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  • 51.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Bosaeus, Ingvar
    Brummer, Robert
    Ellegård, Lars
    Faxen Irving, Gerd
    Larsson, Jörgen
    Thorell, Anders
    Rothenberg, Elisabeth
    Kosttillägg förlänger livet på undernärda äldre2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 51-52, article id C7YMArticle in journal (Refereed)
  • 52.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Bosaeus, Ingvar
    Brunner, Robert
    Ellegård, Lars
    Faxén Irving, Gerd
    Larsson, Jörgen
    Thorell, Anders
    Rothenberg, Elisabeth
    SBU-rapport "missar" övertygande evidensläge: Kosttillägg förlänger livet på undernärda äldre2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 51-52, p. 2299-2300, article id C7YMArticle in journal (Refereed)
    Abstract [sv]

    Tvärtemot slutsatserna i en ny SBU-rapport anser Tommy Cederholm och medförfattare att det finns övertygande ­evidens för att kosttillägg är gynnsamt för undernärda äldre. Ordination ska dock ske först efter utredning, ­göras patientsäkert, dokumenteras och utvärderas ­individuellt.

  • 53.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Compher, C.
    Univ Penn, Sch Nursing, Philadelphia, PA 19104 USA.
    Correia, M. I. T. D.
    Univ Fed Minas Gerais, Belo Horizante, Brazil.
    Gonzalez, M. C.
    Univ Catolica Pelotas, Pelotas, RS, Brazil.
    Fukushima, R.
    Univ Tokyo, Sch Med, Tokyo, Japan.
    Higashiguchi, T.
    Fujita Hlth Univ, Sch Med, Toyoake, Aichi, Japan.
    Van Gossum, A.
    Free Univ Brussels, Brussels, Belgium.
    Jensen, G. L.
    Univ Vermont, Burlington, VT USA.
    Response to the letter: Comment on "GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community": Some considerations about the GLIM criteria - A consensus report for the diagnosis of malnutrition by Drs. LB da Silva Passos and DA De -Souza2019In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 3, p. 1480-1481Article in journal (Other academic)
  • 54.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Cruz-Jentoft, A. J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Maggi, S.
    Sarcopenia and fragility fractures2013In: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 49, no 1, p. 111-117Article, review/survey (Refereed)
    Abstract [en]

    Sarcopenia, a reduction in muscle mass and muscle function, is considered one of the hallmarks of the aging process. Current views consider sarcopenia as the consequence of multiple medical, behavioural and environmental factors that characterize aged individuals. Likewise bone fragility is known to depend on several pathogenetic mechanisms leading to bone mass loss and reduction of bone strength. Muscle weakness, fear of falls, falls and subsequent fractures are associated to concurrent sarcopenia and osteoporosis and lead to restricted mobility, loss of autonomy and reduced life expectancy. The skeletal and the muscular organ systems are tightly intertwined: the strongest mechanical forces applied to bones are indeed, those created by muscle contractions that condition bone density, strength, and microarchitecture. Not surprising, therefore, the decrease in muscle strength leads to lower bone strength. The degenerative processes leading to osteoporosis and sarcopenia show many common pathogenic pathways, like the sensitivity to reduced anabolic hormone secretion, increased inflammatory cytokine activity and reduced physical activity. Thus they may also respond to the same kind of treatments. Basic is life-style interventions related to exercise and nutrition. Sufficient vitamin D levels are of importance for both bone and muscle, primarily provided by sun exposure at younger age, and by supplementation at older age. Resistance training several times per week is crucial, and to be effective adequate access to energy and proteins is necessary.

  • 55.
    Cederholm, Tommy E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Letter to the Editor: Diagnostic criteria for malnutrition: Consequences for the nutrition teams2017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 309-309Article in journal (Refereed)
  • 56.
    Cederholm, Tommy
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Eriksson, Karin
    Palmblad, Jan
    Nutrition and acute leukemia in adults: relation to remission rate and survival.2002In: Haematologia (Budap), ISSN 0017-6559, Vol. 32, no 4, p. 405-17Article in journal (Refereed)
  • 57.
    Cederholm, Tommy
    et al.
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Hedström, Margareta
    Nutritional treatment of bone fracture.2005In: Curr Opin Clin Nutr Metab Care, ISSN 1363-1950, Vol. 8, no 4, p. 377-81Article in journal (Refereed)
  • 58.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden.
    Jensen, Gordon L.
    Univ Vermont, Larner Coll Med, Burlington, VT USA.
    Invited commentary in response to: Development of a nutritional documentation tool: a Delphi study2019In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 121, no 12, p. 1321-1322Article in journal (Other academic)
  • 59.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Jensen, Gordon L.
    Univ Vermont, Coll Med, Deans Off, Burlington, VT USA.; Univ Vermont, Coll Med, Dept Med, Burlington, VT USA..
    To create a consensus on malnutrition diagnostic criteria: A report from the Global Leadership Initiative on Malnutrition (GLIM) meeting at the ESPEN Congress 20162017In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, no 1, p. 7-10, article id S0261-5614(16)31342-5Article in journal (Refereed)
    Abstract [en]

    During the ESPEN Congress in Copenhagen, Denmark (September 2016) representatives of the 4 largest global PEN-societies from Europe (ESPEN), USA (ASPEN), Asia (PENSA) and Latin America (FELANPE), and from national PEN-societies around the world met to continue the conversation on how to diagnose malnutrition that started during the Clinical Nutrition Week, Austin, USA (February 2016). Current thinking on diagnostic approaches was shared; ESPEN suggested a grading approach that could encompass various types of signs, symptoms and etiologies to support diagnosis. ASPEN emphasized where the parties agree; i.e. that the three major published approaches (ESPEN, ASPEN/AND and Subjective Global Assessment (SGA)) all propose weight loss as a key indicator for malnutrition. FELANPE suggested that the anticipated consensus approach needs to prioritize a diagnostic methodology that is available for everybody since resources differ globally. PENSA highlighted that BMI varies by ethnicity/race, and that sarcopenia/muscle mass evaluation is important for the diagnosis of malnutrition. A Core Working Committee of the Global Leadership Initiative on Malnutrition (GLIM) has been established (comprised of two representatives each from the 4 largest PEN-societies) that will lead consensus development in collaboration with a larger Working Group with broad global representation, using e-mail, telephone conferences, and face-to-face meetings during the up-coming ASPEN and ESPEN Congresses. Transparency and external input will be sought. Objectives include: 1. Consensus development around evidence-based criteria for broad application. 2. Promotion of global dissemination of the consensus criteria. 3. Seeking adoption by the World Health Organization (WHO) and the International Classification of Diseases (ICD).

  • 60.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Morley, J
    Sarcopenia: The new definitions2015In: Current opinion in clinical nutrition and metabolic care, ISSN 1363-1950, E-ISSN 1473-6519, Vol. 18, no 1, p. 1-4Article, review/survey (Refereed)
    Abstract [en]

    Purpose of review: To highlight the new international definitions of sarcopenia.

    Recent findings: New international definitions of sarcopenia have been evaluated and shown to be predictive of poor outcomes in older persons.

    Summary: There is now international agreement that the definition for sarcopenia should include not only muscle mass, but also some measure of muscle function, such as walking speed or distance or grip strength.

     

  • 61.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Morley, John
    Ageing: biology and nutrition2013In: Current opinion in clinical nutrition and metabolic care, ISSN 1363-1950, E-ISSN 1473-6519, Vol. 16, no 1, p. 1-2Article in journal (Other academic)
  • 62.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Univ Uppsala Hosp, Dept Geriatr Med, Uppsala, Sweden.
    Morley, John E.
    St Louis Univ, Sch Med, Div Geriatr Med, St Louis, MO 63104 USA; St Louis Univ, Sch Med, Div Endocrinol, St Louis, MO 63104 USA.
    Nutrient interface with biology and aging2015In: Current opinion in clinical nutrition and metabolic care, ISSN 1363-1950, E-ISSN 1473-6519, Vol. 19, no 1, p. 1-4Article in journal (Refereed)
    Abstract [en]

    Purpose of review: To highlight recent conundrums in the interface of nutrition, biology and aging.

    Recent findings: A Mediterranean diet with extra virgin olive oil, or similar plant-based diets, including five helpings of fruit and vegetables, exercise and nonsmoking are the mainstays of aging successfully. Recent studies have questioned the utility of weight loss in older persons, the use of antioxidant vitamin supplements as well as the appropriate level of sodium intake. The understanding of the role of ethnicity in the levels of vitamin D-binding protein has questioned the measurement of 25(OH)vitamin D by itself. Gut microbiota may also appear important for aging.

    Summary: Continuous scientific advances are leading us to question whether some of our nutrient beliefs need to be altered in older persons.

  • 63.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Nouvenne, A.
    Ticinesi, A.
    Maggio, M.
    Lauretani, F.
    Ceda, G. P.
    Borghi, L.
    Meschi, T.
    The Role of Malnutrition in Older Persons with Mobility Limitations2014In: Current pharmaceutical design, ISSN 1381-6128, E-ISSN 1873-4286, Vol. 20, no 19, p. 3173-3177Article in journal (Refereed)
    Abstract [en]

    Movement disability has a high prevalence in elderly population, either healthy or with chronic disease. Impaired nutritional status is a very common condition in geriatric patients too, especially if we consider elderly subjects admitted to hospital. There are growing evidences that nutrition and disability are strictly interconnected. On the one side, nutritional status is one of the multiple elements that influence the onset and the course of a functional disability; on the other side, disability itself may contribute to malnutrition onset and worsening. Nutrition may not be the sole factor involved in movement impairment in the elderly, but consciousness of its importance in frail elderly population is growing among clinicians and scientific community. In this paper we review the existing knowledge of these complex relationships, discussing the main observational and interventional studies that explored the role of nutrition in movement disability onset and recovery. We also point out how specific kinds of diet, such as Mediterranean diet or high-protein diet, are involved in disability prevention. Finally, we take a look at the existing evidence of the role of single nutrient dietary intake, such as carotenoids, selenium or vitamin D, in mobility impairment in the elderly population.

