A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people

Introduction

The SARC-F scale is a newly developed tool to diagnose sarcopenia and obviate the need for measurement of muscle mass. SARC-F ≥ 4 is defined as sarcopenia. The questions of SARC-F cover physical functions targeting sarcopenia or initial presentation for sarcopenia. The aim of the study is to explore the application of SARC-F in the Chinese people.

Methods

Two hundred thirty Chinese people over 65 years old were assessed by the SARC-F scale, PSMS, Lawton IADL and the shortened version of the falls efficacy scale-international (the short FES-I). Hospitalization was investigated. Physical performance and strength were measured. The association of SARC-F with other scales or tests was analyzed.

Results

Poor physical performance and grip strength were associated with SARC-F ≥ 4 independently (P<0.005). The value for agreement of SARC-F ≥ 4 and cutoff points of tests were 0.391 to 0.635. The short FES-I were correlated to SARC-F scores (Spearman’s coefficient 0.692). Poor PSMS and Lawton IADL scores were associated with SARC-F ≥ 4(P=0.000) and SARC-F ≥ 4 was associated with hospitalization in the past 2 years (P=0.000).

Conclusion

The SARC-F scale can identify old Chinese people with impaired physical function who may suffered from sarcopenia. SARC-F judgment reflects fear of falling, indicates the hospitalization events and is associated with ability of daily life. Thus, SARC-F may be a simple and useful tool for screening individuals with impaired physical function. Further studies on SARC-F in Chinese people would be worthy.     

Dietary diversity and cognitive function among elderly people: A population-based study

Objectives

To explore associations of dietary diversity with cognitive function among Chinese elderly.

Design

This cross-sectional study was conducted in 2011-2012, data were analyzed using multiple linear regression and logistic regression models.

Setting

community-based setting in the 23 provinces in China.

Subjects

8,571 elderly participants, including 2984 younger elderly aged 65-79 and 5587 oldest old aged 80+ participated in this study.

Measurement

Intake frequencies of food groups was collected and dietary diversity (DD) was assessed based on the mean of DD score. Cognitive function was assessed using the Chinese version of Mini-Mental State Examination (MMSE), and cognitive impairment was defined using education-based cutoffs. Information about socio-demographics, lifestyles, resilience and health status was also collected.

Results

Poor dietary diversity was significantly associated with cognitive function, with β (95% CI) of -0.11(-0.14, -0.08) for – log (31-MMSE score) and odds ratio (95% CI) of 1.29 (1.14, 1.47) for cognitive impairment. Interaction effect of age with DD was observed on cognitive impairment (P interaction=0.018), but not on–log (31-MMSE score) (P interaction=0.08). Further separate analysis showed that poor DD was significantly associated with increased risk of cognitive impairment in the oldest old (p<0.01), with odds ratio (95% CI) of 1.34 (1.17, 1.54), while not in the younger elderly (p>0.05), with OR (95% CI) being 1.09 (0.80, 1.47) in the fully adjusted model. Similar results were obtained when DD was categorized into four groups.

Conclusions

Poor dietary diversity was associated with worse global cognitive function among Chinese elderly, and particularly for the oldest old. This finding would be very meaningful for prevention of cognitive impairment.

     

The short-form mini-nutritional assessment is as effective as the full-mini nutritional assessment in predicting follow-up 4-year mortality in elderly Taiwanese

Objective

To compare the mortality-predictive ability of the full- and short-form (SF) Mini Nutritional Assessment (MNA).

Design

A prospective cohort study.

Setting

Population-representative sample.

Participants

2872 ≥65-year old men and women.

Measurements

The study analyzed 1999 and 2003 datasets of the Taiwan Longitudinal Survey on Aging (TLSA). Subjects were graded for nutritional status with the full-MNA and MNA-SF of a Taiwanese-specific version (T2, containing calf circumference instead of BMI) at baseline (1999) and tracked their survival status for 4 years. Mortality-predictive abilities of the full-MNA and MNA-SF were compared using Cox regression analysis and Net Reclassification Improvement (NRI).

