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  • 1. Bauer, Juergen
    et al.
    Biolo, Gianni
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cesari, Matteo
    Cruz-Jentoft, Alfonso J.
    Morley, John E.
    Phillips, Stuart
    Sieber, Cornel
    Stehle, Peter
    Teta, Daniel
    Visvanathan, Renuka
    Volpi, Elena
    Boirie, Yves
    Evidence-Based Recommendations for Optimal Dietary Protein Intake in Older People: A Position Paper From the PROT-AGE Study Group2013In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 14, no 8, p. 542-559Article in journal (Refereed)
    Abstract [en]

    New evidence shows that older adults need more dietary protein than do younger adults to support good health, promote recovery from illness, and maintain functionality. Older people need to make up for age-related changes in protein metabolism, such as high splanchnic extraction and declining anabolic responses to ingested protein. They also need more protein to offset inflammatory and catabolic conditions associated with chronic and acute diseases that occur commonly with aging. With the goal of developing updated, evidence-based recommendations for optimal protein intake by older people, the European Union Geriatric Medicine Society (EUGMS), in cooperation with other scientific organizations, appointed an international study group to review dietary protein needs with aging (PROT-AGE Study Group). To help older people (>65 years) maintain and regain lean body mass and function, the PROT-AGE study group recommends average daily intake at least in the range of 1.0 to 1.2 g protein per kilogram of body weight per day. Both endurance-and resistance-type exercises are recommended at individualized levels that are safe and tolerated, and higher protein intake (ie, >= 1.2 g/kg body weight/d) is advised for those who are exercising and otherwise active. Most older adults who have acute or chronic diseases need even more dietary protein (ie, 1.2-1.5 g/kg body weight/d). Older people with severe kidney disease (ie, estimated GFR <30 mL/min/1.73m(2)), but who are not on dialysis, are an exception to this rule; these individuals may need to limit protein intake. Protein quality, timing of ingestion, and intake of other nutritional supplements may be relevant, but evidence is not yet sufficient to support specific recommendations. Older people are vulnerable to losses in physical function capacity, and such losses predict loss of independence, falls, and even mortality. Thus, future studies aimed at pinpointing optimal protein intake in specific populations of older people need to include measures of physical function.

  • 2.
    Bauer, Juergen M.
    et al.
    Carl von Ossietzky Univ Oldenburg, Dept Geriatr Med, D-26133 Oldenburg, Germany..
    Verlaan, Sjors
    Nutricia Adv Med Nutr, Nutricia Res, Utrecht, Netherlands.;Vrije Univ Amsterdam, Med Ctr, Dept Internal Med, Sect Gerontol & Geriatr, Amsterdam, Netherlands..
    Bautmans, Ivan
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Brandt, Kirsten
    Newcastle Univ, Inst Ageing, Sch Agr Food & Rural Dev, Human Nutr Res Ctr, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England..
    Donini, Lorenzo M.
    Univ Roma La Sapienza, Sect Med Pathophysiol Endocrinol & Human Nutr, Dept Expt Med, I-00185 Rome, Italy..
    Maggio, Marcello
    Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Movement Disorders & Prevent Disabil, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Food Sci Unit, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Endocrinol Aging Unit, I-43100 Parma, Italy..
    McMurdo, Marion E. T.
    Univ Dundee, Ninewells Hosp & Med Sch, Ninewells Hosp, Ageing & Hlth, Dundee DD1 9SY, Scotland..
    Mets, Tony
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Seal, Chris
    Newcastle Univ, Inst Ageing, Sch Agr Food & Rural Dev, Human Nutr Res Ctr, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England..
    Wijers, Sander L.
    Nutricia Adv Med Nutr, Nutricia Res, Utrecht, Netherlands..
    Ceda, Gian Paolo
    Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Movement Disorders & Prevent Disabil, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Food Sci Unit, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Endocrinol Aging Unit, I-43100 Parma, Italy..
    De Vito, Giuseppe
    Univ Coll Dublin, Inst Sport & Hlth, Dublin 2, Ireland..
    Donders, Gilbert
    Femicare, Clin Res Women, Tienen, Belgium..
    Drey, Michael
    Klinikum Univ Munchen LMU, Schwerpunkt Akutgeriatrie, Med Klin & Poliklin 4, Munich, Germany..
    Greig, Carolyn
    Univ Birmingham, Sch Sport Exercise & Rehabil Sci, Birmingham, W Midlands, England.;Univ Birmingham, Ctr Musculoskeletal Ageing Res, Birmingham, W Midlands, England..
    Holmbäck, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Narici, Marco
    Univ Nottingham, Royal Derby Hosp, MRC ARUK Ctr Musculoskeletal Ageing Res, Fac Med, Derby, England..
    McPhee, Jamie
    Manchester Metropolitan Univ, Sch Healthcare Sci, All Saints, Manchester M15 6BH, Lancs, England..
    Poggiogalle, Eleonora
    Univ Roma La Sapienza, Sect Med Pathophysiol Endocrinol & Human Nutr, Dept Expt Med, I-00185 Rome, Italy..
    Power, Dermot
    Mater Misericordiae Univ Hosp, Dept Med Older Persons, Dublin, Ireland.;Univ Coll Dublin, Dublin 2, Ireland..
    Scafoglieri, Aldo
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Schultz, Ralf
    St Marien Hosp, Clin Geriatr, Cologne, Germany..
    Sieber, Cornel C.
    Univ Erlangen Nurnberg, Inst Biomed Ageing, Nurnberg, Germany..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial2015In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 16, no 9, p. 740-747Article in journal (Refereed)
    Abstract [en]

