Phase Angle as an Indicator of Baseline Nutritional Status and Sarcopenia in Acute Stroke.

OBJECTIVES: This study aimed to investigate whether phase angle is an indicator of malnutrition and sarcopenia in acute-phase stroke patients. MATERIALS AND METHODS: We conducted a retrospective observational study of stroke patients in a single acute-care hospital. The phase angle was measured within 5 days after admission, and the correlation between nutritional status and sarcopenia index was investigated. The cut-off point that distinguishes malnutrition and sarcopenia was evaluated using the receiver operating characteristic curve. The effects of the geriatric nutritional risk index (GNRI) and sarcopenia on the phase angle were examined using multivariate linear regression analysis. RESULTS: A total of 211 stroke patients (140 men) with a median age of 74 (65-83) were included in the analysis. Malnutrition was present in 38 (18.0%) patients, and 65 (30.8%) had sarcopenia. The phase angle significantly correlated with GNRI, grip strength, skeletal muscle musss index, and calf circumference in both men and women. The cut-off points for discriminating malnutrition were 5.05 for men and 3.96 for women, while the cut-off points for discriminating sarcopenia were 5.28 for men and 4.62 for women. Multivariate linear regression analysis showed that the GNRI and sarcopenia were independently related to the phase angle. CONCLUSIONS: Phase angle is a useful indicator for distinguishing malnutrition and sarcopenia in patients with acute stroke.

Cruciferous vegetable intake is inversely associated with extensive abdominal aortic calcification in elderly women: a cross-sectional study.

We have previously shown that higher intake of cruciferous vegetables is inversely associated with carotid artery intima-media thickness. To further test the hypothesis that an increased consumption of cruciferous vegetables is associated with reduced indicators of structural vascular disease in other areas of the vascular tree, we aimed to investigate the cross-sectional association between cruciferous vegetable intake and extensive calcification in the abdominal aorta. Dietary intake was assessed, using a FFQ, in 684 older women from the Calcium Intake Fracture Outcome Study. Cruciferous vegetables included cabbage, Brussels sprouts, cauliflower and broccoli. Abdominal aortic calcification (AAC) was scored using the Kauppila AAC24 scale on dual-energy X-ray absorptiometry lateral spine images and was categorised as 'not extensive' (0-5) or 'extensive' (≥6). Mean age was 74·9 (sd 2·6) years, median cruciferous vegetable intake was 28·2 (interquartile range 15·0-44·7) g/d and 128/684 (18·7 %) women had extensive AAC scores. Those with higher intakes of cruciferous vegetables (>44·6 g/d) were associated with a 46 % lower odds of having extensive AAC in comparison with those with lower intakes (<15·0 g/d) after adjustment for lifestyle, dietary and CVD risk factors (ORQ4 v. Q1 0·54, 95 % CI 0·30, 0·97, P = 0·036). Total vegetable intake and each of the other vegetable types were not related to extensive AAC (P > 0·05 for all). This study strengthens the hypothesis that higher intake of cruciferous vegetables may protect against vascular calcification.

Exercise Plus Presleep Protein Ingestion Increases Overnight Muscle Connective Tissue Protein Synthesis Rates in Healthy Older Men.

Protein ingestion and exercise stimulate myofibrillar protein synthesis rates. When combined, exercise further increases the postprandial rise in myofibrillar protein synthesis rates. It remains unclear whether protein ingestion with or without exercise also stimulates muscle connective tissue protein synthesis rates. The authors assessed the impact of presleep protein ingestion on overnight muscle connective tissue protein synthesis rates at rest and during recovery from resistance-type exercise in older men. Thirty-six healthy, older men were randomly assigned to ingest 40 g intrinsically L-[1-13C]-phenylalanine and L-[1-13C]-leucine-labeled casein protein (PRO, n = 12) or a nonprotein placebo (PLA, n = 12) before going to sleep. A third group performed a single bout of resistance-type exercise in the evening before ingesting 40 g intrinsically-labeled casein protein prior to sleep (EX+PRO, n = 12). Continuous intravenous infusions of L-[ring-2H5]-phenylalanine and L-[1-13C]-leucine were applied with blood and muscle tissue samples collected throughout overnight sleep. Presleep protein ingestion did not increase muscle connective tissue protein synthesis rates (0.049 ± 0.013 vs. 0.060 ± 0.024%/hr in PLA and PRO, respectively; p = .73). Exercise plus protein ingestion resulted in greater overnight muscle connective tissue protein synthesis rates (0.095 ± 0.022%/hr) when compared with PLA and PRO (p < .01). Exercise increased the incorporation of dietary protein-derived amino acids into muscle connective tissue protein (0.036 ± 0.013 vs. 0.054 ± 0.009 mole percent excess in PRO vs. EX+PRO, respectively; p < .01). In conclusion, resistance-type exercise plus presleep protein ingestion increases overnight muscle connective tissue protein synthesis rates in older men. Exercise enhances the utilization of dietary protein-derived amino acids as precursors for de novo muscle connective tissue protein synthesis during overnight sleep.