Results

The full-MNA and MNA-SF have comparable abilities in predicting follow-up 4-year mortality risk according to the hazard ratios (all p<0.001) and Akaike information criterion (AIC). It also showed a slight improvement (not significant) if the full-MNA in a predictive model was replaced by the MNA-SF (NRI=0.09%, p=0.956).

Conclusion

The MNA-SF has at least comparable or even slightly better ability in predicting follow-up 4-year mortality risk of elderly Taiwanese. Results suggest that MNA-SF with calf circumference may possess some basic characteristics of a comprehensive and universal geriatric screening scale.     

Factors affecting functional impairment among elderly Germans — Results of a longitudinal study

Objective

To investigate causal factors of functional impairment in old age in a longitudinal approach.

Design

A population-based prospective cohort study.

Setting

Elderly individuals were recruited via GP offices at six study centers in Germany. They were observed every 1.5 years over six waves.

Participants

Three thousand two hundred fifty-six people aged 75 years and older at baseline.

Measurements

Functional impairment was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale (IADL) and the Barthel-Index (BI).

Results

Fixed effects regressions revealed that functional impairment (IADL; BI) increased significantly with ageing (β=-.2; β=-1.1), loss of a spouse (β=.5; β=-3.1), not living alone in private household (β=-1.2; β=-5.5), depression (solely significant for IADL: β=.6) and dementia (β=-2.3; β=-18.2). The comorbidity score did not affect functional impairment.

Conclusion

Our findings underline the relevance of changes in sociodemographic variables as well as the occurrence of depression or dementia for functional impairment. While several of these causal factors for functional decline in the oldest old are inevitable, some may not be, such as depression. Therefore, developing interventional strategies to prevent depression might be a fruitful approach in order to delay functional impairment in old age.

     

Minimal important change and minimal detectable change in activities of daily living in community-living older people

Objective

To estimate the minimal important change (MIC) and the minimal detectable change (MDC) of the Katz-activities of daily living (ADL) index score and the Lawton instrumental activities of daily living (IADL) scale.

Design

Data from a cluster-randomized clinical trial and a cohort study.

Setting

General practices in the Netherlands.

Participants

3184 trial participants and 51 participants of the cohort study with a mean age of 80.1 (SD 6.4) years.

Measurements

At baseline and after 6 months, the Katz-ADL index score (0-6 points), the Lawton IADL scale (0-7 points), and self-perceived decline in (I)ADL were assessed using a self-reporting questionnaire. MIC was assessed using anchor-based methods: the (relative) mean change score; and using distributional methods: the effect size (ES), the standard error of measurement (SEM), and 0.5 SD. The MDC was estimated using SEM, based on a test-retest study (2-week interval) and on the anchor-based method.

Results

Anchor-based MICs of the Katz-ADL index score were 0.47 points, while distributional MICs ranged from 0.18 to 0.47 points. Similarly, anchor-based MICs of the Lawton IADL scale were between 0.31 and 0.54 points and distributional MICs ranged from 0.31 to 0.77 points. The MDC varies by sample size. For the MIC to exceed the MDC at least 482 patients are needed.

Conclusion

The MIC of both the Katz-ADL index and the Lawton IADL scale lie around half a point. The certainty of this conclusion is reduced by the variation across calculational methods.

     

Dietary nucleotides extend the life span in Sprague-Dawley rats

Background: Objective

To observe the effect of prolonged feeding of dietary nucleotides (NTs), and to clarify the effect of NTs on life extension of Sprague-Dawley rats.

Methods

There were 50 Sprague-Dawley rats in each group (male:female ratio=1:1), which were fed diets supplemented with NTs at concentrations of 0%, 0.01%, 0.04%, 0.16% and 0.64% (wt/wt) from the age of 4 weeks until natural death. We investigated the moribundity and mortality, survival time, spontaneous tumor incidence, and serum oxidative status.

Results

NTs have significantly influence body weight of first 3 month old and food consumption of male rats throughout the life span; it did dose-dependently inhibit the age-related decrease in the activities of antioxidant enzymes and the age-related increase in the levels of lipid peroxidation product in both sexes. NTs notably increased the mean life span, and the maximal life span. Compared to the control group, the incidence of death from tumors was decreased in NTs groups of both sexes.

