Association of dietary variety with body composition and physical function in community-dwelling elderly Japanese

Objectives

To examine the associations of dietary variety with body composition and physical function in community-dwelling elderly Japanese

Design

Cross-sectional study.

Setting

Community-based.

Participants

A total of 1184 community-dwelling elderly adults aged 65 and over.

Measurements

Dietary variety was assessed with a food frequency questionnaire (maximum, 10 points) that encompassed the 10 main food components of Japanese meals (meat, fish/shellfish, eggs, milk, soybean products, green/yellow vegetables, potatoes, fruit, seaweed, and fats/oils). Body composition was determined by multifrequency bioelectrical impedance analysis. Physical function was assessed by measuring grip strength and usual walking speed. Multiple linear regression analysis was used to examine the associations of dietary variety with body composition and physical function.

Results

After adjusting for potential confounders, higher dietary variety scores were independently associated with higher lean mass (β (SE): 0.176 (0.049), p<0.001) and appendicular lean mass (β (SE): 0.114 (0.027), p<0.001) but not with body fat mass. Elders with a higher dietary variety score had greater grip strength and faster usual walking speed (β (SE): 0.204 (0.071), p=0.004, and β (SE): 0.008 (0.003), p=0.012, respectively).

Conclusion

Greater dietary variety was significantly associated with greater lean mass and better physical function in Japanese elders. The causal relationship warrants investigation in a prospective study.

     

Dietary variety and decline in lean mass and physical performance in community-dwelling older Japanese: A 4-year follow-up study

Objectives

To examine associations of dietary variety with changes in lean mass and physical performance during a 4-year period in an elderly Japanese population. Design: Four-year prospective study.

Setting

The Hatoyama Cohort Study and Kusatsu Longitudinal Study, Japan.

Participants

935 community-dwelling Japanese aged 65 years or older.

Measurements

Dietary variety was assessed using a 10-item food frequency questionnaire. Body composition was determined by multifrequency bioelectrical impedance analysis, and physical performance (grip strength and usual gait speed) was measured in surveys at baseline and 4 years later. Longitudinal analysis included only participants who were originally in the upper three quartiles of lean body mass, appendicular lean mass, grip strength, and usual gait speed. The outcome measures were decline in lean body mass, appendicular lean mass, grip strength, and usual gait speed, defined as a decrease to the lowest baseline quartile level at the 4-year follow-up survey. Associations of dietary variety with the outcome measures were examined by logistic regression analysis adjusted for potential confounders.

Results

In the fully adjusted model, the odds ratios for decline in grip strength and usual gait speed were 0.43 (95% confidence interval, 0.19–0.99) and 0.43 (confidence interval, 0.19–0.99), respectively, for participants in the highest category of dietary variety score as compared with those in the lowest category. Dietary variety was not significantly associated with changes in lean body mass or appendicular lean mass.

Conclusion

Among older adults, greater dietary variety may help maintain physical performance, such as grip strength and usual gait speed, but not lean mass.

     

Is meeting the recommended dietary allowance (RDA) for protein related to body composition among older adults?: Results from the Cardiovascular Health of Seniors and Built Environment Study

Objective

Studies suggest protein intake may be associated with lower body weight, but protein has also been associated with preservation of lean body mass. Understanding the role of protein in maintaining health for older adults is important for disease prevention among this population.

Design

Cross-sectional study of the relationship of dietary protein on body composition.

Setting

New York City community centers.

Participants

1,011 Black, White, and Latino urban men and women 60-99 years of age.

Measurements

Protein intake was assessed using two interviewer-administered 24-hour recalls, and body composition was assessed using bioelectrical impedance analysis (BIA) of fat mass (kg) (FM), fat free mass (kg) (FFM), and impedance resistance (Ohms).

Statistical Analysis

Indices of FM and FFM were calculated by dividing BIA measurements by height squared (m²), and percent FFM was calculated by dividing FFM by the sum of FM and FFM. Log linear models adjusting for age (continuous), race/ethnicity, education, physical activity (dichotomized at the median), hypertension, diabetes, and total calories (continuous).

