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Clinical nutrition and physical rehabilitation in a long-term care setting: preliminary observations in sarcopenic older patients

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Abstract

Background

Sarcopenia could have a negative prognostic impact in long-term care residents, which are characterized by multiple comorbidities and a high level of dependence. However, there is limited evidence on its prevalence and management in this healthcare setting.

Methods

All residents living in a long-term care institution were screened for the presence of sarcopenia. Sarcopenic patients in whom functional status could be assessed were included, based on the Tinetti scale (TS) score, in two parallel single-arm trials and received a specific nutritional supplement for muscle mass recovery in combination (TS ≥ 10) or not (TS < 10) with a supervised physical exercise rehabilitation program for 12 months. The nutritional supplement was administered twice daily for the first 6 months; none for 3 months and again twice daily for the last 3 months.

Results

We screened 95 residents and 81 had low skeletal muscle mass (SMM) according to bioimpedance. Thirty-nine residents were included in the intervention phase due to sarcopenia. At 6 months, patients receiving nutritional support alone (n = 17) showed a significant improvement in body weight (P = 0.009) and composition with an increase in SMM (from 15.3 ± 4.1 to 17.0 ± 5.1 kg, P = 0.013) and SMM index (SMI; from 6.24 ± 1.07 to 6.91 ± 1.54 kg/m2, P = 0.013), but not in handgrip strength (HS). Patients assigned to the multidisciplinary program (n = 22) showed an improvement in both muscle mass [SMM (from 16.6 ± 6.0 to 17.3 ± 5.7 Kg, P = 0.050) and SMI (from 6.63 ± 1.65 to 6.91 ± 1.52 kg/m2, P = 0.038)] and functional status [HS (from 13.5 ± 5.0 to 15.6 ± 6.7; P = 0.028), gait speed (from 0.44 ± 0.18 to 0.51 ± 0.20, P = 0.047) and Short Physical Performance Battery (from 4.6 ± 3.1 to 5.5 ± 3.2, P = 0.047)] at 6 months. The effect was no longer present after discontinuation of the intervention and was restored after its re-introduction at 12 months.

Conclusions

Nutritional and multidisciplinary interventions tailored on patient’s functional status could be considered as strategies for the management of sarcopenia, a high prevalent condition in old adults living in long-term care institutions.

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References

  1. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al (2010) Sarcopenia: European consensus on definition and diagnosis: report of the European working group on sarcopenia in older people. Age ageing. 39:412–23

  2. Vellas B, Fielding R, Bhasin S et al (2016) Sarcopenia trials in specific diseases: report by the international conference on frailty and sarcopenia research task force. J Frailty Aging 5:194–200

    PubMed  CAS  Google Scholar 

  3. Cleasby ME, Jamieson PM, Atherton PJ (2016) Insulin resistance and sarcopenia: mechanistic links between common co-morbidities. J Endocrinol 229:R67–R81

    Article  PubMed  CAS  Google Scholar 

  4. Gregorio L, Brindisi J, Kleppinger A et al (2014) Adequate dietary protein is associated with better physical performance among post-menopausal women 60–90 years. J Nutr Health Aging 18:155–160

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Houston DK, Nicklas BJ, Ding J et al (2008) Dietary protein intake is associated with lean mass change in older, community-dwelling adults: the health, aging, and body composition (Health ABC) Study. Am J Clin Nutr 87:150–155

    Article  PubMed  CAS  Google Scholar 

  6. Bauer J, Biolo G, Cederholm T et al (2013) Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 14:542–559

    Article  PubMed  Google Scholar 

  7. Cruz-Jentoft AJ, Kiesswetter E, Drey M et al (2017) Nutrition, frailty, and sarcopenia. Aging Clin Exp Res. https://doi.org/10.1007/s40520-016-0709-0

    Article  PubMed Central  PubMed  Google Scholar 

  8. Senior HE, Henwood TR, Beller EM et al (2015) Prevalence and risk factors of sarcopenia among adults living in nursing homes. Maturitas 82:418–423

