S. Goisser

Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons--a narrative review.

One of the many threats to independent life is the age-related loss of muscle mass and muscle function commonly referred to as sarcopenia. Another important health risk in old age leading to functional decline is obesity. Obesity prevalence in older persons is increasing, and like sarcopenia, severe obesity has been consistently associated with several negative health outcomes, disabilities, falls, and mobility limitations. Both sarcopenia and obesity pose a health risk for older persons per se, but in combination, they synergistically increase the risk for negative health outcomes and an earlier onset of disability. This combination of sarcopenia and obesity is commonly referred to as sarcopenic obesity. The present narrative review reports the current knowledge on the effects of complex interventions containing nutrition and exercise interventions in community-dwelling older persons with sarcopenic obesity. To date, several complex interventions with different outcomes have been conducted and have shown promise in counteracting either sarcopenia or obesity, but only a few studies have addressed the complex syndrome of sarcopenic obesity. Strong evidence exists on exercise interventions in sarcopenia, especially on strength training, and for obese older persons, strength exercise in combination with a dietary weight loss intervention demonstrated positive effects on muscle function and body fat. The differences in study protocols and target populations make it impossible at the moment to extract data for a meta-analysis or give state-of-the-art recommendations based on reliable evidence. A conclusion that can be drawn from this narrative review is that more exercise programs containing strength and aerobic exercise in combination with dietary interventions including a supervised weight loss program and/or protein supplements should be conducted in order to investigate possible positive effects on sarcopenic obesity.

Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fracture

OBJECTIVESnHip fractures (HFs) in old age frequently cause severe functional impairment and deteriorating autonomy in everyday life. Many older patients with HFs are malnourished or at risk of malnutrition. In this study, we examined the relationship between nutritional status of geriatric patients before HF and their functional and clinical course up to 6xa0months after hospital discharge.nnnDESIGNnObservational study with follow-up after 6xa0months.nnnSETTINGnFour wards of the department of trauma and orthopedic surgery of a large urban maximum care hospital (Klinikum Nürnberg, Nuremberg, Germany).nnnPARTICIPANTSnGeriatric patients aged ≥75xa0years with surgically repaired proximal femoral fracture.nnnMEASUREMENTSnPrefracture nutritional status was determined by Mini Nutritional Assessment (MNA). Comorbidities and complications during hospital stay were obtained from medical documentation. Functional status before HF, postoperatively, at hospital discharge, and 6xa0months later was assessed by Barthel Index for activities of daily living (ADL) and patients mobility level and related to MNA categories. Associations were evaluated using χ(2), Fisher exact, Kruskal-Wallis, Mann-Whitney-U, Jonckheere-Terpstra, and Cochrane-Armitage tests as appropriate, as well as analysis of covariance with repeated measures.nnnRESULTSnOf 97 included patients, 17% were malnourished and 38% at risk of malnutrition before HF. Participants with (risk of) malnutrition were equally mobile but more dependent in ADL prior to HF than well-nourished patients (Pxa0<xa0.001). Independent of nutritional status, after 6xa0months 68% of participants had not regained their prefracture level of independence in ADL. According to analysis of covariance, the ADL development over time until follow-up 6xa0months after hospital discharge did not depend on nutritional status. However, at follow-up malnourished patients more often suffered from remaining losses in ADL ≥25% of initial Barthel Index points (Pxa0=xa0.033) and less often had regained their prefracture mobility level (Pxa0=xa0.020) than well-nourished patients. Clinical course did not differ significantly between the groups with different nutritional status.nnnCONCLUSIONSnIn this study with geriatric HF patients from all functional and cognitive levels, worse prefracture nutritional status was associated with worse functional status and more frequent remaining functional loss, whereas the trajectory of ADL recovery and clinical course did not differ significantly. Further studies with sufficient statistical power are needed to substantiate these inconclusive results. In order to clarify the association of nutritional status with functional and clinical course in geriatric patients after HF, they should preferably focus on the role of nutritional management during the hospital stay.

Low postoperative dietary intake is associated with worse functional course in geriatric patients up to 6 months after hip fracture.

