United Kingdom

Background: • Dietary protein provides essential amino acids required for healthy aging. • Understanding how dietary protein sources vary for different population subgroups will allow for more targeted nutrition interventions. Methods: • Analysis of cross-sectional data from NHANES 2011–2016 • Adults (18+ years) with one 24-hour dietary recall (n = 15,697) • Population proportions were calculated based on protein intake (g/day) for food categories.  Discussion: • The top ten sources of protein accounted for over 40% of dietary protein for all groups. • Chicken (whole pieces) was the top-ranked source for all groups. • Only two plant-based proteins appeared in the top ten sources: beans, peas and legumes for Hispanics, and nuts and seeds for Other. • Public health strategies that encourage diversity in protein sources and incorporate legumes nuts, and poultry have the potential to shift the overall population protein intake distribution toward improving overall diet quality.

ISTRC 2021 - International Sarcopenia Translational Research Conference

Age and Racial/Ethnicity Differences in Dietary Sources of Protein, NHANES, 2011-2016

health disparities

dietary protein

nutrition

Welcome to the inaugural International Sarcopenia Translational Research Conference.  “Where Worlds Meet” – the event brings together a broad range of researchers and practitioners in a truly interdisciplinary forum, covering discovery science through to clinical practice.

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Access to this event requires a registration. Please email Eleanor Lockhart at sarcconf@ncl.ac.uk if you have any questions regarding your registration. 

poster

Background: Association of dietary intake and serum level of polyunsaturated-fatty-acids (omega-3 PUFA) with physical function and body composition in older adults remained inconclusive. Method: Study subjects were 554 women from the Osteoporosis-Risk-Factor-and-PreventionFracture Prevention-Study, with dietary intake assessed with 3-day food record at baseline. Total omega-3 PUFA and DHA blood concentrations were analysed using a highthroughput proton (1H) NMR spectrometry metabolomics platform at the University of Eastern Finland. Multiple physical function tests and short physical performance battery (SPPB) was calculated at the baseline and 3-year followup. Results: The multivariable adjusted models showed statistically-significant associations for ALA with higher SPPB (β= 0.118, P=0.024), knee-extension-force at baseline (β= 0.075, P=0.037) and lower fat mass (β= - 0.081, P=0.034), as well as longer one-leg-stance (βbaseline= 0.119, βfollw-up=0.090, P<0.023), higher walking speed (βbaseline= 0.113, βfollw-up=0.144, P<0.047), and ability to squat to the ground (βbaseline= 0.110, βfollwup=0.096, P<0.047) at baseline and follow-up. Total omega-3 PUFA was statistically-significantly associated with better SPPB (βbaseline= 0.108, P=0.039), one-leg-stance (βbaseline= 0.102, P=0.041), walking speed (βbaseline= 0.110, βfollw-up=0.128, P<0.028) and ability to squat (βbaseline= 0.110, P=0.028). Associations for dietary EPA and DHA, serum omega-3 PUFA and DHA with physical function and body composition was not significant.

Dietary omega-3 polyunsaturated fatty acid and alpha-linolenic acid are associated with sarcopenia indices in older women 65-72 years.
Masoud Isanejad 1, 2, Toni Rikkonen 3, Behnam Tajik 4, Joonas Sirola

Background: Population of elderly in Indonesia is predicted to increase to 36 million in 2025. Increasing in life expectancy will be followed by health problem, one of which is sarcopenia. Screening and diagnosis are required to identify sarcopenia especially in community, so that early and comprehensive management can be applied for elderly. Method: This study is a cross sectional study in elderly population in Sarirejo village office. Total 29 elderly met inclusion criteria were involved in this study. Mini-Cog assessment was performed to screen cognitive impairment. Furthermore database were collected followed by MNA. Examination of lower extremities muscle mass was performed by dual x-ray absorptiometry (DXA) using General Electric health bone health. Physical performance was examined by time up and go (TUG) test. Data result were analyzed and statistically test using Pearson correlation and Ranged Spearman. Results: 27 (93,1%) women and 2 (6,9%) man involved in this study, with educational level of 10,3% (3 sample) have no education level, 48,3% (14 sample) have elementary level, 13,8% (4 sample) have junior high school level, 27,6% (8 sample) have senior high school level. Total of 93,1% (27 sample) were married, and 6,9% (2 sample ) were unmarried. From 29 sample, they were divided into 3 ranged group of age, according to WHO classification. Variable analysis result of TUG score with ranged group of age showed positive correlation with increasing age, F= 3.277, P=0,005. Correlation between age (in common) and TUG score showed result with increasing age (in common), followed by decreasing physical performance (P=0,009; r=0,477). Correlation between body mass index (BMI) score with DXA score showed result with increasing BMI score, followed by higher DXA score (P=<0,001; r=0,838). BMI was also showed positive correlation with sarcopenia group with P=<0,001. There was no correlation between MNA score with sarcopenia (P=0,419) and TUG test with sarcopenia (P=0,674). Conclusion: There was no correlation between MNA score, physical performance with sarcopenia.