Results

Just 33% of women and 50% of men reported meeting the RDA for protein. Both fat free mass index (FFMI) and fat mass index (FMI) were negatively associated with meeting the RDA for protein (Women: FFMI -1.78 95%CI [-2.24, -1.33], FMI -4.12 95% CI [-4.82, -3.42]; Men: FFMI -1.62 95% CI [-2.32, -0.93] FMI -1.80 95% CI [-2.70, -0.89]). After accounting for confounders, women and men consuming at least 0.8 g/kg/day had a 6.2% (95% CI: 5.0%, 7.4%) and a 3.2% (95% CI 1.1%, 5.3%) higher percent fat free mass, respectively.

Conclusions

FFM, FFMI, FM, and FMI were inversely related to meeting the RDA for protein. Meeting the RDA for protein of at least 0.8g/kg/day was associated with a higher percentage of fat free mass among older adults. These results suggest meeting the protein recommendations of at least 0.8 g/kg/day may help to promote lower overall body mass, primarily through loss of fat mass rather than lean mass.

     

Association of dynamics in lean and fat mass measures with mortality in frail older women

Objective

The relationship between body composition and mortality in frail older people is unclear. We used dual-x-ray absorptiometry (DXA) data to examine the association between dynamics in whole-body composition and appendicular (4 limbs) and central (trunk) compartments and all-cause mortality in frail older women.

Design

Prospective study with up to 19 years of follow up.

Setting

Community dwelling older (≥65) women.

Participants

876 frail older participants of the Women’s Health Initiative Observational Study with a single measure of body composition and 581 participants with two measures.

Measurements

Frailty was determined using modified Fried’s criteria. All-cause mortality hazard was modeled as a function of static (single-occasion) or dynamic changes (difference between two time points) in body composition using Cox regression.

Results

Analyses adjusted for age, ethnicity, income, smoking, cardiovascular disease, diabetes, stroke, number of frailty criteria and whole-body lean mass showed progressively decreased rates of mortality in women with higher appendicular fat mass (FM) (P for trend=0.01), higher trunk FM (P for trend=0.03) and higher whole-body FM (P for trend=0.01). The hazard rate ratio for participants with more than a 5% decline in FM between two time points was 1.91; 1.67 and 1.71 for appendicular, trunk and whole-body compartment respectively as compared to women with relatively stable adiposity (p<0.05 for all). Dynamics of more than 5% in lean mass were not associated with mortality.

Conclusion

Low body fat or a pronounced decline in adiposity is associated with increased risks of mortality in frail older women. These results indicate a need to re-evaluate healthy weight in persons with frailty.

     

Kinship Foster Care and School Adjustment: Evidence from a Nationally Representative Sample of Children in Out-of-Home Care in South Korea

Background

There are many appealing reasons to support kinship foster care as an alternative to other types of out-of-home care. In South Korea, however, less is known about whether or not kinship foster care is beneficial for children’s development, and nothing is known about how kinship foster care compares with other types of out-of-home care in terms of its associations with children’s developmental outcomes.

Objective

This study aimed to examine the associations between kinship foster care and children’s school adjustment, which were separately compared with institutional and group home care.

Methods

This study used data from a nationally representative sample of 414 children in out-of-home care in South Korea and employed propensity score weighting to address selection bias.

Results

The main analyses revealed that the children in kinship foster care showed more bonding to school and less misbehavior at school than the children in institutional care. Children in grandparent foster care also showed more bonding to school than those in group home care. Interaction analyses suggested that the associations between specific types of kinship foster care and children’s school adjustment varied by the child’s gender and the presence of a biological father.

Conclusions

Implications for research, policy, and practice to improve the healthy development of children in out-of-home care were discussed based upon the results.

