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JARCP Vol 6, 2017

 

DIVERSIFIED ANALYSIS OF NUTRITIONAL STATUS IN COMMUNITY-DWELLING OLDER ADULTS IN JAPAN

M. Kawashima, M. Kubota, H. Saito, S. Shinozuka

J Aging Res Clin Practice 2017;6:223-228

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Objectives: This study aimed to comprehensively analyze the nutritional status of community-dwelling older adults in Japan. Design and Participant: Participants included 48 outpatients (13 males and 35 females) aged ≧65 years who visited a private clinic in an urban city. Body height, body weight, and blood variables, including albumin, lymphocyte counts and total cholesterol, and pre-albumin, were obtained from the patient charts. The MNA-SF and nutritional intakes, using an established semiquantitative questionnaire, were conducted by an interview with a dietitian. Results: Nutritional risk assessment by MNA-SF revealed that 13 patients (27.1%) were at a risk of malnutrition and 4 patients (8.3%) demonstrated thinness, i.e., BMI <18.5 kg/m2. No statistical difference in terms of sex was found in the MNA-SF or BMI analyses. The caloric, protein, and lipid intake, adjusted by body weight, were significantly higher in females than in males. The daily caloric intake of 15 patients (31.3%) was below the estimated energy requirements defined by Dietary Reference Intakes for Japanese (2015), and the frequency of low estimated energy requirements was significantly higher in males than in females. Multiple regression analysis demonstrated that both BMI and MNA-SF were associated with albumin levels. Conclusions: Our findings suggest that malnutrition is not prevalent among community-dwelling older adults in Japan. Albumin may work as indicators for predicting malnutrition. Considering the lower caloric, protein, and lipid intake of males compared with females, caregivers should note that older adult males may be at a higher risk of malnutrition.

CITATION:
M. Kawashima ; M. Kubota ; H. Saito ; S. Shinozuka (2017): Diversified analysis of nutritional status in community-dwelling older adults in Japan. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.30

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THE RELATIONSHIP BETWEEN ARTHRITIS AND MUSCULAR STRENGTH IN OLDER WOMEN WITH SYMPTOMS OF SARCOPENIA

E.N. Renna, S.G. Slezak, K.B. Mahoney, I.E.Lofgren, D.L. Hatfield, M.J. Delmonico, F. Xu

J Aging Res Clin Practice 2017;6:217-222

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Background: Sarcopenia classification is important for prevention or intervention of sarcopenia in the elderly. However, measures used for the current sarcopenia criteria, including muscular strength, could be impacted by forms of arthritis. Thus, it is crucial to understand the impact arthritis has on sarcopenia status. Objectives: The aim was to investigate if arthritis relates to sarcopenia classification via grip strength or single chair stand in older women. A secondary aim was to assess the relationship between grip strength and upper and lower body strength in those with arthritis. Design: A cross-sectional analysis. Setting and participants: Sixty-one community-dwelling older women (71.9±4.6 years) from Rhode Island. Measurements: Sarcopenia status was classified using established working definitions. Grip strength was measured using a hand grip dynamometer, chair stands were measured via a single chair stand test, and gait speed was assessed using a four-meter walk test. A segmental multi-frequency bioelectrical impedance analysis assessed body composition and arthritis status was based on self-report. Upper and lower body muscular strength were measured using a chest press and leg press one repetition maximum. Results: No associations were observed between arthritis and sarcopenia status (p=0.36) nor arthritis and upper or lower body muscular strength and grip strength. Conclusions: The results of this study may indicate that arthritis is not associated with sarcopenia status but may affect other measures of muscular strength.

CITATION:
E.N. Renna ; S.G. Slezak ; K.B. Mahoney ; I.E.Lofgren ; D.L. Hatfield ; M.J. Delmonico ; F. Xu (2017): The Relationship between Arthritis and Muscular Strength in Older Women with Symptoms of Sarcopenia. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.29

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MODIFICATION OF THE MNA-SF FOR COMMUNITY-DWELLING OLDER ADULTS AT RISK OF MALNUTRITION

I. Nakamura, T. Yoshida, H. Kumagai

J Aging Res Clin Practice 2017;6:210-216

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Objectives: The Mini-Nutritional Assessment Short Form (MNA-SF) may be insufficient for screening and assessing the nutritional status of community-dwelling older adults. We modified MNA-SF to improve the ability for discriminating those at risk of malnutrition. Setting and participants: 123 community-dwelling elderly Japanese. Methods: Nutritional status was examined by the subjective global assessment (SGA), the geriatric nutritional risk index (GNRI) and MNA-SF. The reference standard for the diagnosis of “at risk of malnutrition” was composed from the SGA and GNRI. Specific factors associated with malnutrition in community-dwelling older adults were extracted from a literature survey and classified by a principal component analysis. A new 8-item MNA-home was constructed by adding two items from these components to the MNA-SF and compared with the MNA-SF by applying a receiver operating characteristic (ROC) curve. Results: Among the various potential MNA-home scores, the ROC curve revealed that the MNA-SF plus two items, namely an inability to prepare own meals and no motivation to go out, produced the largest area under the curve (AUC), this value being greater than that from the MNA-SF. The score of MNA-home was significantly correlated with serum albumin and hemoglobin, although the score of MNA-SF was not. The cutoff value for predicting at risk of malnutrition was <14 in the MNA-home. Conclusion: The new MNA-home had a better discriminating ability than the MNA-SF to identify those at risk of malnutrition in community-dwelling older adults. A subsequent long-term study is necessary to validate this MNA-home for correctly discriminating community-dwelling older adults at risk of malnutrition.

CITATION:
I. Nakamura ; T. Yoshida ; H. Kumagai (2017): Modification of the MNA-SF for community-dwelling older adults at risk of malnutrition. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.28

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EFFECT OF LEUCINE-RICH WHEY PROTEIN AS COMPARED TO SOY PROTEIN ON MUSCLE FUNCTION IN ELDERLY INDIVIDUALS WITH OSTEOPENIA. A FOUR MONTH RANDOMIZED STUDY

J.L. Mehlsen, S.B. Pedersen, K.I. Nørgaard, B.L. Langdahl, N. Møller, B. Richelsen

J Aging Res Clin Practice 2017;6:200-209

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Objective: This investigation was conducted to determine whether dietary supplementation with a specific leucine-rich whey protein compound improves physical function and muscle strength in osteopenic elderly people compared to soy protein and placebo. Design, participants and setting: The study was a 16-week randomized single blinded placebo controlled intervention, including 47 women and 10 men from 60-85 years of age with osteopenia (T-score < -1.0 by dual energy X-ray absorptiometry scan). The subjects were assigned to three groups in 2:2:1 relations, daily receiving 1) whey (45.8 g protein including 6.14 g leucine (n=24)), 2) soy (45.9 g protein with 3.1 g leucine (n=23)), and 3) isocaloric placebo with maltodextrin (n=10). A home based resistance training protocol (3 x 45 min / week) was followed by all groups concurrently. The primary focus of the study was on the differences between the two protein groups. Measurements: Physical function was determined by six-minute walk (6MW) and four-meter gait speed (4MGS) tests as primary endpoints, and strength (maximum voluntary contraction) by hand grip, leg extension and -flexion as secondary endpoints. Results: 6MW increased significantly in the whey group compared to the soy group (4% as compared to 1% increment, P < 0.05) but no changes were found in 4MGS. There were no differences between any groups in other variables such as in the strength and balance tests. However, p-urate was significantly lower after whey protein as compared to soy (P < 0.01). Conclusions: Four months of leucine-rich whey protein supplementation and concurrent resistance training significantly increased the six-minute walk test in elderly individuals as compared to soy protein. However, whether this minor increment in the walk test is of clinical importance is unknown. There was no effect on the four-meter gait speed or any other secondary muscle function-related endpoints.

CITATION:
J.L. Mehlsen ; S.B. Pedersen ; K.I. Nørgaard ; B.L. Langdahl ; N. Møller ; B. Richelsen (2017): Effect of leucine-rich whey protein as compared to soy protein on muscle function in elderly individuals with osteopenia. A four month randomized study. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.27

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EARLY IDENTIFICATION OF MALNUTRITION RISK AMONG FREE-LIVING ELDERLY PERSONS IN ATHENS, GREECE

T. Vassilakou, G. Triantafillou, L. Evrenoglou

J Aging Res Clin Practice 2017;6:193-199

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Background: Malnutrition is a serious problem, which cannot be easily detected among free-living elderly people, and may lead to various health and social problems and deteriorate their quality of life. Objectives: To determine the prevalence of malnutrition and malnutrition risk among free-living elderly in the community of an urban municipality of Attica and to identify socio-economic, health and dietary factors that may increase malnutrition risk. Design: Cross-sectional. Setting: Elderly people attending the Open Care Community Centers at N. Philadelphia (an urban municipality of Attica). Participants: 151 free-living people aged over 65 years (78 women and 73 men). Measurements: Mini Nutritional Assessment (MNA) questionnaire was completed, as well as socio-demographic, medical history, physical activity and alcohol consumption data was collected through a personal interview with the participants. Results: None of the individuals was found to be malnourished, but 25,8% of the sample was at risk of malnutrition. After performing backward regression analysis recent appetite (p<0,009) and weight loss (p<0,003), latest development of psychological stress or acute disease (p<0,0001), number of full-course meals (p<0,0001), protein intake index (p<0,002), minimum daily consumption of 2 portions of fruits or vegetables (p<0,0001), daily consumption of liquids (p<0,004), individual's self-evaluation of health (p<0,0001) and nutritional status (p<0,0001) all correlated significantly with MNA Screening Score. Conclusions: A significant number of free-living elderly persons were found at risk of malnutrition. Several dietary variables were found to correlate significantly with malnutrition risk. Early identification of nutritional risk of malnutrition in the community could ameliorate the nutritional status of seniors and consequently their health and quality of life.

