Nutrition, frailty, and sarcopenia Cruz-Jentoft, Alfonso J.; Kiesswetter, Eva; Drey, Michael ...
Aging clinical and experimental research,
02/2017, Volume:
29, Issue:
1
Journal Article
Peer reviewed
Frailty and sarcopenia are important concepts in the quest to prevent physical dependence, as geriatrics are shifting towards identifications of early stages of disability. Definitions of both ...sarcopenia and frailty are still developing, and both concepts clearly overlap in their physical aspects. Malnutrition (both undernutrition and obesity) plays a key role in the pathogenesis of frailty and sarcopenia. The quality of the diet along the lifespan has a close relation with the incidence of both entities, and nutritional interventions may be able to reduce the incidence or revert either of them. This brief review explores the role of energy and protein intake and other key nutrients on muscle function. Nutrition may be a key element of multimodal interventions for frailty and sarcopenia. The results of the “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) trial will offer key insights on the effect of such interventions in frail, sarcopenic older individuals.
Sarcopenia, frailty, cachexia and malnutrition are widespread syndromes in older people, characterized by loss of body tissue and related to poor outcome. The aim of the present cross-sectional study ...was to assess the prevalence of these syndromes and their overlap in older medical inpatients.
Patients aged 70 years or older who had been admitted to the internal medical department of a German university hospital were recruited. Sarcopenia, frailty, cachexia and malnutrition were assessed in a standardized manner according to current consensus definitions. Prevalence rates of these syndromes and their constituents and the concurrent occurrence of the syndromes (overlap) were calculated.
One hundred patients (48 female) aged 76.5 ± 4.7 years with a BMI of 27.6 ± 5.5 kg/m
were included. The main diagnoses were gastroenterological (33%) and oncological diseases (31%). Sarcopenia was present in 42%, frailty in 33%, cachexia in 32% and malnutrition in 15% of the patients. 63% had at least one syndrome: 32% one, 11% two, 12% three and 8% all four. All four syndromes are characterized by significant weight loss during the last 12 months, which was most pronounced in malnourished patients and least pronounced in frail patients, and by significantly reduced physical performance. All syndromes were significantly pairwise related, except malnutrition and frailty. In 19% of patients sarcopenia and frailty occurred concurrently, in 20% frailty and cachexia and in 22% sarcopenia and cachexia with or without additional other syndromes. All malnourished patients except one were also cachectic (93%) and 80% of malnourished patients were also sarcopenic. 53% of malnourished patients were in addition frail, and these patients were affected by all four syndromes.
Nearly two thirds of older medical inpatients had at least one of the tissue loss syndromes sarcopenia, frailty, cachexia and malnutrition. The syndromes overlapped partly and were interrelated. Future studies with larger patient groups and longitudinal design are required to clarify the significance of single and concurrent occurrence of these syndromes for clinical outcome and successful therapy.
The question of which factors drive human eating and nutrition is a key issue in many branches of science. We describe the creation, evaluation, and updating of an interdisciplinary, interactive, and ...evolving "framework 2.0" of Determinants Of Nutrition and Eating (DONE). The DONE framework was created by an interdisciplinary workgroup in a multiphase, multimethod process. Modifiability, relationship strength, and population-level effect of the determinants were rated to identify areas of priority for research and interventions. External experts positively evaluated the usefulness, comprehensiveness, and quality of the DONE framework. An approach to continue updating the framework with the help of experts was piloted. The DONE framework can be freely accessed (http://uni-konstanz.de/DONE) and used in a highly flexible manner: determinants can be sorted, filtered and visualized for both very specific research questions as well as more general queries. The dynamic nature of the framework allows it to evolve as experts can continually add new determinants and ratings. We anticipate this framework will be useful for research prioritization and intervention development.