  • 64.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Palmblad, Jan
    Are omega-3 fatty acids options for prevention and treatment of cognitive decline and dementia?2010In: Current opinion in clinical nutrition and metabolic care, ISSN 1363-1950, E-ISSN 1473-6519, Vol. 13, no 2, p. 150-155Article, review/survey (Refereed)
    Abstract [en]

    PURPOSE OF REVIEW: To report recent data on the potential role of omega-3 fatty acids (n-3 FA) found in oily fish, especially docosahexaenoic acid (DHA), to prevent and treat cognitive decline and Alzheimer's disease. RECENT FINDINGS: Observational studies still provide conflicting results, in which the majority indicate beneficial effects on cognition, both when assessed as a continuous variable or as incident dementia, mainly Alzheimer's disease. Experimental studies have demonstrated potentially ameliorating effects of eicosapentaenoic acid (EPA) and DHA on amyloid fragment formation, signal transduction including upregulation of the apolipoprotein receptor SorLA, as well as on angiogenesis. The role of EPA and DHA metabolites on Alzheimer's disease pathology is under investigation. Recently, three randomized intervention studies, with duration up to 6 months have been reported. In contrast to a small study from Taiwan, no positive overall effects were reported from the Swedish OmegAD Study or from a Dutch study, although post hoc analyses indicate that selected individuals with mild forms of Alzheimer's disease or cognitive decline may respond to treatment. SUMMARY: No firm conclusions can be drawn. Based on epidemiological data, fish including oily fish could be advised as part of a balanced diet for public health purpose, although the evidence for better cognition is only fairly consistent. It is unlikely that n-3 FA will emerge as a treatment option in general for improving cognitive function in patients with Alzheimer's disease. n-3 FA, especially DHA, may turn out as an adjuvant therapy in selected cases. Further long-term intervention studies on individuals with mild cognitive reductions are awaited.

  • 65.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Persson, M.
    Andersson, P.
    Stenvinkel, P.
    Nordfors, L.
    Madden, J.
    Vedin, I.
    Wretlind, B.
    Grimble, R. F.
    Palmblad, J.
    Polymorphisms in cytokine genes influence long-term survival differently in elderly male and female patients2007In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 262, no 2, p. 215-223Article in journal (Refereed)
    Abstract [en]

    Objectives. We asked if single nucleotide polymorphisms (SNP) in inflammatory cytokine genes related to 3-year survival in ill elderly subjects and if genotypes differed between the elderly and a younger control population.

    Design. Prospective observational study.

    Setting. Two geriatric departments at a university hospital.

    Subjects. Eighty three acutely admitted geriatric patients (83 ± 7 year, 70% women) and 207 young healthy subjects (40 ± 1 year, 37% women) were included.

    Outcome measures. Single nucleotide polymorphisms in the genes of tumour necrosis factor (TNF)-α–308 G/A, interleukin (IL)-1β–511 C/T, IL-6–174 G/C and IL-10–1082 A/G were analysed. In the geriatric patients SNP in lymphotoxin (LT)-α +252 G/A and serum levels of TNF-α, IL-6, IL-10, soluble IL-I receptor(R)II were also determined, as well as the 3-year mortality.

    Results. The allele distribution did not differ significantly between the elderly and the young. In the female elderly, 3-year survival was doubled (P < 0.05) in those with the high-producing genotypes of IL-6 –174 GG and TNF-α -308 GA compared with those with low-producing alleles. In contrast, men with high-producing LT-α +252 AA and IL-1β–511 CT&TT genotypes displayed halved 3-year survival (P < 0.05) compared with those with low-producing genotypes, whereas possession of the high-producing IL-10 –1082 GG genotype favoured survival. Serum IL-10 was higher in the high-producing IL-10 genotype in females.

    Conclusion. As high-producing IL-6 –174 genotype favoured 3-year survival in women, whereas the likewise high-producing LT-α +252 and IL-1β -511 genotypes were associated with poor survival in men, we conclude that the specific genotypes, in association with gender, may act as determinants for survival in elderly patients.

  • 66.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Salem, Norman, Jr.
    Palmblad, Jan
    omega-3 Fatty Acids in the Prevention of Cognitive Decline in Humans2013In: Advances in Nutrition, ISSN 2161-8313, Vol. 4, no 6, p. 672-676Article in journal (Refereed)
    Abstract [en]

    The brain is a lipid-rich organ where docosahexaenoic acid (DHA) is enriched and where eicosapentaenoic acid (EPA) may have anti-inflammatory effects. The potential role for n-3 (omega-3) fatty acids such as DHA and EPA in the prevention of cognitive decline, including Alzheimer's disease (AD) has attracted major interest for the past 20 y. This review presents our understanding of recent observational, interventional, and experimental studies, with the aim of providing some answers to the following question: Can n-3 FA intake modulate cognitive function during aging? In longitudinal observation studies we mainly observe inverse relations between fish intake or serum concentrations of DHA and cognitive impairment. Intervention studies of EPA and DHA supplementation in healthy old individuals have been negative so far (i.e., after up to 2 years of treatment, no differences in cognitive decline between treated and nontreated participants have been observed). In studies that provided EPA and DHA to adults with mild cognitive impairment or age-related cognitive impairment the data seem to be positive. However, when patients with established AD were supplemented with EPA and DHA it appears no benefit was gained. For studies on healthy individuals, a major concern is that the treatment periods may have been too short. There might also be subgroup effects because of the Carriage of apolipoprotein E epsilon 4 alleles or risk factor burden. Experimental studies appear to be consistently positive (i.e., n-3 FA supplementation in rodents over a substantial portion of their lives reduces amyloid-beta deposition and hippocampal neuron loss and improves cognitive functioning). We are getting closer to providing evidence-based recommendations on fish and fish oil intake to facilitate memory function during old age. In the meantime it is advised to follow the general CDC dietary recommendations of 2-3 fish meals per week or the equivalent intake of long chain n-3 fatty acids, particularly DHA.

  • 67. Cesari, M
    et al.
    Abellan Van Kan, G
    Ariogul, S
    Baeyens, J.P.
    Bauer, J
    Cankurtaran, M
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cherubini, A
    Cruz-Jentoft, A.J.
    Curgunlu, A
    Landi, F
    Sayer, A.A
    Strandberg, T
    Topinkova, E
    Van Asselt, D
    Vellas, B
    Zekry, D
    Michel, JP
    THE EUROPEAN UNION GERIATRIC MEDICINE SOCIETY (EUGMS) WORKING GROUP ON \"FRAILTY IN OLDER PERSONS\"2013In: Journal of Frailty & Aging, ISSN 2260-1341, Vol. 2, no 3, p. 118-120Article, review/survey (Refereed)
  • 68. Cho, Karl
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lökk, Johan
    Calcium intake in elderly patients with hip fractures2008In: Food & nutrition research, ISSN 1654-6628, Vol. 52, p. 1654-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dietary calcium intake is assumed important in the prevention and treatment of osteoporosis. However, people in countries with a high calcium intake from commodities such as milk and milk products have a high incidence of hip fracture. The effect and influence of calcium intake in the prevention of osteoporotic fracture vary from different studies. OBJECTIVE: To investigate premorbid daily calcium intake in patients with low energy hip fractures during four consecutive years. DESIGN: In total 120 patients (mean age 78+/-8.5 (SD) years) were included between 2002 and 2005. The patients answered a structured food frequency questionnaire (FFQ) and interviews on patients' daily calcium intake from food and supplements took place during a 6-month period before the fracture. Dual energy X-ray absorptiometry (DEXA) was performed in a subgroup of 15 patients. RESULTS: The mean daily calcium intake from food and supplementation was 970+/-500 mg. However, 38% of patients had an intake below the recommended 800 mg/day. There was no significant relationship between calcium intake and age, gender, bone mineral density, serum calcium or albumin, type of fracture or body mass index. The mean free plasma calcium concentration was 2.3+/-0.1, i.e. within the reference limit. In 2005, 80% of the patients who underwent DEXA had manifest osteoporosis. There was a trend towards decreased calcium intake over the observation period, with a mean calcium intake below 800 mg/day in 2005. CONCLUSIONS: Hip fracture patients had a mean calcium intake above the recommended daily intake, as assessed by a FFQ. However, more than one-third of patients had an intake below the recommended 800 mg/day. The intake appeared to decrease over the investigated years. The relationship between calcium intake and fracture susceptibility is complex.

  • 69. Cruz-Jentoft, A J
    et al.
    Boirie, Y
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Re: Issues concerning sarcopenia in ageing adults2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 2, p. 343-344Article in journal (Refereed)
  • 70.
    Cruz-Jentoft, Alfonso J.
    et al.
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatr, Madrid, Spain.
    Bahat, Gülistan
    Istanbul Univ, Istanbul Med Sch, Div Geriatr, Dept Internal Med, Istanbul, Turkey.
    Bauer, Jürgen
    Heidelberg Univ, Ctr Geriatr Med, Agaples Bethanien Krankenhaus, Heidelberg, Germany.
    Boirie, Yves
    CHU Clermont Ferrand, Res Dept, Clermont Ferrand, France.
    Bruyere, Olivier
    Univ Liege, Dept Publ Hlth Epidemiol & Hlth Econ, Liege, Belgium.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Ageing, Stockholm, Sweden.
    Cooper, Cyrus
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England;Univ Oxford, Dept Epidemiol, Ox, England.
    Landi, Francesco
    Univ Cattolica Sacro Cuore, Inst Med Interna & Geriatria, Rome, Italy.
    Rolland, Yves
    Hosp & Univ Toulouse, Dept Geriatr, Toulouse, France.
    Sayer, Avan Aihie
    Newcastle Upon Tyne Hosp NHS Fdn Trust, NIHR Newcastle Biomed Res Ctr, Newcastle, England;Newcastle Univ, Fac Med Sci, Newcastle, England.
    Schneider, Stephane M.
    Univ Cote Azur, CHU Nice, Dept Gastroenterol & Clin Nutr, Nice, France.
    Sieber, Cornel C.
    Friedrich Alexander Univ, Inst Biomed & Ageing, Dept Internal Med Geriatr, Erlangen, Germany.
    Topinkova, Eva
    Charles Univ Prague, Fac Med 1, Dept Geriatr, Prague, Czech Republic;Gen Fac Hosp, Prague, Czech Republic.
    Vandewoude, Maurits
    Univ Antwerp, Dept Geriatr, Ziekenhuisnetwerk Antwerpen ZNA, Antwerp, Belgium.
    Visser, Marjolein
    Vrije Univ Amsterdam, Fac Sci, Dept Hlth Sci, Amsterdam, Netherlands;Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands.
    Zamboni, Mauro
    Univ Verona, Geriatr Sect, Dept Med, Verona, Italy.
    Sarcopenia: revised European consensus on definition and diagnosis2019In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 48, no 1, p. 16-31Article in journal (Refereed)
    Abstract [en]

    Background: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings.