Correlation Between Sarcopenia and Tug, and Sarcopenia With Physical Performance in Elderly Subjects in Sarirejo Village Semarang

Introduction: Coronavirus disease-2019 (COVID-19) is an infectious disease caused by SARS-CoV-2 virus.  The role of skeletal muscle mass in modulating immune response is well documented. Whilst obesity is well-established as a key factor in COVID-19 and outcome, no study has examined the influence of both sarcopenia (low muscle mass) and obesity, termed ‘sarcopenic obesity’ on COVID-19 risk. Using the UK Biobank, we aimed to association between sarcopenic obesity and the risk of COVID-19. Methods: Fully adjusted logistic regression used to analyse associations; covariates included age, ethnicity, socioeconomic status, & comorbidity. Discussion: Sarcopenic obesity significantly increased the likelihood of severe COVID-19 above that of obesity alone (regardless of low muscle mass definition). The mechanisms for this association are complex but could be a result of a reduction in respiratory functioning, immune response, and ability to respond to metabolic stress, Therapeutic approaches targeting both skeletal muscle and adiposity should form a key part in the treatment of COVID-19. 

Sarcopenic obesity and the risk of hospitalisation or death from COVID-19: findings from UK Biobank

Background: The European Working Group on Sarcopenia in Older People definition (EWGSOP2) follows different assessment steps to identify older adults with sarcopenia. Considering that aged population in Spain has a higher percentage of women, the aim of this study was to detect how the EWGSOP2 assessment steps decline in earlier ages in women in order to focus on them when identifying sarcopenia. Methods: Study design: Multicenter cross-sectional study. Participants: 193 older women (mean age: 77.8 +/- 9.1 years), from Valencia (Spain). Assessments and classification: Assessment steps and cut-offs of the EWGSOP2 algorithm (Figure 1). Assessments which showed detection at earlier ages were included for the classification: 1) probable sarcopenia; 2) confirmed sarcopenia; and 3) severe sarcopenia. Age groups: 65-74, 75-84 and ≥85 years old. Statistical analysis: to compare age groups Chisquare test and 1-factor ANOVA, or ANOVA-Welch adjusted by Bonferroni or Games-Howell, respectively. Results: Chair stand shows decline from 65 years old onwards, while ASM, gait speed and SPPB show it from 75 years, all of them with significant differences as aging occurs (p<0.001). On the contrary, ASM Index remains over the cut-off (>5.5 kg/m2) in all age groups. Consequently, participants were classified according to Chair stand, ASM and SPPB, showing that 50% of women aged ≥85 had severe sarcopenia. Conclusion: Chair stand, ASM and SPPB or gait speed seem to be early measurement detectors of sarcopenia for older women. These measurements should be considered in clinical settings in order to apply early intervention. Conclusion: Chair stand, ASM and SPPB or gait speed seem to be early measurement detectors of sarcopenia for older women. These measurements should be considered in clinical settings in order to apply early intervention.

Following the steps of the EWGSOP2 to detect sarcopenia
according to age groups in older women