CITATION:
T. Vassilakou ; G. Triantafillou ; L. Evrenoglou (2017): Early identification of malnutrition risk among free-living elderly persons in Athens, Greece. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.26

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RELEVANCE OF 18F-FLUORODEOXYGLUCOSE-POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF ATYPICAL TEMPORAL ARTERITIS

M. Leclercq, L. Goodrich, C. Le Guillou, X. Gbaguidi

J Aging Res Clin Practice 2017;6:191-192

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Atypical form of Giant cell arteritis (GCA), involving the absence of American College of Rheumatology (ACR) criteria, should be suspected before fever or inflammatory syndrome of unknown origin in the elderly. In that case, the diagnosis may be complex insofar as there are many possible infectious, inflammatory or tumorous etiologies. Completion of multiple and / or invasive clinical investigations can be questionable in a frail elderly population. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a non-invasive examination of high sensitivity and specificity in the diagnosis of GCA which may reveal abnormal fixation of the wall of the aorta and its branches. Its negative predictive value close to 90 % is also a strength to exclude the diagnosis. FDG-PET/CT is also effective in the search for differential diagnoses. On the other hand, FDG-PET/CT should not be prescribed in front of typical form of GCA in which ACR criteria are met. This clinical case illustrate the place of FDG-PET/CT in the diagnostic strategy of an inflammatory syndrome in an elderly patient for whom GCA is suspected.

CITATION:
M. Leclercq ; L. Goodrich ; C. Le Guillou ; X. Gbaguidi (2017): Relevance of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography in the diagnosis of atypical temporal arteritis. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.25

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ELEVEN WEEKS OF STRENGTH TRAINING DECREASED THE EXPRESSION OF IMMUNE-RELATED GENES IN OLDER SUBJECTS INDEPENDENT OF PROTEIN SUPPLEMENT TYPE; A RANDOMIZED CONTROLLED TRIAL

G.O. Gjevestad, H. Hamarsland, T. Raastad, J.J. Christensen, A.S. Biong, S.M. Ulven, K.B. Holven

J Aging Res Clin Practice 2017;6:182-190

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Objective: To investigate the effects of eleven weeks of strength training combined with two isocaloric protein supplements on mRNA expression levels in skeletal muscle and peripheral blood mononuclear blood cells (PBMCs). Design: A double blind randomized controlled study. Setting: The Norwegian School of Sports Sciences, Norway. Participants: Untrained, but otherwise healthy, men and women (n=20, ≥ 70 yrs). Intervention: Participants were randomly allocated to receive either milk protein or a native whey protein supplement (20 g protein, morning and afternoon) combined with a standardized strength training protocol (6-10 RM, 1-3 sets, 3 times/week) for eleven weeks. Measurements: The mRNA expression levels of immune-related genes were measured before and after the intervention period, using RT-qPCR. Cytokines were measured using ELISA. Results: PBMC mRNA expression of interleukin (IL) 6, IL8, chemokine (C-C motif) ligand (CCL) 3, and nuclear receptor subfamily (NR) 1 group H (H) member 3 decreased significantly after the intervention period, whereas the mRNA expression of toll-like receptor (TLR2) increased. In skeletal muscle, the mRNA expression of peroxisome proliferator-activated receptor gamma coactivator 1 alpha (PPARGC1A) and PPARGC1B decreased significantly, whereas the mRNA expression of CCL2, CCL5, TLR2, TLR4 and hypoxia inducible factor 1 alpha subunit (HIF1A) increased significantly after the intervention. We found no significant differences in circulating C-reactive protein and IL6 after the intervention period. The consumption of whey and milk proteins had similar effects on mRNA expression levels after strength training in skeletal muscle as well as PBMCs. Conclusion: Eleven weeks of strength training and protein supplementation reduced the PBMC expression levels of genes involved in the immune system as well as in metabolism, underlining the close interaction between these processes. The upregulation of other immune-related genes observed in PBMCs as well as in skeletal muscle needs further investigations, but may be related to protein supplementation and training adaptations. Different protein supplementation (milk or native whey) did not differentially modulate mRNA expression after the intervention period.

CITATION:
G.O. Gjevestad ; H. Hamarsland ; T. Raastad ; J.J. Christensen ; A.S. Biong ; S.M. Ulven ; K.B. Holven (2017): Eleven weeks of strength training decreased the expression of immune-related genes in older subjects independent of protein supplement type; a randomized controlled trial. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.24

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THE RELATIONSHIP BETWEEN MARKERS OF MALNUTRITION AND MUSCLE WASTING WITH FRAILTY AND PHYSICAL FUNCTION IN OLDER CARE HOME RESIDENTS

A. Slee, T. Ahmed, L. Storey, L. Wilkinson, G. Wilson, G. Garden

J Aging Res Clin Practice 2017;6:176-181

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Background: Older care homes residents may suffer from malnutrition and muscle wasting within a background of varying degrees of frailty, comorbidity and disability. Hence, malnutrition is complicated by co-presence of sarcopenia, cachexia and inactivity-induced muscle atrophy. Objectives: (1) to assess the prevalence of malnutrition in care home residents using different methodologies. (2) To examine the relationship between measurements of nutritional status and muscle mass with frailty and physical function; Design: initial pilot study. Setting: care homes for older people. Participants: 73 participants, 46 female and 27 male; Intervention: observational study. Measurements: height (m), weight (kg), body mass index (BMI) (kg), bioelectrical impedance assessment (BIA) of fat free mass index (FFMI) (kg/m2), mid upper arm muscle circumference (MUAMC) (cm), Edmonton Frailty Scale (EFS) and Barthel Index (BI). Results: There was a relatively high prevalence of malnutrition depending on measure used. MNA-SF 0-7 score was 30% for females and 28% males. Low MUAMC was found in 41% females and 53% males; low BIA FFMI in 37% females and 52% males. Good correlation (P<0.001) was found for most measures including against EFS and BI for MNA-SF and MUAMC. Conclusions: Malnutrition prevalence was relatively high. MNA-SF and MUAMC correlated well with functional status and frailty EFS measures. FFMI by BIA correlated well with MNA-SF and MUAMC. This range of practical techniques should be explored further for determining malnutrition risk and muscle wasting in relation to functionality and frailty in care home residents.

CITATION:
A. Slee ; T. Ahmed ; L. Storey ; L. Wilkinson ; G. Wilson ; G. Garden (2017): The Relationship between Markers of Malnutrition and Muscle Wasting with Frailty and Physical Function in Older Care Home Residents. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.23

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mTOR REGULATES THE PROLIFERATION AND DIFFERENTIATION OF TENDON STEM CELLS: AN IN VITRO STUDY

S. Gao, H. Tang, B.H. Zhou, K.L. Tang

J Aging Res Clin Practice 2017;6:168-175

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Objectives: The mechanistic target of rapamycin (mTOR) controls cell growth and proliferation via translation regulation in eukaryotes. The present study investigated the effects of mTOR on the proliferation and differentiation of tendon stem cells (TSCs). Methods: The proliferation and differentiation ability of TSCs was tested in response to antagonist (MHY1485), and a depressor of mTOR (Rapamycin and KU0063794). CCK test was performed to test cell proliferation; quantitative real-time PCR (RT-PCR) and Western blot test were performed to evaluate the differentiation of TSCs. Results: Blocking of mTOR1 inhibited the proliferation of TSCs and blocking of mTOR2 enhanced the proliferation of TSCs; however, the effects of mTOR1 surpassed the effects of mTOR2. Blocking of mTOR1 or activation of mTOR2 induced the expression of TNC, and blocking of mTOR2 inhibited the expression of TNC. Blocking of mTOR1 by rapamycin decreased the expression of ap2. Both blocking of mTOR1 or mTOR2 had little effects on the expression of Runx2 and Sox9; however, activation of mTOR2 induced the expression of Runx2 and Sox9. Moreover, the Western blot test showed that blocking of mTOR1 by Rapamycin or the blocking of both mTOR1 and mTOR2 by KU-0062794 enhanced the expression of TNC; in addition, blocking of mTOR1 by Rapamycin enhanced the expression of c-EBPα and Sox9. However, activation of mTOR1 and mTOR2 by MHY1485 increased the expression of Runx2. Conclusions: mTOR played important roles in the proliferation and differentiation of TSCs. Furthermore, mTOR1 and mTOR2 played different roles on the proliferation and differentiation of TSCs. Blocking mTOR1 inhibited the proliferation of TSCs and played a dominant function.Blocking of mTOR1 enhanced the expression of tenocyte related genes; however, blocking of mTOR2 inhibited the expression of TNC. Blocking of mTOR1 by rapamycin decreased the expression of ap2 and activation of mTOR2 induced the expression of Runx2.