     

Body composition and anti-neoplastic treatment in adult and older subjects - A systematic review

Background

The estimation of the risk of poor tolerance and overdose of antineoplastic agents protocols represents a major challenge in oncology, particularly in older patients. We hypothesize that age-related modifications of body composition (i.e. increased fat mass and decreased lean mass) may significantly affect tolerance to chemotherapy.

Method

We conducted a systematic review for the last 25 years (between 1990 and 2015), using US National library of Medicine Medline electronic bibliographic database and Embase database of cohorts or clinical trials exploring (i) the interactions of body composition (assessed by Dual X-ray Absorptiometry, Bioelectrical Impedance Analyses, or Computerized Tomography) with pharmacokinetics parameters, (ii) the tolerance to chemotherapy, and (iii) the consequences of chemotherapies or targeted therapies on body composition.

Results

Our search identified 1504 articles. After a selection (using pre-established criteria) on titles and abstract, 24 original articles were selected with 3 domains of interest: impact of body composition on pharmacokinetics (7 articles), relationship between body composition and chemotoxicity (14 articles), and effect of anti-cancer chemotherapy on body composition (11 articles). The selected studies suggested that pharmacokinetic was influenced by lean mass, that lower lean mass could be correlated with toxicity, and that sarcopenic patients experienced more toxicities that non-sarcopenic patients. Regarding fat mass, results were less conclusive. No studies specifically explored the topic of body composition in older cancer patients.

Conclusions

Plausible pathophysiological pathways linking body composition, toxicity, and pharmacokinetics are sustained by the actual review. However, despite the growing number of older cancer patients, our review highlighted the lack of specific studies in the field of anti-neoplastic agents toxicity regarding body composition conducted in elderly.

     

Effects of Low-Dose Dairy Protein Plus Micronutrient Supplementation during Resistance Exercise on Muscle Mass and Physical Performance in Older Adults: A Randomized,Controlled Trial

Objectives

To investigate whether supplementation with low-dose dairy protein plus micronutrients augments the effects of resistance exercise (RE) on muscle mass and physical performance compared with RE alone among older adults.

Design

Randomized controlled trial.

Setting

Tokyo, Japan.

Participants

Eighty-two community-dwelling older adults (mean age, 73.5 years) were randomly allocated to an RE plus dairy protein and micronutrient supplementation group or an RE only group (n = 41 each).

Intervention

The RE plus supplementation group participants ingested supplements with dairy protein (10.5 g/day) and micronutrients (8.0 mg zinc, 12 μg vitamin B12, 200 μg folic acid, 200 IU vitamin D, and others/day). Both groups performed the same twice-weekly RE program for 12 weeks.

Measurements

Whole-body, appendicular, and leg lean soft-tissue mass (WBLM, ALM, and LLM, respectively) with dual-energy X-ray absorptiometry, physical performance, biochemical characteristics, nutritional intake, and physical activity were measured before and after the intervention. Data were analyzed by using linear mixed-effects models.

Results

The groups exhibited similar significant improvements in maximum gait speed, Timed Up-and-Go, and 5-repetition and 30-s chair stand tests. As compared with RE only, RE plus supplementation significantly increased WBLM (0.63 kg, 95% confidence interval [CI]: 0.31-0.95), ALM (0.37 kg, 95% CI: 0.16-0.58), LLM (0.27 kg, 95% CI: 0.10-0.46), and serum concentrations of 25-hydroxyvitamin D (4.7 ng/mL, 95% CI: 1.6-7.9), vitamin B12 (72.4 pg/mL, 95% CI: 12.9-131.9), and folic acid (12.9 ng/mL, 95% CI: 10.3-15.5) (all P < 0.05 for group-by-time interactions). Changes over time in physical activity and nutritional intake excluding the supplemented nutrients were similar between groups.

Conclusion

Low-dose dairy protein plus micronutrient supplementation during RE significantly increased muscle mass in older adults but did not further improve physical performance.