Conclusions

Long-term feeding of NTs could dose-dependently increase life span in Sprague-Dawley rats, especially, the tumor-bearing ones. Moreover, the antioxidative property of NTs may be responsible for the increased life span.     

The associations among coping, nadir CD4+ T-cell count, and non-HIV-related variables with health-related quality of life among an ambulatory HIV-positive patient population

Purpose

We investigated HRQoL among HIV-positive outpatients from October, 2006-December, 2007, incorporating medical chart review, and a survey of coping styles.

Methods

Consented HIV-positive patients receiving medical care at University of Colorado Denver, with HAART as first antiretroviral regimen, completed the MOS-HIV and Brief COPE survey instruments. Linear regression identified a priori factors hypothesized to be associated with the MOS-HIV composite mental and physical health scores (MHS, PHS). Brief COPE survey maladaptive and adaptive coping components were added to the models and retained if significant.

Results

Among the 157 patient cohort, parsimonious multivariable linear regression models (P?Conclusions Factors independently associated with lower MHS and lower PHS include lower nadir CD4+ T-cell counts, and use of maladaptive coping. Efforts to reduce use of maladaptive coping strategies and earlier identification and treatment of HIV may improve HRQoL in HIV-positive patients.     

Impact of nutritional status and sleep quality on hospital utilisation in the oldest old with heart failure

Objectives

To describe three-year trends in nutritional status and sleep quality and their impact on hospital utilisation in the oldest old (80 +) with heart failure (HF).

Design

Single-centred longitudinal observational study.

Setting

South-eastern Sweden.

Participants

90 elderly (80+) with objectively verified HF.

Measurements

Baseline data from the Mini Nutritional Assessment (MNA) and on sleep quality were collected through structured interviews following the HF diagnosis (n=90) and at a three-year follow-up (n=41). Data on hospital utilisation during the three years following the HF diagnosis were also collected.

Results

Nineteen percent of the participants were found to have impaired nutritional status, a condition that increased hospital utilisation by four bed days per year. A majority (85%) had impaired sleep quality, but no impact on hospital utilisation was found. Nutritional status and sleep quality were stable over the three-year period.

Conclusion

In the oldest old with HF, impaired nutritional status and impaired sleep quality are already common at HF diagnosis. Impaired nutritional status increases hospital utilisation significantly. Therefore, it is of supreme importance to systematically evaluate nutritional status and sleep quality in the oldest old when they are diagnosed with HF, as well as to take action if impairments are present.

     

Forced mild physical training improves blood volume in the motor and hippocampal cortex of old mice

Objectives

To assess the effect of mild forced physical training on cerebral blood volume (CBV) and other brain parameters in old mice.

Setting

Treadmill in the animal house.

Participants

Thirty old (>25 mo) male mice were randomly assigned to one of three groups, exercise (E), exercise plus testosterone (T) (ET), and rest (C).

Intervention

Mild physical training on treadmill (30 min a day at belt speed = 8 m/min, five days a week) with or without one weekly injection of testosterone.

Measurements

CBV, quantitative transverse relaxation time (T2) maps, and cortical thickness were measured by magnetic resonance imaging.

Results

A significant increase of CBV was found in the motor and hippocampal cortex of E and ET mice; cortical thickness was not affected. T2 maps analysis suggested that water distribution did not change. T administration did not add to the effect of physical training.

Conclusion

This work provides first quantitative evidence that exercise initiated at old age is able to improve the hemodynamic status of the brain cortex in key regions for movement and cognition without inducing edema.     

Enduring inequality: educational disparities in health among the oldest old in Sweden 1992–2011

Objectives

Although the past two decades have involved changes in the living conditions of the oldest old in Sweden, little is known about how health inequalities have developed in this group during the period. This study explores the educational disparities in a wide range of health outcomes among the oldest old in Sweden between 1992 and 2011.

Methods

The study uses the repeated cross-sectional design of the SWEOLD survey, a nationally representative survey of the oldest old in Sweden with comparable data from 1992, 2002, and 2011. The development of educational disparities in health was tracked across the three waves.