CITATION:
S. Gao ; H. Tang ; BH. Zhou ; KL. Tang (2017): mTOR Regulates the Proliferation and Differentiation of Tendon Stem Cells: An In Vitro Study. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.22

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COMPARISON OF CURRENT SARCOPENIA CLASSIFICATION CRITERIA IN OLDER NEW ENGLAND WOMEN

S.G. Slezak, K.B Mahoney, E.N. Renna, I.E. Lofgren, F. Xu, D.L. Hatfield, M.J. Delmonico

J Aging Res Clin Practice 2017;6:163-167

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Objectives: To evaluate the prevalence of sarcopenia in a sample of older, sedentary women using criteria from the European Working Group on Sarcopenia in Older People (EWGSOP), the International Working Group (IWG), and the Foundation for the National Institutes of Health Sarcopenia Project (FNIHSP). Design: Cross-sectional analysis. Setting and Participants: Community-dwelling women (n = 61) aged 71.9 ± 4.6 years (mean±SD) with a BMI 27.3 ± 6.0 kg/m2 who by self-report were healthy and did not exercise were recruited and evaluated for sarcopenia. Measurements: Height, weight, grip strength, gait speed, and appendicular lean mass (via segmental multi-frequency bioelectrical impedance analysis: SMF-BIA) were measured. Prevalence was reported using descriptive statistics and a Fisher’s exact test was used to analyze the distribution frequency of sarcopenia classification by different criteria. Results: In this sample 14.8% met EWGSOP criteria, 6.6% met FNIHSP criteria, and 3.3% met IWG criteria. There was a borderline significant difference in distribution frequency between EWGSOP and IWG classification criteria (p=0.053). Conclusion: The variation in sarcopenia prevalence depending on the diagnostic criteria used is consistent with previous research and there are borderline significant differences between classification criteria in this population. These data suggest the need for additional examination to determine current cut points for ALM measured by SMF-BIA, as well as which established definition of sarcopenia is appropriate for this population.

CITATION:
S.G. Slezak ; K.B Mahoney ; E.N.Renna ; I.E. Lofgren ; F. Xu ; D.L. Hatfield ; M.J. Delmonico (2017): Comparison of Current Sarcopenia Classification Criteria in Older New England Women. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.21

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HUGE EQUATION ACCURACY FOR SCREENING CHRONIC KIDNEY DISEASE: A PROSPECTIVE STUDY

C.G. Musso, S. Maytin, P. Conti, S. Terrasa, A. Primerano, A. Reynaga, M. Vilas, J. Jauregui

J Aging Res Clin Practice 2017;6:158-162

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Objectives: Chronically reduced glomerular filtration rate (GFR) in old people does not always mean that they suffer from chronic kidney disease (CKD) since their GFR can just be induced by ageing. The HUGE equation has been recently described and validated in Spain for screening CKD without taking into account the patient´s GFR value This study evaluated HUGE performance in Argentine patiens. Material & Method: This was a prospective study to assess the operational characteristics of the HUGE equation for diagnosing CKD (diagnostic accuracy) in an ambulatory adult (age ≥ 18 years old) population (n: 205) assisted at the ambulatory clinical consult of Hospital Italiano de San Justo, Buenos Aires, Argentina in 2016. Results: It was documented that HUGE equation had a sensitivity of 56.7% (IC: 37.4% - 74.5%), and a specificity of 95.9% (IC: 88.6% - 99.1%) for screening CKD in elderly individuals who have an estimated GFR < 45 ml/min/1.73 m². Additionally, it was found that the screening strategy of combining HUGE with estimated GFR and urinalyses, showed a very good performance for detecting CKD, not only in elderly people but also in young people. Both triple combined CKD screening strategies showed a sensitivity around 86%, and 98% in young and elderly people, respectively. Conclusion: This study documented that the HUGE equation had and acceptable performance for screening moderate-severe CKD (stages III b-V) in elderly people, and an excellent performance for screening CKD in general population in combination with estimated GFR and urinalyses.

CITATION:
C.G. Musso ; S. Maytin ; P. Conti ; S. Terrasa ; A. Primerano ; A. Reynaga ; M. Vilas ; J. Jauregui (2017): HUGE equation accuracy for screening chronic kidney disease: a prospective study. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.20

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DIOGENES SYNDROME: A PROSPECTIVE OBSERVATIONAL STUDY

J.-C. Monfort, E. Devouche, C. Wong, I. Pean, L. Hugonot-Diener

J Aging Res Clin Practice 2017;6:153-157

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Objectives: This prospective study was designed to look for the most appropriate appellation, clinical symptoms, and underlying associated diseases, and to investigate a possible central etiology. Design and Participants: This prospective observational study involved 50 subjects aged 50-93 years, living in their home in Paris, and consecutively notified to the community authorities due to risks (fire) or nuisances (stench, parasites, hoarding). Clinical symptoms, associated diagnoses, cognitive capacity and life events during childhood were assessed. Results: Hoarding is both the most frequent and the least alerting symptom. Six clinical types cover both medical and social situations that lead to notifications of risk and nuisances to the authorities. Almost half of the situations remained social as no diseases were found to be associated with the Diogenes syndrome. A traumatic life event during childhood could be a risk factor for all Diogenes syndromes although it is most often present among subjects without an associated disease. Conclusions: Our results are in favor of maintaining the appellation “Diogenes syndrome”, which embraces the entirety of the diverse situations reported to the authorities, social services and medical networks. These situations require time and a coordinated investigation by a medico-social team, as subjects with Diogenes syndrome do not always have an associated disease.

CITATION:
J.-C. Monfort ; E. Devouche ; C. Wong ; I. Pean ; L. Hugonot-Diener (2017): DIOGENES SYNDROME: A PROSPECTIVE OBSERVATIONAL STUDY. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.19

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EFFECTS OF FLOUR OR FLAXSEED OIL UPON INTRA-ABDOMINAL ADIPOSITY IN MALE RATS SUBJECTED TO EARLY WEANING

B. Ferolla da Camara Boueri, C. Ribeiro Pessanha, A. D\'Avila Pereira, D. Cavalcante Ribeiro, A. de Sousa dos Santos, C.C. Alves do Nascimento-Saba, C.A. Soares da Costa, G. Teles Boaventura1

J Aging Res Clin Practice 2017;6:149-152

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The present study was designed to evaluate intra-abdominal adiposity in rats subjected to early weaning and subsequently treated with diet containing flour or flaxseed oil until young life. Pups were weaned for separation from mothers at 14 days (early weaning, EW), and 21 days (control, C). After 21 days, control (C60) was fed with control diet. EW was divided into control (EWC60); flaxseed flour (EWFF60); flaxseed oil (EWFO60) diets until 60 days. At 21-60 day, intra-abdominal fat mass were evaluated. At 60 days, retroperitoneal adipocyte area was determined. At 21 days, EW group displayed lower (P<0.05) intra-abdominal fat mass. At 60 days, EWC60 group displayed lower (P<0.05) intra-abdominal fat mass. Adipocytes area were lower (P<0.05) in experimental groups. EWC60 displayed lower (P < 0.05) adipocytes area (vs. EWFF60 and EWFO60). Flour and flaxseed oil diets contribute to recovery of intra-abdominal adiposity after precocious interruption of lactation.