    Article  PubMed  Google Scholar 

  9. Cereda E, Pedrolli C, Klersy C et al (2016) Nutritional status in older persons according to healthcare setting: a systematic review and meta-analysis of prevalence data using MNA(®). Clin Nutr 35:1282–1290

    Article  PubMed  Google Scholar 

  10. Cruz-Jentoft AJ, Landi F, Schneider SM et al (2014) Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS). Age Ageing 43:748–759

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kovács É, Jónásné Sztruhár I, Asiama E et al (2016) Prevalence and associated factors of sarcopenia among older adults living in institutions providing long-term care. Orv Hetil 157:1847–1853

    Article  PubMed  Google Scholar 

  12. Marzetti E, Calvani R, Tosato M et al (2017) Sarcopenia: an overview. Aging Clin Exp Res. https://doi.org/10.1007/s40520-016-0704-5

    Article  PubMed  Google Scholar 

  13. Bauer JM, Verlaan S, Bautmans I et al (2015) Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc 16:740–747

    Article  PubMed  Google Scholar 

  14. Rondanelli M, Klersy C, Terracol G et al (2016) Whey protein, amino acids, and vitamin D supplementation with physical activity increases fat-free mass and strength, functionality, and quality of life and decreases inflammation in sarcopenic elderly. Am J Clin Nutr 103:830–840

    Article  PubMed  CAS  Google Scholar 

  15. Cramer JT, Cruz-Jentoft AJ, Landi F et al (2016) Impacts of high-protein oral nutritional supplements among malnourished men and women with sarcopenia: a multicenter, randomized, double-blinded, controlled trial. J Am Med Dir Assoc 17(11):1044–1055

    Article  PubMed  Google Scholar 

  16. Landi F, Marzetti E, Martone AM et al (2014) Exercise as a remedy for sarcopenia. Curr Opin Clin Nutr Metab Care 17:25–33

    PubMed  Google Scholar 

  17. Calvani R, Miccheli A, Landi F et al (2013) Current nutritional recommendations and novel dietary strategies to manage sarcopenia. J Frailty Aging 2:38–53

    PubMed  PubMed Central  Google Scholar 

  18. Andrews E, Dombeck M (2004) The role of scientific evidence of risk and benefits in determining risk management policies for medications. Pharmacoepidemiol Drug Saf 13:599–608

    Article  PubMed  Google Scholar 

  19. http://www.rehabmeasures.org/Lists/RehabMeasures. Accessed Jan 2016

  20. American College of Sports Medicine, Chodzko-Zajko WJ, Proctor DN et al (2009) American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 41:1510–1530

    Article  Google Scholar 

  21. Cereda E, Bertoli S, Vanotti A et al (2010) Estimated height from knee-height in Caucasian elderly: implications on nutritional status by mini nutritional assessment. J Nutr Health Aging 14:16–22

    Article  PubMed  CAS  Google Scholar 

  22. World Health Organization (1995) Physical status: the use and interpretation of anthropometry. Report of a WHO expert committee. World Health Organ Tech Rep Ser 854:1–452

    Google Scholar 

  23. Janssen I, Baumgartner RN, Ross R et al (2004) Skeletal muscle cutpoints associated with elevated physical disability risk in older men and women. Am J Epidemiol 159:413–421

    Article  PubMed  Google Scholar 

  24. Janssen I, Heymsfield SB, Ross R (2002) Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 50:889–896

    Article  PubMed  Google Scholar 

  25. Lauretani F, Russo CR, Bandinelli S et al (2003) Age-associated changes in skeletal muscles and their effect on mobility: an operational diagnosis of sarcopenia. J Appl Physiol (1985) 95:1851–1860

    Article  Google Scholar 

  26. Abellan van Kan G, Rolland Y, Andrieu S et al(2009) Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an International Academy on Nutrition and Aging (IANA) Task Force. J Nutr Health Aging 13:881–889

    Article  Google Scholar 

  27. Guralnik JM, Simonsick EM, Ferrucci L et al(1994) A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 49:M85–M94

    Article  PubMed  CAS  Google Scholar 

  28. Parmelee PA, Thuras PD, Katz IR et al (1995) Validation of the cumulative illness rating scale in a geriatric residential population. J Am Geriatric Soc 43:130–137