Background: Sarcopenia is a prevalent condition with aging, and it is related to clinical and functional decline. Previously care setting has shown to play an important role in sarcopenia prevalence, plus in Spain aged population has a high percentage of women. Objective: to analyse the clinical and functional characteristics of community-dwelling and institutionalised older women with or without sarcopenia. Methods: Study design: A multicentre cross-sectional study. Setting: Valencia (Spain), Jan 2019-Feb 2020. Sample: older women (n=197), living in community (48.2%) and in residential facilities (51.8%). Clinical variables: number of medications, visits to doctor, number of hospitalisation stays, falls, Abbreviated Charlson’s Comorbidity Index. Results: Sarcopenic older women living in community took more medication (p=0.021) and presented significant functional decline for Barthel Index and biceps strength (both p= 0.0001) compared to non-sarcopenic women. Institutionalised sarcopenic older women showed higher number of falls (p=0.001), a decline of Barthel Index and biceps strength (both p= 0.0001), and also a significant decline in quadriceps strength (p=0.001) and calf circumference (p=0.004) compared to nonsarcopenic women. Conclusion: Number of medication and number of falls are characteristic of sarcopenic women living in community and institutionalised, respectively. The main functional variables that characterise sarcopenic women, whether they live in the community or institutionalised are Barthel Index and biceps strength. Clinicians may take these findings into consideration in order to identify sarcopenic women depending on their living setting.

Clinical and functional characteristics of sarcopenic vs non sarcopenic older women living in different settings

Background: 1) Cow’s milk is a source of several nutrients and non-nutrients that synergistically may be beneficial for skeletal muscle . 2) Muscle strength (grip strength, GS), a key component of sarcopenia , declines with advancing age , and has been proposed as a biological marker of ageing. 3) Evidence that links milk intake to decline in muscle strength from midlife to old age is lacking. Methods: 1) Analytic sample: 2723 (50.8% women) participants who had data for at least one exposure (milk, g/day) and one outcome (GS, kg). 2) Milk intake assessment: 5-day food diaries (ages 36, 43, 53 and 60-64 years) 6 . 3) Exposure: grand mean of total, reduced-fat and full-fat milk consumption were each categorised in thirds (T1 (lowest) to T3 (highest)). 4) Outcomes: maximum GS at ages 53, 60-64, and 69 years, and probable sarcopenia at age 69 defined by sex-specific cut-offs (<16 kg in women; <27 kg in men) 2 . 5) Statistical analyses: logistic regression to examine the risk of probable sarcopenia, and multilevel models to investigate decline in GS in relation to milk intake thirds. Conclusion: The data suggests that a higher milk consumption across adulthood is associated with better muscle strength in midlife and may reduce the risk of sarcopenia in later life.

Association between milk intake and decline in muscle strength from mid- to late life: the MRC National Survey of Health and Development

Introduction: 1) Low-income countries are expected to see the largest increase in over 60-year-olds over the next 30 years.1 This will lead to an increase in age related conditions such as sarcopenia and frailty. Assessing the prevalence and relationship of these syndromes is important in understanding how many older adults may be affected. 2) Sarcopenia has rarely been studied in rural communities in lowincome countries, yet may be an important contributor to poor health and impaired functioning. Bioimpedance analysis (BIA) and physical function tests used in the diagnosis of sarcopenia have also been associated with frailty. Methods: 1) Data were analysed from a randomly selected frailty-weighted sample of 235 adults aged ≥60 years from 5 randomly selected villages in Hai district, Kilimanjaro region of northern Tanzania. 2) This cohort was created from 1207 older adults who were screened using the Brief Frailty Instrument for Tanzania (B-FIT) to generate a sample with an artificially inflated number of frail and pre-frail individuals. 3) A diagnosis of sarcopenia was derived using the European Working Group on Sarcopenia in Older People’s definition; using estimated appendicular skeletal muscle mass by BIA, and grip strength. Those who also had poor physical performance by a low “timed up and go” (TUG) score were categorised as having severe sarcopenia. 4) Frailty was identified through a comprehensive geriatric assessment. Results: 1) A strong association was observed between frailty and sarcopenia: Chi2 test X= 35.475 (p <0.001), suggesting a relationship between the two syndromes. 2) Of the 235 individuals, 194 had complete data for grip strength, anthropometric and BIA measurements, allowing a diagnosis of sarcopenia to be derived. 47 (24.2%) participants had sarcopenia, of whom 19 had severe sarcopenia. Adjusting for frailty-weighting, the estimated prevalence of sarcopenia and severe sarcopenia in the screened population was 19.5% and 5.4% respectively. 3) 41 of the 235 individuals investigated did not have sufficient data recorded to diagnose sarcopenia, this included grip strength and measurements needed for bioimpedance analysis. 4) Phase angle (by BIA), grip strength and TUG all predicted frailty independently in multivariate regression analyses. 5) All of the physical factors investigated were significantly poorer in the frail group compared to the non-frail group (p<0.001). Conclusion: 1) The estimated prevalence of sarcopenia in rural northern Tanzania was 19.5%, this prevalence is higher than global estimates of sarcopenia in ≥60 year olds. 2) Phase angle and physical function tests were effective at predicting frailty in this population. 3) Bioimpedance may be an effective method for assessing sarcopenia in Northern Tanzania, and other low resource environments. 