CITATION:
B. Ferolla da Camara Boueri ; C. Ribeiro Pessanha ; A. D'Avila Pereira ; D. Cavalcante Ribeiro ; A. de Sousa dos Santos ; C.C. Alves do Nascimento-Saba ; C.A. Soares da Costa ; G. Teles Boaventura (2017): VARIOUS DIAGNOSTIC MEASURES OF FRAILTY AS PREDICTORS FOR FALLS, WEIGHT CHANGE, QUALITY OF LIFE, AND MORTALITY AMONG OLDER FINNISH MEN . The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.18

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SARCOPENIA AND SARCOPENIC OBESITY IN OLDER COMMUNITY-DWELLING ADULTS WITH FAVORABLE HEALTH CONDITIONS

E. Ramírez-García, K. Moreno-Tamayo, S.C. Briseño-Fabian, S. Sánchez-García

J Aging Res Clin Practice 2017;6:143-148

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Objective: Determine the prevalence of sarcopenia and sarcopenic obesity in community-dwelling older adults with favorable health conditions using the diagnostic criteria from the European Working Group on Sarcopenia in Older People (EWGSOP). Design: Cross-sectional study. Setting/Participants: Including 197 older adults representing a population-based sample (n = 1,252) from baseline (year 2014) of the Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults (COSFOMA). Measurements: Anthropometric and body composition measurements were performed using bioelectric impedance analysis (BIA). Walking speed was determined with walking time of 4.5 m (<0.8 m/s), grip strength with dynamometer (women <20 kg and men <30 kg) and muscle mass using BIA (muscle mass index: women <6.1 kg/m2 and men <8.5 kg/m2). The cutoff point for low muscle mass was set at 2 SD below average for a group of young adults. For obesity, body fat percentage >60th percentile was considered (38.4% female and 26.7% male). A p value <0.050 was considered statistically significant. Results: Mean age of the 197 older adults (44.2% female and 55.8% male) was 66.4 years (5.6): women 66.6 years (5.6) and men 66.4 years (5.8). The prevalence of sarcopenia was 7.1% (women 6.9% and men 7.2%). The presence of sarcopenic obesity was 2.5% (women 1.1% and men 3.6%). Conclusion: The magnitude of sarcopenia in older adults is important despite the absence of adverse health effects. This finding provides a reference point for future studies.

CITATION:
E. Ramírez-García ; K. Moreno-Tamayo ; S.C. Briseño-Fabian ; S. Sánchez-García (2017): Sarcopenia and sarcopenic obesity in older community-dwelling adults with favorable health conditions. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.17

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THE POTENTIAL ROLE OF DIETARY FACTORS ON URINARY INCONTINENCE IN THE ELDERLY

E.P. Cherniack, H.F. Lee

J Aging Res Clin Practice 2017;6:139-142

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Maintenance of urinary continence is a complex physiological process. Multiple morbidities can alter this process including polypharmacy, and age-related loss of physiological function. An increasing body of evidence suggests the importance of dietary factors and ingested substances. Modification of nutrients and ingested substances might prove beneficial adjunctive therapies in the treatment of incontinence, but remain unproven. Extrapolation of the results of epidemiologic studies of the relationship of excess caloric intake to continence, from the general adult population, suggests trials of weight loss might help. Population studies of vitamin D supplementation and continence also suggest an association, but prospective experimental trials involving vitamin D supplementation have yet to be done. A potential but far more equivocally documented relationship exists for vitamin B12 and continence. Surprisingly little evidence exists for other potential risk factors for incontinence such alcohol and sweeteners, natural or artificial. Future research should involve prospective trials of weight loss and vitamin D, and exploration of the relationship between other dietary factors and continence.

CITATION:
E.P. Cherniack ; H.F. Lee (2017): The potential role of dietary factors on urinary incontinence in the elderly. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.16

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FRAILTY SYNDROME AND ANTHROPOMETRIC MEASUREMENTS IN THE ELDERLY LIVING AT HOME

R.A. Partezani Rodrigues, J.R. Silva Fhon, V.M. Rojas Huayta, W.L. Fuentes Neira, M. de Lourdes de Farias Pontes, A.O. Silva, G.P. Cardoso Defina

J Aging Res Clin Practice 2017;6:133-138

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Disturbance in the nutritional status in the elderly can change anthropometric measurements. These changes on their body could associated with frailty syndrome. The aim was to assess the frailty syndrome and its association with demographic variables and anthropometric measures. Cross-sectional study with 235 elderly people living at home. Descriptive statistics applied were measures of central tendency and dispersion, with frequencies for the qualitative variables. Student’s t test was used to compare the means of sex with age, weight, height, waist circumference, waist/height ratio, body mass index and frailty and multinomial logistic regression analysis between categories of frailty and demographic and anthropometric variables. It was significant p≤0.05. There was a relationship between gender and body weight, waist circumference and the waist/height ratio; the data also showed that frailty increases with age. It was found that having a waist/height ratio ≥0.50 and a body mass index ≥27 increased the risk of frailty. The study shows that the association between frailty and anthropometric measures should be a priority in elderly care.

CITATION:
R.A. Partezani Rodrigues ; J.R. Silva Fhon ; V.M. Rojas Huayta ; W.L. Fuentes Neira ; M. de Lourdes de Farias Pontes ; A.O. Silva ; G.P. Cardoso Defina (2017): Frailty syndrome and anthropometric measurements in the elderly living at home. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.15

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TREATMENT SATISFACTION: A NEGLECTED BUT IMPORTANT OUTCOME MEASURE IN OLDER PEOPLE WITH TYPE 2 DIABETES

H. Langerman, R. Gadsby

J Aging Res Clin Practice 2017;6:124-132

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Objective: To investigate the effect of comprehensive geriatric care (CGC) in elderly referred to a rehabilitation unit. This article describes the considerations behind the study. Design: Participants were randomized to either CGC or standard care. Setting: Participants were recruited from two community care rehabilitation units in Aarhus Municipality, Denmark, in the period between 2012 and 2015. Participants: Inclusion: Elderly patients aged 65 and older admitted from home or hospital. Exclusion: Persons receiving palliative care or assessed by a geriatrician during the past month. Intervention: Medical history, physical examination, blood tests, medication adjustment and follow-up by a geriatrician. The control group received standard care with the general practitioners (GPs) as back-up. Outcomes: Primary outcome: Hospital contacts drawn from national registers. Secondary outcomes: GPs contacts, institutionalization, medication status and mortality collected from national registers and Activities of daily living (ADL), physical and cognitive function and quality of life measures collected by a blinded occupational therapist. All outcomes were assessed at day 10, 30 and 90 after arrival at the rehabilitation unit. Conclusion: A new model of care for elderly referred to community rehabilitation was developed and implemented. The potential benefits of this model were compared with usual care in a community rehabilitation unit in a pragmatic randomized clinical trial. We hypothesized that the geriatrician-performed CGC in elderly referred to a rehabilitation unit will reduce the hospital contacts by 25 % without increase in mortality and in contacts to GPs and home care services. We expect that this model will prevent deterioration in ADL, and physical and cognitive functioning, and reduce the risk of institutionalization. If the results are positive, community rehabilitation services should be encouraged to change their routines for treatment of this population accordingly.

CITATION:
H. Langerman ; R. Gadsby (2017): TREATMENT SATISFACTION: A NEGLECTED BUT IMPORTANT OUTCOME MEASURE IN OLDER PEOPLE WITH TYPE 2 DIABETES. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.14

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BASELINE FINDINGS OF CARENUTRITION INTERVENTION (RCT) AMONG OLDER CAREGIVERS - RISK OF MALNUTRITION AND INSUFFICIENT PROTEIN INTAKE

S. Kunvik, R. Valve, K. Salminen, M. Salonoja, M.H. Suominen

J Aging Res Clin Practice 2017;6:117-123

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Objectives: Older caregivers are vulnerable to nutritional problems, but only a few studies have examined their nutrition. The purpose of this study was to determine the associations between nutritional status and nutrient intake among older caregivers. Design: Cross-sectional analysis of baseline data from the CareNutrition randomized controlled trial (RCT). Setting: Community-dwelling caregivers from the Western part of Finland in two different clusters. Participants: A total of 79 caregivers aged ≥65 with normal cognition were recruited for the study, all of whom had officially approved caregiver status by The Social Insurance Institution of Finland. Measurement: Nutritional status was assessed by the Mini Nutritional Assessment (MNA), nutrient intake by a three-day food diary, nutrition-related blood markers by laboratory tests, cognition by the Mini Mental State Examination (MMSE), and other baseline characteristics were also evaluated using validated methods. Results: The majority of the caregivers (79.7%) had a good nutritional status (MNA points >23.5), 19% were at risk of malnutrition (MNA points 17-23.5) and one person (1.3%) already suffered from malnutrition (MNA points <17). The female caregivers were at a higher risk of malnutrition than the males (26.5% vs. 6.7%, p=0.026). Depressive symptoms and medication were associated with decreased nutritional status, and good health-related quality of life with better nutritional status. Mean protein intake was 1.0 g/kg IBW/d and 79.7% of the caregivers (77.6% female, 83.3% male) did not consume the recommended protein intake of 1.2 g/kg IBW/d. Their intake of dietary fibre, folate and vitamin D was also insufficient. Conclusion: Every fifth caregiver was at risk of malnutrition. The females were at a higher risk than the males. Most of the caregivers had insufficient protein intakes. These findings confirm the importance of investigating the nutritional status of older caregivers and indicate a need for preventive nutritional guidance.

