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Nutrition and Lifestyle Interventions for Frailty and Sarcopenia

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Geriatric Nutrition".

Deadline for manuscript submissions: closed (5 January 2025) | Viewed by 30067

Special Issue Editor


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Guest Editor
Department of Geriatric Medicine, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore
Interests: frailty; intrinsic capacity; sarcopenia; cognitive disorders

Special Issue Information

Dear Colleagues,

Although considered distinct clinical syndromes, frailty and sarcopenia share common manifestations, such as slowness and weakness, frequently co-occur, and predispose the patient to a loss of functional independence, premature mortality and decline in quality of life. Malnutrition features among the common contributors to both key conditions. Despite their complex and multi-factorial underpinnings, there is consistent evidence that both frailty and sarcopenia are potentially preventable and reversible. However, the mechanisms by which multi-domain interventions impact on sarcopenia and/or frailty remain incompletely understood. Taking into account the World Health Organization (WHO)-proposed model of healthy ageing, it is also timely to explore how addressing sarcopenia and frailty may support the functional ability necessary to enable well-being in older age.

This Special Issue aims to compile research into the impact of lifestyle interventions on frailty and sarcopenia, work which is increasingly pertinent as we strive to support a globally ageing population.

Dr. Laura Bg Tay
Guest Editor

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Keywords

  • frailty
  • sarcopenia
  • nutrition
  • multidomain

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Published Papers (8 papers)

