Associations between micronutrient consumption and markers of biological ageing

Longitudinal associations between micronutrient consumption and leukocyte telomere length

Lee et al., JHND Early View

Background

There are few studies on the association between nutrient intake and telomere length, which may reflect cumulative oxidative stress and indicate biological ageing. In the present study, we evaluated longitudinal associations between the consumption of micronutrients, including antioxidant nutrients and B vitamins involved in one-carbon transfer pathways, and leukocyte telomere length (LTL).

Methods

The study included 1958 middle-aged and older Korean men and women (age range at baseline: 40–69 years) from a population-based cohort. We collected dietary information at baseline using a semiquantitative food frequency questionnaire (June 2001 to January 2003) and assessed the consumption of micronutrients, including vitamins A, B1, B2, B3, B6, B9 (folate), C and E, as well as calcium, phosphorus, potassium, iron and zinc. We measured LTL using a real-time polymerase chain reaction at the 10-year follow-up examination (February 2011 to November 2012).

Results

In the multiple regression model adjusted for potential confounders, LTL was positively associated with the consumption of vitamin C (P< 0.05), folate (P = 0.05) and potassium (P = 0.05) in all participants. In the age-stratified analysis, the association between the consumption of vitamin C (P < 0.01), folate (P < 0.05) and potassium (P < 0.05) with LTL was significant only among participants aged <50 years.

Conclusions

Our findings suggest that the earlier consumption of vitamin C, folate and potassium, which are abundant in fruits and vegetables, can delay biological ageing in middle-aged and older adults.

Low socioeconomic status is a risk factor for vitamin D deficiency

Low socio-economic status is a newly identified independent risk factor for poor vitamin D status in severely obese adults

Léger-Guist’hau et al., JHND Early View

Background

Hypovitaminosis D is very prevalent, especially in the obese population. However, the degree of severity and the parameters involved in vitamin D deficiency in this population are still unclear. The present study aimed to identify, from among the factors known to influence vitamin D status in a healthy population, those impacting the same parameter in obese population.

Methods

Serum 25-OH-D concentration was measured in 564 patients with class III obesity [i.e. severe and morbid obesity; mean (SD) body mass index (BMI) 42.04 (6.92) kg m–2] and their demographic, clinical, biological, anthropometric, dietary and socio-economic data were collected.

Results

We observed that 96% of the obese patients had serum 25-OH-D lower than 30 ng mL−1. Severe vitamin D deficiency (serum 25-OH-D concentration <10 ng mL−1) affected 35% of this population. We found an inverse relationship between 25-OH-D levels and BMI (= 0.012), fat mass (= 0.041), metabolic syndrome (< 0.0001), fasting blood glucose (= 0.023), homeostasis model assessment for insulin resistance (P = 0.008), waist circumference (= 0.001), and fasting blood triglycerides (= 0.002) and C-reactive protein (= 0.005). Low socio-economic status independently increased the risk of severe vitamin D deficiency [odds ratio (OR) = 1.98; 95% confidence interval (CI) 1.25–3.13], especially in the autumn–winter season (OR = 2.94; 95% CI 1.98–4.36), morbid obesity (OR = 3.19; 95% CI 1.49–6.82), metabolic syndrome (OR = 1.6; 95% CI 1.06–2.42) and inflammation (OR = 1.03; 95% CI 1.01–1.06).

Conclusions

Vitamin D deficiency is extremely common among obese patients, and the prevalence of severe deficiency is high. The association of adiposity, high body mass index, metabolic syndrome and inflammation with vitamin D status is marked, whereas low socio-economic status appears to be a major risk factor for severe vitamin D deficiency, suggesting that vitamin D deficiency may at least in part be responsible for the greater health vulnerability of populations with low socio-economic status.

 

Determining body fat using a modified body adiposity index

Modified body adiposity index for body fat estimation in severe obesity

Bernhard et al., JHND Early View

Background

The body adiposity index (BAI) comprises a simple method for estimating body fat (BF) that needs to be validated in patients with severe obesity. The present study aimed to determine BAI accuracy with respect to the determination BF in patients with severe obesity.

