl, Michaela Katja; Böcker, Wolfgang; Chubanov, Vladimir ...
Experimental and clinical endocrinology & diabetes,
01/2019, Volume:
127, Issue:
1
Journal Article
Peer reviewed
Open access
Abstract
Sarcopenia in geriatric patients is often associated with or even caused by changes of the endocrine and nervous system. The multifactorial pathogenesis of sarcopenia and additional ...multimorbidity in geriatric patients makes it difficult to study distinct pathogenic pathways leading to sarcopenia. Patients suffering from diabetes, Cushing’s syndrome, chronic kidney disease, Klinefelter’s syndrome or motor neuron diseases, such as amyotrophic lateral sclerosis for example are known to have impaired muscle property and reduced physical performance. These patients are typically younger and suffer from conditions caused by a known molecular disease mechanism and a peculiar sarcopenic phenotype. Therefore, these sequelae can serve as prototypic disease models to study isolated endocrinological and neurodegenerative causes for sarcopenia. This review focuses on diseases whose etiopathogenesis of muscle impairment is known. The idea is to use these diseases as proof of principles to develop a classification algorithm of sarcopenia in the elderly to make a more mechanism-oriented therapy be possible.
Abstract
Background
Previous research has described a neuroprotective effect of IGF-I, supporting neuronal survival, axon growth and proliferation of muscle cells. Therefore, the association between ...IGF-I concentration, muscle histology and electrophysiological markers in a cohort of patients with sarcopenia dares investigation.
Methods
Measurement of serum concentrations of IGF-I and binding partners, electromyographic measurements with the MUNIX (Motor Unit Number Index) method and muscle biopsies were performed in 31 patients with acute hip fracture older age 60 years. Molecular markers for denervation (neural cell adhesion molecule NCAM) and proliferation markers (Ki67) were assessed by immunofluorescence staining of muscle biopsy tissue. Skeletal muscle mass by bioelectrical impedance analysis and hand-grip strength were measured to assess sarcopenia status according to EWGSOP2 criteria.
Results
Thirty-one patients (20 women) with a mean age of 80.6 ± 7.4 years were included. Concentrations of IGF-I and its binding partners were significantly associated with sarcopenia (ß = − 0.360;
p
= 0.047) and MUNIX (ß = 0.512;
p
= 0.005). Further, expression of NCAM (ß = 0.380;
p
= 0.039) and Ki67 (ß = 0.424;
p
= 0.022) showed significant associations to IGF-I concentrations.
Conclusions
The findings suggest a pathogenetic role of IGF-I in sarcopenia based on muscle denervation.
Motoneuron loss is associated with sarcopenia Drey, Michael; Krieger, Benjamin; Sieber, Cornel C ...
Journal of the American Medical Directors Association,
06/2014, Volume:
15, Issue:
6
Journal Article
Peer reviewed
Sarcopenia, age-related muscle wasting, is associated with increased morbidity and mortality in the affected individuals. The pathogenesis of sarcopenia is not yet fully understood. A multifactorial ...concept is currently favored. The reduced number of motor units as a potential mechanism of muscle mass loss is explored in the present study.
This is a cross-sectional study.
The participants were community-dwelling older adults.
The participants were sarcopenic (75) and nonsarcopenic (74) according to the criteria of the European Working Group on Sarcopenia in Older People aged 65 to 94 years.
The motor unit number index (MUNIX) of the hypothenar muscle was used to assess the number and size motor unit size index (MUSIX) of motor units.
The participants with pathologic MUNIX and MUSIX (n = 23) are significantly more frequently sarcopenic (n = 17, P = .029) than nonsarcopenic (n = 6). The participants with pathologic MUNIX and MUSIX (n = 23) had significantly less muscle mass than the nonsarcopenic controls (P < .001). After adjusting for age and sex, only gait speed has shown no difference between the 2 groups. Pearson's correlation coefficient between MUSIX and the reciprocal value of MUNIX is 0.87 (P < .001).
Sarcopenia induced by a small number of motoneurons can be identified by applying the MUNIX method to the hypothenar muscle. An enlargement of motor units because of motoneuron loss seems to preserve physical performance.
Objectives
To validate the modified Mini Nutritional Assessment (MNA) short‐forms (MNA‐SFs) with respect to agreement with full MNA classification in the target populations of the MNA.
Design
...Prospective analysis.
Setting
Community, nursing home, rehabilitation.
Participants
Six hundred fifty‐seven individuals aged 65 and older (75.3% female; mean age 82.3 ± 7.4).
Measurements
Classification agreement between full MNA score and MNA‐SF scores.
Results
Agreement between the full MNA and classification using the MNA‐SFs was 84.6% when the MNA‐SF using body mass index (BMI) was applied and 81.4% when the MNA‐SF using calf circumference (CC) was applied. The highest agreement of classification was found in the community setting (90.8% and 90.4%, respectively) and the lowest in the rehabilitation setting (72.4% and 71.4%, respectively). Both MNA‐SFs tended to underestimate nutritional status, but that was significant only for the MNA‐SF with CC.
Conclusion
The modified MNA‐SFs represent a valuable tool for rapid and reliable nutritional screening.
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