Clinical and pathophysiological relationships in sarcopenia and frailty. described with multiple causes, inter-relationships and complex pathways proposed. The most striking difference with the Fried definition of frailty was that any variable . synthetic response to both feeding and exercise, termed anabolic resistance. Nutrition, sarcopenia and frailty: a complex relationship. Juergen M. Criteria for the phenotypic definition of frailty developed by Fried et al (). The general. Nutrition, sarcopenia and frailty: a complex relationship . Nevertheless there is still no consensus on the definition of sarcopenia and its diagnosis. Despite its.
In that study, sedentariness was associated only with comorbidities, while the weekly caloric expenditure was associated with HGS, gait speed, and fatigue, all the criteria of the frailty phenotype. However, it is noteworthy that the instrument used by those authors to assess the weekly caloric expenditure was the Minnesota Leisure Time Physical, which contains activities not practiced in Brazil, which may lead to a ceiling effect on the score, in addition to being difficult to apply in the Brazilin elderly population because it requires remembering activities of little relevance for this population.
Low gait speed shows an association with various negative outcomes in elderly subjects 29including frailty syndrome In the present study, gait speed was correlated with the SPPB total score, in agreement with Vasunilashorn et al. They found, after adjustment for gender and age, that elderly subjects with SPPB scores below 10 had higher risks of developing mobility deficits compared to subjects with higher scores, while scores below 7 indicated a fold-higher chance of being unable to walk four blocks.
Nutrition and Sarcopenia: A Review of the Evidence and Implications for Preventive Strategies
The regression model used in the present study also showed that gait speed was the variable most strongly indicative of depression for both sarcopenia indicators These findings are similar to those of Chale-Rush et al. Several authors emphasize the importance of gait speed in assessing the elderly individual. A recent systematic literature review highlighted that there is sufficient evidence to characterize gait speed as a consistent predictor of adverse events in the elderly.
In that study, low gait speed was correlated with inability to perform BADL, dementia, mortality, falls, institutionalization, and hospitalization. The authors additionally emphasized the low cost and high clinical applicability of the marker There was a significant difference between the fallers and non-fallers in HGS in this study.Frederick Wu - Testosterone, sarcopenia and frailty
This finding may suggest less muscle strength of the lower limbs in the faller group. No associations were found between MNA score and the frailty profile of the elderly subjects. However, MNA was significantly correlated with the SPPB total score, demonstrating a possible influence of nutritional status on the functionality of the elderly.
This finding agrees with the results of Lee et al. The authors hypothesized a possible influence of nutritional status on sarcopenia and, consequently, on frailty. The main limitations of this study are related to the choice of the sample because it was specific to a secondary health care service, a factor that limits the external validity of the findings. In addition, the sarcopenia measurements were performed indirectly instead of using more accurate equipment to determine the loss of muscle mass and strength.
Nevertheless, all the instruments used are easily applicable in clinical practice and can be included in daily evaluations by any health professional who cares for the elderly, facilitating the early detection of factors that may be primarily responsible for the onset of frailty and its negative outcomes. Conclusion This study confirmed the association between sarcopenia and frailty and showed that physical inactivity and gait speed may be the most important factors in screening for frailty syndrome.
Identifying these factors is important for efforts to prevent or attenuate the deleterious effects of sarcopenia, especially in the functional profile of the elderly. Frailty in older adults: Severe osteopenia and osteoporosis, sarcopenia, and frailty status in community-dwelling older women: Frailty among community-dwelling elderly people in France: Prevalence of and risk factors for sarcopenia in elderly Chinese men and women.
Sarcopenia is related to physical functioning and leg strength in middle-aged women. Conceptualisation and measurement of frailty in elderly people.
European consensus on definition and diagnosis: Am J Clin Nutr. Initial manifestations of frailty criteria and the development of frailty phenotype in the Women's Health and Aging Study II.
Associated factors and health impact of sarcopenia in older chinese men and women: Defining sarcopenia in terms of risk of physical limitations: J Am Geriatr Soc. Interplay of stress and physical inactivity on muscle loss: Longitudinal muscle strength changes in older adults: However, whilst amino acid supplementation has been shown to increase lean mass and improve physical function [ 18 ], other trials have not been successful [ 1619 ].
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Further work, including longer-term trials, is needed to define optimal protein intakes in older age [ 16 ]. Vitamin D An association between vitamin-D-deficient osteomalacia and myopathy has been recognised for many years [ 20 ], but the role of vitamin D, and the extent to which it has direct effects on normal muscle strength and physical function remains controversial [ 21 ].
The potential mechanisms that link vitamin D status to muscle function are complex and include both genomic and nongenomic roles [ 2022 ]. The vitamin D receptor VDR has been isolated from skeletal muscle, indicating that it is a target organ [ 20 ], and polymorphisms of the VDR have been shown to be related to differences in muscle strength [ 23 ]. At the genomic level, binding of the biologically active form of the vitamin 1,dihydroxyvitamin D results in enhanced transcription of a range of proteins, including those involved in calcium metabolism [ 20 ].
