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Malnutrition and sarcopenia

Abstract

Risk for or established malnutrition is frequent in older adults, accompanied by functional limitations, increased morbidity and mortality. Protein-energy malnutrition is often observed and leads besides other predisposing factors to sarcopenia, the increased loss of muscle mass with aging. Sarcopenia is an integral correlate of the physical component of the frailty syndrome. Even though sarcopenia often reaches levels where mobility, balance and functionality on overall are hampered, its diagnosis has not become part of the standard diagnostic and therapeutic repertoire of geriatric medicine. This will hopefully change with a recently published revised international definition of sarcopenia, as well an own ICD-number. From a pathophysiological point of view, both malnutrition and sarcopenia share many components, a low-inflammatory state (inflamm-aging) being an important one. Nutritional interventions with and without parallel physical activity programs can prevent and often also reverse sarcopenia. It is hoped that upcoming even more potent nutritional treatment options—including for sarcopenic obesity—will lower the burden of malnutrition and sarcopenia for many older adults.

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(taken from Ref. [30])

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(taken from Ref. [30])

References

  1. 1.

    Russell CA, Elia M (2012) Nutrition screening survey in the UK and Republic of Ireland in 2001. A report by the Malnutrition Advisory Group of the British Association for Parenteral and enteral Nutrition (BAPEN). http://www.bapen.org.uk/pdfs/nsw-2011-report.pdf. Accessed 2012

  2. 2.

    Morley JE (2001) Decreased food intake with aging. J Gerontol A Biol Sci Med Sci 56(Suppl. 2):81–88

    Article  PubMed  Google Scholar 

  3. 3.

    Kaiser M, Bauer JM, Ramsch C et al (2009) MNA-International Group. J Nutr Health Aging 13:782–788

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Frontera WR, Hughes VA, Fielding R et al (2000) Aging of skeletal muscle: a 12-yr longitudinal study. J Appl Physiol 88:1321–1326

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Baumgartner RN, Waters LW (2006) Sarcopenia and sarcopenic-obesity. In: Pathy MS, Sinclair AJ, Morley JE (eds) Principles and practice of geriatric medicine. Wiley, Chichester, pp 909–933

    Google Scholar 

  6. 6.

    Goodpaster B, Won Park S, Harris TB et al (2006) THe loss of skeletal muscle strength, mass, and quality in older adults: The Health, Aging and Body Composition Study. J Gerontol Biol Sci Med Sci 61A:1059–1064

    Article  Google Scholar 

  7. 7.

    Ferrucci L, Guralnik JM, Buchner D et al (2007) Departures of linearity tin the relationship between measures of muscular strength and physical performance of the lower extremities.: the Women’s Health and Aging Study. J Gerontol A Biol Sci Med Sci 52:M275–M285

    Google Scholar 

  8. 8.

    Volkert D, Beck AM, Cederholm T et al (2018) ESPEN guideline on clinical nutrition and hydration in geriatrics. Clin Nutr. https://doi.org/10.1016/j.clnu.2018.05.024

    Article  PubMed  Google Scholar 

  9. 9.

    Morley JE (2010) Anorexia, weight loss, and frailty. J Am Med Dir Assoc 11:225–228

    Article  PubMed  Google Scholar 

  10. 10.

    Fried L, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146–M156

    Article  CAS  Google Scholar 

  11. 11.

    Deutz NE, Bauer JM, Barazzoni R et al (2014) Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr 33:929–936

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Bauer JM, 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 

  13. 13.

    Goisser S, Kemmler W, Porzel S et al (2015) Sarcopenic obesity and complex interventions with nutrition and exercise in community-dwelling older persons—a narrative review. Clin Interv Aging 10:1267–1682

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Barazzoni R, Bischoff SC, Boirie Y et al (2018) Sarcopenic obesity: time to meet the challenge. Clin Nutr 37:1787–1793

    Article  PubMed  Google Scholar 

  15. 15.