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Research

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17 pages, 2650 KiB  
Article
Evaluating the Impact of Multimodal Prehabilitation with High Protein Oral Nutritional Supplementation (HP ONS) with Beta-Hydroxy Beta-Methylbutyrate (HMB) on Sarcopenic Surgical Patients—Interim Analysis of the HEROS Study
by Frederick Hong-Xiang Koh, Vanessa Yik, Shuen-Ern Chin, Shawn Shi-Xian Kok, Hui-Bing Lee, Cherie Tong, Phoebe Tay, Esther Chean, Yi-En Lam, Shi-Min Mah, Li-Xin Foo, Clement C Yan, Wei-Tian Chua, Haziq bin Jamil, Khasthuri G, Lester Wei-Lin Ong, Alvin Yong-Hui Tan, Koy-Min Chue, Leonard Ming-Li Ho, Cheryl Xi-Zi Chong, Jasmine Ladlad, Cheryl Hui-Min Tan, Nathanelle Ann Xiaolian Khoo, Jia-Lin Ng, Winson Jianhong Tan and Fung-Joon Fooadd Show full author list remove Hide full author list
Nutrients 2024, 16(24), 4351; https://doi.org/10.3390/nu16244351 - 17 Dec 2024
Viewed by 1127
Abstract
Background: Multimodal prehabilitation programs, which may incorporate nutritional supplementation and exercise, have been developed to combat sarcopenia in surgical patients to enhance post-operative outcomes. However, the optimal regime remains unknown. The use of beta-hydroxy beta-methylbutyrate (HMB) has beneficial effects on muscle mass and [...] Read more.
Background: Multimodal prehabilitation programs, which may incorporate nutritional supplementation and exercise, have been developed to combat sarcopenia in surgical patients to enhance post-operative outcomes. However, the optimal regime remains unknown. The use of beta-hydroxy beta-methylbutyrate (HMB) has beneficial effects on muscle mass and strength. However, its effect on muscle quality in the perioperative setting has yet to be established. This study aims to explore the impact of a multimodal prehabilitation program using a bundle of care that includes high-protein oral nutritional supplementation (HP ONS) with HMB and resistance exercise on muscle quality and functional outcomes in sarcopenic surgical patients. Methods: Sarcopenic adult patients undergoing elective major gastrointestinal surgeries were recruited for this pilot interventional cohort study. They were enrolled in a 2–4-week multimodal prehabilitation program comprising resistance exercise, nutritional supplementation, vitamin supplementation, comorbid optimization and smoking cessation. Participants were provided three units of HP ONS with HMB per day pre-operatively. The primary outcome was changes in intramuscular adipose tissue (IMAT) as a proxy of muscle quality, assessed using Artificial Intelligence (AI)-aided ultrasonography. Secondary outcomes include changes in anthropometric measurements and functional characteristics. Outcomes were measured before prehabilitation, after prehabilitation and 1 month post-operatively. Results: A total of 36 sarcopenic patients, with a median age of 71.5 years, were included in this study. There was an increase in the IMAT index after two weeks of prehabilitation (p = 0.032) to 1 month after surgery (p = 0.028). Among functional parameters, improvement was observed in gait speed (p = 0.01) after two weeks of prehabilitation, which returned to baseline post-operatively. The median length of hospital stay was 7 (range: 2–75) days. Conclusions: The increase in the IMAT index in a sarcopenic surgical cohort undergoing prehabilitation may be due to altered muscle metabolism in elderly sarcopenic patients. A prehabilitation regime in sarcopenic patients incorporating HP ONS with HMB and resistance exercise is feasible and is associated with increased gait speed. Full article
(This article belongs to the Special Issue Nutrition and Lifestyle Interventions for Frailty and Sarcopenia)
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20 pages, 1160 KiB  
Article
Circulating Amino Acid Concentration after the Consumption of Pea or Whey Proteins in Young and Older Adults Affects Protein Synthesis in C2C12 Myotubes
by Jérôme Salles, Marine Gueugneau, Karima Laleg, Christophe Giraudet, Phelipe Sanchez, Adeline Blot, Ruddy Richard, Nathalie Neveux, Catherine Lefranc-Millot, Caroline Perreau, Laetitia Guérin-Deremaux, Yves Boirie and Stéphane Walrand
Nutrients 2024, 16(17), 2870; https://doi.org/10.3390/nu16172870 - 27 Aug 2024
Viewed by 2042
Abstract
As older adults tend to reduce their intake of animal-source proteins, plant-source proteins may offer valuable resources for better protein intake. The aim of this study was to assess whether the pea proteins can be used to achieve blood amino acid levels that [...] Read more.
As older adults tend to reduce their intake of animal-source proteins, plant-source proteins may offer valuable resources for better protein intake. The aim of this study was to assess whether the pea proteins can be used to achieve blood amino acid levels that stimulate muscle protein synthesis. We measured variations in plasma amino acid concentrations in young and older adults given pea (NUTRALYS® S85 Plus) or whey proteins either alone or in a standardized meal. The effect of amino acid concentrations on protein synthesis in C2C12 myotubes was determined. In terms of results, plasma amino acid concentrations reflected the difference between the amino acid contents of whey and pea proteins. Blood leucine showed a greater increase of 91 to 130% with whey protein compared to pea protein, while the opposite was observed for arginine (A greater increase of 147 to 210% with pea compared to whey). Culture media prepared with plasmas from the human study induced age-dependent but not protein-type-dependent changes in myotube protein synthesis. In conclusion, pea and whey proteins have the same qualities in terms of their properties to maintain muscle protein synthesis. Pea proteins can be recommended for older people who do not consume enough animal-source proteins. Full article