Results

The results show that although the prevalence of most health problems increased during the period, the prevalence of disability in activities of daily living decreased. Despite these changes, educational disparities in health remained largely unaffected.

Conclusions

The results of the study suggest that the association between education and health is remarkably robust. It prevailed into the oldest age groups, was consistently found for a wide range of health problems, and tended to be stable over extended periods of time.

     

Skeletal muscle expression of LDH and monocarboxylate transporters in growing rats submitted to protein malnutrition

Background

In different circumstances such as infant malnutrition, old age or chronic disease, decline of muscular strength, particularly anaerobic power, is shown. In this context, our laboratory, has demonstrated a decrease in anaerobic glycolytic power in pre-pubertal Bolivian children living at low and high altitude and suffering from marginal protein malnutrition.

Aim of the study

To bring molecular support to the relationship between protein malnutrition and anaerobic glycolytic metabolism, we studied the impact of prolonged protein malnutrition on lactate metabolism in different muscles of growing rats. Lactate dehydrogenase (LDH), monocarboxylate transporters (MCT1, MCT4) and membrane protein CD147 were chosen as specific markers of anaerobic glycolytic metabolism.

Methods

Two groups of 10 weaning male rats were fed for 10 weeks either ad libitum with a well-balanced diet containing 18% protein or an isocaloric-diet containing 8% protein. LDH activity and mRNA amounts of LDH isoforms, MCT, CD147 were measured.

Results

Protein deprivation during rat growth induced a decrease of LDH specific activity in skeletal muscles (mean value of ?41%), accompanied by isoform distribution modifications in soleus, but not in glycolytic muscles (extensor digitorum longus (EDL) or plantaris). A reduction in mRNA amounts encoding the LDH A and B subunits was observed in EDL. A decrease in LDH B mRNA amounts was monitored in plantaris, whereas no modification in both LDH isoform mRNA quantities was observed in soleus. MCT1 mRNA quantities were decreased in EDL but MCT4 mRNA quantities remained stable. CD147 mRNA amounts were unchanged except for EDL with a 42% increase.

Conclusions

The global decreases of LDH activity, LDH and MCT gene expressions in growing rat skeletal muscles support the observed alterations of lactate metabolism associated with lowered muscular anaerobic performances in protein malnutrition.     

Xerostomia and medication: A cross-sectional study in long-term geriatric wards

Objective

The purpose of this study was to determine the prevalence of xerostomia in old people living in long-term geriatric wards, and to measure the relationship between xerostomia and etiologic factors such as age and medication (total number of medications, xerogenic medications, anticholinergic medications and medications that induce hypersialorrhea).

Design

An observational retrospective, comparative, multicentre epidemiological study.

Setting

Long-term geriatric wards, in Reims, France.

Participants

769 old people living in long-term geriatric wards.

Measurements

Prevalence of xerostomia assessed from age, total number of medications, xerogenic medications, anticholinergic medications and those that induce hypersialorrhea. Multivariable logistic regression was used to calculate Odds Ratios (OR) and their 95% Confidence Intervals (95% CI).

Results

Among 769 old people (average age 84.6±8.4 years old), 287 residents suffered from xerostomia (37.3%). Significant predictors of xerostomia were: resident??s age OR=1.56, 95% CI (1.30?C1.88), p<0.0001 and anticholinergic medications OR=1.35, 95% CI (1.05?C1.73), p=0.02. The only protective factor against xerostomia identified was medications that induce hypersialorrhea OR=0.81, 95% CI (0.67?C0.98), p=0.03. The total number of medications and xerogenic medications did not play a significant role in xerostomia.

Conclusion

Increasing Age and anticholinergic medications induce a dry mouth. Conversely, the total number of medications and xerogenic medications do not influence xerostomia. Medications that induce hypersialorrhea protect against the occurrence of dry mouth.     

A jerte valley cherry product provides beneficial effects on sleep quality. Influence on aging

Objective

In the present work, we evaluated the effect of the intake of a Jerte Valley cherry-based product (JVCP), compared to a placebo product, on sleep quality, urinary 6-sulfatoxymelatonin (aMT6-s) levels and the serum concentration of interleukin-1β (IL-1β), tumor necrosis factor α (TNF-α) and interleukin-8 (IL-8).