     

Cardiovascular disease risk factors among children of different socioeconomic status in Istanbul,Turkey: Directions for public health and nutrition policy

Objectives

The aim of the current study was to examine the influence of socioeconomic status (SES) on physiological (lipid profile, obesity indices) and behavioral (dietary habits, physical activity) cardiovascular disease (CVD) risk factors among primary schoolchildren in Istanbul.

Design

Cross sectional study.

Setting

One private school and two public schools from different SES districts in Istanbul.

Participants

510 randomly selected children aged 12 and 13 years old (257 boys, 253 girls).

Results

The prevalence of overweight (15.2%) and the energy intake (p < 0.001 and p < 0.05 for boys and girls respectively) were found to be higher for the middle/ high SES group for both genders. Regarding biochemical indices, middle/ high SES children had higher values of High Density Lipoprotein-cholesterol (HDL-C) (p < 0.001 and p < 0.05 for boys and girls respectively) and lower values of TC/HDL-C ratio and LDL-C/HDL-C ratio (p < 0.05 and p < 0.001 for boys and girls respectively). This could be attributed to the higher physical activity levels observed for middle/ high SES children (p < 0.001).

Conclusion

The findings of the current study revealed a coexistence of both overweight and higher energy intake in middle/ high SES children, as well as a coexistence of underweight and lower physical activity levels in low SES children. These observations should guide the public health policy in developing appropriate intervention strategies to efficiently tackle these health and social issues early in life.

     

Assessment of Physical Activity of Hospitalised Older Adults: A Systematic Review

Background

The assessment of physical activity levels of hospitalised older people requires accurate and reliable measures. Physical activities that older people in hospital commonly engage in include exercises and walking. Measurement of physical activity levels of older inpatients is essential to evaluate the impact of interventions to improve physical activity levels and to determine associations between physical activity in hospital and other health-related outcome measures.

Objective

To determine which measures are used to measure physical activity of older people in hospital, and to describe their properties and applications.

Method

A systematic review of four databases: Medline, Embase, CINAHL and AMED was conducted for papers published from 1996 to 2016. Inclusion criteria were participants aged ≥ 65 years and studies which included measures of physical activity in the acute medical inpatient setting. Studies which specifically assessed the activity levels of surgical patients or patients with neurological conditions such as stroke or brain injury were excluded. All study designs were included in the review.

Results

18 studies were included from 127 articles selected for full review. 15 studies used objective measures to measure the physical activity of older inpatients: 11 studies used accelerometers and four used direct systematic observations. Seven accelerometers were identified including the StepWatch Activity Monitor, activPAL, GENEActiv, Kenz Lifecorder EX, Actiwatch-L, Tractivity and AugmenTech Inc. Pittsburgh accelerometer. Three studies used a subjective measure (interviews with nurses and patients) to classify patients into low, intermediate and high mobility groups. The StepWatch Activity Monitor was reported to be most accurate at step-counting in patients with slow gait speed or altered gait. The activPAL was reported to be highly accurate at classifying postures.

Conclusion

Physical activity levels of older inpatients can be measured using accelerometers. The accuracy of the accelerometers varies between devices and population-specific validation studies are needed to determine their suitability in measuring physical activity levels of hospitalised older people. Subjective measures are less accurate but can be a practical way of measuring physical activity in a larger group of patients.

     

Muscle mass index and animal source of dietary protein are positively associated with insulin resistance in participants of the NuAge study

Objectives

Contribute evidence towards the complex interrelationships of body composition, insulin sensitivity and protein intake independently from adiposity in an older population.

Design

This is a cross-sectional analysis of an existing dataset in which a literature-supported model linking together the variables of interest is tested using path analysis.

Setting

The loss of muscle mass has been implicated in the development of insulin resistance. We propose to test associations of muscle mass with insulin sensitivity and their respective associations with animal and vegetable sources of protein intake, independently from adiposity.

Participants

Non-diabetic participants aged 68–82 years from the NuAge study with all available measures (n=441) were included.