    Objectives: To increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia.

    Recommendations: Sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia.

    Conclusions; EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

  • 71. Cruz-Jentoft, Alfonso J
    et al.
    Landi, Francesco
    Schneider, Stéphane M
    Zúñiga, Clemente
    Arai, Hidenori
    Boirie, Yves
    Chen, Liang-Kung
    Fielding, Roger A
    Martin, Finbarr C
    Michel, Jean-Pierre
    Sieber, Cornel
    Stout, Jeffrey R
    Studenski, Stephanie A
    Vellas, Bruno
    Woo, Jean
    Zamboni, Mauro
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Prevalence of and interventions for sarcopenia in ageing adults : a systematic review: Report of the International Sarcopenia Initiative (EWGSOP and IWGS)2014In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 43, no 6, p. 748-759Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: to examine the clinical evidence reporting the prevalence of sarcopenia and the effect of nutrition and exercise interventions from studies using the consensus definition of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).

    METHODS: PubMed and Dialog databases were searched (January 2000-October 2013) using pre-defined search terms. Prevalence studies and intervention studies investigating muscle mass plus strength or function outcome measures using the EWGSOP definition of sarcopenia, in well-defined populations of adults aged ≥50 years were selected.

    RESULTS: prevalence of sarcopenia was, with regional and age-related variations, 1-29% in community-dwelling populations, 14-33% in long-term care populations and 10% in the only acute hospital-care population examined. Moderate quality evidence suggests that exercise interventions improve muscle strength and physical performance. The results of nutrition interventions are equivocal due to the low number of studies and heterogeneous study design. Essential amino acid (EAA) supplements, including ∼2.5 g of leucine, and β-hydroxy β-methylbutyric acid (HMB) supplements, show some effects in improving muscle mass and function parameters. Protein supplements have not shown consistent benefits on muscle mass and function.

    CONCLUSION: prevalence of sarcopenia is substantial in most geriatric settings. Well-designed, standardised studies evaluating exercise or nutrition interventions are needed before treatment guidelines can be developed. Physicians should screen for sarcopenia in both community and geriatric settings, with diagnosis based on muscle mass and function. Supervised resistance exercise is recommended for individuals with sarcopenia. EAA (with leucine) and HMB may improve muscle outcomes.

  • 72.
    Dent, E.
    et al.
    Torrens Univ Australia, Wakefield St, Adelaide, SA, Australia;Baker Heart & Diabet Inst, Melbourne, Vic, Australia.
    Morley, J. E.
    St Louis Univ, Sch Med, Div Geriatr Med, St Louis, MO 63104 USA.
    Cruz-Jentoft, A. J.
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatr, Madrid, Spain.
    Arai, H.
    Natl Ctr Geriatr & Gerontol, Obu, Japan.
    Kritchevsky, S. B.
    Wake Forest Sch Med, Sticht Ctr Hlth Aging & Alzheimers Prevent, Winston Salem, NC USA.
    Guralnik, J.
    Bauer, J. M.
    Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA;Heidelberg Univ Agaples Bethanien Krankenhaus, Ctr Geriatr Med, Heidelberg, Germany.
    Pahor, M.
    Univ Florida, Dept Aging & Geriatr Res, Gainesville, FL USA.
    Clark, B. C.
    OMNI, Athens, OH USA.
    Cesari, M.
    Fdn IRCCS Ca Granda Osped Maggiore Policlin, Geriatr Unit, Milan, Italy;Univ Milan, Dept Clin Sci & Community Hlth, Milan, Italy.
    Ruiz, J.
    Univ Miami, Miller Sch Med, Div Geriatr & Palliat Med, Miami, FL 33136 USA.
    Sieber, C. C.
    Aubertin-Leheudre, M.
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Ageing, Nurnberg, Germany;Univ Quebec Montreal, Fac Sci, Dept Sci Act Phys, Montreal, PQ, Canada.
    Waters, D. L.
    Univ Otago, Dept Med, Sch Physiotherapy, Dunedin, New Zealand.
    Visvanathan, R.
    Univ Adelaide, Fac Hlth & Med Sci, Adelaide Med Sch, Adelaide Geriatr Training & Res Aged Care GTRAC C, Adelaide, SA, Australia.
    Landi, F.
    Fdn Policlin A Gemelli, Rome, Italy.
    Villareal, D. T.
    Michael E DeBakey VA Med Ctr, Ctr Translat Res Inflammatory Dis, Houston, TX USA;Baylor Coll Med, Houston, TX 77030 USA.
    Fielding, R.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, MA 02111 USA.
    Won, C. W.
    Kyung Hee Univ, Coll Med, Dept Family Med, Elderly Frailty Res Ctr, Seoul, South Korea.
    Theou, O.
    Univ Adelaide, Fac Hlth & Med Sci, Adelaide Med Sch, Adelaide Geriatr Training & Res Aged Care GTRAC C, Adelaide, SA, Australia;Dalhousie Univ, Dept Med, Halifax, NS, Canada.
    Martin, F. C.
    Chinese Univ Hong Kong, Populat Hlth Sci, London, England.
    Dong, B.
    Sichuan Univ, West China Hosp, Natl Clin Res Ctr Geriatr, Chengdu, Sichuan, Peoples R China.
    Woo, J.
    Chinese Univ Hong Kong, Dept Med, Hong Kong, Peoples R China.
    Flicker, L.
    Univ Western Australia, Med Sch, Western Australian Ctr Hlth & Ageing, Perth, WA, Australia.
    Ferrucci, L.
    NIA, Intramural Res Program, Bethesda, MD 20892 USA.
    Merchant, R. A.
    Natl Univ Hlth Syst, Natl Univ Hosp, Div Geriatr Med, Dept Med, Singapore, Singapore.
    Cao, L.
    Sichuan Univ, West China Hosp, Ctr Gerontol & Geriatr, Chengdu, Sichuan, Peoples R China.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Theme Aging, Karolinska Univ Hosp, Stockholm, Sweden.
    Ribeiro, S. M. L.
    Univ Sao Paulo, Sch Publ Hlth, Sao Paulo, SP, Brazil.
    Rodriguez-Manas, L.
    Hosp Univ Getafe, Serv Geriatr, Madrid, Spain.
    Anker, S. D.
    Charite, Dept Cardiol CVK, Berlin, Germany;Charite, Berlin Brandenburg Ctr Regenerat Therapies BCRT, Berlin, Germany;Charite, German Ctr Cardiovasc Res DZHK Partner Site Berli, Berlin, Germany;Univ Gottingen, Med Sch, Dept Cardiol & Pneumol, Gottingen, Germany.
    Lundy, J.
    Perry Cty Mem Hosp, Perryville, MO USA.
    Gutierrez Robledo, L. M.
    Natl Inst Geriatr, Mexico City, DF, Mexico.
    Bautmans, I.
    VUB, Gerontol Dept, Laarbeeklaan 103, B-1090 Brussels, Belgium;VUB, Frailty Ageing FRIA Res Dept, Laarbeeklaan 103, B-1090 Brussels, Belgium;Univ Ziekenhuis Brussel UZ Brussel, Geriatr Dept, Laarbeeklaan 101, B-1090 Brussels, Belgium.
    Aprahamian, I.
    Fac Med Jundiai, Div Geriatr, Dept Internal Med, Jundiai, Brazil.
    Schols, J. M. G. A.
    Maastricht Univ, FHML, Caphri, Dept Hlth Serv Res, Maastricht, Netherlands;Maastricht Univ, Sect Old Age Med, Maastricht, Netherlands.
    Izquierdo, M.
    Univ Publ Navarra, Dept Hlth Sci, CIBER Fragilidad & Envejecimiento Saludable, Navarrabiomed,IdiSNA,Navarra Inst Hlth Res, Navarra, Spain.
    Vellas, B.
    CHU Toulouse, Gerontopole Clin, Toulouse, France.
    International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management2018In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 22, no 10, p. 1148-1161Article in journal (Refereed)
    Abstract [en]

    Objectives: Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR).

    Methods: To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process.

    Recommendations: We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.

  • 73. Deutz, M.E
    et al.
    Bauer, J.M
    Barazzoni, R
    Biolo, G
    Boirie, Y
    Bosy-Westphal, A
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cruz-Jentoft, A
    Krznariç, Z
    Nair, K.S
    Singer, P
    Teta, Daniel
    Tipton, K
    Calder, P.C
    Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN Expert Group2014In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, no 6, p. 929-936Article in journal (Refereed)
    Abstract [en]

    The aging process is associated with gradual and progressive loss of muscle mass along with lowered strength and physical endurance. This condition, sarcopenia, has been widely observed with aging in sedentary adults. Regular aerobic and resistance exercise programs have been shown to counteract most aspects of sarcopenia. In addition, good nutrition, especially adequate protein and energy intake, can help limit and treat age-related declines in muscle mass, strength, and functional abilities. Protein nutrition in combination with exercise is considered optimal for maintaining muscle function.

    With the goal of providing recommendations for health care professionals to help older adults sustain muscle strength and function into older age, the European Society for Clinical Nutrition and Metabolism (ESPEN) hosted a Workshop on Protein Requirements in the Elderly, held in Dubrovnik on November 24 and 25, 2013. Based on the evidence presented and discussed, the following recommendations are made (a) for healthy older people, the diet should provide at least 1.0–1.2 g protein/kg body weight/day, (b) for older people who are malnourished or at risk of malnutrition because they have acute or chronic illness, the diet should provide 1.2–1.5 g protein/kg body weight/day, with even higher intake for individuals with severe illness or injury, and (c) daily physical activity or exercise (resistance training, aerobic exercise) should be undertaken by all older people, for as long as possible.