    Article  CAS  Google Scholar 

  29. Katz PR (2011) An international perspective on long term care: focus on nursing homes. J Am Med Dir Assoc 12:487–492.e1

    Article  PubMed  Google Scholar 

  30. Lardiés-Sánchez B, Sanz-Paris A, Boj-Carceller D et al (2016) Systematic review: Prevalence of sarcopenia in ageing people using bioelectrical impedance analysis to assess muscle mass. Eur Geriatr Med 7:262–266

    Article  Google Scholar 

  31. Bauer JM, Kaiser MJ, Sieber CC (2008) Sarcopenia in nursing home residents. J Am Med Dir Assoc 9:545–551

    Article  PubMed  Google Scholar 

  32. Cereda E, Vanotti A (2008) Short dietary assessment improves muscle dysfunction identification by Geriatric Nutritional Risk Index in uncomplicated institutionalised patients over 70 years old. Clin Nutr 27:126–132

    Article  PubMed  Google Scholar 

  33. Hubbard GP, Elia M, Holdoway A et al (2012) A systematic review of compliance to oral nutritional supplements. Clin Nutr 31:293–312

    Article  PubMed  Google Scholar 

  34. Fiatarone MA, O’Neill EF, Doyle Ryan N et al (1994) Exercise training and nutritional supplementation for physical frailty in very elderly people. NEJM 330:1769–1775

    Article  PubMed  CAS  Google Scholar 

  35. Bonnefoy M, Cornu C, Normand S et al (2003) The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study. Br J Nutr 89:731–739

    Article  PubMed  CAS  Google Scholar 

  36. Devries MC, Phillips SM (2015) Supplemental protein in support of muscle mass and health: advantage whey. J Food Sci 80:A8–A15

    Article  CAS  Google Scholar 

  37. Borack MS, Volpi E (2016) Efficacy and safety of leucine supplementation in the elderly. J Nutr 146:2625S–2629S

    Article  CAS  Google Scholar 

  38. Ceglia L, Harris SS (2013) Vitamin D and its role in skeletal muscle. Calcif Tissue Int 92:151–162

    Article  PubMed  CAS  Google Scholar 

  39. Salles J, Chanet A, Giraudet C et al (2013) 1,25(OH)2-vitamin D3 enhances the stimulating effect of leucine and insulin on protein synthesis rate through Akt/PKB and mTOR mediated pathways in murine C2C12 skeletal myotubes. Mol Nutr Food Res 57:2137–2146

    Article  PubMed  CAS  Google Scholar 

  40. Pavasini R, Guralnik J, Brown JC et al (2016) Short physical performance battery and all-cause mortality: systematic review and meta-analysis. BMC Med 14:215

    Article  PubMed  PubMed Central  Google Scholar 

  41. Volpato S, Romagnoni F, Soattin L et al (2004) Body mass index, body cell mass, and 4-year all-cause mortality risk in older nursing home residents. J Am Geriatr Soc 52:886–891

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Fondazione Angelo Poretti e Angelo Magnani ONLUS, Via Poretti 4, 21040 Vedano Olona, Varese, Italy

    Sergio Dimori, Giorgio Leoni, Luca Fior & Fulvio Gasparotto

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  1. Sergio Dimori
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  2. Giorgio Leoni
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  3. Luca Fior
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  4. Fulvio Gasparotto
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Correspondence to Sergio Dimori.

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This work was partially supported by Fondazione Angelo Poretti e Angelo Magnani ONLUS, Vedano Olona, Italy.

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All the Authors have no conflicts of interest.

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The study was approved by the local Ethics Committee. Written informed consent was obtained from every patient recruited.

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Dimori, S., Leoni, G., Fior, L. et al. Clinical nutrition and physical rehabilitation in a long-term care setting: preliminary observations in sarcopenic older patients. Aging Clin Exp Res 30, 951–958 (2018). https://doi.org/10.1007/s40520-017-0859-8

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