Measurements

A model considering age, sex, chronic diseases, physical activity; smoking and sources of protein intake influencing body composition components and insulin sensitivity was created and tested with Path Analysis for their independent associations. Muscle mass index (MMI; kg/height in m²) and % body fat were derived from DXA and BIA. Insulin resistance was estimated by the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score and physical activity by the Physical Activity Scale for the Elderly (PASE) questionnaire. Protein intakes were obtained from three non-consecutive 24h-diet recalls.

Results

In the final model, direct positive associations were observed between HOMA-IR score and MMI (β=0.42; 95%CI: 0.24; 0.6) and % body fat (β=0.094; 95%CI: 0.07; 0.11). There were no direct associations between animal protein intake and MMI or with HOMA-IR. There was a significant direct negative association between plant protein intake and MMI (β= -0.068; 95%CI: -0.13; -0.003) and significant indirect associations mediated through MMI and % body fat between HOMA-IR and animal protein intake (β=0.0321; 95%CI: 0.01; 0.05), as well as plant protein intake (β= -0.07; 95%CI: -0.1; 0.0).

Conclusions

Our final model indicated that MMI and HOMA score were significantly positively associated. Protein intake sources were related to HOMA-IR score differently through MMI and % body fat, respectively.

     

Academic Achievement of Korean Adolescents from Multicultural Families: National Survey Results

Background

Multicultural families and foreign residents are rapidly increasing in Korea. Thus, the proportion of children and adolescents from minority racial/ethnic groups are also increasing, and there are concerns about adolescents who fail to adapt to school and show low academic achievement and poor health status.

Objective

This study aimed to investigate influencing factors related to academic achievement among Korean multicultural adolescents.

Methods

Cross-sectional data from 2234 Korean multicultural adolescent participants from the 2010–2014 Korea Youth Risk Behavior Web-based Survey were analyzed using multiple regression.

Results

Perceived economic status and breakfast frequency affected academic achievement, regardless of gender. Family affluence, satisfaction with sleep time, and lifetime smoking were additional factors in males. For females, depression and frequency of physical school activities were additional factors.

Conclusion

The present study suggests that diverse individual factors should be considered, including economic status, health status, and health-related behaviors, to improve multicultural adolescents’ academic achievement.

     

Single-arm resistance training study to determine the relationship between training outcomes and muscle growth factor mRNAs in older adults consuming numerous medications and supplements

Objectives

Determine if the muscle mRNA levels of three growth factors (insulin-like growth factor-1 [IGF1], ciliary neurotropic factor [CNTF], and vascular endothelial growth factor-D [VEGFD]) are correlated with muscle size and strength gains from resistance exercise while piloting a training program in older adults taking medications and supplements for age-associated problems.

Design

Single-arm prospective study.

Setting

US Veterans Affairs hospital.

Participants

Older (70±6 yrs) male Veterans (N=14) of US military service.

Intervention

Thirty-five sessions of high-intensity (80% one-rep max) resistance training including leg press, knee curl, and knee extension to target the thigh muscles.

Measurements

Vastus lateralis biopsies were collected and body composition (DEXA) was determined pre- and post-training. Simple Pearson correlations were used to compare training outcomes to growth factor mRNA levels and other independent variables such as medication and supplement use.

Results

Average strength increase for the group was ≥ 25% for each exercise. Subjects averaged taking numerous medications (N=5±3) and supplements (N=2±2). Of the growth factors, a significant correlation (R>0.7, P≤0.003) was only found between pre-training VEGFD and gains in lean thigh mass and extension strength. Mass and strength gains were also correlated with use of α-1 antagonists (R=0.55, P=0.04) and pre-training lean mass (R=0.56, P=0.04), respectively.

Conclusions

Muscle VEGFD, muscle mass, and use of α-1 antagonists may be predisposing factors that influence the response to training in this population of older adults but additional investigation is required to determine if these relationships are due to muscle angiogenesis and blood supply.

     

The body fat-cognition relationship in healthy older individuals: Does gynoid vs android distribution matter?