    Background: Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats to physical performance, independence, and quality of life. Nutritional supplementation could positively influence aspects of sarcopenia and thereby prevent mobility disability. Objective: To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of sarcopenia. Design: A multicenter, randomized, controlled, double-blind, 2 parallel-group trial among 380 sarcopenic primarily independent-living older adults with Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index. The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an iso-caloric control product to consume twice daily for 13 weeks. Primary outcomes of handgrip strength and SPPB score, and secondary outcomes of chair-stand test, gait speed, balance score, and appendicular muscle mass (by DXA) were measured at baseline, week 7, and week 13 of the intervention. Results: Handgrip strength and SPPB improved in both groups without significant between-group differences. The active group improved more in the chair-stand test compared with the control group, between-group effect (95% confidence interval): -1.01 seconds (-1.77 to -0.19), P = .018. The active group gained more appendicular muscle mass than the control group, between-group effect: 0.17 kg (0.004-0.338), P = .045. Conclusions: This 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic older adults. This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. These results warrant further investigations into the role of a specific nutritional supplement as part of a multimodal approach to prevent adverse outcomes among older adults at risk for disability.

  • 3. Fielding, Roger A.
    et al.
    Vellas, Bruno
    Evans, William J.
    Bhasin, Shalender
    Morley, John E.
    Newman, Anne B.
    van Kan, Gabor Abelian
    Andrieu, Sandrine
    Bauer, Juergen
    Breuille, Denis
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Chandler, Julie
    De Meynard, Capucine
    Donini, Lorenzo
    Harris, Tamara
    Kannt, Aimo
    Guibert, Florence Keime
    Onder, Graziano
    Papanicolaou, Dimitris
    Rolland, Yves
    Rooks, Daniel
    Sieber, Cornet
    Souhami, Elisabeth
    Verlaan, Sjors
    Zamboni, Mauro
    Sarcopenia: An Undiagnosed Condition in Older Adults. Current Consensus Definition: Prevalence, Etiology, and Consequences. International Working Group on Sarcopenia2011In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 12, no 4, p. 249-256Article in journal (Refereed)
    Abstract [en]

    Sarcopenia, the age-associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability, and health care planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy, on November 18, 2009, to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multifactorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. Although cachexia may be a component of sarcopenia, the 2 conditions are not the same. The diagnosis of sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall health. Sarcopenia should specifically be considered in patients who are bedridden, cannot independently rise from a chair, or who have a measured gait speed less that 1 m/s(-1). Patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry with sarcopenia being defined using currently validated definitions. A diagnosis of sarcopenia is consistent with a gait speed of less than 1 m.s(-1) and an objectively measured low muscle mass (eg, appendicular mass relative to ht(2) that is <= 7.23 kg/m(2) in men and <= 5.67 kg/m(2) in women). Sarcopenia is a highly prevalent condition in older persons that leads to disability, hospitalization, and death.