Vitamin D status and supplementation impacts on skeletal muscle function: comparisons between young athletes and older adults.

PURPOSE OF REVIEW: The present narrative review analyzes emerging research implicating vitamin D status and supplementation with skeletal muscle homeostasis and functions in two distinct segments of the adult population: young athletes and older adults. RECENT FINDINGS: Vitamin D deficiency compromises multiple indices of muscle function in young athletes and older adults. A variety of vitamin D3 (cholecalciferol) supplementation regimens may transition young athletes and older adults from deficient or inadequate to adequate vitamin D status. Vitamin D supplementation, used to treat a vitamin D deficiency, but not necessarily an inadequacy, promotes muscle anabolism in older adults. For both young athletes and older adults, vitamin D supplementation, which transitions them from inadequate to adequate vitamin D status, may not beneficially affect measures of muscle strength and power, or physical performance. Also, when vitamin D status is adequate, vitamin D supplementation to further increase serum 25(OH)D concentrations does not seem to confer additional benefits to muscle strength and power and physical performance. SUMMARY: The impacts of vitamin D status and supplementation on skeletal muscle homeostasis and functions seem comparable in young athletes who strive to maximize physical performance and older adults who seek to attenuate muscle mass and physical performance declines.

Nutrient biomarker patterns, cognitive function, and fMRI measures of network efficiency in the aging brain.

A central aim of research in the psychological and brain sciences is to establish therapeutic interventions to promote healthy brain aging. Accumulating evidence indicates that diet and the many bioactive substances present in food are reasonable interventions to examine for dementia prevention. However, interdisciplinary research that applies methods from nutritional epidemiology and network neuroscience to investigate the role of nutrition in shaping functional brain network efficiency remains to be conducted. The present study therefore sought to combine methods across disciplines, applying nutrient biomarker pattern (NBP) analysis to capture the effects of plasma nutrients in combination and to examine their collective influence on measures of functional brain network efficiency (small-world propensity). We examined the contribution of NBPs to multiple indices of cognition and brain health in non-demented elders (n = 116), investigating performance on measures of general intelligence, executive function, and memory, and resting-state fMRI measures of brain network efficiency within seven intrinsic connectivity networks. Statistical moderation investigated whether NBPs influenced network efficiency and cognitive outcomes. The results revealed five NBPs that were associated with enhanced cognitive performance, including biomarker patterns high in plasma: (1) ω-3 and ω-6 polyunsaturated fatty acids (PUFAs), (2) lycopene, (3) ω-3 PUFAs, (4) carotenoids, and (5) vitamins B (riboflavin, folate, B12) and D. Furthermore, three NBPs were associated with enhanced functional brain network efficiency, including biomarker patterns high in plasma: (1) ω-6 PUFAs, (2) ω-3 PUFAs, and (3) carotene. Finally, ω-3 PUFAs moderated the fronto-parietal network and general intelligence, while ω-6 PUFAs and lycopene moderated the dorsal attention network and executive function. In sum, NBPs account for a significant proportion of variance in measures of cognitive performance and functional brain network efficiency. The results motivate a multidisciplinary approach that applies methods from nutritional epidemiology (NBP analysis) and cognitive neuroscience (functional brain network efficiency) to characterize the impact of nutrition on human health, aging, and disease.

The diversity of healthy diets for older persons across the world.

PURPOSE OF REVIEW: To examine eating patterns, and with a particular focus on the different healthy diets followed by older persons across the world and the factors that can limit accessibility to healthy foods. RECENT FINDINGS: Recent evidence has demonstrated that older people are, generally speaking, following less healthy diets with respect to the past. The only exception seems to be China, but the quality of the food there appears to be less than optimal. Socioeconomic status and, in particular, the price of food seems to be the most important factors linked to diet quality. SUMMARY: Although healthy diets are associated with lower risk of several chronic disabling diseases, elderly people tend to follow less healthy diets with respect to the past. Public health strategies can and should promote healthy eating patterns in this population.

Therapeutic and lifestyle approaches to obesity in older persons.