Objective

To examine the relationship between regional and whole body fat accumulation and core cognitive executive functions.

Design

Cross-sectional study.

Settings and participants

78 healthy men and women aged between 65 and 75 years recruited through consumer’s database.

Measurements

DXA measured percentage total body fat, android, gynoid distribution and android/gynoid ratio; inhibition and working memory updating through Random Number Generation test and cognitive flexibility by Trail Making test. First-order partial correlations between regional body fat and cognitive executive function were computed partialling out the effects of whole body fat. Moderation analysis was performed to verify the effect of gender on the body fat-cognition relationship.

Results

Results showed a differentiated pattern of fat-cognition relationship depending on fat localization and type of cognitive function. Statistically significant relationships were observed between working memory updating and: android fat (r = -0.232; p = 0.042), gynoid fat (r = 0.333; p = 0.003) and android/gynoid ratio (r = -0.272; p = 0.017). Separating genders, the only significant relationship was observed in females between working memory updating and gynoid fat (r = 0.280; p = 0.045). In spite of gender differences in both working memory updating and gynoid body fat levels, moderation analysis did not show an effect of gender on the relationship between gynoid fat and working memory updating.

Conclusions

Results suggest a protective effect of gynoid body fat and a deleterious effect of android body fat. Although excessive body fat increases the risk of developing CDV, metabolic and cognitive problems, maintaining a certain proportion of gynoid fat may help prevent cognitive decline, particularly in older women. Guidelines for optimal body composition maintenance for the elderly should not target indiscriminate weight loss, but weight maintenance through body fat/lean mass control based on non-pharmacological tools such as physical exercise, known to have protective effects against CVD risk factors and age-related cognitive deterioration.

     

The Benefits of Center-Based Care and Full-Day Kindergarten for School Attendance in the Early Grades

Background

School absenteeism has been recognized as a growing issue in the United States, especially during the early elementary school years when it is most pervasive. Accordingly, there has been growing interest in understanding why children are absent and whether certain early educational experiences can reduce children’s rates of school absences.

Objective

The objective of this investigation was to estimate the additive and multiplicative benefits of children’s early school experiences in preschool (center-based care) and kindergarten (center-based care and full day kindergarten enrollment) for patterns of school absenteeism in kindergarten and first grade.

Method

To address these objectives, data were drawn from the Early Childhood Longitudinal Study Kindergarten Class of 2010–2011 and included 12,835 children and families.

Results

Children who attended center-based care in preschool and kindergarten had fewer missed school days and were less likely to be chronically absent in kindergarten and first grade. Children in full-day kindergarten programs had more absences by the end of kindergarten, but fewer absences by the end of the following year. No specific combination of early school arrangements was most beneficial. Instead, children who experienced more early educational arrangements were generally absent less frequently and these benefits were larger in first grade than in kindergarten.

Conclusions

When taken together, findings underscore the importance of formal early educational programs and opportunities on longer-term school attendance.

     

Replacing sedentary time with physical activity: effects on health-related quality of life in older Japanese adults

Background

The isotemporal substitution (IS) approach can be used to assess the effect of replacing one activity with the equal duration of another activity on relevant outcomes. This study examined the associations of objectively assessed sedentary behavior (SB) and physical activity (PA) with health-related quality of life (HRQOL) in older Japanese adults, using the IS approach.

Methods

Participants were 287 older Japanese adults (aged 65–84?years) who wore accelerometers for at least 7 days. We calculated the average daily time spent in SB (≤1.5 METs); light-intensity PA (LPA: >?1.5 to <?3.0 METs); and moderate- to vigorous-intensity PA (MVPA: ≥3.0 METs) per day. HRQOL was assessed using the Medical Outcomes Survey Short Form-8 questionnaire.

Results

The IS models showed replacing SB or LPA with MVPA to be significantly associated with better physical component summary scores. Replacing SB with MVPA was marginally associated with better mental component summary scores.