Design

This was a blind, placebo-controlled, randomized, crossover study.

Setting

University of Extremadura (Spain).

Participants

Ten young (20–30 years old), ten middle-aged (35–55 years old), and ten elderly (65–85 years old) participants.

Intervention

A placebo (Kool-Aid®) or JVCP (patent no. ES 2342141 B1) were consumed twice a day, as lunch and dinner desserts.

Measurements

Actigraphic monitoring was used to record and display the temporal patterns of the individuals’ activity and rest. Urinary aMT6-s and serum cytokines (IL-1β, TNF-α and IL-8) were also determined.

Results

The consumption of the JVCP improved the nocturnal rest, measured by sleep efficiency, number of awakenings, total nocturnal activity, sleep latency, assumed sleep, actual sleep time and immobility. Moreover, it was detected an increase in both the levels of aMT6-s found in first-void morning urine and the concentrations of serum pro-somnogenic cytokines obtained from samples collected at the acrophase of the melatonin rhythm (1.00 am) in all experimental age groups after the JVCP consumption. Generally, better results were obtained with advancing age.

Conclusion

The ingestion of the JVCP may contribute to establish a high-quality sleep and be used as a potential nutraceutical tool to prevent sleep disorders with the advance of age.     

Vitamin B12 deficiency in the brain leads to DNA hypomethylation in the TCblR/CD320 knockout mouse

Background

DNA methylation is an epigenetic phenomenon that can modulate gene function by up or downregulation of gene expression. Vitamin B₁₂ and folate pathways are involved in the production of S-Adenosylmethionine, the universal methyl donor.

Findings

Brain vitamin B₁₂ concentration and global DNA methylation was determined in transcobalamin receptor (TCblR/CD320) knock out (KO) (n?=?4) and control mice (n?=?4) at 20?C24?weeks of age. Median [IQR] brain vitamin B₁₂ concentrations (pg/mg) in TCblR/CD320 KO mice compared with control mice was 8.59 [0.52] vs 112.42 [33.12]; p?<?0.05. Global DNA methylation levels in brain genomic DNA were lower in TCblR/CD320 KO compared with control mice (Median [IQR]: 0.31[0.16] % vs 0.55[0.15] %; p?<?0.05.).

Conclusions

In TCblR/CD320 KO mice, brain vitamin B₁₂ drops precipitously by as much as 90% during a 20?week period. This decrease is associated with a 40% decrease in global DNA methylation in the brain. Future research will reveal whether the disruption in gene expression profiles due to changes in DNA hypomethylation contribute to central nervous system pathologies that are frequently seen in vitamin B₁₂ deficiency.     

Smoking decreases the level of circulating CD34+ progenitor cells in young healthy women - a pilot study

Background

Decreased levels of circulating bone marrow-derived progenitor cells have been associated with risk factors and cardiovascular diseases. Smoking is the most important modifiable risk factor for atherosclerosis in young women. The aim of this pilot study was to assess in healthy premenopausal women without other risk factors for cardiovascular disease the influence of nicotine abuse on the number of circulating progenitor cells in relation to endothelial function.

Methods

The number of endothelial progenitor cells, measured as colony-forming units in a cell-culture assay (EPC-CFU) and the number of circulating CD34 + and CD34 +/CD133 + cells, measured by flow cytometry, was estimated in 32 women at the menstrual phase of the menstrual cycle. In addition, flow-mediated dilation (FMD) was assessed as a marker for vascular function. In a subgroup of these women (n = 20), progenitor cells were also investigated at the mid-follicular and luteal phases of the menstrual cycle.

Results

Compared to non-smokers, the abundance of circulating CD34 + cells was significantly lower in smoking women in the menstrual, mid-luteal, and mid-follicular phases of the menstrual cycle. The number of CD34 + progenitor cells was revealed to have significant positive correlation with FMD in young healthy women, whereas CD34 +/CD133 + progenitor cells and EPC-CFU showed no significant correlation.

Conclusion

The number of CD34 + progenitor cells positively correlates with FMD in young healthy women and is decreased by smoking.     