  • 74. Ekstrom, W.
    et al.
    Al-Ani, A. N.
    Saaf, M.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Ponzer, S.
    Hedstrom, M.
    Health related quality of life, reoperation rate and function in patients with diabetes mellitus and hip fracture-A 2 year follow-up study2013In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 44, no 6, p. 769-775Article in journal (Refereed)
    Abstract [en]

    Introduction: Diabetes mellitus confers an increased risk of hip fractures. There is a limited knowledge of how the outcome after a hip fracture in patients with diabetes affect Health Related Quality of Life (HRQoL). The primary aim of this study was to evaluate HRQoL. Secondary aims were reoperation rate, complications and functions in patients with diabetes followed for 2 years after a hip fracture. Materials and methods: Out of 2133 patients diabetes was present in 234 patients (11%). Main outcome measurements were HRQoL evaluated with EuroQoL 5-D-index score, reoperation rate, surgical and medical complications, function as walking ability, daily activities, living condition and pain. Results: Preoperatively, patients with diabetes mellitus had more pain (p = 0.044), co-morbidities, reduced health status (p = 0.001) and more often used a walking frame (p = 0.014) than patients without diabetes, whereas Katz ADL index, cognition and body mass index did not differ. There was no difference in fracture type, surgical method or reoperation between the two groups or between patients with insulin treated or oral treated diabetes. The EQ-5D(index) score decreased from 0.64 at admission to 0.45 at 4 months, 0.49 at 12 months and 0.51 at 24 months with similar results for patients with and without diabetes. During the first postoperative year there was not more medical complications among patients with diabetes, however cardiac (p = 0.023) and renal failure (p = 0.032) were more frequent in patients with diabetes at 24 months. Patients with diabetes more often had severe hip pain at 4 months (p = 0.031). At 12 months more diabetic patients were living independently (p = 0.034). There was no difference in walking ability, ADL and living condition between the groups at 24 months. Conclusion: The findings of this study indicate that patients with diabetes mellitus had more pain, co-morbidities, reduced health status preoperatively than patients without diabetes. Hip fracture patients with diabetes mellitus have more hip pain at 4 months. Cardiac and renal failure was more frequent in patients with diabetes at 24 months but otherwise we found a comparable re-operation rate, function and deterioration of Health Related Quality of Life as patients without diabetes within 2 years after a hip fracture.

  • 75. Ekstrom, Wilhelmina
    et al.
    Samuelsson, Bodil
    Ponzer, Sari
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Thorngren, Karl-Goran
    Hedstrom, Margareta
    Sex effects on short-term complications after hip fracture: a prospective cohort study2015In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 10, p. 1259-1266Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate potential sex differences and other factors associated with complications within 4 months after a hip fracture. Methods: A total of 1,915 patients. 65 years (480 men) with hip fracture were consecutively included in a prospective multicenter cohort study. A review of medical records and patient interviews according to a study protocol based on the Standardized Audit of Hip Fractures in Europe (SAHFE, RIKSHOFT) was performed. Sex differences in comorbidity according to the American Society of Anesthesiologists score and complications 4 months after a hip fracture were registered. Multivariate logistic regression analysis was performed to identify factors related to complications. Results: Male sex was associated with worse general health according to the American Society of Anesthesiologists classification (P=0.005) and with more comorbidities (P<0.001). Male sex emerged as a risk factor for developing pneumonia (P<0.001), and additionally, 18% of the men suffered from cardiac complications compared with 13% of the females (P=0.018). Female sex was predisposed for urinary tract infections, 30% vs 23% in males (P=0.001). Mortality was higher in the male vs female group, both within 30 days (15% vs 10%, P=0.001) and at 4 months (24% vs 14%, P=0.001). Conditions associated with pneumonia were male sex, pulmonary disease, and cognitive impairment. Cardiac complications were associated with delayed surgery and cardiovascular and pulmonary disease. Conclusion: Before surgery, men with hip fracture already have a poorer health status and higher comorbidity rate than women, thus resulting in a twofold increased risk of pneumonia. Cognitive dysfunction and pulmonary disease contributed to pneumonia in men. Delayed surgery seems to increase the risk for cardiac complications. It is important to consider the sex perspective early on together with cardiopulmonary comorbidity and cognitive dysfunction to be able to counteract serious complications that may lead to death.

  • 76. Elkan, A-C
    et al.
    Engvall, I-L
    Tengstrand, B
    Cederholm, T
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Hafström, I
    Malnutrition in women with rheumatoid arthritis is not revealed by clinical anthropometrical measurements or nutritional evaluation tools2008In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 62, no 10, p. 1239-1247Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate diagnostic instruments for assessment of nutritional status in patients with rheumatoid arthritis (RA) in relation to objective body composition data.Subjects and methods: Study subjects include 60 in-ward patients (83% women, median age 65 years). Anthropometric measures and the nutritional tools Mini Nutritional Assessment (MNA), Subjective Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening tool 2002 (NRS-2002). Body composition was determined by dual-energy X-ray absorptiometry and fat-free mass index (FFMI; kg/m(2)) and fat mass index (FMI; kg/m(2)) were calculated.Results: Mean body mass index (BMI) for RA women and men were 24.4 and 26.9 kg/m(2), respectively. Twelve per cent of the women and none of the few men had BMI<18.5 kg/m(2), that is, the cutoff value for malnutrition. FFMI indicated 52% of the women and 30% of the men to be malnourished. The sensitivity and specificity for BMI to detect malnutrition according to FFMI were 27 and 100%, whereas for arm muscle circumference the sensitivity was 36% and the specificity 89% and for triceps skin fold 43 and 93%, respectively. For MNA, sensitivity was 85% and specificity 39% and for SGA 46 and 82%. Both MUST and NRS-2002 had sensitivity of 45% and specificity of 19%.Conclusion: A large proportion of in-ward RA patients had reduced FFMI. Concurrent elevation of fat mass made BMI a non-reliable tool to detect malnutrition. Of the tested clinical evaluation tools, MNA might be used as a screening instrument, but because of its low specificity it should be followed by body composition determination.

  • 77.
    Englund, Davis A.
    et al.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, USA.
    Kirn, Dylan R.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, USA.
    Koochek, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Zhu, Hao
    Hebrew SeniorLife, Inst Aging Res, Boston, USA.
    Travison, Thomas G.
    Hebrew SeniorLife, Inst Aging Res, Boston, USA; Harvard Med Sch, Boston, USA.
    Reid, Kieran F.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, USA.
    von Berens, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Melin, Michael
    Karolinska Inst, Dept Lab Med, Stockholm, 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.
    Gustafsson, Thomas
    Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
    Fielding, Roger A.
    Tufts Univ, Jean Mayer USDA Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, USA.
    Nutritional Supplementation With Physical Activity Improves Muscle Composition in Mobility-Limited Older Adults, The VIVE2 Study: A Randomized, Double-Blind, Placebo-Controlled Trial2018In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 73, no 1, p. 95-101Article in journal (Refereed)
    Abstract [en]

    Background: Nutritional supplementation and physical activity have been shown to positively influence muscle mass and strength in older adults. The efficacy of long-term nutritional supplementation in combination with physical activity in older adults remains unclear.

    Methods: Mobility-limited (short physical performance battery [SPPB] ≤9) and vitamin D insufficient (serum 25(OH) D 9–24 ng/mL) older adults were recruited for this study. All subjects participated in a physical activity program. Subjects were randomized to consume a daily nutritional supplement (150 kcal, 20 g whey protein, 800 IU vitamin D, 119 mL beverage) or placebo (30 kcal, nonnutritive, 119 mL). In a prespecified secondary analysis, we examined total-body composition (dual energy X-ray absorptiometry), thigh composition (computed tomography), and muscle strength, power, and quality before and after the 6-month intervention.

    Results: One hundred and forty-nine subjects were randomized into the study [mean (standard deviation, SD) age 78.5 (5.4) years; 46.3% female; mean (SD) short physical performance battery 7.9 (1.2); mean (SD) vitamin D 18.7 (6.4) ng/mL]. After the intervention period both groups demonstrated improvements in muscle strength, body composition, and thigh composition. Nutritional supplementation lead to further losses of intermuscular fat (p = .049) and increased normal muscle density (p = .018).

    Conclusions: Six months of physical activity resulted in improvements in body composition, subcutaneous fat, intermuscular fat, and strength measures. The addition of nutritional supplementation resulted in further declines in intermuscular fat and improved muscle density compared to placebo. These results suggest nutritional supplementation provides additional benefits to mobility-limited older adults undergoing exercise training.

  • 78.
    Englund, Davis
    et al.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA..
    Kirn, Dylan
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA..
    Koochek, Afsaneh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Travison, Thomas
    Hebrew SeniorLife, Inst Aging Res, Boston, MA USA..
    Reid, Kieran
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA..
    von Berens, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Zhu, Hao
    Hebrew SeniorLife, Inst Aging Res, Boston, MA USA..
    Lilja, Mats
    Karolinska Inst, Dept Lab Med, Stockholm, Sweden..
    Gustafsson, Thomas
    Karolinska Inst, Dept Lab Med, Stockholm, 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.
    Fielding, Roger
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA..
    Nutritional supplementation with physical activity improves muscle composition in mobility-limited older adults, the VIVE2 study: a randomized, double-blind, placebo-controlled trial2017In: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 31, no S1, article id 460.3Article in journal (Other academic)
  • 79.
    Eriksdotter, Maria
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Clin Geriatr, Huddinge, Sweden.;Karolinska Univ Hosp, Dept Geriatr Med, Huddinge, Sweden..
    Vedin, Inger
    Karolinska Inst, Div Hematol, Dept Med, Huddinge, Sweden..
    Falahati, Farshad
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Clin Geriatr, Huddinge, Sweden..
    Freund-Levi, Yvonne
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Clin Geriatr, Huddinge, Sweden..
    Hjorth, Erik
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Neurodegenerat, Huddinge, Sweden..
    Faxen-Irving, Gerd
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Clin Geriatr, Huddinge, Sweden..
    Wahlund, Lars-Olof
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Clin Geriatr, Huddinge, Sweden.;Karolinska Univ Hosp, Dept Geriatr Med, Huddinge, Sweden..
    Schultzberg, Marianne
    Karolinska Inst, Dept Neurobiol Care Sci & Soc NVS, Div Neurodegenerat, Huddinge, Sweden..
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Palmblad, Jan
    Karolinska Inst, Div Hematol, Dept Med, Huddinge, Sweden..
    Plasma Fatty Acid Profiles in Relation to Cognition and Gender in Alzheimer's Disease Patients During Oral Omega-3 Fatty Acid Supplementation: The OmegAD Study2015In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 48, no 3, p. 805-812Article in journal (Refereed)
    Abstract [en]