Conclusion

These findings indicate that replacing SB with the same amount of MVPA may contribute to better physical HRQOL in older adults.

     

Academic and Mental Health Outcomes of Youth Placed in Out-of-Home Care: The Role of School Stability and Engagement

Background

Youth placed in out-of-home care are at significant risk of low academic achievement and poor mental health. Few studies have considered the potential effects of school-related factors, such as school placement stability and school engagement, on youth outcomes.

Objective

The current study examined the potential main effects of school placement stability and engagement on academic achievement and mental health. Furthermore, we examined whether school-related factors moderated the association between home placement stability and youth outcomes.

Methods

Participants included 420 youth (age 6–14 at baseline) placed in out-of-home care participating in a national longitudinal study of youth in contact with the child welfare system. Youth, caregivers, and caseworkers provided relevant information at baseline, 18, and 36 months. Hierarchical regression models were constructed to test potential main and moderating effects of school engagement and school placement stability on youth mental health and academic achievement prospectively, while accounting for relevant covariates.

Results

School placement stability was an independent predictor of youth internalizing and externalizing symptoms, but was not significantly associated with academic outcomes. Furthermore, there were no main effects of school engagement or home placement stability on youth outcomes and school-related factors did not moderate the relationship between home placement stability and youth outcomes.

Conclusion

For children and adolescents who do not have the benefit of a stable, safe, or caring home environment, school stability may be contribute to an environment that can foster healthy development.

     

Knowledge of parents from public and private school students on emergency management of avulsed permanent teeth

Aim

To evaluate the level of general knowledge of parents with regards to first-aid measures for permanent tooth avulsion and to correlate such knowledge with their children’s school setting (public or private).

Subjects and methods

A total of 179 parents answered a questionnaire containing 6 objective questions regarding the management of dental avulsion and emergency procedures. Data concerning the age and schooling of the respondents were also obtained.

Results

Parents from the private school group had higher levels of education and were more likely to have a correct attitude regarding the immediate replantation of the avulsed tooth as compared to parents of children studying in public schools (p?<?0.05). However, the pattern of answers given for the questions concerning the cleaning of the avulsed tooth and the appropriate storage medium was very similar between both groups of parents, suggesting a lack of technical information among the participants.

Conclusion

Parents were found to have low levels of knowledge regarding first-aid measures in an emergency related to permanent tooth avulsion and replantation, irrespective of their children’s school setting.

     

Fat Quality Index and Risk of Cardiovascular Disease in the Sun Project

Objectives

To examine the association between a dietary fat quality index (FQI), and the risk of incident cardiovascular events or deaths in the Seguimiento Universidad de Navarra (SUN) cohort.

Design

Longitudinal analysis during 10.1 years of median follow-up. Cox models were used to estimate adjusted hazard ratios (HR) of incident cardiovascular diseases (CVD) according to tertiles of FQI and of different fat subtypes.

Setting

University of Navarra, Spain.

Participants

19,341 middle-aged adults.

Measurements

Fat intake was measured with a validated food-frequency questionnaire. The FQI was calculated according to the ratio: (monounsaturated+polyunsaturated) / (saturated+trans fatty acids).

Results

We observed 140 incident cases of CVD. No association was found for FQI (HR=0.94, 95 %CI 0.61–1.47 for the highest vs the lowest tertile, p for trend=0.884). No significant associations were found for different dietary fat subtypes on CVD risk. The results suggest no clear association between a higher FQI and a higher amount of energy from fat and incidence of CVD (p for interaction: 0.259 and p for trend only among participants with a percentage of energy from fat ≥35% of total energy: 0.272).

Conclusion

In this Mediterranean cohort, the FQI was not associated with cardiovascular events. A “heart-healthy diet” should focus its attention on dietary fat sources and should use an overall dietary pattern approach, rather than limiting the focus on fat subtypes. More research is needed to validate dietary advice on specific fatty acids intake or saturated fatty acids replacements for reducing CVD risk.