CITATION:
S. Kunvik ; R. Valve ; K. Salminen ; M. Salonoja ; M.H. Suominen (2017): Baseline findings of CareNutrition intervention (RCT) among older caregivers - risk of malnutrition and insufficient protein intake. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.13

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ORAL NUTRITIONAL SUPPLEMENTS AND TASTE ADHERENCE IN MALNOURISHED ELDERLY ADULT’S OUTPATIENTS

D.A. de Luis, O. Izaola, A Castro, J.J. Lopez, B. Torres, E. Gomez Hoyos, A. Ortola

J Aging Res Clin Practice 2017;6:112-116

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Abstract: The aim of our study was to evaluate a hypercaloric sweet milkbased oral nutrition supplement in a prospective 3 day-study designed to assess the taste preferences of this oral nutritional supplement (ONS) in elderly malnourished out-patients and the influence on adherence in daily intake during two months.A total of 28 out-patients with recent weight loss were included in this study. One flavour (chocolate, vanilla or strawberry) was administered each day in a random way during three consecutive days. In the first three days, patients were asked to fulfill two questionnaires in order to reflect ONS tolerance and acceptance. Sweet and aftertaste were better for chocolate flavour than for vanilla or strawberry flavours. Patients who chose vainilla took a total of 96.3+7.4 average bricks during outpatient followup (1.60+0.3 per day), patients who chose chocolate took 76.8+15.0 bricks (1.28+0.8 per day) and patients who chose strawberry bricks taken 60.3+19.5 bricks (1.10+0.7 per day), with a significant difference with vainilla flavour (p <0.01). The improvement of weight (vanilla +1.0+0.8 kg vs chocolate +0.5+0.8 kg vs 0.6+1.0 kg:p=0.03), tricipital skinfols (vanilla +1.5+0.3 mm vs chocolate +1.1+0.4 mm vs 0.7+0.3 mm:p=0.03), prealbumin levels (vanilla +4.2+0.8 mg/dl vs chocolate +3.9+0.7 mg/dl vs +3.6+1.0 mg/dl:p=0.01) and transferrin levels (vanilla +100.0+21.8 mg/dl vs chocolate +75.5+18.8 mg/dl vs 63.8+14.1 mg/dl:p=0.03) was higher in patients treated with vanilla ONS than chocolate or strawberry ONS. The three flavoured ONS taste preferences are similar although the consumption is high in vanilla flavoured ONS.

CITATION:
D.A. de Luis ; O. Izaola ; A Castro ; J.J. Lopez ; B. Torres ; E. Gomez Hoyos ; A. Ortola (2017): Oral nutritional supplements and taste adherence in malnourished elderly adult’s outpatients. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.12

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EFFECTS OF INDIRECT NUTRITIONAL INTERVENTION BY A REGISTERED DIETITIAN THROUGH VISITING NURSES IN NUTRITIONALLY AT-RISK OLDER HOME-CARE RECIPIENTS: A RANDOMIZED PILOT STUDY

T. Tsuji, K. Yamasaki, N. Nishikawa, K. Yamamoto, Y. Yasui, D. Habu

J Aging Res Clin Practice 2017;6:105-111

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Objectives: Home-visit nutritional support services by registered dietitians for home-care patients are not popular due to a shortage of visiting registered dietitians. This study examined the effects of indirect nutritional intervention by a registered dietitian through visiting nurses in community-dwelling older home-care recipients. Design: A randomized, open-label, controlled clinical trial. Setting: Community. Participants: Thirty-four nutritionally at-risk older home-care recipients aged 65 years or older who were receiving home-visit nursing care services. Intervention: Dietary counseling promoting highly varied food intake provided by visiting nurses trained by a registered dietitian. Measurements: Nutritional status based on the Mini Nutritional Assessment-Short Form (MNA®-SF), dietary variety, anthropometric measurements, activities of daily living, and subjective diet-related quality of life were measured at baseline and after three months. Results: Nutritional status tended to improve in the intervention group (P = 0.087). Analysis of the changes of MNA®-SF item scores revealed significant improvement in “Appetite loss” (P = 0.046) and a trend toward improvement in “Weight loss” (P = 0.053) in the intervention group. Conclusion: Indirect nutritional intervention by a registered dietitian through visiting nurses was effective in improving the nutritional status of nutritionally at-risk older home-care recipients.

CITATION:
T. Tsuji ; K. Yamasaki ; Y. Masuda ; N. Nishikawa ; K. Yamamoto ; Y. Yasui ; D. Habu (2017): Effects of indirect nutritional intervention by a registered dietitian through visiting nurses in nutritionally at-risk older home-care recipients: a randomized pilot study. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.11

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ACUTE DIETARY NITRATE SUPPLEMENTATION FAILS TO IMPROVE EXERCISE ECONOMY IN ELDERLY

M. Driller, L. Thompson, J. McQuillan, R. Masters

J Aging Res Clin Practice 2017;6:101-104

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Objective: Improvements in exercise economy following dietary nitrate (NO3-) supplementation in young, athletic populations has been well documented, but little research has focused on whether these same benefits translate to elderly populations. Design: Participants completed two experimental trials in a double-blind, randomized, crossover design. Setting: University laboratory. Participants: Twenty-one elderly participants >65 yr (10 male/11 female, mean ± SD; age: 72 ± 6 yr). Intervention: Each trial consisted of participants ingesting a 70ml dose of either NO3- rich (NIT; 5.0mmol.L-1) or NO3- depleted (PLA; 0.003mmol.L-1) beetroot juice two hours prior to reporting to the laboratory. Measurements: On arrival at the laboratory, blood pressure was assessed followed by a five minute walking economy test on a treadmill (3km.h-1 and 1% gradient). VO2, heart rate and RPE were monitored during the walking test. Results: There were no significant differences (p > 0.05) between NIT and PLA trials for any of the measured variables during the walking test. Furthermore, no differences were found for blood pressure between trials. All results were associated with trivial or unclear effect sizes. Conclusion: Despite recent reports of improved exercise economy in young, athletic populations following NO3- supplementation, the current study did not find any benefit to sub-maximal VO2, heart rate, perceived exertion or blood pressure in elderly participants when performing a 5-minute walk following NO3- supplementation.

CITATION:
M. Driller ; L. Thompson ; J. McQuillan ; R. Masters (2017): Frailty in end-stage renal disease patients under dialysis and its association with clinical and biochemical markers. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.10

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CHANGES IN FUNCTIONAL CAPACITY IN POSTMENOPAUSAL WOMEN ADHERING TO A MEDITERRANEAN DIET

E. Ardolino, A. Garrett Ramos, H. Hutchins-Wiese, J. Kerstetter, J. Bihuniak, A. Kleppinger, A.M. Kenny

J Aging Res Clin Practice 2017;6:94-100

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Objectives: To evaluate whether Mediterranean style diet (MedSD) is associated with better physical performance. There is evidence from large epidemiological studies that MedSD associates with lower risk of chronic disease and mortality. Poor functional capacity, partially affected by poor physical performance, also predicts higher morbidity and mortality resulting in higher healthcare costs. Design: One group, longitudinal pilot clinical intervention trial of 24 weeks total; 12 weeks observation followed by 12 weeks intervention in 16 postmenopausal women (age>65 y) evaluating effects on physical performance. Setting: Outpatient clinical research center. Participants: 16 postmenopausal women (age>65 y) selected for typical American diet. Intervention: Women consumed their typical diet for 12 weeks followed by a 12-week MedSD intervention. A registered dietitian counseled the subjects to make 4 dietary changes: 1) incorporate 3 tablespoons Extra Virgin Olive Oil (EVOO) daily; 2) include 3-5 servings/week of high omega-3 fish (salmon or tuna); 3) incorporate 1.5 ounces of walnuts daily; 4) incorporate increased amounts of fruits, vegetables and whole grains. Measurement: Food frequency questionnaire scores, 3-day diet record, serum total fatty acids, anthropometry, physical activity, functional capacity (chair rise time, single leg time, hand grip strength were measured. Pre-post analysis compared the 2 weeks typical diet period with the 2 weeks MedSD intervention period. Correlations were used to relate dietary change to physical performance change. Results: Diet analysis revealed adherence to the MedSD (p = < 0.001). No significant differences were observed in hand grip strength or the Short Physical Performance Battery. Significant correlations were found between change in chair rise time and changes in intake of carbohydrates (r= 0.587) and trans and saturated fat (r= 0.818). Inability to identify other significant correlations in primary outcomes was likely affected by small sample size and physically robust participant group. Conclusions: Alterations in consumption patterns to adhere to a MedSD, including reductions in saturated fat and carbohydrate consumption, correlate with improvement in chair rise time. This study design can be used for future studies with a larger group of frailer, older adults to assess the effect of MedSD on physical performance.

