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Sarcopenia and Nutritional Status

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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (15 September 2019) | Viewed by 96771

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Prof. Dr. Francesco Landi

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Geriatrics Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: muscle strength; physical activity; geriatrics

Dr. Emanuele Marzetti

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Guest Editor

Department of Geriatrics, Neurosciences and Orthopaedics, Policlinico Universitario Agostino Gemelli, Rome, Italy
Interests: Muscle function; Skeletal Muscle; Geriatrics; Frailty; Sarcopenia; Mitochondria; Biomarkers
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Dear Colleagues,

Sarcopenia, the progressive and generalized loss of skeletal muscle mass and strength/function associated with aging, increases the risk of a vast array of adverse health outcomes, including falls, morbidity, loss of independence, disability, and mortality. As such, sarcopenia poses a huge socioeconomic burden in developed countries. The development and implementation of effective interventions against sarcopenia are therefore a public health priority. A deeper understanding of the intimate mechanisms of muscle aging is also necessary to identify relevant biological targets for specific intervention. Indeed, the contemporary management of sarcopenia relies on exercise and specific nutritional recommendations.

The aim of this Special Issue is to address all the aspects related to the correlation between nutritional status and muscle health, as well as potential interventions to prevent and to treat sarcopenia.

As such, we invite you to submit your latest original research or review articles to this Special Issue.

Dr. Francesco Landi
Dr. Emanuele Marzetti
Guest Editors

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Keywords

Aging
Physical frailty
Malnutrition
Sarcopenia
Diet
Protein intake
Nutritional intervention

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Published Papers (9 papers)

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Research

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13 pages, 484 KiB

Open AccessArticle

by Hélio J. Coelho-Júnior, Riccardo Calvani, Anna Picca, Ivan O. Gonçalves, Francesco Landi, Roberto Bernabei, Matteo Cesari, Marco C. Uchida and Emanuele Marzetti

Nutrients 2020, 12(2), 508; https://doi.org/10.3390/nu12020508 - 17 Feb 2020

Cited by 30 | Viewed by 5156

Abstract

The present study investigated the associations between frailty status and (a) daily protein intake, (b) daily body weight-adjusted protein intake, (c) branched-chain amino acid (BCAA) consumption, (d) evenness of protein distribution across main meals, (e) number of daily meals providing at least 30 g of protein, and (f) number of daily meals providing at least 0.4 g protein/kg of body weight in community-dwelling older adults. The relationship between frailty status and protein-related dietary parameters was explored across different frailty assessment tools. Two hundred older adults were enrolled in the study. Participant frailty status was determined according to a modified Fried’s frailty phenotype (mFP), the FRAIL scale, and the Study of Osteoporotic Fracture (SOF) index. Diet was assessed by 24-h dietary recall, while diet composition was estimated using a nutritional software. A frailty instrument-dependent relationship was observed between frailty status and protein-related dietary parameters. Protein consumption was associated with frailty status only in participants identified as frail according to the mFP. In addition, protein and BCAA intake was found to be greater in robust and pre-frail participants relative to their frail counterparts. Our findings suggest that the association between frailty and protein-related dietary parameters is tool dependent. Specifically, protein and BCAA consumption appears to be lower only in older adults identified as frail by the mFP. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

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18 pages, 1872 KiB

Open AccessArticle

Fatty Acid Profile and Antioxidant Status Fingerprint in Sarcopenic Elderly Patients: Role of Diet and Exercise

by Paola Antonia Corsetto, Gigliola Montorfano, Catherine Klersy, Luca Massimino, Vittoria Infantino, Giancarlo Iannello, Milena Anna Faliva, Henry Lukaski, Simone Perna, Tariq A. Alalwan, Angela Maria Rizzo and Mariangela Rondanelli