Methods

A cross-sectional prospective study comparing two methods for BF estimation was conducted in 433 patients with severe obesity between August 2012 to December 2014. BF was estimated by bioelectrical impedance analysis (BIA) with specific equations developed for BF estimation in patients with severe obesity and BAI. The BF estimation in 240 patients with severe obesity (Group 1: G1) was used to evaluate BAI limitations and to develop a specific equation in this population. The new equation proposed was validated in another 158 patients with severe obesity (Group 2: G2).

Results

There was a significant difference between BF determination by BIA and BAI (P = 0.039). The mean (SD) BF in G1 was 52.3% (6.1%) determined by BIA and 51.6% (8.1%) determined by BAI. Sex, waist–hip ratio (WHR) and obesity grade determined significant errors on BF estimation by BAI. A new equation (modified body adiposity index; MBAI) was developed by linear regression to minimise these errors [MBAI% = 23.6 + 0.5 × (BAI); add 2.2 if body mass index ≥ 50 kg m–2 and 2.4 if WHR ≥ 1.05]. The new equation reduced the difference [1.2% (5.9%), P < 0.001 to 0.4% (4.12%), P = 0.315] and improved the correlation (0.6–0.7) between methods.

Conclusions

BAI present significant limitations in severe obesity and MBAI was effective for BF estimation in this population.

 

Does body mass index impact on muscle wasting and recovery following critical illness?

Does body mass index impact on muscle wasting and recovery following critical illness? A pilot feasibility observational study

Segaran et al JHND Early View

Background

Critical illness is associated with muscle loss, weakness and poor recovery. The impact that illness and the ensuing metabolic response has on obese patients is not known. Objectives were to test if obese patients lose less muscle depth compared to non-obese patients; if a reduction in muscle depth was associated with reduced strength and recovery; and to assess the feasibility of these methods with a range of body mass index’s (BMI).

Methods

A prospective observational pilot study of muscle depth in critically ill patients categorised by BMI was performed. Muscle depth changes were assessed by ultrasound on study days 1, 3, 5, 7, 12 and 14. Strength was measured via handgrip dynamometry and Medical Research Council (MRC) sum score on waking and at discharge from the intensive care unit. Level of dependency was measured with the Barthel index.

Results

44 critically ill patients; 17 had normal BMI, 10 were overweight and 17 were obese. The three groups did not differ in baseline characteristics, except obese patients had significantly greater initial muscle depth. Muscle depth loss was similar between the BMI groups at each of the time points. Handgrip and MRC sum score were only possible in a small number of patients because of reduced alertness and weakness. Majority were deemed fully dependent based on the Barthel index.

Conclusions

Obese patients lost muscle depth in a comparable manner to non-obese patients, suggesting that BMI may not prevent muscle depth loss. It was not possible to determine the effect on strength because the clinical condition of patients precluded reliable measurements.

Vitamin D improves muscle strength but not mobility in community-dwelling elderly

Vitamin D supplementation and its influence on muscle strength and mobility in community-dwelling older persons: a systematic review and meta-analysis

Rosendahl-Riise et al., JHND Early View

Background

It has been suggested that vitamin D status or supplementation is important for maintaining or improving muscle strength and mobility in older adults. The study results, however, do not provide consistent results. We therefore aimed to summarise the available evidence systematically, including only studies conducted in community-dwelling older persons.

Methods

A systematic search of the literature was performed in April of 2016. The systematic review includes studies that used vitamin D with or without calcium supplementation as the exposure variable and various measurements of muscle strength and mobility. The meta-analysis was limited to studies using hand grip strength (HGS) and timed-up-and-go test as the outcome variables.

Results

A total of 15 studies out of 2408 articles from the literature search were included in the systematic review, providing 2866 participants above the age of 65 years. In the majority of studies, no improvement in muscle strength and mobility was observed after administration of vitamin D with or without calcium supplements. In the meta-analysis, we observed a nonsignificant change in HGS [+0.2 kg (95% confidence interval = −0.25 to 0.7 kg; seven studies)] and a small, significant increase in the timed-up-and-go test [0.3 s (95% confidence interval = 0.1 to 0.5 s; five studies)] after vitamin D supplementation. The meta-analyses showed a high degree of heterogeneity between the studies.