     

Sarcopenia as a predictor of future cognitive impairment in older adults

Objectives

We investigated the association between the indices of sarcopenia and future risk of cognitive impairment in older adults.

Design

Community-based prospective cohort study.

Setting

Community.

Participants

A total of 297 participants aged ≥65 years without cognitive impairment at baseline (mean age, 71.9 ± 6.6 years; men:women, 158:139) and who underwent cognitive evaluation at the 5-year follow-up.

Measurements

Sarcopenia parameters including appendicular lean mass (ALM), handgrip strength, and the Short Physical Performance Battery (SPPB) score at baseline were compared according to the later progression of mild cognitive impairment (MCI) and/or dementia. The operational criteria suggested by the Foundation for the National Institutes of Health Sarcopenia Project were used. We performed multivariate logistic regression analysis to identify the independent indicators of the progression of cognitive impairment.

Results

Among the 297 participants, 242 (81.5%) remained cognitively normal (nonprogression group), whereas 55 (18.5%) showed progression of cognitive impairment (50 subjects (16.8%) to MCI and 5 subjects (1.7%) to dementia) (progression group). Compared with the nonprogression group, subjects in the progression group were older, had a lower educational level, and had lower physical function as assessed by the SPPB; a higher percentage were depressed. Other baseline markers of sarcopenia, including the ALM-to-body mass index ratio and handgrip strength did not differ significantly between the groups. The association between a low SPPB score (<9) and progression of cognitive impairment was maintained after adjustment for conventional risk factors for cognitive impairment (hazard ratio 2.222, 95% confidence interval 1.047–4.716, P = 0.038).

Conclusion

Decreased physical performance, as assessed by the SPPB, but not other markers of sarcopenia, was independently associated with the risk of later cognitive impairment in older adults.

     

Development of a novel six-month nutrition intervention for a randomized trial in older men with mobility limitations

Objectives

Nutrition impacts the development of sarcopenia and protein intake is an important modulator of skeletal muscle mass loss in older people. The Optimizing Protein Intake in Older Men with Mobility Limitation (OPTIMEN) Trial was designed to assess the independent and combined effects of higher protein intake and a promyogenic agent, testosterone, on lean body mass, muscle strength and physical function in older men with mobility disability. The purpose of this paper is to describe the experimental design and nutrition intervention, including techniques used by research dietitians to develop and deliver energy and protein-specific meals to the homes of community-dwelling participants. Strategies to enhance long-term dietary compliance are detailed.

Design

Randomized, double-blind, placebo-controlled six-month intervention trial.

Setting

Participants were recruited from Boston MA USA and surrounding communities.

Participants

Older men who were mobility-limited (Short Physical Performance Battery (SPPB) 3-10) and consuming less protein (<0.83 g/kg/day) were recruited for this study.

Intervention

Here we report the successful implementation of a double-blind, placebo-controlled, parallel group, randomized controlled trial with a 6-month intervention period among community-living men, age 65 years and older with a mobility limitation. A controlled feeding plan was used to deliver required energy intakes and prescribed protein quantities of 0.8 or 1.3 grams/kilogram/day (g/kg/d) in three meals plus snacks and supplements. A 2x2 factorial design was used to assess the effects of protein level alone and in combination with testosterone (vs. placebo) on changes in lean body mass (primary outcome), muscle strength, and physical function.

Results

A total of 154 men met the eligibility criteria; 112 completed a 2-week run-in period designed to evaluate compliance with the nutrition intervention. Of these, 92 subjects met compliance eligibility criteria and agreed to be randomized; 85% completed the full trial. The study successfully delivered three meals per day to subjects, with a high degree of compliance and subject satisfaction. Overall self-reported compliance rates were 80% and 93% for the meals and supplements, respectively. Details of compliance strategies are discussed.

Conclusion

This community-based study design may serve as a model for longer-term nutritional interventions requiring monitoring of dietary compliance in a home-based feeding and supplementation trial.