Nutrients 2019, 11(11), 2569; https://doi.org/10.3390/nu11112569 - 24 Oct 2019

Cited by 12 | Viewed by 5683

Abstract

Plasma fatty acids (FAs) and oxidant status contribute to the etiology of sarcopenia in the elderly concurring to age-related muscle loss and elderly frailty through several mechanisms including changes in FA composition within the sarcolemma, promotion of chronic low-grade inflammation, and insulin resistance. The aim of this study was to determine the FA profile and pro-antioxidant status in sarcopenic frail elderly patients enrolled in a nutritional and physical activity program and to evaluate their correlation with clinical markers. Moreover, the possible changes, produced after a short-term clinical protocol, were evaluated. Plasma and erythrocyte FA composition and pro-antioxidant status were analyzed in sarcopenic elderly subjects recruited for the randomized clinical study and treated with a placebo or dietary supplement, a personalized diet, and standardized physical activity. Subjects were tested before and after 30 days of treatment. Pearson correlations between biochemical parameters and patients’ characteristics at recruitment indicate interesting features of sarcopenic status such as negative correlation among the plasma FA profile, age, and physical characteristics. Physical activity and dietetic program alone for 30 days induced a decrease of saturated FA concentration with a significant increase of dihomo-gamma-linolenic acid. Supplementation plus physical activity induced a significant decrease of linoleic acid, omega-6 polyunsaturated FAs, and an increase of stearic and oleic acid concentration. Moreover, glutathione reductase activity, which is an indicator of antioxidant status, significantly increased in erythrocytes. Changes over time between groups indicate significant differences for saturated FAs, which suggest that the amino acid supplementation restores FA levels that are consumed during physical activity. A relationship between FA and clinical/metabolic status revealed unique correlations and a specific metabolic and lipidomic fingerprint in sarcopenic elderly. The results indicate the positive beneficial role of supplementation and physical activity on plasma FA status and the antioxidant system as a co-adjuvant approach in sarcopenic, frail, elderly patients. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

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15 pages, 1122 KiB

Open AccessArticle

Factors Associated with Sarcopenia and 7-Year Mortality in Very Old Patients with Hip Fracture Admitted to Rehabilitation Units: A Pragmatic Study

by Vincenzo Malafarina, Concetta Malafarina, Arantzazu Biain Ugarte, J. Alfredo Martinez, Itziar Abete Goñi and M. Angeles Zulet

Nutrients 2019, 11(9), 2243; https://doi.org/10.3390/nu11092243 - 18 Sep 2019

Cited by 32 | Viewed by 6418

Abstract

Background: Admitted bedridden older patients are at risk of the development of sarcopenia during hospital stay (incident sarcopenia). The objective of this study was to assess the factors associated with sarcopenia (incident and chronic) and its impact on mortality in older people with hip fracture. Methods: A multicenter, pragmatic, prospective observational study was designed. Older subjects with hip fracture admitted to two rehabilitation units were included. Sarcopenia was assessed at admission and at discharge according to the revised EWGSOP (European Working Group on Sarcopenia in Older People) consensus definition. The mortality was evaluated after 7 years of follow-up. Results: A total of 187 subjects (73.8% women) age 85.2 ± 6.3 years were included. Risk factors associated to incident and chronic sarcopenia were undernutrition (body mass index—BMI and Mini Nutritional Assessment−Short Form—MNA-SF), hand-grip strength and skeletal muscle index. During follow-up 114 patients died (60.5% sarcopenic vs. 39.5% non-sarcopenic, p = 0.001). Cox regression analyses showed that factors associated to increased risk of mortality were sarcopenia (HR: 1.67, 95% CI 1.11–2.51) and low hand-grip strength (HR: 1.76, 95% CI 1.08–2.88). Conclusions: Older patients with undernutrition have a higher risk of developing sarcopenia during hospital stay, and sarcopenic patients have almost two times more risk of mortality than non-sarcopenic patients during follow-up after hip fracture. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

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12 pages, 255 KiB

Open AccessArticle

Sarcopenia is Associated with Malnutrition but Not with Systemic Inflammation in Older Persons with Advanced CKD

by Simone Vettoretti, Lara Caldiroli, Silvia Armelloni, Camilla Ferrari, Matteo Cesari and Piergiorgio Messa