(This article belongs to the Special Issue Nutrition and Lifestyle Interventions for Frailty and Sarcopenia)
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12 pages, 1524 KiB  
Article
Diagnosing Sarcopenia with AI-Aided Ultrasound (DINOSAUR)—A Pilot Study
by Vanessa Yik, Shawn Shi Xian Kok, Esther Chean, Yi-En Lam, Wei-Tian Chua, Winson Jianhong Tan, Fung Joon Foo, Jia Lin Ng, Sharmini Sivarajah Su, Cheryl Xi-Zi Chong, Darius Kang-Lie Aw, Nathanelle Ann Xiaolian Khoo, Paul E. Wischmeyer, Jeroen Molinger, Steven Wong, Lester Wei-Lin Ong and Frederick Hong-Xiang Koh
Nutrients 2024, 16(16), 2768; https://doi.org/10.3390/nu16162768 - 20 Aug 2024
Cited by 1 | Viewed by 2905
Abstract
Background: Sarcopenia has been recognized as a determining factor in surgical outcomes and is associated with an increased risk of postoperative complications and readmission. Diagnosis is currently based on clinical guidelines, which includes assessment of skeletal muscle mass but not quality. Ultrasound has [...] Read more.
Background: Sarcopenia has been recognized as a determining factor in surgical outcomes and is associated with an increased risk of postoperative complications and readmission. Diagnosis is currently based on clinical guidelines, which includes assessment of skeletal muscle mass but not quality. Ultrasound has been proposed as a useful point-of-care diagnostic tool to assess muscle quality, but no validated cut-offs for sarcopenia have been reported. Using novel automated artificial intelligence (AI) software to interpret ultrasound images may assist in mitigating the operator-dependent nature of the modality. Our study aims to evaluate the fidelity of AI-aided ultrasound as a reliable and reproducible modality to assess muscle quality and diagnose sarcopenia in surgical patients. Methods: Thirty-six adult participants from an outpatient clinic were recruited for this prospective cohort study. Sarcopenia was diagnosed according to Asian Working Group for Sarcopenia (AWGS) 2019 guidelines. Ultrasonography of the rectus femoris muscle was performed, and images were analyzed by an AI software (MuscleSound® (Version 5.69.0)) to derive muscle parameters including intramuscular adipose tissue (IMAT) as a proxy of muscle quality. A receiver operative characteristic (ROC) curve was used to assess the predictive capability of IMAT and its derivatives, with area under the curve (AUC) as a measure of overall diagnostic accuracy. To evaluate consistency between ultrasound users of different experience, intra- and inter-rater reliability of muscle ultrasound parameters was analyzed in a separate cohort using intraclass correlation coefficients (ICC) and Bland–Altman plots. Results: The median age was 69.5 years (range: 26–87), and the prevalence of sarcopenia in the cohort was 30.6%. The ROC curve plotted with IMAT index (IMAT% divided by muscle area) yielded an AUC of 0.727 (95% CI: 0.551–0.904). An optimal cut-off point of 4.827%/cm2 for IMAT index was determined with a Youden’s Index of 0.498. We also demonstrated that IMAT index has excellent intra-rater reliability (ICC = 0.938, CI: 0.905–0.961) and good inter-rater reliability (ICC = 0.776, CI: 0.627–0.866). In Bland–Altman plots, the limits of agreement were from −1.489 to 1.566 and −2.107 to 4.562, respectively. Discussion: IMAT index obtained via ultrasound has the potential to act as a point-of-care evaluation for sarcopenia screening and diagnosis, with good intra- and inter-rater reliability. The proposed IMAT index cut-off maximizes sensitivity for case finding, supporting its use as an easily implementable point-of-care test in the community for sarcopenia screening. Further research incorporating other ultrasound parameters of muscle quality may provide the basis for a more robust diagnostic tool to help predict surgical risk and outcomes. Full article
(This article belongs to the Special Issue Nutrition and Lifestyle Interventions for Frailty and Sarcopenia)
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13 pages, 925 KiB  
Article
Pro-Inflammatory Diets Are Associated with Frailty in an Urban Middle-Aged African American and White Cohort
by Marie Fanelli Kuczmarski, May A. Beydoun, Michael F. Georgescu, Nicole Noren Hooten, Nicolle A. Mode, Michele K. Evans and Alan B. Zonderman
Nutrients 2023, 15(21), 4598; https://doi.org/10.3390/nu15214598 - 29 Oct 2023
Cited by 3 | Viewed by 1668
Abstract
Diet quality is a modifiable risk factor for frailty, but research on the association of frailty with dietary inflammatory potential is limited. The objective was to determine associations between diet quality assessed by the dietary inflammatory index (DII) with frailty status over time. [...] Read more.
Diet quality is a modifiable risk factor for frailty, but research on the association of frailty with dietary inflammatory potential is limited. The objective was to determine associations between diet quality assessed by the dietary inflammatory index (DII) with frailty status over time. Participants with both dietary and frailty data from the longitudinal Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used (n = 2901, 43.5% male, 43.8% African American, 48.5 y mean baseline age, with a mean 8.7 y of follow-up). Group-based trajectory modeling identified two frailty (remaining non-frail or being pre-frail/frail over time) and three diet quality trajectory groups (high or medium pro-inflammatory and anti-inflammatory potentials). Multiple logistic regression found both medium pro-inflammatory and anti-inflammatory DII trajectory groups, compared to the high pro-inflammatory group, were positively associated with being non-frail over time for the overall sample, both sexes and races. Kaplan–Meier curves and log-rank test revealed anti-inflammatory DII scores were associated with lower risk for being pre-frail or frail. No longitudinal relationship existed between frailty status at baseline and annualized DII change, a check on reverse causality. This study contributes to our current knowledge providing longitudinal evidence of the link between anti-inflammatory DII score with lower frailty risk. Full article