Conclusions

In conclusion, we observed no improvement in muscle strength after the administration of vitamin D with or without calcium supplements. We did find a small but significant deterioration of mobility. However, this is based on a limited number of studies and participants.

Malnutrition is common in Vietnamese outpatients with COPD

Nutritional status of Vietnamese outpatients with chronic obstructive pulmonary disease

Hogan et al., JHND Early View

Background

Nutritional screening and assessment is not currently part of routine clinical practice in Vietnam. Therefore, the present study aimed to investigate the utility of the commonly used methods for identifying malnutrition in outpatients with chronic obstructive pulmonary disease (COPD).

Methods

A cross-sectional pilot study and a larger retrospective study were carried out in outpatients with COPD who were attending a respiratory clinic in Ho Chi Minh City, Vietnam. Routine clinical data were collected [body mass index (BMI), forced expiratory volume in 1 s (FEV1)]. Nutritional screening and assessment were performed using the Malnutrition Screening Tool (MST) and Subjective Global Assessment (SGA) as the gold standard to diagnose malnutrition.

Results

In total, 393 outpatients had documented BMI and 29 were prospectively assessed using SGA: males, n = 25; females, n = 4; mean (SD) age 69.7 (9.6) years; mean (SD) BMI 21.0 (3.4) kg m–2; mean (SD) FEV1 percentage predicted 57.0% (19.7%). Malnutrition risk was identified in 20.7% (= 6) of patients using the MST (38% sensitivity; 94% specificity). However, 45% (= 13) were diagnosed as malnourished using the SGA (31% mild/moderate; 14% severe). All malnourished patients not identified by the MST had evidence of muscle wasting. BMI had a strong negative correlation with muscle wasting as assessed using the SGA (r = −0.857, = 28; < 0.001) and all malnourished patients had a BMI <21 kg m–2 (range 14.6–20.8 kg m–2, nourished range 20.0–27.6 kg m–2).

Conclusions

Malnutrition is common in Vietnamese outpatients with COPD. A BMI threshold of <21 kg m–2 appears to represent a useful and pragmatic cut-off point for identifying outpatients requiring comprehensive nutritional assessment and support.

 

Roles of carers supporting elderly malnourished patients

The nutrition and food-related roles, experiences and support needs of female family carers of malnourished older rehabilitation patients

Sky Marshall et al., JHND Early View

Background

To improve perceived value of nutrition support and patient outcomes, the present study aimed to determine the nutrition and food-related roles, experiences and support needs of female family carers of community-dwelling malnourished older adults admitted to rehabilitation units in rural New South Wales, Australia, both during admission and following discharge.

Methods

Four female family carers of malnourished rehabilitation patients aged ≥65 years were interviewed during their care-recipients’ rehabilitation admission and again at 2 weeks post-discharge. The semi-structured interviews were audiotaped, transcribed and analysed reflecting an interpretative phenomenological approach by three researchers. A series of ‘drivers’ relevant to the research question were agreed upon and discussed.

Results

Three drivers were identified. ‘Responsibility’ was related to the agency who assumed responsibility for providing nutrition support and understanding family carer obligation to provide nutrition support. ‘Family carer nutrition ethos’ was related to how carer nutrition beliefs, knowledge and values impacted the nutrition support they provided, the high self-efficacy of family carers and an incongruence with an evidence-based approach for treating malnutrition. ‘Quality of life’ was related to the carers’ focus upon quality of life as a nutrition strategy and outcome for their care-recipients, as well as how nutrition support impacted upon carer burden.

Conclusions

Rehabilitation units and rehabilitation dietitians should recognise and support family carers of malnourished patients, which may ultimately lead to an improved perceived benefit of care and patient outcomes. Intervention research is required to make strong recommendations for practice.