We examined the relationship between postoperative dietary intake (DI) of geriatric hip fracture (HF) patients and their functional and clinical course until 6 months after hospital discharge. In eighty-eight HF patients ≥xa075 years, postoperative DI was estimated with plate diagrams of main meals over four postoperative days. DI was stratified as >50, >25-50, ≤xa025xa0% of meals served. Functional status according to Barthel index (activities of daily living) and patients mobility level before fracture, postoperatively, at discharge and 6 months later were assessed and related to DI levels. In-hospital complications were recorded according to clinical diagnosis. Associations were evaluated using χ2 and Kruskal-Wallis tests, and repeated-measures ANOVA and ANCOVA. Postoperatively, 28xa0% of participants ate >50xa0%, 43xa0% ate >25-50xa0% and 28xa0% ≤xa025xa0% of meals served. Irrespective of pre-fracture functional status, patients with DI ≤xa025xa0% had significantly lower Barthel index scores at all times after surgery (all P50xa0% more often had regained their pre-fracture mobility level than those with DI ≤xa025xa0% at discharge (>50xa0%: 36xa0%; >25-50xa0%: 10xa0%; ≤xa025xa0%: 0xa0%; P=xa00·001) and 6 months after discharge (88; 87; 68xa0%; P=xa00·087) and had significantly less complications (median 2 (25th-75th percentile 1-3); 3 (25th-75th percentile 2-4); 3 (25th-75th percentile 3-4); P=xa00·012). To conclude, geriatric HF patients had very low postoperative voluntary DI and thus need specific nutritional interventions to achieve adequate DI to support functional and clinical recovery.

Whole-body electromyostimulation to fight sarcopenic obesity in community-dwelling older women at risk. Resultsof the randomized controlled FORMOsA-sarcopenic obesity study

SummaryThe effect of whole body-electromyostimulation in community-dwelling women ≥70 with sarcopenic obesity was heterogeneous, with high effects on muscle mass, moderate effects on functional parameters, and minor effects on fat mass. Further, we failed to determine a supportive effect of additional protein-enriched dietary supplementation in this albeit predominately well-nourished group.IntroductionThe aim of the study was to determine the effect of whole-body electromyostimulation (WB-EMS) on sarcopenic obesity (SO) in community-dwelling women more than 70xa0years with sarcopenic obesity.MethodsSeventy-five community-dwelling women ≥70xa0years with SO were randomly allocated to either a WB-EMS-application with (WB-EMS &P; 24.9u2009±u20091.9xa0kg/m2) or without (WB-EMS; 25.2u2009±u20091.8xa0kg/m2) dietary supplementation (150xa0kcal/day, 56xa0% protein) or a non-training control group (CG; 24.7u2009±u20091.4xa0kg/m2). WB-EMS consisted of one weekly session of 20xa0min (85xa0Hz, 350xa0μs, 4xa0s of strain–4xa0s of rest) performed with moderate to high intensity. Primary study endpoint was the Sarcopenia Z-Score constituted by skeletal muscle mass index (SMI, as assessed by dual energy X-ray absorptiometry), grip strength, and gait speed, and secondary study endpoint was body fat (%).ResultsSarcopenia Z-score comparably increases in the WB-EMS and the WB-EMS&P-group (pu2009≤u2009.046). Both groups differ significantly (pu2009≤u2009.001) from the CG which deteriorated significantly (pu2009=u2009.006). Although body fat changes were most pronounced in the WB-EMS (−0.9u2009±u20092.1; pu2009=u2009.125) and WB-EMS&P (−1.4u2009±u20092.5; pu2009=u2009.028), reductions did not statistically differ (pu2009=u2009.746) from the CG (−0.8u2009±u20092.7; pu2009=u2009.179). Looking behind the covariates, the most prominent changes were determined for SMI, with a significant increase in both EMS-groups (2.0–2.5xa0%; pu2009≤u2009.003) and a decrease in the CG (−1.2u2009±u20093.1xa0%; pu2009=u2009.050) with significant between-group differences (pu2009=u2009.001).ConclusionWB-EMS is a safe and attractive method for increasing muscle mass and functional capacity in this cohort of women 70+ with SO; however, the effect on body fat is minor. Protein-enriched supplements did not increase effects of WB-EMS alone.

Prevalence of sarcopenia in Germany and the corresponding effect of osteoarthritis in females 70 years and older living in the community: results of the FORMoSA study

Background Although sarcopenia represents a challenging burden for health care systems around the world, its prevalence in the elderly population varies widely. The primary aim of the study was to determine the prevalence of sarcopenia in community-dwelling (CD) German women aged 70 years and older; the secondary aim was to assess the effect of osteoarthritis (OA) on sarcopenia prevalence in this cohort. Methods A total of 689 Caucasian females 18–35 years old and 1,325 CD females 70 years+ living in Northern Bavaria, Germany, were assessed during the initial phase of the FORMoSA research project. Anthropometry, total and regional muscle mass, were assessed by segmental multifrequency Bioelectrical Impedance Analysis. Further 10 m walking speed and handgrip strength were evaluated to apply the European Working Group on Sarcopenia in Older People definition of sarcopenia. Covariates were determined by questionnaires and interviews. Results Applying the algorithm of the European Working Group on Sarcopenia in Older People of two standard deviations below the mean value for appendicular skeletal muscle mass of a reference cohort of the young cohort (5.66 kg/m2), low gait speed (≤0.8 m/s), and low grip strength (<20 kg), the prevalence of sarcopenia in CD German females 70 years and older was 4.5% (70–79 years: 2.8% vs ≥80 years: 9.9%; P<0.001). Participants with OA at the hip and lower limbs (n=252) exhibited significantly higher rates of sarcopenia (OA: 9.1 vs non-OA: 3.5%). Of importance, anthropometric, demographic, health, and lifestyle parameters (except exercise participation) of our cohorts corresponded with Bavarian or German data for CD women 70 years+. Conclusion The prevalence of sarcopenia in CD German females 70 years+ is relatively low. However, participants with OA at the hip or lower limbs were at increased risk for sarcopenia.