CITATION:
E. Ardolino ; A. Garrett Ramos ; H. Hutchins-Wiese ; J. Kerstetter ; J. Bihuniak ; A. Kleppinger ; A.M. Kenny (2017): Changes in functional capacity in postmenopausal women adhering to a Mediterranean diet. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.9

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HEALTH-FUNCTION INDICATORS FOR THE PREDICTION OF ELDERLY FRAILTY

I-C. Lee, Y.-H. Chiu, I-N. Lee, C.-Y.Lee

J Aging Res Clin Practice 2017;6:88-93

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Objectives: It is crucially worth noticing of how to assess elderly frailty in recent years. This study explores 16 common indicators of health function to investigate the relationship between these indicators and frailty. It ranks the indicators as reference for frailty assessments. Design: Cross-sectional study. Setting: Regional frailty study. Participants : The sample comprised 597 elderly people who residence in the community. Measurements: This study commenced in 2012. By June 2014, 597 people aged over 65 years participated in this study. With the permission of the subjects, the trained interviewer conducted a face-to-face survey and measured the subjects’ walking speed and the strength of their grip. The statistical methods were t-test, Chi-square, logistic regression analysis and the decision tree. Results: In this study, there is 31.7% of elderly demonstrating the symptoms of frailty. Of the health-function indicators, the relationship between decreased appetite and frailty is the strongest, followed by IADL disability, declining cognitive function, malnutrition and pain. Poor eyesight and falling do not show a significant relationship to frailty. Conclusion: Among 16 health-function indicators, the association between nutritional problems and frailty in elderly people is the most significant. Future assessments of frailty should consider the importance of health-function indicators in order to enhance the scope. Screening at-risk elderly people for potential frailty will enable proper health-care planning to achieve the goal of healthy ageing.

CITATION:
I-C. Lee ; Y.-H. Chiu ; I-N. Lee ; C.-Y.Lee (2017): Health-Function Indicators for the Prediction of Elderly Frailty. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.8

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EFFECTIVENESS OF PILATES AND CAMELLIA SINENSIS SUPPLEMENTATION ON CARDIOMETABOLIC RISK FACTORS AND REDOX MARKERS IN POSTMENOPAUSAL WOMEN: A PLACEBO-CONTROLLED, RANDOMIZED TRIAL

S. Junges, R. Dias Molina, C. Bittencourt Jacondino, M. Lopes Da Poian, E. Tatsch, R. Noal Moresco, M.G. Valle Gottlieb

J Aging Res Clin Practice 2017;6:80-87

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Objective: To verify the effectiveness of Pilates and Camellia sinensis extract (CSE) supplementation on cardiometabolic risk factors and redox markers in postmenopausal women. Design: A placebo-controlled, randomized trial. Setting: community-dwelling postmenopausal women without disability. Participants: fifty postmenopausal women volunteers with cardiometabolic risk factors (high waist circumference, triglycerides, HDL-c, glucose and blood pressure). The volunteers participants were randomized in four groups: Pilates+CSE (14); Pilates+Placebo (11); CSE (11); and Placebo (14). Intervention: the CSE and Pilates+CSE intervention groups consumed one 500mg CSE capsule with excipient per day for 24 weeks. The Placebo group consumed one capsule with a placebo excipient per day for 24 weeks. Pilates training was performed twice weekly for 60 minutes each time, over 24 weeks. Measurements: cardiometabolic risk factors (glucose, waist circumference (WC), systolic blood pressure (SBP), diastolic blood pressure (DBP), triglycerides, high-density lipoproteins-HDL-c) and oxidative metabolism markers (advanced oxidation protein products (AOPP), ferric-reducing ability of plasma (FRAP), nitrosative stress marker (NOx), ischemia modified albumin (IMA). Results: When baseline variables were adjusted, the WC of the Pilates + CSE was significantly lower than that of the CSE and Placebo groups after the intervention (p<0,001).The triglycerides levels of the Pilates + CSE and Pilates + Placebo groups were significantly lower than those of the Placebo group (p= 0,010) . The glucose levels of the Pilates + CSE group were significantly lower than those of the Placebo group (p= 0,041). Whitin-group pre and post intervention comparison showed that Pilates+CSE group presented the best effect in some cardiometabolic risk factors, with significant reductions in tree cardiometabolic risk factor: waist circumference, triglycerides, glucose and FRAP (P=0.003, P<0.001, P=0.021 and P=0.041, respectively). The Pilates+Placebo group was found to be effective in reducing triglycerides (P=0.002), while the CSE group presented increased post-intervention NOx levels (p= 0.009). Conclusion: Our results suggest that Pilates and Camellia sinensis extract intervention may help to reduce some cardiometabolic risk factors in postmenopausal women.

CITATION:
S. Junges ; R. Dias Molina ; C. Bittencourt Jacondino ; M. Lopes Da Poian ; E. Tatsch ; R. Noal Moresco ; M.G. Valle Gottlieb (2017): EFFECTIVENESS OF PILATES AND CAMELLIA SINENSIS SUPPLEMENTATION ON CARDIOMETABOLIC RISK FACTORS AND REDOX MARKERS IN POSTMENOPAUSAL WOMEN: A PLACEBO-CONTROLLED, RANDOMIZED TRIAL. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.7

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THE BENEFITS AND BARRIERS OF EXERCISE FOR THE PHYSICAL HEALTH OF OLDER WOMEN

A. Tinker, L. Molloy, I. Monks, L. Pennells, E. Russell, E. Haines

J Aging Res Clin Practice 2017;6:73-79

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CITATION:
A. Tinker ; L. Molloy ; I. Monks ; L. Pennells ; E. Russell ; E. Haines (2017): The benefits and barriers of exercise for the physical health of older women. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.6

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GENETIC VARIANTS RELATED TO LIPID METABOLISM AS A RISK FACTOR TO LATE-ONSET ALZHEIMER’S DISEASE

M.A.S. Pinhel, A.M. Crestani, G.F. Sousa-Amorim, M.L. Gregório, J.C. Cação, W.A. Tognola, D. Rossi Silva Souza

J Aging Res Clin Practice 2017;6:68-72

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Background: Genetic polymorphisms in genes regulating cholesterol metabolism have been suggested to risk factor of developing Alzheimer’s disease (AD). Objective: to analyze the frequency of polymorphisms apolipoprotein E (APOE-HhaI) and adenosine triphosphate binding cassette transporter 1 (ABCA1-StyI) in patients with late-onset AD. Design: case-control study. Participants: We studied 166 subjects (≥65 years old): Study Group (SG)- 88 patients and Control Group (CG)- 88 without dementia. Setting: The polymorphisms were determined using the polymorphism chain reaction and restriction fragment length polymorphism (PCR-RFLP) methods. It was applied Fisher's exact/chi-square tests (P<0.05). Results: Genotypes with APOE*4 prevailed in SG. The genotypic combination between APOE-HhaI and ABCA1-StyI polymorphisms showed a prevalence of heterozygous genotypes of risk for AD. Conclusion: Although genetic variants for ABCA1-StyI alone does not differentiate patients and controls, the G allele in synergy with APOE*4 allele is highlighted in patients suggesting the influence of ABCA1 in the disease.

CITATION:
M.A.S. Pinhel ; A.M. Crestani ; G.F. Sousa-Amorim ; M.L. Gregório ; J.C. Cação ; W.A. Tognola ; D. Rossi Silva Souza (2017): Genetic variants related to lipid metabolism as a risk factor to late-onset Alzheimer’s disease. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.3

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IDEAL REDUCTION OF CALORIES FOR GREATEST REDUCTION OF BODY FAT AND MAINTENANCE OF LEAN BODY MASS

M. Lombardo, R. Magarotto, F. Marinelli, E. Padua, M. Caprio, G. Annino, A. Bellia, F. Iellamo

J Aging Res Clin Practice 2017;6:62-67

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Objectives: This retrospective clinical study was intended to assess the ideal number of calories in the Mediterranean-style diet (MD) required for maximum weight reduction through a greater decrease in fat mass (FM) and maintenance of fat-free mass (FFM). Methods: We analysed the data of 90 non-smoking subjects (56 females, age = 32.5 ± 9.6 years, BMI = 28.3 ± 5.4 kg/m2, data as mean ± SD). The participants underwent two-month individualised MDs with similar macronutrient composition (55% carbohydrate, 30% fat, 15% protein and fibre > 30 g) but different amounts of energy, which varied daily from 374 kcal to 1305 kcal compared with the total energy expenditure measured by metabolic Holter. The sample was divided into nine groups of 10 subjects in order to establish the amount of energy restriction that was most effective in terms of achieving fat loss and maintaining muscle mass. Results: All subject groups had significant improvements in body composition parameters (weight loss = 2.7 ± 1.8 kg, FM loss = 2.2 ± 1.2 kg and FFM loss = 0.5 ± 1.3 kg). Differences between the nine groups were not significant but higher FM loss was observed in groups one, three, six and eight. Groups one and four had the highest FFM increase and groups two, three and eight had the highest FFM loss. Conclusions: These data suggest that increasing the amount of energy restriction in a low-calorie MD might be useless in terms of obtaining a higher FM loss but a lower restriction could be more effective for maintaining FFM.