    Background: omega 3 fatty acids (omega 3 FAs) may slow the rate of decline in cognitive performance in mild forms of cognitive impairment and Alzheimer's disease (AD). However, the relationship between changes of plasma omega 3 FA levels and cognitive performance, as well as effects of gender, are poorly known. Objective: To study the effect of 6-month administration of DHA-rich omega 3 FA supplementation on plasma FA profiles in patients with mild to moderate AD in relation to cognitive performance and gender. This investigation is part of the OmegAD Study. Methods: 174 AD patients (74 +/- 9 years) were randomized to a daily intake of 2.3g omega 3 FA or placebo for 6 months; subsequently all received the omega 3 FA preparation for the next 6 months. Baseline as well as changes in plasma levels of the main omega 3 FAs in 165 patients, while receiving omega 3 FA supplementation for 6 months, were analyzed for association to cognitive performance (assessed by ADAS-cog and MMSE scores) as well as to gender. Results: Preservation of cognitive functioning, assessed by ADAS-cog or its sub-items (but not MMSE) scores, was significantly associated to increasing plasma omega 3 FA levels over time. Thus, the higher omega 3 FA plasma levels rose, the lower was the rate of cognitive deterioration. This effect was not related to gender; since although females displayed higher omega 3 FA plasma levels than did males after 6 months of supplementation, this difference disappeared when adjusted for body weight. Conclusions: Since our study suggests dose-response relationships between plasma levels of omega 3 FA and preservation of cognition, future omega 3 FA trials in patients with mild AD should consider exploring graded (and body weight adjusted) doses of omega 3 FA.

  • 80.
    Faxen-Irving, Gerd
    et al.
    Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc NVS, Huddinge.
    Falahati, Farshad
    Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc NVS, Huddinge.
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Eriksdotter, Maria
    Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc NVS, Huddinge; Karolinska Univ Hosp, Dept Geriatr, Huddinge.
    Vedin, Inger
    Karolinska Inst, Dept NVS, Dept Med, Div Hematol, Huddinge.
    Wahlund, Lars-Olof
    Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc NVS, Huddinge; Karolinska Univ Hosp, Dept Geriatr, Huddinge.
    Schultzberg, Marianne
    Karolinska Inst, Div Neurodegenerat, Huddinge.
    Hjorth, Erik
    Karolinska Inst, Div Neurodegenerat, Huddinge.
    Palmblad, Jan
    Karolinska Inst, Dept NVS, Dept Med, Div Hematol, Huddinge.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Akad Sjukhuset, Dept Geriatr Med, Uppsala.
    Freund-Levi, Yvonne
    Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc NVS, Huddinge; Karolinska Univ Hosp, Dept Geriatr, Huddinge.
    Does Fatty Acid Composition in Subcutaneous Adipose Tissue Differ between Patients with Alzheimer's Disease and Cohabiting Proxies?2018In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 61, no 2, p. 515-519Article in journal (Refereed)
    Abstract [en]

    Low tissue levels of the major marine ω3 fatty acids (FAs) DHA and EPA are found in Alzheimer’s disease (AD). We investigated if healthy proxies to AD patients have higher levels of these ω3 FAs. We observed lower levels of EPA and DHA in subcutaneous adipose tissue biopsies from 64 AD patients compared with 16 cognitively healthy proxies. No significant difference was observed when pairwise comparisons were made between a subset of 16 AD patients and their co-habiting proxies. Larger studies are needed to replicate these findings and to determine if they could depend on FA intake or differences in metabolism.

  • 81. Faxen-Irving, Gerd
    et al.
    Freund-Levi, Yvonne
    Eriksdotter-Jonhagen, Maria
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Hjorth, Erik
    Palmblad, Jan
    Vedin, Inger
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Wahlund, Lars-Olof
    Effects on Transthyretin in Plasma and Cerebrospinal Fluid by DHA-Rich n-3 Fatty Acid Supplementation in Patients with Alzheimer's Disease: The OmegAD Study2013In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 36, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Transthyretin (TTR) binds amyloid-beta (A beta) and may reduce brain A beta, a pathological feature in Alzheimer's disease (AD). N - 3 fatty acids (FA), docosahexaenoic (DHA), and eicosapentaenoic acid (EPA) may increase TTR transcription in rat hippocampus. We studied effects of n - 3 FA supplementation on TTR-levels in patients with AD. Outpatients were randomized to receive 1.7 g DHA and 0.6 g EPA (n - 3/n - 3 group) or placebo (placebo/n - 3 group) during 6 months. After 6 months, all patients received n - 3 FA for another 6 months. TTR and FA were measured in plasma in all subjects, whereas TTR in cerebrospinal fluid (CSF) was measured in a subgroup. The study was completed by 89 patients in the n- 3/n - 3 group (75 y, 57% w) and 85 in the placebo/n - 3 group (75 y, 46% w). Baseline plasma - TTR was within normal range in both groups. After 6 months, plasma - TTR decreased in the placebo/n - 3 group (p < 0.001 within and p < 0.015 between the groups). No changes were observed in CSF TTR. From 6 to 12 months when both groups were supplemented, plasma - TTR increased significantly in both groups. Repeated measures ANOVA indicated an increase in TTR over time (p = 0.04) in those receiving n - 3 FA for 12 months. By linear regression analyses, n - 3 FA treatment was independently associated with increased plasma - TTR at 6 months (beta = -0.172, p = 0.028). Thus, n - 3 FA treatment appeared to increase plasma-TTR in patients with AD. Since TTR may influence A beta deposition in the brain, the results warrant further exploration.

  • 82. Faxén-Irving, G
    et al.
    Andrén-Olsson, B
    af Geijerstam, A
    Basun, H
    Cederholm, T
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    The effect of nutritional intervention in elderly subjects residing in group-living for the demented.2002In: Eur J Clin Nutr, ISSN 0954-3007, Vol. 56, no 3, p. 221-7Article in journal (Other scientific)
  • 83. Faxén-Irving, G
    et al.
    Andrén-Olsson, B
    Geijerstam, A
    Basun, H
    Cederholm, T
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Nutrition education for care staff and possible effects on nutritional status in residents of sheltered accommodation.2005In: Eur J Clin Nutr, ISSN 0954-3007, Vol. 59, no 8, p. 947-54Article in journal (Refereed)
  • 84. Faxén-Irving, Gerd
    et al.
    Basun, Hans
    Cederholm, Tommy
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Nutritional and cognitive relationships and long-term mortality in patients with various dementia disorders.2005In: Age Ageing, ISSN 0002-0729, Vol. 34, no 2, p. 136-41Article in journal (Refereed)
  • 85.
    Ferdous, Tamanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Razzaque, Abdur
    icddr,b: Knowledge for Global Lifesaving Solutions, Dhaka, Bangladesh.
    Wahlin, Åke
    Department of Psychology, Stockholm University,.
    Kabir, Zarina Nahar
    Division of Nursing, NVS, Karolinska Institute.
    Nutritional status and self-reported and performance-based evaluationof physical function of elderly persons in rural Bangladesh2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 5, p. 518-524Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the impact of nutritional status on self-reported as well as performance-based indicators of physical function in a rural elderly population in Bangladesh. Methods: A cross-sectional study conducted in Matlab, Bangladesh, included 457 randomly selected community living elderly persons aged 60 years or more (60-92years; 69±7years). Mobility, Activities of Daily Living (ADL), performance tests, handgrip strength, Mini Nutritional Assessment (MNA), and a structured questionnaire were used to assess physical function, nutritional status, socio-economic and health status respectively. Descriptive and linear hierarchical regression analyses were applied. Results: Seven percent of the participants reported limitations in mobility, and 8% reported limitations in ADL. However, more than half of the participants had difficulties performing one or more items in the performance tests. According to MNA, 26% of the participants were undernourished and 62% were at risk of malnutrition. More undernourished participants reported limited mobility, impaired ADL, and difficulties in the performance tests compared to the well-nourished participants. A corresponding reduction in grip strength was observed in the undernourished group. Accordingly, higher MNA scores, indicating better nutritional status, were significantly associated with higher mobility index, higher ADL index, higher performance tests index, and higher scores in handgrip strength. These associations remained after adjusting for demographic, socio-economic and health status differences. Conclusion: Good nutritional status is important for physical function of elderly people, even after controlling for possible confounders. Performance tests indicated a higher degree of functional impairment than that observed by self-reported estimation.

  • 86.
    Ferdous, Tamanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Kabir, Zarina Nahar
    Division of Nursing, NVS, Karolinska Institutet.
    Wahlin, Åke
    Department of Psychology, Stockholm University.
    Streatfield, Kim
    icddr, b: Knowledge for Global Lifesaving Solutions, Dhaka, Bangladesh.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    The multidimensional background of malnutrition amongrural older individuals in Bangladesh – a challenge for the Millennium Development Goal2009In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 12, no 12, p. 2270-2278Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the associations and relative impact of illness, socio-economic and social indicators for nutritional status among elderly persons in rural Bangladesh.

    Design: A multi-disciplinary cross-sectional study employing home interviews to collect information on demographic, socio-economic, and social status; clinical examination to classify medical diagnoses, and the Mini Nutritional Assessment (MNA) to assess nutritional status of each participant.

    Setting: Matlab, Bangladesh.

    Subjects: A total of 625 randomly selected individuals (≥60 years of age) participated in home interviews, and 473 underwent clinical examination. Complete information on nutritional status was available for 457 individuals, median age 68 years, 55% women.

    Results: Twenty-six percent of the elderly participants were undernourished and 62% were at risk of malnutrition according to MNA. More than three quarters of the participants had acute infections, 66% suffered from chronic illnesses, 36% had sensory impairments, and 81% were suffering from gastrointestinal disorders. Acute infections (p<0.001), gastrointestinal disorders (p<0.05), depressive symptoms (p<0.001), and impaired cognitive function (p<0.01) were significantly and independently associated with poorer nutritional status. Moreover, female gender (p<0.05), having no income (p<0.01), being illiterate (p<0.01), and not receiving regular financial support (p<0.05) were also independently associated with poor nutritional status.

    Conclusions: Malnutrition among elderly people in rural Bangladesh is associated with female gender, medical, psychological, socio-economic and social indicators. A multidimensional approach is probably needed to reduce undernutrition in older populations in low-income countries like Bangladesh.