Simple kcal/kg formula is comparable to prediction equations for estimating resting energy expenditure in older cognitively impaired long term care residents

Objective

Assessment of energy needs is a critical step in developing the nutrition care plan, especially for individuals unable to modulate their own energy intakes. The purpose of this study was to assess precision and accuracy of commonly used prediction equations in comparison to measured resting energy expenditure in a sample of “oldest old” adults residing in long term care (LTC).

Subjects and Design

Resting energy expenditure (mREE) was measured by indirect calorimetry in 45 residents aged 86.1 ± 7.3 years, and compared to frequently used prediction equations (pREE): Mifflin St.Jeor, Harris Benedict, World Health Organization and Owen. Precision and accuracy were determined by concordance correlation coefficients and number of individuals within ± 10% of mREE. Bland Altman plots with linear dependence trends were constructed to visualize agreement. To complete analyses, the common 25 kcal/kg formula was assessed and alternative formulas were determined for best fit by regressing adjusted mREE on body weight.

Results

mREE averaged 976.2 ± 190.3 kcal/day for females and 1260.0 ± 275.9 kcal/d for males. The strength of the relationships between pREE and mREE were only moderate (r = 0.41–0.72). In examining linear trends in the Bland Altman plots, significant systematic deviation from mREE was detected for all pREE. Two kcal/kg formulas were generated: 20.6 kcal/kg for females and 22.7 kcal/kg for males, which were not significantly different.

Conclusion

None of the prediction equations adequately estimated energy needs in this sample of the “oldest old.” A simple formula using 21–23 kcal/kg may be a more practical and reliable method to determine energy needs in the LTC setting.     

Immunomodulatory effects of a probiotic drink containing Lactobacillus casei Shirota in healthy older volunteers

Purpose

There is growing evidence that probiotics confer health benefits to the host by modulating immune function, especially in older people, where immunosenescence is a feature even of healthy ageing. The aim of this study was to investigate the effect of a probiotic drink containing Lactobacillus casei Shirota (LcS) on immune function in a healthy non-immunocompromised older population.

Methods

Thirty healthy old volunteers were recruited into a randomized placebo-controlled, single-blind crossover study. The volunteers were supplemented with the probiotic drink containing 1.3 × 10¹⁰ CFU LcS or skimmed milk per day for 4 weeks, followed by 4 weeks of washout and were crossed over to the other treatment. Peripheral blood and saliva samples were collected at baseline and end of each treatment.

Results

Probiotic consumption was associated with a significant increase in natural killer (NK) cell activity relative to baseline and a significant decrease in the mean fluorescence intensity of CD25 expression in the resting T cells compared with placebo. Additionally, there was a trend towards an increased ratio of IL-10 to IL-12 relative to baseline after LcS intake.

Conclusions

Consumption of a probiotic drink containing LcS improved NK cell activity and tended to produce a more anti-inflammatory cytokine profile in an older population.     

Quality of life in HIV subtype C infection among asymptomatic subjects and its association with CD4 counts and viral loads – a study from South India

Objective

To study the association between quality of life (QOL) domains and biological markers of disease progression of HIV infection, i.e. viral load (VL) and CD4 counts among asymptomatic subjects with HIV subtype C infection in South India.

Design

Quality of life was measured using the locally validated version of the WHOQOL HIV-BREF. The subjects were neurologically asymptomatic, non psychiatrically ill HIV infected men and women participating in a cohort study.

Results

The results indicated mixed findings, with some QOL dimensions being associated with high VLs and low CD4 counts while several others did not show any associations. Significant associations were seen between low CD4 counts and the psychological and social relationships domain, with lower mean scores in these domains being reported by subjects having CD4 counts <200 /mm. However, there were no significant differences between the CD4 subgroups for the domains related to physical health, level of independence, environment, and spirituality domains. Significant lower mean QOL scores were found in the highest VL subgroup compared to other groups for the following WHOQOL HIV-BREF domains: physical, psychological, level of independence, and environmental.

Conclusions

In this sample of HAART naïve asymptomatic HIV infected subjects, some QOL dimensions were associated with the biological markers of disease progression i.e. VL and CD4 counts, while several were not. The associations were significant only in the high VL and low CD4 groups.