    Cederholm T, Hellström K (1995) Reversibility of protein-energy malnutrition in a group of chronically ill elderly out-patients. Clin Nutr 14:81–87

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Gingrich A, Rennekamp R, Brandl B et al (2018) Do aspects of protein intake vary across the week in healthy community-dwelling older adults? An enable Study. Nutrients. https://doi.org/10.3390/nu10091217

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Cederholm T, Jensen GL, Correia MITD et al (2018) GLIM criteria for the diagnosis of malnutrition—a consensus report from the global clinical nutrition community. Clin Nutr. https://doi.org/10.1016/j.clnu.2018.08.002

    Article  PubMed  Google Scholar 

  18. 18.

    Jensen GL, Cederholm T, Correia MITD et al (2019) GLIM criteria for the diagnosis of malnutrition—a consensus report from the global clinical nutrition community. JPEN 43:32–40

    Article  Google Scholar 

  19. 19.

    Rosenberg IH (1997) Sarcopenia: origins and clinical relevance. J Nutr 127(5 Suppl):990S–991S

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Mijnarends DM, Luiking YC, Halfens RJG et al (2018) Muscle health and costs: a glance at their relationship. J Nutr Health Aging 22:766–773

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Malmstrom TK, Miller DK, Simonsick EM et al (2016) SARC-F: a symptom score to predict persons with sarcopenia at risk for poor functional outcomes. J Cachexia Sarcopenia Muscle 7:28–36

    Article  Google Scholar 

  22. 22.

    Antunes AC, Araujo DA, Verissimo MT et al (2017) Sarcopenia and hospitalisation costs in older adults: a cross-sectional study. Nutr Diet 74:46–50

    Article  PubMed  Google Scholar 

  23. 23.

    Steffl M, Sima J, Shiells K et al (2017) The increase in health care costs associated with muscle weakness in older people without long-term illness in the Czech Republic: results from the Survey of Health, Ageing and Retirement in Europe (SHARE). Clin Interv Aging 12:2003–2007

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    De Buyser SI, Petrovic M, Taes YE et al (2016) Validation of the FNIH sarcopenia criteria and SOF frailty index as predictors of long-term mortality in ambulatory older men. Age Ageing 45:602–608

    Article  PubMed  Google Scholar 

  25. 25.

    Janssen I, Heymsfield SB, Robert 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 

  26. 26.

    Cruz-Jentoft AJ, Bayeyens 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 39:412–423

    Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Muscaritoli M, Anker SD, Argiles J et al (2010) Consensus definition of sarcopenia, cachexia and pre-cachexia: joint document elaborated by Special Interest Groups (SIG) “cachexia-anorexia in chronic wasting diseases” and “nutrition in geriatrics”. Clin Nutr 29:154–159

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    ICD-10 MC Diagnosis Code (2018) ICD-10 CMDiagnosis Code M62.84. Cited 12 Mar 2018. http://www.icd10data.com/ICD10CM/Codex/M00-M99/M60-M63/M62-/M62.84. Accessed 2012

  29. 29.

    Vellas B, Fielding RA, Bens C et al (2018) Implications of ICD-10 for sarcopenia clinical practice and clinical trials: report by the International Conference on Frailty and Sarcopenia Research Task Force. J Frailty Aging 7:2–9

    CAS  PubMed  Google Scholar 

  30. 30.

    Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing 48:16–31

    Article  PubMed  Google Scholar 

  31. 31.

    Studenski S, Perera S, Patel K et al (2011) Gait speed and survival in older adults. JAMA 305:50–58

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Zamboni M, Mazzali G, Fantin F et al (2008) Sarcopenic obesity: a new category of obesity in the elderly. Nutr Metab Cardiovasc Dis 18:388–395

    Article  CAS  PubMed  Google Scholar 

  33. 33.

    Kemmler W, Teschler M, Weissenfels A et al (2017) Prevalence of sarcopenia and sarcopenic obesity in older German neb using recognized definitions: high accordance but low overlap! Osteoporosis Int 28:1881–1891

    Article  CAS  Google Scholar 

  34. 34.

    Evans WJ, Morley JE, Argiles J et al (2008) Cachexia: a new definition. Clin Nutr 27:793–799

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Fearon K, Strasser F, Anker SD et al (2011) Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 12:489–495

    Article  PubMed  Google Scholar 

  36. 36.