  • 87.
    Fielding, R. A.
    et al.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, 711 Washington St, Boston, MA 02111 USA..
    Travison, T. G.
    Hebrew SeniorLife, Inst Aging Res, Boston, MA USA.;Harvard Med Sch, Boston, MA USA..
    Kirn, D. R.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, 711 Washington St, Boston, MA 02111 USA..
    Koochek, A.
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Clin Nutr & Metab, Uppsala, Sweden..
    Reid, K. F.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, 711 Washington St, Boston, MA 02111 USA..
    von Berens, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Zhu, H.
    Hebrew SeniorLife, Inst Aging Res, Boston, MA USA..
    Folta, S. C.
    Tufts Univ, Friedman Sch Nutr Sci & Policy, 711 Washington St, Boston, MA 02111 USA..
    Sacheck, J. M.
    Tufts Univ, Friedman Sch Nutr Sci & Policy, 711 Washington St, Boston, MA 02111 USA..
    Nelson, M. E.
    Tufts Univ, Friedman Sch Nutr Sci & Policy, 711 Washington St, Boston, MA 02111 USA.;Univ New Hampshire, Sustainabil Inst, Durham, NH 03824 USA..
    Liu, C. K.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, 711 Washington St, Boston, MA 02111 USA.;Boston Univ, Sch Med, Sect Geriatr, Boston, MA 02118 USA..
    Åberg, Anna Cristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. School of Education, Health and Society, Dalarna University, Sweden.
    Nydahl, Margaretha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. School of Education, Health and Society, Dalarna University, Sweden.
    Lilja, M.
    Karolinska Inst, Dept Lab Med, Stockholm, Sweden..
    Gustafsson, T.
    Karolinska Inst, Dept Lab Med, Stockholm, Sweden..
    Cederholm, Tommy E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Effect of structured physical activity and nutritional supplementation on physical function in mobility-limited older adults: Results from the VIVE2 randomized trial2017In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 21, no 9, p. 936-942Article in journal (Refereed)
    Abstract [en]

    The interactions between nutritional supplementation and physical activity on changes in physical function among older adults remain unclear. The primary objective of this study was to examine the impact of nutritional supplementation plus structured physical activity on 400M walk capacity in mobility-limited older adults across two sites (Boston, USA and Stockholm, Sweden). All subjects participated in a physical activity program (3x/week for 24 weeks), involving walking, strength, balance, and flexibility exercises. Subjects were randomized to a daily nutritional supplement (150kcal, 20g whey protein, 800 IU vitamin D) or placebo (30kcal, non-nutritive). Participants were recruited from urban communities at 2 field centers in Boston MA USA and Stockholm SWE. Mobility-limited (Short Physical Performance Battery (SPPB) ae<currency>9) and vitamin D insufficient (serum 25(OH) D 9 - 24 ng/ml) older adults were recruited for this study. Primary outcome was gait speed assessed by the 400M walk. Results: 149 subjects were randomized into the study (mean age=77.5 +/- 5.4; female=46.3%; mean SPPB= 7.9 +/- 1.2; mean 25(OH)D=18.7 +/- 6.4 ng/ml). Adherence across supplement and placebo groups was similar (86% and 88%, respectively), and was also similar across groups for the physical activity intervention (75% and 72%, respectively). Both groups demonstrated an improvement in gait speed with no significant difference between those who received the nutritional supplement compared to the placebo (0.071 and 0.108 m/s, respectively (p=0.06)). Similar effects in physical function were observed using the SPPB. Serum 25(OH)D increased in supplemented group compared to placebo 7.4 ng/ml versus 1.3 ng/ml respectively. Results suggest improved gait speed following physical activity program with no further improvement with added nutritional supplementation.

  • 88.
    Flodin, Lena
    et al.
    Karolinska Univ Hosp, Dept Geriatr Med, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, 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.
    Saaf, Maria
    Karolinska Univ Hosp, Dept Diabet Endocrinol & Metab, Stockholm, Sweden..
    Samnegard, Eva
    Danderyd Hosp, Karolinska Inst, Dept Clin Sci, Div Orthoped, Stockholm, Sweden..
    Ekstrom, Wilhelmina
    Karolinska Univ Hosp, Karolinska Inst, Dept Mol Med & Surg, Sect Orthoped & Sports Med, Stockholm, Sweden..
    Al-Ani, Amer N.
    Karolinska Univ Hosp, Dept Orthopaed, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden..
    Hedstrom, Margareta
    Karolinska Univ Hosp, Dept Orthopaed, Stockholm, Sweden.;Karolinska Inst, Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden..
    Effects of protein-rich nutritional supplementation and bisphosphonates on body composition, handgrip strength and health-related quality of life after hip fracture: a 12-month randomized controlled study2015In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 15, article id 149Article in journal (Refereed)
    Abstract [en]

    Background: The catabolic state that follows hip fracture contributes to loss of muscle mass and strength, that is sarcopenia, which impacts functional ability and health-related quality of life. Measures to prevent such long-term postoperative consequences are of important concern. The aim of this study was to evaluate the combined effects of protein-rich nutritional supplementation and bisphosphonate on body composition, handgrip strength and health-related quality of life following hip fracture. Methods: The study included 79 men and women with hip fracture, mean age 79 years (SD 9), without severe cognitive impairment, who were ambulatory and living independently before fracture. Patients were randomized postoperatively to receive liquid supplementation that provided 40 g of protein and 600 kcal daily for six months after the fracture, in addition to bisphosphonates once weekly for 12 months (group N, n = 26), or bisphosphonates alone once weekly for 12 months (group B, n = 28). All patients, including the controls (group C, n = 25) received calcium 1 g and vitamin D3 800 IU daily. Body composition as measured by dual-energy X-ray absorptiometry (DXA), handgrip strength (HGS) and health-related quality of life (HRQoL) were registered at baseline, six and 12 months postoperatively. Results: There were no differences among the groups regarding change in fat-free mass index (FFMI), HGS, or HRQoL during the study year. Intra-group analyses showed improvement of HGS between baseline and six months in the N group (P = 0.04). HRQoL decreased during the first year in the C and B groups (P = 0.03 and P = 0.01, respectively) but not in the nutritional supplementation N group (P = 0.22). Conclusions: Protein-rich nutritional supplementation was unable to preserve FFMI more effectively than vitamin D and calcium alone, or combined with bisphosphonate, in this relatively healthy group of hip fracture patients. However, trends toward positive effects on both HGS and HRQoL were observed following nutritional supplementation.

  • 89.
    Flodin, Lena
    et al.
    Karolinska Univ Hosp, Dept Geriatr Med, Huddinge, Sweden.;Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Inst, Stockholm, Sweden..
    Laurin, Agnes
    Karolinska Inst, Stockholm, Sweden..
    Lökk, Johan
    Karolinska Univ Hosp, Dept Geriatr Med, Huddinge, Sweden; Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, 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.
    Hedstrom, Margareta
    Dept Clin Sci Intervent & Technol CLINTEC, Stockholm, Sweden.;Karolinska Inst, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Orthoped, Huddinge, Sweden..
    Increased 1-year survival and discharge to independent living in overweight hip fracture patients2016In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 87, no 2, p. 146-151Article in journal (Refereed)
    Abstract [en]

    Background and purpose - Hip fracture patients usually have low body mass index (BMI), and suffer further postoperative catabolism. How BMI relates to outcome in relatively healthy hip fracture patients is not well investigated. We investigated the association between BMI, survival, and independent living 1 year postoperatively.

    Patients and methods - This prospective multicenter study involved 843 patients with a hip fracture (mean age 82 (SD 7) years, 73% women), without severe cognitive impairment and living independently before admission. We investigated the relationship between BMI and both 1-year mortality and ability to return to independent living.

    Results - Patients with BMI > 26 had a lower mortality rate than those with BMI < 22 and those with BMI 22-26 (6%, 16%, and 18% respectively; p = 0.006). The odds ratio (OR) for 1-year survival in the group with BMI > 26 was 2.6 (95% CI: 1.2-5.5) after adjustment for age, sex, and physical status. Patients with BMI > 26 were also more likely to return to independent living after the hip fracture (OR = 2.6, 95% CI: 1.4-5.0). Patients with BMI < 22 had similar mortality and a similar likelihood of independent living to those with BMI 22-26.

    Interpretation - In this selected group of patients with hip fracture, the overweight and obese patients (BMI > 26) had a higher survival rate at 1 year, and returned to independent living to a higher degree than those of normal (healthy) weight. The obesity paradox and the recommendations for optimal BMI need further consideration in patients with hip fracture.

  • 90.
    Flodin, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Laurin, Agnes
    Lökk, Johan
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Hedström, Margareta
    Overweight in hip fracture patients is associated with increased 1-year survival and discharge to independent living: a prospective study of 843 patients2015Manuscript (preprint) (Other academic)
  • 91. Flodin, Lena
    et al.
    Saaf, Maria
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Al-Ani, Amer N.
    Ackermann, Paul W.
    Samnegard, Eva
    Dalen, Nils
    Hedstrom, Margareta
    Additive effects of nutritional supplementation, together with bisphosphonates, on bone mineral density after hip fracture: a 12-month randomized controlled study2014In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 9, p. 1043-1050Article in journal (Refereed)
    Abstract [en]

    Background: After a hip fracture, a catabolic state develops, with increased bone loss during the first year. The aim of this study was to evaluate the effects of postoperative treatment with calcium, vitamin D, and bisphosphonates (alone or together) with nutritional supplementation on total hip and total body bone mineral density (BMD). Methods: Seventy-nine patients (56 women), with a mean age of 79 years (range, 61-96 years) and with a recent hip fracture, who were ambulatory before fracture and without severe cognitive impairment, were included. Patients were randomized to treatment with bisphosphonates (risedronate 35 mg weekly) for 12 months (B; n=28), treatment with bisphosphonates along with nutritional supplementation (40 g protein, 600 kcal daily) for the first 6 months (BN; n=26), or to controls (C; n=25). All participants received calcium (1,000 mg) and vitamin D3 (800 IU) daily. Total hip and total body BMD were assessed with dual-energy X-ray absorptiometry at baseline, 6, and 12 months. Marker of bone resorption C-terminal telopeptide of collagen I and 25-hydroxy vitamin D were analyzed in serum. Results: Analysis of complete cases (70/79 at 6 months and 67/79 at 12 months) showed an increase in total hip BMD of 0.7% in the BN group, whereas the B and C groups lost 1.1% and 2.4% of BMD, respectively, between baseline and 6 months (P=0.071, between groups). There was no change in total body BMD between baseline and 12 months in the BN group, whereas the B group and C group both lost BMD, with C losing more than B (P=0.009). Intention-to-treat analysis was in concordance with the complete cases analyses. Conclusion: Protein-and energy-rich supplementation in addition to calcium, vitamin D, and bisphosphonate therapy had additive effects on total body BMD and total hip BMD among elderly hip fracture patients.