  • 4. Morley, John E.
    et al.
    Abbatecola, Angela Marie
    Argiles, Josep M.
    Baracos, Vickie
    Bauer, Juergen
    Bhasin, Shalender
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Coats, Andrew J. Stewart
    Cummings, Steven R.
    Evans, William J.
    Fearon, Kenneth
    Ferrucci, Luigi
    Fielding, Roger A.
    Guralnik, Jack M.
    Harris, Tamara B.
    Inui, Akio
    Kalantar-Zadeh, Kamyar
    Kirwan, Bridget-Anne
    Mantovani, Giovanni
    Muscaritoli, Maurizio
    Newman, Anne B.
    Rossi-Fanelli, Filippo
    Rosano, Giuseppe M. C.
    Roubenoff, Ronenn
    Schambelan, Morris
    Sokol, Gerald H.
    Storer, Thomas W.
    Vellas, Bruno
    von Haehling, Stephan
    Yeh, Shing-Shing
    Anker, Stefan D.
    Sarcopenia With Limited Mobility: An International Consensus2011In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 12, no 6, p. 403-409Article in journal (Refereed)
    Abstract [en]

    A consensus conference convened by the Society of Sarcopenia, Cachexia and Wasting Disorders has concluded that "Sarcopenia, le, reduced muscle mass, with limited mobility" should be considered an important clinical entity and that most older persons should be screened for this condition. "Sarcopenia with limited mobility" is defined as a person with muscle loss whose walking speed is equal to or less than 1 m/s or who walks less than 400 m during a 6-minute walk, and who has a lean appendicular mass corrected for height squared of 2 standard deviations or more below the mean of healthy persons between 20 and 30 years of age of the same ethnic group. The limitation in mobility should not clearly be a result of otherwise defined specific diseases of muscle, peripheral vascular disease with intermittent claudication, central and peripheral nervous system disorders, or cachexia. Clinically significant interventions are defined as an increase in the 6-minute walk of at least 50 meters or an increase of walking speed of at least 0.1 m/s.

  • 5. Nordström, Peter
    et al.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Hommel, Ami
    Norrman, Per Ola
    Thorngren, Karl-Göran
    Nordström, Anna
    Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 1, article id 91.e1Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To investigate the effects of geriatric rehabilitation on short-term risk of death and readmission after a hip fracture were investigated in a nationwide cohort. In addition, the association of discharge location (nursing home or patient's home) with the short-term risk of death was assessed.

    DESIGN, SETTING, AND PARTICIPANTS:

    The cohort consisted of 89,301 individuals at least 50 years of age, with a first hip fracture registered in the Swedish quality register RIKSHÖFT, the years 2004-2012.

    MEASURES:

    Short-term risk of death and readmission to hospital after discharge was compared at 8 hospitals, where most patients received inpatient care in geriatric wards, and those treated at 71 regular hospitals.

    RESULTS:

    The risks of death within 30 days of admission were 7.1% in patients admitted to geriatric ward hospitals and 7.4% in those treated at regular hospitals (multivariable-adjusted hazard ratio [HR] 0.91, 95% CI 0.85-0.97), whereas the odds of readmission within 30 days of discharge were 8.7% and 9.8%, respectively (multivariable-adjusted odds ratio 0.86, 95% CI 0.81-0.91). The risk of death was influenced by discharge location and inpatient length of stay (LOS). Thus, for patients discharged to short-term nursing homes with a LOS of at most 10 days, each additional day of LOS reduction increased the risk of death within 30 days of discharge by 13% (HR 1.13, 95% CI 1.08-1.18). This association was reduced in patients discharged to permanent nursing homes (HR 1.04, 95% CI 1.02-1.07), and not significant in those discharged to their own home (OR 1.00, 95% CI 0.91-1.10).

    CONCLUSION:

    The risks of death and readmission were lower in patients with hip fracture who received care in hospitals with geriatric wards. The risk of death after discharge increased with shorter LOS, especially in patients discharged to short-term nursing homes.

  • 6.
    Tylner, Sara
    et al.
    Huddinge Municipal, Huddinge, Sweden..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Faxen-Irving, Gerd
    Karolinska Inst, Clin Geriatr Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Clin Nutr & Dietet, Stockholm, Sweden..
    Effects on Weight, Blood Lipids, Serum Fatty Acid Profile and Coagulation by an Energy-Dense Formula to Older Care Residents: A Randomized Controlled Crossover Trial2016In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 3, article id UNSP 275.e5Article in journal (Refereed)
    Abstract [en]