    Salvioli S, Capri M, Valensin S et al (2006) Inflamm-aging, cytokines and aging: state of the art, new hypotheses on the role of mitochondria and new perspectives from systemic biology. Curr Pharm Des 12:3161–3171

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    Walston J, McBurnie MA, Newman A et al (2002) Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch Intern Med 162:2333–2341

    Article  Google Scholar 

  38. 38.

    Leng SX, Tian X, Matteini A, Li H et al (2011) IL6-independent association of elevated serum neopterin levels with prevalent frailty in community-dwelling older adults. Age Ageing 40:475–481

    Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Landi F, Cesari M, Calvani R et al (2017) The “Sarcopenia and Physical fRailty IN older people: multicomponent Treatment strategies” (SPRINTT) randomized controlled trial: design and methods. Aging Clin Exp Res 28:89–100

    Article  Google Scholar 

  40. 40.

    Landi F, Sieber C, Fielding RA et al (2018) Nutritional Intervention in Sarcopenia: report from the International Conference on Frailty and Sarcopenia Research Task Force. J Frailty Aging 7:247–252

    CAS  PubMed  Google Scholar 

  41. 41.

    Vasquez-Morales A, Wanden-Berghe C, Sanz-Valero J (2012) Exercise and nutritional supplements: effects of combined use in people over 65 years: a systematic review. Nutr Hosp 28:1077–1084

    Google Scholar 

  42. 42.

    Wright J, Baldwin C (2018) Oral nutritional support with or without exercise in the management of malnutrition in nutritionally vulnerable older people: a systematic review and meta-analysis. Clin Nutr 37:1879–1891

    Article  PubMed  Google Scholar 

  43. 43.

    Dent E, Morley JE, Cruz-Jentoft AJ et al (2018) International Clinical Practice Guidelines for Sarcopenia (ICFSR): screening, diagnosis and management. J Nutr Health Aging 22:1148–1161

    Article  CAS  PubMed  Google Scholar 

  44. 44.

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

    Article  CAS  PubMed  Google Scholar 

  45. 45.

    Milne AC, Potter J, Vivanti A et al (2009) Protein and energy supplementation in elderly people at risk from malnutrition. Cochrane Database Syst Rev 15:CD003288

    Google Scholar 

  46. 46.

    Wilkinson DJ, Hossain T, Hill DS et al (2013) Effects of leucine and its metabolite beta-hydroxy-beta-methybutyrate on human skeletal muscle protein metabolism. J Physiol 591:2911–2923

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Katsanos CS, Aarsland A, Cree MG et al (2009) Muscle protein synthesis and balance responsiveness to essential amino acids ingestion in the presence of elevated plasma free fatty acid concentrations. J Clin Endocrinol Metab 94:2984–2990

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Komar B, Schwingshackl L, Hoffmann G (2015) Effects of leucine-rich protein supplements on anthropometric parameter and muscle strength in the elderly: a systematic review and meta-analysis. J Nutr Health Aging 19:437–446

    Article  CAS  PubMed  Google Scholar 

  49. 49.

    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 

  50. 50.

    Bo Y, Liu C, Ji Z et al (2018) A high whey protein, vitamin D and E supplement preserves muscle mass, strength, and quality of life in sarcopenic older adults: a double-blind randomized controlled trial. Clin Nutr. https://doi.org/10.1016/j.clnu.2017.12.020

    Article  PubMed  Google Scholar 

  51. 51.

    Liberman K, Njemini R, Luiking Y et al (2019) 13 weeks of supplementation of vitamin D and leucine-enriched whey protein nutritional supplement attenuates chronic low grade inflammation in sarcopenic frail older adults: the PROVIDE study. Aging Clin Exp Res (in press)

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Correspondence to Cornel C. Sieber.

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Sieber, C.C. Malnutrition and sarcopenia. Aging Clin Exp Res 31, 793–798 (2019). https://doi.org/10.1007/s40520-019-01170-1

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Keywords

  • Malnutrition
  • Sarcopenia
  • Frailty
  • Definition
  • Nutritional treatment