The nongenomic actions of vitamin D are currently less well understood [ 22 ]. Much of the epidemiological literature is consistent with the possibility that there are direct effects of vitamin D on muscle strength. However, the evidence is not always consistent as some observational studies find no association between vitamin D status and physical function, and supplementation studies have not always resulted in measurable improvements in function [ 21 ].
In a review of published studies, Annweiler and colleagues [ 21 ] discuss the reasons for the divergence in study findings, some of which may be due to methodological differences, including a lack of consideration of confounding influences in some studies.
Further evidence is needed, particularly as vitamin D insufficiency is common among older adults [ 24 ].
Antioxidant Nutrients There is increasing interest in the role of oxidative stress in aetiology of sarcopenia, and markers of oxidative damage have been shown to predict impairments in physical function in older adults [ 25 ]. Damage to biomolecules such as DNA, lipid, and proteins may occur when reactive oxygen species ROS are present in cells in excess. The actions of ROS are normally counterbalanced by antioxidant defence mechanisms that include the enzymes superoxide dismutase and glutathione peroxidase, as well exogenous antioxidants derived from the diet, such as selenium, carotenoids, tocopherols, flavonoids, and other plant polyphenols [ 1525 ].
In older age, an accumulation of ROS may lead to oxidative damage and contribute to losses of muscle mass and strength [ 15 ]. A number of observational studies have shown positive associations between higher antioxidant status and measures of physical function [ 10 ].
Importantly these associations are seen both in cross-sectional analyses and in longitudinal studies, such that poor status is predictive of decline in function. The observed effects are striking. For example, among older men and women in the InCHIANTI study, higher plasma carotenoid concentrations were associated with a lower risk of developing a severe walking disability over a follow-up period of 6 years; after taking account of confounders that included level of physical activity and other morbidity, the odds ratio was 0.
Inverse associations have also been described for vitamin E and selenium status and risk of impaired physical function [ 10 ]. There have been few studies of older adults to determine how antioxidant supplementation affects muscle strength, and the benefits of supplementation remain uncertain [ 27 ]. Since ROS have both physiological and pathological roles, interventions based on simple suppression of their activities may be unlikely to improve age-related declines in muscle mass and function [ 28 ].
However, low antioxidant intakes and status are common [ 629 ], and this remains an important question to be addressed. Since eicosanoids derived from carbon polyunsaturated fatty acids are among the mediators and regulators of inflammation [ 13 ], this raises the possibility that variations in intake of n-3 and n-6 LCPUFAs, and their balance in the diet, could be of importance.
There is some observational evidence to support an effect of n-3 LCPUFA status on muscle function, as higher grip strength was found in older men and women who had greater consumption of oily fish [ 31 ]—one of the richest sources of n-3 LCPUFAs in the UK diet. Consistent with this finding, a number of studies of patients with rheumatoid arthritis have shown that supplementation with fish oil resulted in improved grip strength [ 13 ].
In a recent randomised controlled trial, supplementation of older adults with n-3 LCPUFA eicosapentaenoic and docosahexaenoic acids resulted in an enhanced anabolic response to amino acid and insulin infusion. Whilst these novel data suggest that the stimulation of muscle protein synthesis by n-3 LCPUFA supplementation could be useful for the prevention and treatment of sarcopenia [ 32 ], further evidence is needed to establish the therapeutic potential of n-3 LCPUFAs in inflammatory conditions [ 13 ].
Foods and Dietary Patterns One problem with the existing evidence base is that dietary components are often highly correlated with each other. This may help to explain why the effects of supplementation with single nutrients may be less than that predicted by the observational evidence. It also means that from observational data it may be difficult to understand the relative importance of the influences of different nutrients on sarcopenia.
In turn, since diets are patterned, high fruit and vegetable consumption may be indicators of other dietary differences which could be important for muscle function, such as greater consumption of oily fish and higher intakes of vitamin D and n-3 LCPUFAs [ 33 ]. The cumulative effects of nutrient deficiencies have been described by Semba et al.
Nutrition and Sarcopenia: A Review of the Evidence and Implications for Preventive Strategies
This emphasises the importance of the quality of diets of older adults, as well as the quantity of food consumed, to ensure that intakes of a range of nutrients are sufficient.
Compared with the evidence that links variations in nutrient intake and status to physical function, much less is known about the influence of dietary patterns and dietary quality in older age.
Data from studies of younger adults appear to be consistent with this finding.
Benefits of healthier diets and greater fruit and vegetable consumption on physical function in mid-life have also been described in women in the Whitehall study [ 36 ], and in men and women in the Atherosclerosis Risk in Communities Study [ 37 ]. Diet and Exercise Resistance exercise training interventions have been shown to be effective in increasing muscle strength and improving physical function in older adults [ 38 ]. A further issue in understanding a possible protective role for diet in sarcopenia is, therefore, the potential for interactions between diet and exercise, and the extent to which interventions that combine supplementation and exercise training may be more effective than changing nutrient intake alone.
Current findings point to the need for further research—particularly to address the effects of differing quantity and timing of supplementation [ 3940 ]. At present we have limited insights into the combined effects of vitamin D supplementation and resistance exercise on muscle strength and function [ 41 ].