    Objectives: Dietary intake in frail old adults is often lower than estimated needs. The aim of this study was to evaluate the effects of an energy-dense oral supplement on nutritional status, food intake, and physical function in residents living in care residential homes. Design: Randomized controlled intervention trial with a crossover design. Setting: Five care residential homes in the southern Stockholm area. Participants: Older people living at care residential homes: age 65 or older, malnourished or at risk of malnutrition according to Mini Nutritional Assessment-Short Form (MNA-SF). Intervention: Energy-dense formula (oleic and linoleic acid emulsion enriched with protein and micronutrients) (Calogen Extra, Nutricia) 30 mL distributed 3 times daily for 6 weeks. Measurements: Body weight, 3-day food and fluid record, appetite rating, and physical function (ie, Short Physical Performance Battery, grip strength, and peak expiratory flow). Biochemical indicators of nutritional status, blood lipids, and serum phospholipid fatty acid (FA) profile. Results: Twenty-eight participants completed the 2 phases of the crossover study; group A (n = 14, 87 +/- 6 years, 50% women) and group B (n = 14, 82 +/- 8 years, 71% women). The intervention periods combined resulted in significantly (P <.05) increased energy intake (238 +/- 544 kcal), weight gain (1.4 +/- 3.7 kg), improved appetite, relative reduction of saturated FA and increase in polyunsaturated FA, increased apoliporotein A, and reduced serum fibrinogen (-0.9 +/- 1.5 g/L). Conclusion: Distribution of an oleic and linoleic acid based fat emulsion enriched with protein and micronutrients (Calogen Extra) 3 times daily to old people in care residential homes improved nutritional status, had positive effects on fatty acid profile and blood lipids, and a potential antithrombotic effect.

  • 7.
    Verlaan, Sjors
    et al.
    Vrije Univ Amsterdam Med Ctr, Sect Gerontol & Geriatr, Dept Internal Med, De Boelelaan 1117, NL-1081 HV Amsterdam, Netherlands.;Nutricia Res, Nutricia Adv Med Nutr, Utrecht, Netherlands..
    Ligthart-Melis, Gerdien C.
    Nutricia Res, Nutricia Adv Med Nutr, Utrecht, Netherlands.;Texas A&M Univ, Dept Hlth & Kinesiol, Ctr Translat Res Aging & Longev, College Stn, TX USA..
    Wijers, Sander L. J.
    Nutricia Res, Nutricia Adv Med Nutr, Utrecht, Netherlands..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Maier, Andrea B.
    Univ Melbourne, Royal Melbourne Hosp, Dept Med & Aged Care, Melbourne, Vic, Australia.;Vrije Univ Amsterdam, MOVE Res Inst Amsterdam, Dept Human Movement Sci, Amsterdam, Netherlands..
    de van der Schueren, Marian A. E.
    Vrije Univ Amsterdam Med Ctr, Sect Nutr & Dietet, Dept Internal Med, Amsterdam, Netherlands.;HAN Univ Appl Sci, Fac Hlth & Social Studies, Dept Nutr Sports & Hlth, Nijmegen, Netherlands..
    High Prevalence of Physical Frailty Among Community-Dwelling Malnourished Older Adults: A Systematic Review and Meta-Analysis2017In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 18, no 5, p. 374-382Article, review/survey (Refereed)
    Abstract [en]

    Background: Malnutrition and frailty are two geriatric syndromes that significantly affect independent living and health in community-dwelling older adults. Although the pathophysiology of malnutrition and physical frailty share common pathways, it is unknown to what extent these syndromes overlap and how they relate to each other. Methods: A systematic review was performed resulting in a selection of 28 studies that assessed both malnutrition and frailty in community-dwelling older adults. Furthermore, a meta-analysis was performed on 10 studies that used Mini-Nutritional Assessment and the Fried frailty phenotype to estimate the prevalence of malnutrition within physical frailty and vice versa. Results: In the systematic review, 25 of the 28 studies used the Mini-Nutritional Assessment (long or short form) for malnutrition screening. For frailty assessment, 23 of the 28 studies focused on the physical frailty phenotype, of which 19 followed the original Fried phenotype. Fifteen studies analyzed the association between malnutrition and frailty, which was significant in 12 of these. The meta-analysis included 10 studies with a total of 5447 older adults. In this pooled population of community-dwelling older adults [ mean (standard deviation) age: 77.2 (6.7) years], 2.3% was characterized as malnourished and 19.1% as physically frail. The prevalence of malnutrition was significantly associated with the prevalence of physical frailty (P < .0001). However, the syndromes were not interchangeable: 68% of the malnourished older adults was physically frail, whereas only 8.4% of the physical frail population was malnourished. Conclusions: The systematic review and meta-analysis revealed that malnutrition and physical frailty in community-dwelling older adults are related, but not interchangeable geriatric syndromes. Two out of 3 malnourished older adults were physically frail, whereas close to 10% of the physically frail older adults was identified as malnourished.

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