Nutrients 2019, 11(6), 1378; https://doi.org/10.3390/nu11061378 - 19 Jun 2019

Cited by 60 | Viewed by 5559

Abstract

Background: In patients with chronic kidney disease (CKD), sarcopenia can be determined by a wide spectrum of risk factors. We evaluated the association of sarcopenia with nutritional, behavioral and inflammatory patterns in older patients with advanced CKD. Methods: we cross-sectionally evaluated 113 patients with CKD stages 3b-5. Sarcopenia was defined according to the EWGSOP2 criteria. We assessed: anthropometry, bioelectrical impedance analysis, physical, and psychological performance. Nutritional status was assessed using the Malnutrition Inflammation Score (MIS) and by verifying the eventual presence Protein Energy Wasting syndrome (PEW). Systemic inflammation was assessed by dosing: CRP, IL6, TNFα, MCP1, IL10, IL17, fetuin, IL12. Results: 24% of patients were sarcopenic. Sarcopenic individuals had lower creatinine clearance (18 ± 11 vs. 23 ± 19 mL/min; p = 0.0087) as well as lower BMI (24.8 ± 3.0 vs. 28.4 ± 5.5 Kg/m²; p < 0.0001) and a lower FTI (11.6 ± 3.9 vs. 14.4 ± 5.1 kg/m², p = 0.023). Sarcopenic persons had higher prevalence of PEW (52 vs. 20%, p < 0.0001) and a tendency to have higher MIS (6.6 ± 6.5 vs. 4.5 ± 4.0, p = 0.09); however, they did not show any difference in systemic inflammation compared to non-sarcopenic individuals. Conclusions: CKD sarcopenic patients were more malnourished than non-sarcopenic ones, but the two groups did not show any difference in systemic inflammation. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

10 pages, 257 KiB

Open AccessArticle

The Role of Muscle Decline in Type 2 Diabetes Development: A 5-Year Prospective Observational Cohort Study

by Katarzyna Maliszewska, Edyta Adamska-Patruno, Joanna Goscik, Danuta Lipinska, Anna Citko, Aleksandra Krahel, Katarzyna Miniewska, Joanna Fiedorczuk, Monika Moroz, Maria Gorska and Adam Kretowski

Nutrients 2019, 11(4), 834; https://doi.org/10.3390/nu11040834 - 12 Apr 2019

Cited by 22 | Viewed by 3794

Abstract

The major risk factors of T2DM (type 2 diabetes mellitus) development are still under investigation. We evaluate the possible risk factors associated with type 2 diabetes (T2DM) in adult subjects during a five-year prospective cohort study. We recruited 1160 subjects who underwent oral glucose tolerance test, anthropometric measurements, and body composition and body fat distribution analysis at a baseline visit and again at follow-up after approximately five years. The conclusions of this study are based on observation of 219 subjects who attended both the first and follow-up visits. The fasting serum insulin was measured, and HOMA-IR (homeostatic model assessment of insulin resistance) was calculated. During the follow-up period, T2DM was diagnosed in 7.4% of participants, impaired fasting glucose in 37.7%, and impaired glucose tolerance in 9.3%. Logistic regression models, adjusted for age, were constructed. The changes in glucose concentration, visceral fat tissue content, insulin resistance, and %loss of muscle mass were chosen as the potential predictors for T2DM development. A set of independent variables was extracted. The constructed feature set comprised change in HOMA-IR (OR (odds ratio) = 1.01, p < 0.01) and change in %loss of muscle mass (OR = 0.84, p < 0.03). With an aim to validate the prediction capability using the selected attributes, a support vector machine classifier and leave-one-out cross-validation procedure was applied, yielding 92.78% classification accuracy. Our results show the correlation between the %loss of muscle mass and T2DM development in adults, independent of changes in insulin resistance. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

Review

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15 pages, 1022 KiB

Open AccessReview

Sarcopenia and Heart Failure

by Francesco Curcio, Gianluca Testa, Ilaria Liguori, Martina Papillo, Veronica Flocco, Veronica Panicara, Gianluigi Galizia, David Della-Morte, Gaetano Gargiulo, Francesco Cacciatore, Domenico Bonaduce, Francesco Landi and Pasquale Abete

Nutrients 2020, 12(1), 211; https://doi.org/10.3390/nu12010211 - 14 Jan 2020

Cited by 160 | Viewed by 13720

Abstract

Modifications of lean mass are a frequent critical determinant in the pathophysiology and progression of heart failure (HF). Sarcopenia may be considered one of the most important causes of low physical performance and reduced cardiorespiratory fitness in older patients with HF. Sarcopenia is frequently misdiagnosed as cachexia. However, muscle wasting in HF has different pathogenetic features in sarcopenic and cachectic conditions. HF may induce sarcopenia through common pathogenetic pathways such as hormonal changes, malnutrition, and physical inactivity; mechanisms that influence each other. In the opposite way, sarcopenia may favor HF development by different mechanisms, including pathological ergoreflex. Paradoxically, sarcopenia is not associated with a sarcopenic cardiac muscle, but the cardiac muscle shows a hypertrophy which seems to be “not-functional.” First-line agents for the treatment of HF, physical activity and nutritional interventions, may offer a therapeutic advantage in sarcopenic patients irrespective of HF. Thus, sarcopenia is highly prevalent in patients with HF, contributing to its poor prognosis, and both conditions could benefit from common treatment strategies based on pharmacological, physical activity, and nutritional approaches. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