  • 92.
    Franzon, Kristin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Sjögren, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Med Prod Agcy, Uppsala, 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.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Predictors of Independent Aging and Survival: A 16-Year Follow-Up Report in Octogenarian Men2017In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 65, no 9, p. 1953-1960Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To examine the longitudinal associations between aging with preserved functionality, i.e. independent aging and survival, and lifestyle variables, dietary pattern and cardiovascular risk factors.

    DESIGN: Cohort study.

    SETTING: Uppsala Longitudinal Study of Adult Men, Sweden.

    PARTICIPANTS: Swedish men (n = 1,104) at a mean age of 71 (range 69.4-74.1) were investigated, 369 of whom were evaluated for independent aging 16 years later, at a mean age of 87 (range 84.8-88.9).

    MEASUREMENTS: A questionnaire was used to obtain information on lifestyle, including education, living conditions, and physical activity. Adherence to a Mediterranean-like diet was assessed according to a modified Mediterranean Diet Score derived from 7-day food records. Cardiovascular risk factors were measured. Independent aging at a mean age of 87 was defined as lack of diagnosed dementia, a Mini-Mental State Examination score of 25 or greater, not institutionalized, independence in personal activities of daily living, and ability to walk outdoors alone. Complete survival data at age 85 were obtained from the Swedish Cause of Death Register.

    RESULTS: Fifty-seven percent of the men survived to age 85, and 75% of the participants at a mean age of 87 displayed independent aging. Independent aging was associated with never smoking (vs current) (odds ratio (OR) = 2.20, 95% confidence interval (CI) = 1.05-4.60) and high (vs low) adherence to a Mediterranean-like diet (OR = 2.69, 95% CI = 1.14-6.80). Normal weight or overweight and waist circumference of 102 cm or less were also associated with independent aging. Similar associations were observed with survival.

    CONCLUSION: Lifestyle factors such as never smoking, maintaining a healthy diet, and not being obese at age 71 were associated with survival and independent aging at age 85 and older in men.

  • 93.
    Franzon, Kristin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Zethelius, Bjorn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Modifiable Midlife Risk Factors, Independent Aging, and Survival in Older Men: Report on Long-Term Follow-Up of the Uppsala Longitudinal Study of Adult Men Cohort2015In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 63, no 5, p. 877-885Article in journal (Refereed)
    Abstract [en]

    ObjectivesTo examine relationships between modifiable midlife factors, aging, and physical and cognitive function (independent aging) and survival in very old age. DesignProspective cohort. SettingUppsala Longitudinal Study of Adult Men, Uppsala, Sweden. ParticipantsSwedish men investigated in 1970-74 (aged 48.6-51.1) and followed up for four decades (N=2,293). MeasurementsConventional cardiovascular risk factors, body mass index (BMI), and dietary biomarkers were measured, and a questionnaire was used to gather information on lifestyle variables at age 50. Four hundred seventy-two men were reinvestigated in 2008-09 (aged 84.8-88.9). Independent aging was defined as survival to age 85, Mini-Mental State Examination score of 25 or greater, not living in an institution, independent in personal care and hygiene, able to walk outdoors without personal help, and no diagnosis of dementia. The National Swedish Death Registry provided survival data. ResultsThirty-eight percent of the cohort survived to age 85. Seventy-four percent of the participants in 2008-09 were aging independently. In univariable analyses, high leisure-time physical activity predicted survival but not independent aging. Low work-time physical activity was associated more strongly with independent aging (odds ratio (OR)=1.84, 95% confidence interval (CI)=1.18-2.88) than with survival (OR=1.27, 95% CI=1.05-1.52). In multivariable analyses, midlife BMI was negatively associated (OR=0.80/SD, 95% CI=0.65-0.99/SD), and never or former smoking was positively associated (OR=1.66, 95% CI=1.07-2.59), with independent aging. As expected, conventional cardiovascular and lifestyle risk factors were associated with mortality. ConclusionA normal midlife BMI and not smoking were associated with independent aging close to four decades later, indicating that normal weight at midlife has the potential not only to increase survival, but also to preserve independence with aging.

  • 94.
    Franzon, Kristin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    The impact of muscle function, muscle mass and sarcopenia on independent ageing in very old Swedish men2019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 153Article in journal (Refereed)
    Abstract [en]

    Background Preserved functions of daily life and cognition are cornerstones of independent aging, which is crucial for maintaining a high quality of life. The aim of this study was to examine the impact of sarcopenia, and its underlying components, on independent ageing in a cohort study of very old men.

    Methods The presence of sarcopenia and independent ageing at a mean age of 87 was investigated in 287 men from the Uppsala Longitudinal Study of Adult Men. Five years later 127 men were re-evaluated for independent ageing. Sarcopenia was defined by two different definitions from the European Working Group on Sarcopenia in Older People. In the first definition sarcopenia was defined as skeletal muscle index < 7.26 kg/m2 and either gait speed ≤0.8 m/s or hand grip strength < 30 kg. In the later up-dated definition, HGS < 27 kg and/or chair stand test > 15 s defines probable sarcopenia, which is confirmed by SMI < 7.0 kg/m2. Independent ageing was defined as a Mini-Mental State Examination score of ≥25 points, absence of diagnosed dementia, community-dwelling, independency in personal care and ability to walk outdoors alone.

    Results Sarcopenia at baseline was observed in 21% (60/287) and 20% (58/287), respectively, due to definition. The prevalence of independent ageing was 83% (239/288) at baseline and 69% (87/127) five years later. None of the sarcopenia diagnoses were associated with independent ageing. In contrast, gait speed was both in cross-sectional (odds ratio (OR) per one standard deviation increase 2.15, 95% confidence interval (CI) 1.47–3.15), and in longitudinal multivariate analyses (OR 1.84, 95% CI 1.19–2.82). In the cross-sectional analysis also higher hand grip strength was associated with independent ageing (OR 1.58, 95% CI 1.12–2.22), while a slower chair stand test was inversely associated (OR 0.61, 95% CI 0.43–0.86). Muscle mass; i.e. skeletal muscle index, was not associated with independent ageing.

    Conclusions For very old men, especially a higher gait speed, but also a higher hand grip strength and a faster chair stand test, were associated with independent ageing, while skeletal muscle index alone, and the composite sarcopenia phenotype measured with two different definitions, were not.

  • 95. Freund Levi, Y
    et al.
    Vedin, I
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Faxén Irving, G
    Eriksdotter, M
    Hjorth, E
    Schultzberg, M
    Vessby, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Wahlund, L-O
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Salem, N
    Palmblad, J
    Transfer of omega-3 fatty acids across the blood-brain barrier after dietary supplementation with a docosahexaenoic acid-rich omega-3 fatty acid preparation in patients with Alzheimer's disease: the OmegAD study2014In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 275, no 4, p. 428-436Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Little is known about the transfer of essential fatty acids (FAs) across the human blood-brain barrier (BBB) in adulthood. In this study, we investigated whether oral supplementation with omega-3 (n-3) FAs would change the FA profile of the cerebrospinal fluid (CSF).

    METHODS: A total of 33 patients (18 receiving the n-3 FA supplement and 15 receiving placebo) were included in the study. These patients were participants in the double-blind, placebo-controlled randomized OmegAD study in which 204 patients with mild Alzheimer's disease (AD) received 2.3 g n-3 FA [high in docosahexaenoic acid (DHA)] or placebo daily for 6 months. CSF FA levels were related to changes in plasma FA and to CSF biomarkers of AD and inflammation.

    RESULTS: At 6 months, the n-3 FA supplement group displayed significant increases in CSF (and plasma) eicosapentaenoic acid (EPA), DHA and total n-3 FA levels (P < 0.01), whereas no changes were observed in the placebo group. Changes in CSF and plasma levels of EPA and n-3 docosapentaenoic acid were strongly correlated, in contrast to those of DHA. Changes in DHA levels in CSF were inversely correlated with CSF levels of total and phosphorylated tau, and directly correlated with soluble interleukin-1 receptor type II. Thus, the more DHA increased in CSF, the greater the change in CSF AD/inflammatory biomarkers.

    CONCLUSIONS: Oral supplementation with n-3 FAs conferred changes in the n-3 FA profile in CSF, suggesting transfer of these FAs across the BBB in adults.

  • 96. Freund-Levi, Yvonne
    et al.
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Faxén-Irving, Gerd
    Garlind, Anita
    Grut, Mikaela
    Vedin, Inger
    Palmblad, Jan
    Wahlund, Lars-Olof
    Eriksdotter-Jönhagen, Maria
    Omega-3 supplementation in mild to moderate Alzheimer's disease: effects on neuropsychiatric symptoms2008In: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 23, no 2, p. 161-169Article in journal (Refereed)
    Abstract [en]

    Background: Epidemiological and animal studies have suggested that dietary fish or fish oil rich in omega-3 fatty acids (ω3), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), may have effects in psychiatric and behavioral symptoms in Alzheimer's disease (AD). An association with APOEω4 carriers and neuropsychiatric symptoms in AD has also been suggested. Objective: To determine effects of dietary ω3 supplementation to AD patients with mild to moderate disease on psychiatric and behavioral symptoms, daily functions and a possible relation to APOEgenotype. Methods: Randomized, double-blind, placebo-controlled clinical trial where 204 AD patients (74 ± 9 years) with acetylcholine esterase inhibitor treatment and a MMSE >15 points were randomized to daily intake of 1.7 g DHA and 0.6 g EPA (ω3 group) or placebo for 6 months. Then, all received the ω3 supplementation for 6 more months. Neuropsychiatric symptoms were measured with Neuropsychiatric Inventory (NPI) and Montgomery Åsberg Depression Scale (MADRS). Caregivers burden and activities of daily living (Disability Assessment for Dementia, DAD) were also assessed. Results: One hundred and seventy-four patients fulfilled the trial. 72% were APOEω4 carriers. No significant overall treatment effects on neuropsychiatric symptoms, on activities of daily living or on caregiver's burden were found. However, significant positive treatment effects on the scores in the NPI agitation domain in APOEω4 carriers (p = 0.006) and in MADRS scores in non-APOEω4 carriers (p = 0.005) were found. Conclusions: Supplementation with ω3 in patients with mild to moderate AD did not result in marked effects on neuropsychiatric symptoms except for possible positive effects on depressive symptoms (assessed by MADRS) in non-APOEω4 carriers and agitation symptoms (assessed by NPI) in APOEω4 carriers. ClinicalTrials.gov identifier: NCT00211159.