CITATION:
M. Lombardo ; R. Magarotto ; F. Marinelli ; E. Padua ; M. Caprio ; G. Annino ; A. Bellia ; F. Iellamo (2017): Ideal reduction of calories for greatest reduction of body fat and maintenance of lean body mass. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.1

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EFFECT OF INCREASED DAILY INTAKE OF PROTEIN, COMBINED WITH A PROGRAM OF RESISTANCE EXERCISES, ON THE MUSCLE MASS AND PHYSICAL FUNCTION OF COMMUNITY-DWELLING ELDERLY WOMEN

H. Mori, Y. Tokuda

J Aging Res Clin Practice 2017;6:56-61

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Background: In elderly women, significant loss of muscle mass due to declining levels of estrogen secretion is a health concern. Increasing the recommended dietary allowance of protein intake has been included as a general health guideline to prevent age-related sarcopenia. Objectives: To investigate effects of light-to-moderate resistance training combined with increased protein intake on the muscle mass, strength, and physical function of community-dwelling elderly women. Design: The 12-week training program combined weight-bearing and resistance band exercises, performed 3 times per week. Setting: Hyogo Prefecture, in either City K or Town H. Practical Intervention: Women were randomly allocated to three groups: exercise with protein intake adjusted to the recommended daily allowance (RDA) of 1.0–1.1 g/kg body weight/day (MP+EX group); exercise with protein intake adjusted above the RDA level at 1.2–1.3 g/kg body weight/day (HP+EX group); and a control group receiving classroom-based session on nutrition management, with protein intake adjusted to the RDA level (MP group). Measurements: Body weight and physical composition were measured by multi-frequency bioelectrical impedance analysis. Results: Exercise prevented decreases in muscle mass and strength and in performance of physical function tasks (p<0.05). Increasing dietary intake of protein above RDA level increased muscle mass (p<0.01), walking speed (p<0.01) and knee extensor strength (p<0.05). Conclusion: Adjusting protein intake to 1.2–1.3 g/kg body weight/day, in combination with light-to-moderate resistance training, can improve body composition and physical function in elderly women. The result of this study could be effective in lowering the incidence of age-related sarcopenia.

CITATION:
H. Mori ; Y. Tokuda (2016): Effect of increased daily intake of protein, combined with a program of resistance exercises, on the muscle mass and physical function of community-dwelling elderly women. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.124

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FOLATE AND SYNTHETIC FOLIC ACID INTAKE, SERUM B VITAMIN AND HOMOCYSTEINE CONCENTRATIONS, AND COGNITIVE IMPAIRMENT IN ELDERLY BRAZILIANS

V. Ferri Ross Perucha, R. de Cássia de Aquino, N. Gaspareto, E.M. Guerra-Shinohara, P. Mendonça da Silva Amorim, V. d’Almeida

J Aging Res Clin Practice 2017;6:48-55

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Background: An increased risk of cognitive decline in the elderly with B12 deficiency has been associated with excessive synthetic folic acid in food fortification and supplements. Objectives: To assess the dietary folate and folic acid intake from food fortification, as well as serum vitamin B12, folate, iron, and homocysteine concentrations among the elderly and their relationships with cognitive changes. Design: Cross-sectional, observational study. Setting and Participants: Community-dwelling elderly (N = 40), predominantly female (90%), with an average age of 69 years. Measurements: Dietary intake information was collected using four 24-hour dietary recalls, adjusted for iron and folic acid in fortified flour and supplements. Serum vitamin B12, B6, folate, iron, and homocysteine concentrations were determined. Cognitive function was assessed using the Mini-Mental State Examination, adjusted for educational level. Results: Possible serum vitamin B12 deficiency (<258 pmol/L) was present in 5% of the elderly participants, while 27.5% had possible functional deficiency (<400 pmol/L). No serum folate deficiency (<6.8 nmol/L) was observed; however, 15% had possible deficiency (<13.6 nmol/L), and 7.5% had supraphysiological levels. Hyperhomocysteinemia (≥15 µmol/L) was present in 65% of the sample. Almost half of the participants (47.5%) showed cognitive impairment. There were no significant relationships between the Mini-Mental State Examination results and the B12, folate, iron, and homocysteine concentrations. However, the participants with serum vitamin B12 levels <400 pmol/L tended to have poorer Mini-Mental State Examination scores, which were related to older age (P = 0.045) and changes in the oral cavity (P = 0.034). In addition, folic acid consumption was inversely related with serum vitamin B12 levels (P = 0.030). Macrocytosis was not observed. Conclusions: Although Mini-Mental State Examination-assessed cognitive impairment was not related with the investigated biochemical variables, increased folic acid consumption seems to have a negative impact on vitamin B12 metabolism; therefore, fortification may be contributing to functional disability and masking hematological signs in the elderly.

CITATION:
V. Ferri Ross Perucha ; R. de Cássia de Aquino ; N. Gaspareto ; E.M. Guerra-Shinohara ; P. Mendonça da Silva Amorim ; V. d’Almeida (2017): Folate and synthetic folic acid intake, serum B vitamin and homocysteine concentrations, and cognitive impairment in elderly Brazilians. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.5

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COMPREHENSIVE GERIATRIC CARE VERSUS STANDARD CARE FOR ELDERLY REFERRED TO A REHABILITATION UNIT – A RANDOMIZED CONTROLLED TRIAL

D. Zintchouk, T. Lauritzen, E.M. Damsgaard

J Aging Res Clin Practice 2017;6:40-47

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Objective: To investigate the effect of comprehensive geriatric care (CGC) in elderly referred to a rehabilitation unit. This article describes the considerations behind the study. Design: Participants were randomized to either CGC or standard care. Setting: Participants were recruited from two community care rehabilitation units in Aarhus Municipality, Denmark, in the period between 2012 and 2015. Participants: Inclusion: Elderly patients aged 65 and older admitted from home or hospital. Exclusion: Persons receiving palliative care or assessed by a geriatrician during the past month. Intervention: Medical history, physical examination, blood tests, medication adjustment and follow-up by a geriatrician. The control group received standard care with the general practitioners (GPs) as back-up. Outcomes: Primary outcome: Hospital contacts drawn from national registers. Secondary outcomes: GPs contacts, institutionalization, medication status and mortality collected from national registers, activities of daily living (ADL), physical and cognitive function and quality of life measures collected by a blinded occupational therapist. All outcomes were assessed at day 10, 30 and 90 after arrival at the rehabilitation unit. Conclusion: A new model of care for elderly referred to community rehabilitation was developed and implemented. The potential benefits of this model were compared with usual care in a community rehabilitation unit in a pragmatic randomized clinical trial. We hypothesized that the geriatrician-performed CGC in elderly referred to a rehabilitation unit will reduce the hospital contacts by 25 % without increase in mortality and in contacts to GPs and home care services. We expect that this model will prevent deterioration in ADL, physical and cognitive functioning, and reduce the risk of institutionalization. If the results are positive, community rehabilitation services should be encouraged to change their routines for treatment of this population accordingly.

CITATION:
D. Zintchouk ; T. Lauritzen ; E.M. Damsgaard (2016): COMPREHENSIVE GERIATRIC CARE VERSUS STANDARD CARE FOR ELDERLY REFERRED TO A REHABILITATION UNIT – A RANDOMIZED CONTROLLED TRIAL. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.126

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PSYCHOMETRIC PROPERTIES OF THE SUBJECTIVE-OBJECTIVE MALNUTRITION RISK ASSESSMENT (SOMRA) IN A STUDY OF SWEDISH PEOPLE AGED ? 60 YEARS

M. Naseer, C.Fagerström

J Aging Res Clin Practice 2017;6:32-39

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Objective: This study aimed to investigate the risk of malnutrition and to evaluate the psychometric properties of the Subjective-Objective Malnutrition Risk Assessment (SOMRA), SOMRA cut-offs and Swedish-Guidelines on Malnutrition Risk Assessment (SGMRA) for Swedish people aged ≥ 60 years. Setting: This study included both older people living at home and those in special housing. Participants: 1222 of the 1402 subjects aged ≥ 60 years who had participated in the baseline survey (2001–2003) as part of the ongoing National Study on Aging and Care-Blekinge (SNAC-B) were included because they had provided complete information on Mini-Nutritional Assessment (MNA). Measurements: The risk of malnutrition was estimated by the SOMRA, MNA, and SGMRA. To measure concurrent validity, the Receiver Operating Characteristics (ROC) curve, Cohen’s kappa (κ) and Spearman’s rank correlation coefficient rho (rs) were used. Youden’s index (J) was computed to assess the optimal cut-off on SOMRA. Cronbach’s alpha (α) was used to test reliability. Results: The risks of malnutrition measured by SOMRA, MNA and SGMRA were 6.5%, 8.6% and 20.9%, respectively. The risk was higher among older people living in special housing compared to those at home (p < 0.05). Different optimal cut-offs on SOMRA were observed for residents living at home (≥ 1) and those in special housing (≥ 3). Compared to SGMRA, the SOMRA and SOMRA cut-off ≥ 3 gave higher values for J (0.68, 0.81, and 0.84, respectively), κ (0.59, 0.77, and 0.84, respectively) and rs (0.64, 0.78, and 0.84, respectively) for the older people in special housing. The reliability for SOMRA was α = 0.71. Conclusion: The risk of malnutrition was higher among older people in special housing than among those living at home. For the people in special housing, the SOMRA and SOMRA cut-off ≥ 3 showed higher concurrent validity with MNA compared to the SGMRA, but not for older people living at home. SOMRA includes six items, takes less time to implement and is composed of both subjective and anthropometric measurements; therefore, it is suitable for use in special housing and/or clinical settings to identify the risk of malnutrition or the need for nutritional support.