(This article belongs to the Special Issue Nutrition and Lifestyle Interventions for Frailty and Sarcopenia)
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14 pages, 1037 KiB  
Article
Midlife Life’s Simple 7, Psychosocial Health, and Physical Frailty, Hospital Frailty, and Comprehensive Frailty 10 Years Later
by Qi Wang, Chunmiao Zhou, Caiyun Dong, Jiajun Zhang, Ziwei Xie, Huizi Sun, Chunying Fu, Wenting Hao and Dongshan Zhu
Nutrients 2023, 15(10), 2412; https://doi.org/10.3390/nu15102412 - 22 May 2023
Cited by 3 | Viewed by 2272
Abstract
This study aims to examine the associations between midlife Life’s Simple 7 (LS7) status, psychosocial health (social isolation and loneliness), and late-life multidimensional frailty indicators, and to investigate their synergistic effect on frailty. We used cohort data from the UK Biobank. Frailty was [...] Read more.
This study aims to examine the associations between midlife Life’s Simple 7 (LS7) status, psychosocial health (social isolation and loneliness), and late-life multidimensional frailty indicators, and to investigate their synergistic effect on frailty. We used cohort data from the UK Biobank. Frailty was assessed using physical frailty phenotype, hospital frailty risk score, and frailty index. Cox proportional-hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) on the association between the LS7 score, psychosocial health, and frailty. For the association of LS7 with physical and comprehensive frailty, 39,047 individuals were included. After a median follow-up of 9.0 years, 1329 (3.4%) people were identified with physical frailty, and 5699 (14.6%) with comprehensive frailty. For the association of LS7 with hospital frailty, 366,570 people were included. After a median follow-up of 12.0 years, 18,737 (5.1%) people were identified with hospital frailty. Compared to people with a poor LS7 score, those with an intermediate (physical frailty: 0.64, 0.54–0.77; hospital frailty: 0.60, 0.58–0.62; and comprehensive frailty: 0.77, 0.69–0.86) and optimal LS7 score (physical frailty: 0.31, 0.25–0.39; hospital frailty: 0.39, 0.37–0.41; and comprehensive frailty: 0.62, 0.55–0.69) were associated with a lower risk of frailty. Poor psychosocial health was associated with an increased risk of frailty. People who had a poor psychosocial status and poor LS7 score had the highest risk of frailty. A better LS7 score in midlife was associated with a reduced risk of physical, hospital, and comprehensive frailty. There was a synergistic effect of psychosocial status and LS7 on frailty. Full article
(This article belongs to the Special Issue Nutrition and Lifestyle Interventions for Frailty and Sarcopenia)
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15 pages, 1720 KiB  
Article
Efficacy of Dietary Intervention with Group Activities on Dietary Intakes, Frailty Status, and Working Memory: A Cluster-Randomized Controlled Trial in Community Strongholds
by Szu-Yun Wu, Yu-Yao Cheng, Hsing-Yi Chang, Pei-Hsuan Wang, I-Ching Hsieh, Nai-Hua Yeh, Kuo-Chin Huang and Wen-Harn Pan
Nutrients 2023, 15(8), 1976; https://doi.org/10.3390/nu15081976 - 19 Apr 2023
Cited by 5 | Viewed by 2691
Abstract
Geriatric community centers often offer nutrition lectures to older adults. In order to make learning more interesting and pragmatic, we developed group activity sessions. This undertaking was tested for its efficacy in changes of frailty status and several other geriatric health parameters. A [...] Read more.
Geriatric community centers often offer nutrition lectures to older adults. In order to make learning more interesting and pragmatic, we developed group activity sessions. This undertaking was tested for its efficacy in changes of frailty status and several other geriatric health parameters. A cluster-randomized controlled trial was conducted between September 2018 and December 2019 at 13 luncheon-providing community strongholds in Taipei, Taiwan. During the 3-month intervention period, 6 experimental strongholds received a weekly 1 h exercise workout and 1 h nutrition activities aiming at achieving the recommendations of the Taiwanese Daily Food Guide for elderlies; the other 7 received a weekly 1 h exercise workout and 1 h other activities. Dietary intakes and frailty status were the primary outcomes. Secondary outcomes included working memory and depression. The measurements were performed at baseline, 3 months, and 6 months. The nutrition intervention significantly reduced the intake of refined grains and roots (p = 0.003) and increased that of non-refined grains and roots (p = 0.008), dairy products (p < 0.0001), and seeds and nuts (at borderline, p = 0.080) at 3 months. Some, but not all, of these changes were maintained at 6 months. Performance improvements included the frailty status score (p = 0.036) and forward digit span (p = 0.004), a working memory parameter, at 3 months. Only the forward digit span remained improved (p = 0.007) at 6 months. The 3-month nutrition group activities combined with exercise sessions improved the frailty status and working memory more than exercise alone. The dietary and frailty improvements were accompanied by improved dietary intakes and advanced behavioral stages. However, the improved frailty status backslid after intervention ceased, suggesting that boosting activities are needed for maintaining the intervention effect. Full article
(This article belongs to the Special Issue Nutrition and Lifestyle Interventions for Frailty and Sarcopenia)
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Review