Investigating the Prevalence of Sarcopenia, and its Association with Frailty in Northern Tanzania

Introduction: The prevalence of PD and sarcopenia both increase with age. They share features of pathogenesis including IL6 driven neuroinflammation and mitochondrial dysfunction. However the degree to which they co-occur and if the presence of sarcopenia is influenced by Parkinson’s disease stage is unknown. Methods: Predefined literature search strategies were used on MEDLINE, EMBASE, Scopus and Web of Science. Studies conducted in people with PD or aPS reporting on the prevalence of sarcopenia or those providing sufficient data to compute this using validated sarcopenia definitions were included. Mean prevalence was calculated across studies. A pooled odds ratio was calculated across studies reporting on prevalence of sarcopenia in controls. Risk of bias was assessed using the AXIS tool. Results: 1683 studies (199 duplicates) were identified through the search; 67 assessed in full; 14 met inclusion criteria. Average study quality score was 14.5/20. The mean prevalence of sarcopenia in parkinsonian patients was 17.9% (range 2- 31.4%). The mean prevalence of probable sarcopenia (i.e. low muscle strength) was 49.1% (range 17.5-76.7%). In all studies with non-parkinsonian controls, sarcopenia was more prevalent in those with parkinsonian disorders. The combined odds ratio was 2.49 (p <0.0001) see fig. 1. UPDRS III score positively correlated with prevalence of sarcopenia but this was not consistently shown in individual studies, see fig 2. Only 3 studies commented on the prevalence of sarcopenia in aPS and there was little agreement as to whether sarcopenia is more prevalent in PD or aPS. Conclusions: Sarcopenia is a prevalent and important issue in parkinsonian disorders. Probable sarcopenia is especially common. Recognition of this should prompt clinical testing and provision of appropriate interventions to minimise negative clinical outcomes associated with movement disorders being compounded by muscle weakness.

The Prevalence of Sarcopenia in Parkinson’s Disease and Related Disorders A systematic review

Adiposity and grip strength: a Mendelian Randomisation study

Background: Sarcopenia is associated with a low intake of energy and nutrients (e.g., protein and specific micronutrients as calcium, selenium, magnesium and vitamin D), which appears to influence muscle mass (muscle quantity and quality) and function (strength and walking speed). Material and methods: This research was part of a cross-sectional study called the Nutriage project (Ref. 0359_NUTRIAGE_1_E-5), which included a sample of permanent residents in fifteen nursing homes for older adults in Galicia (Northwest Spain). Food intake data were collected by the precise weighing method. Results were compared with Dietary Reference Intakes for >70-year-olds, alongside recommendations of the European Society for Clinical Nutrition and Metabolism and PROT-AGE group. The variables analyzed were energy, protein, selenium, calcium, magnesium and vitamin D in both sexes. Means for nutrient intake, were calculated, and differences by sex and age categories were tested using t-test or ANOVA. P values < 0.05 were considered statistically significant. Results: The sample selected for this study was 162 residents, where 65.4% were women and 34.6% were men. The average age of the participants was 85.6 years. Conclusions: The dietary intake of the institutionalized elderly in this study did not meet the recommended nutritional requirements in terms of calcium, magnesium and vitamin D. 5% of the residents did not meet their caloric needs and 22% of them were below the protein recommendations of ESPEN and PROT-AGE group. Despite finding no significant differences, in our sampl e we have seen that energy, protein and micronutrient consumption is higher in women than in men. Based on these findings, the nutritional intake of nursing homes is inadequate in terms of micronutrients, especially considering the published scientific evidence on the contribution of proteins and specific nutrients for the prevention of sarcopenia.

Next from ISTRC 2021 - International Sarcopenia Translational Research Conference

Dietary omega-3 polyunsaturated fatty acid and alpha-linolenic acid are associated with sarcopenia indices in older women 65-72 years. Masoud Isanejad 1, 2, Toni Rikkonen 3, Behnam Tajik 4, Joonas Sirola

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