CITATION:
M. Naseer ; C.Fagerström (2016): Psychometric Properties of the Subjective-Objective Malnutrition Risk Assessment (SOMRA) in a Study of Swedish People Aged ≥ 60 Years. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.125

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INTERVENTIONS FOR INDIVIDUALS WITH YOUNG-ONSET DEMENTIA. A REVIEW OF THE LITERATURE

M. Aplaon, P. Belchior, I. Gélinas, N. Bier, A. Aboujaoudé

J Aging Res Clin Practice 2017;6:28-31

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Objective: The aim of this study was to conduct a scoping review of the literature to investigate non-pharmacological interventions for individuals with young-onset dementia and examine their success. Methods: A comprehensive review of the literature was conducted. The following databases were included in our search: Ovid Medline, PsycINFO, Pubmed, CINHAL. Studies were retained if they were 1) peer-reviewed; 2) published in English; 3) focused on non-pharmacological interventions; 4)designed for persons with dementia; and 5) diagnosis before the age of 65. Results: A total of 7 articles met our inclusion criteria and were included in the study. Of those, four consisted in social programs involving the community as part of the intervention, two focused on a cognitive based intervention and one focused on a cognitive behavioral intervention. The social interventions were successful in improving the mood and well-being of participants as well as providing respite for caregivers. The cognitive interventions were successful in improving perceived functional outcomes and affective symptoms of participants. Discussion: A discussion of each intervention including their benefits for individuals with young-onset dementia and their caregivers is presented.

CITATION:
M. Aplaon ; P. Belchior ; I. Gélinas ; N. Bier ; A. Aboujaoudé (2016): Interventions for individuals with young-onset dementia. A review of the literature. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.123

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RELATIVE VALIDITY OF SHORT QUESTIONNAIRES TO ASSESS MEDITERRANEAN DIET OR LOW-FAT DIET ADHERENCE

K. Miura, T.R. Entwistle, J.E. Fildes, A.C. Green

J Aging Res Clin Practice 2017;6:23-27

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Background: Short diet questionnaires can quickly identify dietary habits with minimal burden for users but they require validation for use in specific populations. Objective: To assess relative validity against a food frequency questionnaire (FFQ) of two short questionnaires to assess a Mediterranean diet and a low-fat diet, respectively, among organ transplant recipients as a part of a pilot study. Design: Cross-sectional validation study. Setting: Heart or lung transplant recipients completed two short dietary questionnaires and a full semi-quantitative FFQ as the reference methods, on 3 separate days. Participants: Sixteen heart (n=8) or lung (n=8) transplant recipients aged 16 years or more, at least 6-months post-transplant and clinically stable patients in Manchester, UK. Measurements: Two short dietary questionnaires to assess their Mediterranean diet and low-fat diet and a semi-quantitative FFQ. Relative validity was assessed by comparing the scores derived from each short questionnaire with that of the FFQ. Agreement was assessed using the limits of agreement (LOA), and the agreement was expressed as a ratio of the score from the short dietary to the FFQ score with a ratio of 1.00 indicating perfect agreement. The agreement was formally tested by the two one-sided t-test procedure. Results: The mean agreement was 0.99 (95% LOA 0.60–1.38) for the Mediterranean and 1.04 (95% LOA 0.42–1.64) for the low-fat diet. The two one-sided t-test procedure showed the short questionnaires and the reference method were equivalent (Mediterranean diet overall p=0.004; low-fat diet overall p<0.001). Conclusions: Dietary habits to measure Mediterranean diet and a low-fat diet by short dietary questionnaires and full FFQ were comparable among organ transplant recipients.

CITATION:
K. Miura ; T.R. Entwistle ; J.E. Fildes ; A.C. Green (2017): Relative validity of short questionnaires to assess Mediterranean diet or low-fat diet adherence. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.4

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HYDROGEN: THERAPEUTIC POTENTIAL IN WELLNESS AND MEDICINE

M. Lemaire, F. Barbier

J Aging Res Clin Practice 2017;6:14-22

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Persistent oxidative stress plays an important role in a variety of pathologies, and the search for an effective and well tolerated antioxidant agent continues. Molecular hydrogen acts as a therapeutic antioxidant by selectively reducing cytotoxic oxygen radicals. The non-specific mechanism of hydrogen as a therapeutic antioxidant gives it broad therapeutic potential across a wide range of medical applications, as has been shown by a substantial volume of preclinical data, as well as a growing body of clinical evidence. This review provides an overview of the therapeutic potential of hydrogen, in ageing and wellness applications as well as medical applications, including acute ischemia/reperfusion injury, inflammation and ulceration, metabolic disorders, neurodegenerative disorders, and cancer (anti-cancer effects, radiation toxicities, and side effects of cisplatin) with an emphasis on clinical data. Overall, this review shows that hydrogen is an effective antioxidant, anti-inflammatory and cytoprotective agent.

CITATION:
M. Lemaire ; F. Barbier (2017): Hydrogen: therapeutic potential in wellness and medicine. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2017.2

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KNOWLEDGE OF ALZHEIMER’S DISEASE AND TRAINING NEEDS IN FINAL YEAR MEDICAL AND PHARMACY STUDENTS

C. Scerri

J Aging Res Clin Practice 2017;6:9-13

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Although a significant number of medical and pharmacy professionals come into contact with an increasing number of individuals with Alzheimer’s disease and other dementias, there is concern on the lack of knowledge and skills received during their undergraduate training programmes with the consequence of not providing the required hospital and community care for these individuals following programme completion. The aim of this report is to describe the results of a small scale study investigating the level of knowledge of Alzheimer’s disease and training needs in medical and pharmacy students at the end of their final year of undergraduate training. The findings indicated a lack of in-depth knowledge for both categories of students, in particular on risk factors and pharmacotherapeutic management highlighting an urgent need of refining existent training programmes that equip future medical and pharmacy professionals with the necessary skills in providing adequate care and management for individuals with the disease.

CITATION:
C. Scerri (2016): Knowledge of Alzheimer’s disease and training needs in final year medical and pharmacy students. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.122

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ANTIOXIDANT SUPPLEMENTS IN ALZHEIMER’S DEMENTIA AND MILD COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW

E.J. Pegg

J Aging Res Clin Practice 2017;6:1-8

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Objective: Current treatments have only a modest effect on impairment in Alzheimer’s Dementia (AD) and there is no treatment currently licensed for Mild Cognitive Impairment (MCI). Oxidative stress is postulated to play a role in the pathogenesis of AD and MCI and this provides a rationale for treatment with antioxidant supplements. The aim of this review is to evaluate the effect of antioxidant supplements in people with AD and MCI. Methods: A systematic review of published randomised controlled trials was carried out. 4 electronic databases were searched. Studies were included if they compared the use of a placebo with the following antioxidant supplements in people with AD or MCI: Vitamin e, vitamin c, selenium, alpha lipoic acid, phenols, zinc, curcumin, beta carotene, coenzyme Q10, melatonin. The primary outcome measure was cognitive impairment. Secondary outcome measures included functional impairment, behavioural disturbance and safety. Results: 10 trials were identified which met the inclusion criteria. Outcome data was not suitable for meta-analysis. 5 studies reported a small positive treatment effect on cognition and 1 reported a negative effect. 2 reported a positive treatment effect on functional ability and 1 on behaviour. There were no consistent adverse effects found overall however two studies raised concern of possible worsening of cognition in certain circumstances. Conclusions: The findings of this systematic review do not support the use of antioxidant supplements to slow cognitive, functional or behavioural deterioration in people with AD or MCI. However the majority of included studies had a high or unknown risk of bias. In the one study which had a low overall risk of bias, there was evidence that antioxidant supplements may have a positive effect on functional decline in AD. The overall risk of harm associated with short term antioxidant supplementation appears to be low however caution is warranted. Further studies evaluating the role of oxidative stress in the pathogenesis of AD are suggested.

CITATION:
E.J. Pegg (2016): Antioxidant supplements in Alzheimer’s dementia and mild cognitive impairment: A systematic review. The Journal of Aging Research and Clinical Practice (JARCP). http://dx.doi.org/10.14283/jarcp.2016.121

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