Red blood cell membrane omega-3 fatty acid levels and physical performance: Cross-sectional data from the MAPT study

BACKGROUND & AIMSnStudies have shown that omega-3 polyunsaturated fatty acids (PUFAs) are associated with brain, cardiovascular and immune function, as well as physical performance and bone health in older adults. So far, few studies have highlighted the associations between PUFA status and performance-based tests of physical function. To study the associations between the omega-3 index (red blood cell (RBC) membrane content of omega-3 PUFAs, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)) and physical performance measured with the Short Physical Performance Battery (SPPB) in a sample of community-dwelling older adults.nnnDESIGNnCross-sectional study using the baseline data of the Multidomain Alzheimers Disease Trial (MAPT), a randomized, placebo-controlled trial.nnnPARTICIPANTS AND MEASUREMENTSn1449 participants with available data on PUFAs were included. Omega-3 index and Short Physical Performance Battery (SPPB) scores were measured at enrollment and the omega-3 index expressed as the percentage of total fatty acid content was calculated. We also dichotomized the omega-3 index as low (lowest quartile) vs. high (three upper quartiles).nnnRESULTSnParticipants were 75.2 (±4.4) years old, 64.5% were female. Bivariate analyses found that participants who were in the lowest omega-3 index quartile (Q1) had a SPPB score significantly lower than participants in the three other quartiles (Q2-Q4). However, adjusted (for age, gender, cognitive function, depressive status, Body Mass Index and grip strength) multiple linear regression showed that the omega-3 index-SPPB score association did not reach statistical significance [βxa0=xa0-0.166; (-0.346; 0.013); pxa0=xa00.07] in our sample.nnnCONCLUSIONnThis cross-sectional study found that participants with a low omega-3 index had worse performance-based test results of physical function than people with a high omega-3 index, but this association did not reach statistical significance once confounders were controlled for. Studies looking at the over-time associations between PUFA status and physical performance changes may shed more light on this topic.

Omega-3 fatty acid levels in red blood cell membranes and physical decline over 3 years: longitudinal data from the MAPT study

Studies have shown that omega-3 polyunsaturated fatty acids (PUFAs) are associated with brain, cardiovascular, and immune function, as well as physical performance and bone health in older adults. So far, few studies have investigated the associations between PUFA status and performance-based tests of physical function. The objective of this study was to investigate the associations between the omega-3 PUFA levels (eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA)) in red blood cell (RBC) membranes and physical performance, in a sample of community-dwelling older adults. This is a longitudinal observational study using data from the Multidomain Alzheimer’s Disease Trial (MAPT), a randomized, placebo-controlled trial. Four hundred participants from MAPT placebo group with available PUFA data were included. Omega-3 PUFA levels in RBC membranes were measured at baseline, and their percentage of total RBC membrane fatty acid content was calculated. We dichotomized the standardized omega-3 PUFA levels in RBC membranes as low (lowest quartile) vs. high (three upper quartiles). Gait speed (in m/s) and short physical performance battery (SPPB) score (range from 0 to 12, higher is better) were used to assess physical performance at baseline and after 6, 12, 24, and 36xa0months. Participants were 75.2 (±xa04.3) years old and 68% were female. Bivariate analyses found that the characteristic of the participants in the lowest quartile of omega-3 PUFA levels (Q1) and those in the three upper quartiles (Q2–Q4) was not different at baseline; only those in Q1 were slightly older. In an unadjusted model, the difference in gait speed after 3xa0years of follow-up was significant (−xa00.09xa0±xa00.03xa0m/s; pxa0=xa00.008) between participants in Q1 and those in Q2–Q4. In a model adjusted for age, gender, educational level, cognitive function, depressive status, body mass index, physical activity, grip strength, and their time interaction, this difference remained clinically relevant (−xa00.07xa0±xa00.04xa0m/s; pxa0=xa00.075). No difference between the two groups was found for the SPPB score development over 3xa0years. Older adults with subjective memory complaints and in the lower quartile of omega-3 have a faster decline on gait speed compared to people in the three upper quartiles. Other longitudinal studies are needed to explore this association and to examine mechanisms.