  • 97. Freund-Levi, Yvonne
    et al.
    Eriksdotter-Jonhagen, Maria
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Faxén-Irving, Gerd
    Garlind, Anita
    Vedin, Inger
    Vessby, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Wahlund, Lars-Olof
    Palmblad, Jan
    Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegAD study - A randomized double-blind trial2006In: Archives of Neurology, ISSN 0003-9942, E-ISSN 1538-3687, Vol. 63, no 10, p. 1402-1408Article in journal (Refereed)
    Abstract [en]

    Background: Epidemiologic and animal studies have suggested that dietary fish or fish oil rich in omega-3 fatty acids, for example, docosahexaenoic acid and eicosapentaenoic acid, may prevent Alzheimer disease (AD).

    Objective: To determine effects of dietary omega-3 fatty acid supplementation on cognitive functions in patients with mild to moderate AD.

    Design: Randomized, double-blind, placebo-controlled clinical trial.

    Participants: Two hundred four patients with AD (age range [mean +/- SD], 74 +/- 9 years) whose conditions were stable while receiving acetylcholine esterase inhibitor treatment and who had a Mini-Mental State Examination (MMSE) score of 15 points or more were randomized to daily intake of 1.7 g of docosahexaenoic acid and 0.6 g of eicosapentaenoic acid (omega-3 fatty acid-treated group) or placebo for 6 months, after which all received omega-3 fatty acid supplementation for 6 months more.

    Main Outcome Measures: The primary outcome was cognition measured with the MMSE and the cognitive portion of the Alzheimer Disease Assessment Scale. The secondary outcome was global function as assessed with the Clinical Dementia Rating Scale; safety and tolerability of omega-3 fatty acid supplementation; and blood pressure determinations.

    Results: One hundred seventy-four patients fulfilled the trial. At baseline, mean values for the Clinical Dementia Rating Scale, MMSE, and cognitive portion of the Alzheimer Disease Assessment Scale in the 2 randomized groups were similar. At 6 months, the decline in cognitive functions as assessed by the latter 2 scales did not differ between the groups. However, in a subgroup (n=32) with very mild cognitive dysfunction (MMSE > 27 points), a significant (P <.05) reduction in MMSE decline rate was observed in the omega-3 fatty acid-treated group compared with the placebo group. A similar arrest in decline rate was observed between 6 and 12 months in this placebo subgroup when receiving omega-3 fatty acid supplementation. The omega-3 fatty acid treatment was safe and well tolerated.

    Conclusions: Administration of omega-3 fatty acid in patients with mild to moderate AD did not delay the rate of cognitive decline according to the MMSE or the cognitive portion of the Alzheimer Disease Assessment Scale. However, positive effects were observed in a small group of patients with very mild AD (MMSE > 27 points).

  • 98. Freund-Levi, Yvonne
    et al.
    Vedin, Inger
    Hjorth, Erik
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Irving, Gerd Faxen
    Schultzberg, Marianne
    Eriksdotter, Maria
    Palmblad, Jan
    Vessby, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Wahlund, Lars-Olof
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Basu, Samar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Oxidative Stress and Inflammation.
    Effects of Supplementation with Omega-3 Fatty Acids on Oxidative Stress and Inflammation in Patients with Alzheimer's Disease: The OmegAD Study2014In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 42, no 3, p. 823-831Article in journal (Refereed)
    Abstract [en]

    Background: Oxidative stress and inflammation are two key mechanisms suggested to be involved in the pathogenesis of Alzheimer's disease (AD). Omega-3 fatty acids (omega-3 FAs) found in fish and fish oil have several biological properties that may be beneficial in AD. However, they may also auto-oxidize and induce in vivo lipid peroxidation. Objective: The objective of this study was to evaluate systemic oxidative stress and inflammatory biomarkers following oral supplementation of dietary omega-3 FA. Methods: Forty patients with moderate AD were randomized to receive 1.7 g DHA (22:6) and 0.6 g EPA (20:5) or placebo for 6 months. Urinary samples were collected before and after supplementation. The levels of the major F-2-isoprostane, 8-iso-PGF(2 alpha) a consistent in vivo biomarker of oxidative stress, and 15-keto-dihydro-PGF(2 alpha), a major metabolite of PGF(2 alpha) and biomarker of inflammatory response, were measured. Results: F-2-isoprostane in urine increased in the placebo group after 6 months, but therewas no clear difference in treatment effect between supplemented and non-supplemented patients on the urinary levels of F-2-isoprostanes and 15-keto-dihydro-PGF(2 alpha). At baseline, the levels of 15-keto-dihydro-PGF(2 alpha) showed negative correlative relationships to omega-3 FAs, and a positive correlation to linoleic acid. 8-iso-PGF(2 alpha) correlated negatively to the omega-6 FA arachidonic acid. Conclusion: The findings indicate that supplementation of omega-3 FAs to patients with AD for 6 months does not have a clear effect on free radical-mediated formation of F-2-isoprostane or cyclooxygenase-mediated formation of prostaglandin F-2 alpha. The correlative relationships to FAs indicate a potential role of FAs in immunoregulation.

  • 99.
    Gomes, Filomena
    et al.
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Schuetz, Philipp
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Bounoure, Lisa
    Cantonal Hosp Aarau, Aarau, Switzerland.;Univ Basel, Med Fac, Basel, Switzerland..
    Austin, Peter
    Oxford Univ Hosp, Oxford, England.;Southampton Univ Hosp, Southampton, Hants, England..
    Ballesteros-Pomar, Maria
    Complejo Asistencial Univ Leon, Leon, Spain..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Fletcher, Jane
    Queen Elizabeth Hosp, Birmingham, W Midlands, England..
    Laviano, Alessandro
    Sapienza Univ Rome, Rome, Italy..
    Norman, Kristina
    Charite Univ Med Berlin, Berlin, Germany..
    Poulia, Kalliopi-Anna
    Laiko Gen Hosp Athens, Athens, Greece..
    Ravasco, Paula
    Univ Lisbon, Lisbon, Portugal..
    Schneider, Stephane M.
    Univ Nice Sophia Antipolis, Nice, France..
    Stanga, Zeno
    Univ Hosp Bern, Bern, Switzerland.;Univ Bern, Bern, Switzerland..
    Elizabeth Weekes, C.
    Guys & St Thomas NHS Fdn Trust, London, England.;Kings Coll London, London, England..
    Bischoff, Stephan C.
    Univ Hohenheim, Inst Nutr Med, Stuttgart, Germany..
    ESPEN guidelines on nutritional support for polymorbid internal medicine patients2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 336-353Article in journal (Refereed)
    Abstract [en]

    Background & aims: Polymorbidity (also known as multimorbidity)-defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards.

    Methods: The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds.

    Results: From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations.

    Conclusions: Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes.

  • 100.
    Grönstedt, Helena
    et al.
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Univ Hosp, Allied Hlth Profess, Funct Area Occupat Therapy & Physiotherapy, Stockholm, Sweden.
    Vikström, Sofia
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Stockholm, 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. Uppsala Univ Hosp, Dept Geriatr Med, Uppsala, Sweden;Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden.
    Franzen, Erika
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Univ Hosp, Allied Hlth Profess, Funct Area Occupat Therapy & Physiotherapy, Stockholm, Sweden;Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Seiger, Åke
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Wimo, Anders
    Karolinska Inst, Div Neurogeriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Faxen-Irving, Gerd
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden;Karolinska Univ Hosp, Funct Area Clin Nutr, Allied Hlth Professionals, Stockholm, Sweden.
    Boström, Anne-Marie
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden;Western Norway Univ Appl Sci, Haugesund, Norway.
    A study protocol of Older Person's Exercise and Nutrition Study (OPEN) - a sit-to-stand activity combined with oral protein supplement - effects on physical function and independence: a cluster randomized clinical trial2018In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, article id 138Article in journal (Refereed)
    Abstract [en]

    Background: Poor nutrition and age per see add to the development of sarcopenia, i.e. loss of muscle mass and strength, which contributes to increased risk of impaired activities of daily living (ADL) and reduced independence. Protein deficiency plays an important role in the development of sarcopenia. In order to increase the muscle mass protein intake should be combined with physical exercise. A daily physical activity, the sit-to-stand exercise, has been proven to decrease older persons' dependence in ADL. Our study aims to evaluate the effects of the sit-to-stand exercise in combination with a protein-rich nutritional supplement, on physical function and independence in frail nursing home residents. The resident's perceptions and experiences of the intervention and the staff's experiences of supporting the resident to complete the intervention will also be explored.

    Methods: The study is a two-arm cluster-randomized controlled trial which will be performed in nursing homes at two municipalities in Sweden. We will recruit 120 residents, age 75 or older and able to stand up from a seated position. Residents (n = 60) randomized to the intervention group will perform the sit-to-stand exercise at four occasions daily and will be offered a protein-rich oral supplement, twice a day. The intervention period will last for 12 weeks and measures of physical function, nutritional status, quality of life and health economy will be performed at baseline and at 12-weeks follow-up. The primary outcome will be the number of chair rises performed in 30 s. The control group will receive standard care. Data will be analysed by intention-to-treat analysis and with mixed effect models. During the last part of the intervention period individual interviews with the residents, on the topic of feasibility with the OPEN concept will be held. Likewise, focus-group-interviews with staff will be performed.

    Discussion: The residents' physical and mental health could be expected to improve. Even the work situation for staff could be positively affected. One innovative feature of the OPEN study is the simple intervention consisting of a basic daily activity that can be performed by several nursing home residents with the support of existing staff and available resources.

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