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14 pages, 840 KiB

Open AccessReview

Vitamin D Deficiency and Sarcopenia in Older Persons

by Francesca Remelli, Aurora Vitali, Amedeo Zurlo and Stefano Volpato

Nutrients 2019, 11(12), 2861; https://doi.org/10.3390/nu11122861 - 21 Nov 2019

Cited by 220 | Viewed by 20880

Abstract

Vitamin D deficiency is a common health problem worldwide, in particular among older people. Vitamin D regulates and modulates the physiology and function of multiple human systems, including the skeletal muscle. The effect of vitamin D on the muscle has been widely investigated, suggesting that this hormone can stimulate the proliferation and differentiation of skeletal muscle fibers, maintaining and improving muscle strength and physical performance. Older persons have a higher prevalence of low Vitamin D levels as a consequence of low dietary intake and reduced ultraviolet irradiation of the skin. Therefore, older people with vitamin D deficiency might be at risk of sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength often complicated by adverse events, such as falls, disability hospitalization and death. Several randomized clinical trials have been conducted to investigate the effect of oral vitamin D supplementation in older patients to prevent or treat sarcopenia, but results are still controversial. In this narrative review we summarize the biological, clinical and epidemiological evidence supporting the hypothesis of a causal association between Vitamin D deficiency and an increased risk of sarcopenia in older people. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

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23 pages, 342 KiB

Open AccessReview

Efficacy of Nutritional Interventions as Stand-Alone or Synergistic Treatments with Exercise for the Management of Sarcopenia

by Sarah Damanti, Domenico Azzolino, Carlotta Roncaglione, Beatrice Arosio, Paolo Rossi and Matteo Cesari

Nutrients 2019, 11(9), 1991; https://doi.org/10.3390/nu11091991 - 23 Aug 2019

Cited by 44 | Viewed by 14054

Abstract

Sarcopenia is an age-related and accelerated process characterized by a progressive loss of muscle mass and strength/function. It is a multifactorial process associated with several adverse outcomes including falls, frailty, functional decline, hospitalization, and mortality. Hence, sarcopenia represents a major public health problem and has become the focus of intense research. Unfortunately, no pharmacological treatments are yet available to prevent or treat this age-related condition. At present, the only strategies for the management of sarcopenia are mainly based on nutritional and physical exercise interventions. The purpose of this review is, thus, to provide an overview on the role of proteins and other key nutrients, alone or in combination with physical exercise, on muscle parameters. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

23 pages, 2244 KiB

Open AccessReview

The Role of Muscle Mass Gain Following Protein Supplementation Plus Exercise Therapy in Older Adults with Sarcopenia and Frailty Risks: A Systematic Review and Meta-Regression Analysis of Randomized Trials

by Chun-De Liao, Hung-Chou Chen, Shih-Wei Huang and Tsan-Hon Liou

Nutrients 2019, 11(8), 1713; https://doi.org/10.3390/nu11081713 - 25 Jul 2019

Cited by 123 | Viewed by 19210

Abstract

Aging and frailty are associated with a high risk of lean mass (LM) loss, which leads to physical disability and can be effectively alleviated by protein supplementation (PS) and muscle strengthening exercise (MSE). In this study, the associations between LM gain and PS + MSE efficacy (measured using physical outcomes) in elderly patients with a high risk of sarcopenia or frailty were identified. A comprehensive search of online databases was performed to identify randomized controlled trials (RCTs) reporting the efficacy of PS + MSE in elderly patients with sarcopenia or frailty. The included RCTs were analyzed using meta-analysis and risk of bias assessment. We finally included 19 RCTs in this meta-analysis with a median (range/total) Physiotherapy Evidence Database score of 7/10 (5–9/10). The PS + MSE group exhibited significant improvements in the whole-body LM (standard mean difference (SMD) = 0.66; p < 0.00001), appendicular LM (SMD = 0.35; p < 0.00001), leg strength (SMD = 0.65; p < 0.00001), and walking capability (SMD = 0.33; p = 0.0006). Meta-regression analyses showed that changes in appendicular LM were significantly associated with the effect sizes of leg strength (β = 0.08; p = 0.003) and walking capability (β = 0.17; p = 0.04), respectively. Our findings suggest that LM gain after PS + MSE significantly contributes to the efficacy of the intervention in terms of muscle strength and physical mobility in elderly patients with a high risk of sarcopenia or frailty. Full article

(This article belongs to the Special Issue Sarcopenia and Nutritional Status)

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