Ready-meal consumption in older people: association with obesity and dietary intake

ObjectiveTo investigate ready-meal consumption trends in older French people, its association with overall diet quality and obesity.DesignCross-sectional analysisSettingMultidomain Alzheimer Preventive Trial (MAPT), FranceSubjects421 MAPT participants (mean age 76.8xa0years) who filled a food frequency questionnaire.ResultsThe frequency of ready-meal consumption was low, with nearly 90% of participants declaring consumingu2009≤u20091 ready-meal per week. Compared to non- and low-consumers (≤u20091 ready-meal/week), regular consumers (≥u20092 ready-meals/week) were older (pu2009<u20090.01), more often frail and pre-frail (p 0.04), with impaired cognition (pu2009=u20090.02) and functional status (pu2009=u20090.02), with more depressive symptoms (pu2009=u20090.03) and more difficulties with preparing meals (pu2009=u20090.01). Results from multivariate analyses showed that regular ready-meal consumption was not associated with obesity (pu2009=u20090.26) and diet quality (pu2009=u20090.37).ConclusionsIn our sample, few older people declared consumption of 2 or more ready-meals per week, this consumption was not associated with a higher prevalence of obesity or a lower diet quality, despite the fact that these subject were older, with a lower physical and cognitive status. These findings suggest that, for these people with difficulties in meal preparation, convenience foods consumed occasionally could help to maintain diet quality and weight status.

Ernährungsmanagement in der AlterstraumatologieNutritional management in geriatric traumatology

ZusammenfassungDie Prävalenz der Mangelernährung bzw. des Risikos einer Mangelernährung bei alterstraumatologischen Patienten ist hoch und geht mit weitreichenden negativen Folgen für die Patienten einher. Um diese Situation zu verbessern, sollte bei alterstraumatologischen Patienten ein umfassendes Ernährungs- und Flüssigkeitsmanagement erfolgen. Dieses beinhaltet neben der Identifizierung der betroffenen Patienten ein ausführliches Assessment möglicher Ursachen, die Dokumentation ihrer Nahrungs- und Flüssigkeitszufuhr sowie v.xa0a. Maßnahmen, um die Ernährungssituation sowohl prä- als auch postoperativ zu verbessern. Der vorliegende Beitrag gibt eine Übersicht über den aktuell von der Arbeitsgruppe Alterstraumatologie der Deutschen Gesellschaft für Geriatrie empfohlenen Standard zum Ernährungsmanagement bei alterstraumatologischen Patienten.AbstractThe prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation. This article gives an overview of the recently updated recommendations on nutritional management in orthogeriatric patients as published by the orthogeriatric working group of the German Geriatric Society.The prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation. This article gives an overview of the recently updated recommendations on nutritional management in orthogeriatric patients as published by the orthogeriatric working group of the German Geriatric Society.

Nutritional management in geriatric traumatology

ZusammenfassungDie Prävalenz der Mangelernährung bzw. des Risikos einer Mangelernährung bei alterstraumatologischen Patienten ist hoch und geht mit weitreichenden negativen Folgen für die Patienten einher. Um diese Situation zu verbessern, sollte bei alterstraumatologischen Patienten ein umfassendes Ernährungs- und Flüssigkeitsmanagement erfolgen. Dieses beinhaltet neben der Identifizierung der betroffenen Patienten ein ausführliches Assessment möglicher Ursachen, die Dokumentation ihrer Nahrungs- und Flüssigkeitszufuhr sowie v.xa0a. Maßnahmen, um die Ernährungssituation sowohl prä- als auch postoperativ zu verbessern. Der vorliegende Beitrag gibt eine Übersicht über den aktuell von der Arbeitsgruppe Alterstraumatologie der Deutschen Gesellschaft für Geriatrie empfohlenen Standard zum Ernährungsmanagement bei alterstraumatologischen Patienten.AbstractThe prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation. This article gives an overview of the recently updated recommendations on nutritional management in orthogeriatric patients as published by the orthogeriatric working group of the German Geriatric Society.The prevalence of malnutrition or the risk of malnourishment is high among orthogeriatric patients and a poor nutritional status is associated with a negative outcome. A comprehensive management of preoperative and postoperative nutritional and fluid intake in these patients can help to improve the situation. The management includes identification of patients affected, a thorough assessment of the nutritional status, work-up of possible underlying causes, documentation of nutritional and fluid intake and, most importantly, procedures to improve the preoperative and postoperative nutritional situation. This article gives an overview of the recently updated recommendations on nutritional management in orthogeriatric patients as published by the orthogeriatric working group of the German Geriatric Society.