There is growing evidence that substituting animal-based with plant-based foods is associated with a lower risk of cardiovascular diseases (CVD), type 2 diabetes (T2D), and all-cause mortality. Our ...aim was to summarize and evaluate the evidence for the substitution of any animal-based foods with plant-based foods on cardiometabolic health and all-cause mortality in a systematic review and meta-analysis.
We systematically searched MEDLINE, Embase, and Web of Science to March 2023 for prospective studies investigating the substitution of animal-based with plant-based foods on CVD, T2D, and all-cause mortality. We calculated summary hazard ratios (SHRs) and 95% confidence intervals (95% CI) using random-effects meta-analyses. We assessed the certainty of evidence (CoE) using the GRADE approach.
In total, 37 publications based on 24 cohorts were included. There was moderate CoE for a lower risk of CVD when substituting processed meat with nuts SHR (95% CI): 0.73 (0.59, 0.91), n = 8 cohorts, legumes 0.77 (0.68, 0.87), n = 8, and whole grains 0.64 (0.54, 0.75), n = 7, as well as eggs with nuts 0.83 (0.78, 0.89), n = 8 and butter with olive oil 0.96 (0.95, 0.98), n = 3. Furthermore, we found moderate CoE for an inverse association with T2D incidence when substituting red meat with whole grains/cereals 0.90 (0.84, 0.96), n = 6 and red meat or processed meat with nuts 0.92 (0.90, 0.94), n = 6 or 0.78 (0.69, 0.88), n = 6, as well as for replacing poultry with whole grains 0.87 (0.83, 0.90), n = 2 and eggs with nuts or whole grains 0.82 (0.79, 0.86), n = 2 or 0.79 (0.76, 0.83), n = 2. Moreover, replacing red meat for nuts 0.93 (0.91, 0.95), n = 9 and whole grains 0.96 (0.95, 0.98), n = 3, processed meat with nuts 0.79 (0.71, 0.88), n = 9 and legumes 0.91 (0.85, 0.98), n = 9, dairy with nuts 0.94 (0.91, 0.97), n = 3, and eggs with nuts 0.85 (0.82, 0.89), n = 8 and legumes 0.90 (0.89, 0.91), n = 7 was associated with a reduced risk of all-cause mortality.
Our findings indicate that a shift from animal-based (e.g., red and processed meat, eggs, dairy, poultry, butter) to plant-based (e.g., nuts, legumes, whole grains, olive oil) foods is beneficially associated with cardiometabolic health and all-cause mortality.
Poor oral health might be a modifiable determinant of malnutrition in older age. We aimed to investigate the associations of multiple oral health characteristics with incident malnutrition in ...community-dwelling older adults.
This exploratory analysis is based on prospective data from 893 participants, aged 55–80 years without malnutrition in 2005/06 from the Longitudinal Aging Study Amsterdam. In 2007, 19 oral health characteristics from the domains teeth/dentures, oral hygiene, oral problems, and self-rated oral health were assessed by questionnaire. Incident malnutrition was defined as presence of low body mass index (<20 kg/m² in people <70 years, <22 kg/m² ≥70 years) and/or self-reported involuntary weight loss ≥5% in previous 6 months at any of the follow-ups (2008/09, 2012/13, 2015/16). Associations of oral aspects with incident malnutrition were analyzed by cox proportional hazard models and adjusted for confounders.
The 9-year incidence of malnutrition was 13.5%. Sixteen of 19 oral health aspects were not associated with incident malnutrition in the crude models. Adjusted hazard ratios for incident malnutrition were 2.14 (1.10–4.19, p = 0.026) for toothache while chewing, 2.10 (0.88–4.98, p = 0.094) for an unhealthy oral health status, and 1.99 (0.93–4.28, p = 0.077) for xerostomia in edentulous participants, however, the two latter ones failing to reach statistical significance.
We identified toothache while chewing as determinant of incident malnutrition in community-dwelling older adults, and found indications that poor oral health and xerostomia in combination with having no teeth may play a role in developing malnutrition. However, these outlined tendencies need to be proven in further studies.