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19 pages, 329 KiB  
Review
Optimizing the Preoperative Preparation of Sarcopenic Older People: The Role of Prehabilitation and Nutritional Supplementation before Knee Arthroplasty
by Francesco Pegreffi, Rita Chiaramonte, Sabrina Donati Zeppa, Fulvio Lauretani, Marco Salvi, Irene Zucchini, Nicola Veronese, Michele Vecchio, Alessia Bartolacci, Vilberto Stocchi and Marcello Maggio
Nutrients 2024, 16(20), 3462; https://doi.org/10.3390/nu16203462 - 12 Oct 2024
Viewed by 2101
Abstract
Background: Age-related loss of skeletal muscle strength and mass is linked to adverse postoperative outcomes in older individuals with sarcopenia. Half of patients suffer from severe associated osteoarthritis requiring orthopedic interventions. Mitigating the onset and progression of sarcopenia before surgery is essential to [...] Read more.
Background: Age-related loss of skeletal muscle strength and mass is linked to adverse postoperative outcomes in older individuals with sarcopenia. Half of patients suffer from severe associated osteoarthritis requiring orthopedic interventions. Mitigating the onset and progression of sarcopenia before surgery is essential to improve the prognosis and reduce surgical complications. The aim of this research was to innovatively explore whether the preoperative period could be the appropriate timeframe to empower surgical resilience, through prehabilitation and dietary supplementation, in older sarcopenic patients undergoing knee arthroplasty. Methods: The current literature concerning the effectiveness of prehabilitation and dietary supplementation before knee arthroplasty in sarcopenic older individuals was reviewed, following the SANRA criteria, between December 2023 and February 2024. The study inclusion criteria were as follows: (1) prehabilitation and/or dietary supplementation interventions; (2) human participants aged 65 years and older; (3) relevant outcome reporting (functional status, postoperative complications, and patient-reported outcomes); and (4) articles written in English The extracted information included study characteristics, demographics, intervention details, outcomes, and the main findings. Results: Merged prehabilitation and dietary supplementation strategies extrapolated from the current literature and involving strength, resistance, balance, and flexibility training, as well as essential amino acids, iron, vitamin D, adenosine triphosphate, and glucosamine sulphate supplementation, could improve the functional capacity, ability to withstand the upcoming surgical stressors, and postoperative outcomes in older people undergoing knee arthroplasty. Conclusions: Addressing complex links between knee osteoarthritis and sarcopenia in older individuals undergoing knee arthroplasty requires a multidimensional approach. Prehabilitation emerges as a crucial preliminary step, allowing the optimization of surgical outcomes. Nutraceutical integration, included in a comprehensive care plan, could have a synergic effect in achieving prehabilitation goals. Those interventions are essential for surgical resilience, in terms of muscle function preservation, recovery acceleration, and overall quality of life enhancement. Intensive collaboration among specialists could advance knowledge and the sharable consensus concerning the critical and evolutive field of perioperative care. Full article
(This article belongs to the Special Issue Nutrition and Lifestyle Interventions for Frailty and Sarcopenia)
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27 pages, 4775 KiB  
Review
The Integral Role of Magnesium in Muscle Integrity and Aging: A Comprehensive Review
by Ana Carolina Remondi Souza, Andrea Rodrigues Vasconcelos, Denise Deo Dias, Geovana Komoni and José João Name
Nutrients 2023, 15(24), 5127; https://doi.org/10.3390/nu15245127 - 16 Dec 2023
Cited by 14 | Viewed by 14601
Abstract
Aging is characterized by significant physiological changes, with the degree of decline varying significantly among individuals. The preservation of intrinsic capacity over the course of an individual’s lifespan is fundamental for healthy aging. Locomotion, which entails the capacity for independent movement, is intricately [...] Read more.
Aging is characterized by significant physiological changes, with the degree of decline varying significantly among individuals. The preservation of intrinsic capacity over the course of an individual’s lifespan is fundamental for healthy aging. Locomotion, which entails the capacity for independent movement, is intricately connected with various dimensions of human life, including cognition, vitality, sensory perception, and psychological well-being. Notably, skeletal muscle functions as a pivotal nexus within this intricate framework. Any perturbation in its functionality can manifest as compromised physical performance and an elevated susceptibility to frailty. Magnesium is an essential mineral that plays a central role in approximately 800 biochemical reactions within the human body. Its distinctive physical and chemical attributes render it an indispensable stabilizing factor in the orchestration of diverse cellular reactions and organelle functions, thereby rendering it irreplaceable in processes directly impacting muscle health. This narrative review offers a comprehensive exploration of the pivotal role played by magnesium in maintaining skeletal muscle integrity, emphasizing the critical importance of maintaining optimal magnesium levels for promoting healthy aging. Full article
(This article belongs to the Special Issue Nutrition and Lifestyle Interventions for Frailty and Sarcopenia)
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