Regarding the development of strategies to prevent malnutrition in older people toothache while chewing, xerostomia, and self-rated oral health would be of specific interest as these factors are modifiable and can be easily assessed by self-reports.
The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of ...malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.
Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3-6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.
Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).
CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.
Malnutrition prevalence was lower in CD (11 %) than in the other settings (16-19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.
The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.
The obesity epidemic has reached old age in most industrialized countries, but trials elucidating the benefits and risks of weight reduction in older adults above 70 years of age with obesity remain ...scarce. While some findings demonstrate a reduced risk of mortality and other negative health outcomes in older individuals with overweight and mild obesity (i.e. body mass index (BMI) < 35 kg/m
2
), other recent research indicates that voluntary weight loss can positively affect diverse health outcomes in older individuals with overweight and obesity (BMI > 27 kg/m
2
), especially when combined with exercise. However, in this age group weight reduction is usually associated with a reduction of muscle mass and bone mineral density. Since uncertainty persists as to which level overweight or obesity might be tolerable (or even beneficial) for older persons, current recommendations are to consider weight reducing diets only for older persons that are obese (BMI ≥ 30 kg/m
2
) and have weight-related health problems. Precise treatment modalities (e.g. appropriate level of caloric restriction and indicated dietary composition, such as specific dietary patterns or optimal protein content) as well as the most effective and safest way of adding exercise are still under research. Moreover, the long-term effects of weight-reducing interventions in older individuals remain to be clarified, and dietary concepts that work for older adults who are unable or unwilling to exercise are required. In conclusion, further research is needed to elucidate which interventions are effective in reducing obesity-related health risks in older adults without causing relevant harm in this vulnerable population.
Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we ...investigated predictors of incident MN in older NH-residents.
NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m
) < 20 at FU) was analyzed in univariate generalized estimated equation (GEE) models. Significant (p < 0.1) variables were selected for multivariate GEE-analyses. Effect estimates are presented as odds ratios and their respective 99.5%-confidence intervals.
Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 1.56-4.98), a quarter (2.15 1.56-2.97) or half of the meal eaten (1.72 1.40-2.11) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0-23.0) (1.86 1.44-2.40) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 1.05; 2.03) (vs. the youngest age-group 65-74 years)), severe cognitive impairment (1.38 1.04; 1.84) (vs. none) and being immobile (1.28 1.00-1.62) (vs. mobile) predicted incident MN in the final model.
10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.
Dietary behavior encompasses many aspects, terms for which are used inconsistently across different disciplines and research traditions. This hampers communication and comparison across disciplines ...and impedes the development of a cumulative science. We describe the conceptual analysis of the fuzzy umbrella concept "dietary behavior" and present the development of an interdisciplinary taxonomy of dietary behavior.
A four-phase multi-method approach was employed. Input was provided by 76 scholars involved in an international research project focusing on the determinants of dietary behavior. Input was collected from the scholars via an online mind mapping procedure. After structuring, condensing, and categorizing this input into a compact taxonomy, the result was presented to all scholars, discussed extensively, and adapted. A second revision round was then conducted among a core working group.
A total of 145 distinct entries were made in the original mind mapping procedure. The subsequent steps allowed us to reduce and condense the taxonomy into a final product consisting of 34 terms organized into three main categories: Food Choice, Eating Behavior, and Dietary Intake/Nutrition. In a live discussion session attended by 50 of the scholars involved in the development of the taxonomy, it was judged to adequately reflect their input and to be a valid and useful starting point for interdisciplinary understanding and collaboration.
The current taxonomy can be used as a tool to facilitate understanding and cooperation between different disciplines investigating dietary behavior, which may contribute to a more successful approach to tackling the complex public health challenges faced by the field. The taxonomy need not be viewed as a final product, but can continue to grow in depth and width as additional experts provide their input.
Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the ...present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.
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