PURPOSE OF REVIEW: Obesity rates worldwide continue to increase and will disproportionately affect older adults because of population aging. This review highlights recent progress pertaining to therapeutic approaches to obesity in older adults. RECENT FINDINGS: Caloric restriction alone improves physical function and quality of life in older adults with obesity but is associated with loss of lean mass and increases fracture risk. Adding progressive resistance training to caloric restriction attenuates loss of muscle and bone mass and increasing protein intake enhances this effect. Adding aerobic endurance training to caloric restriction further improves cardiorespiratory fitness but adding both aerobic endurance training and resistance training to caloric restriction results in the greatest improvement in overall physical function while still preserving lean mass. Future promising therapeutic interventions include testosterone, myostatin inhibitors, and bariatric surgery, but there are few studies specific to obese older adults. SUMMARY: The optimal approach toward obesity in older persons is lifestyle intervention incorporating caloric restriction and exercise consisting of aerobic endurance training and resistance training. Maintenance of adequate protein intake, calcium, and vitamin D is advisable. There is insufficient evidence specific to obese older adults to recommend testosterone or bariatric surgery at this time. Myostatin inhibitors may become a future treatment, and clinical trials are ongoing.

New insights into the anorexia of ageing: from prevention to treatment.

PURPOSE OF REVIEW: Undernutrition in older adults is associated with frailty, functional decline, and mortality. The 'anorexia of ageing' is the age-related appetite and weight loss underpinning such undernutrition. This review examines the latest evidence for its prevention and treatment. RECENT FINDINGS: Existing nutritional therapies for the anorexia of ageing include supporting nutritional intake with fortified food or supplements, including protein, omega-3 fatty acids, multivitamins, and vitamin D. The Mediterranean diet provides high fat intake and nutrient density in a moderate volume of colourful and flavoursome food and is strengthening in evidence for healthy ageing. Studies of the gut microbiome, which potentially regulates normal appetite by acting on the brain-gut communication axis, are pertinent. Utilisation of the genetic profile of individuals to determine nutritional needs is an exciting advancement of the past decade and may become common practice. SUMMARY: Prevention or early treatment of the anorexia of ageing in older adults is critical. Latest evidence suggests that once significant weight loss has occurred, aggressive nutritional support may not result in improved outcomes.

Reflecting on Concepts Relevant to Contemplating the Relationships Between Glucose-Insulin Perturbations, Nutrition, and Aging.

Background: Medical professionals attribute a crucial role in the development of several age-related, chronic health maladies to glucose-insulin perturbations - particularly, discernible insulin resistance (IR). However, little information is available concerning the degree to which relatively minor changes in IR participate over time in overall aging population, e.g., when circulating glucose and/or insulin concentrations are consistently within the higher end of normally accepted ranges. Objective: Obtaining precise knowledge is important, because proper nutritional management has the distinct capability of ameliorating the consequences. Methods: Five key concepts are suggested to underpin current thinking as to the applicable mechanisms and these are (1) the practical use of fasting blood glucose (FBG) levels as an estimate of IR, (2) the potential role of even slightly aberrant insulin regulation over time in the aging process, (3) the implementation of "continuum of risks" rather than checkpoints in considering prevention, (4) the presence and meaning of an aging paradox discovered in a recent study, and (5) the importance nutritional considerations in the "deadly triangle" as key factors in aging. Conclusions: Maintaining relatively low levels of FBG representing IR during aging via nutritional means has the potential to deliver a longer, more healthful lifespan as well as ameliorate many adverse manifestations of aging.

Nutrition, Physical Exercise, and the Prevalence of Sarcopenia in Elderly Residents in Nursing Homes in China.

BACKGROUND This study aimed to investigate the factors associated with sarcopenia in elderly residents in three nursing homes in Suzhou City, East China including the association with nutrition and physical exercise. MATERIAL AND METHODS Elderly residents (n=316) from three nursing homes included 112 men and 204 women. The appendicular skeletal muscle index (ASMI), grip strength, and movements were measured to diagnose sarcopenia. The correlation between sarcopenia with age, sex, body mass index (BMI), ASMI, upper arm circumference, calf circumference, muscle content, grip strength, dietary intake, degree and duration of movement were also assessed. RESULTS The prevalence of sarcopenia was 28.8% (30.4% for men and 27.9% for women). Patients with sarcopenia were older compared with controls. Height, BMI, upper arm circumference, calf circumference and arm muscle mass, lower limb muscle mass, limb skeletal muscle index and ASMI, grip strength, and pace of movement were lower than controls. The prevalence of sarcopenia correlated with the intake of meat, fish, eggs, and milk, and duration of weekly aerobic and resistance exercise. Logistic regression analysis showed a positive correlation between the prevalence of sarcopenia and age, and a negative correlation between BMI and consumption of meat, eggs, and milk. CONCLUSIONS The prevalence of sarcopenia in elderly residents in three nursing homes in Suzhou City was 28.8%. Increasing age was a risk factor for sarcopenia. Increased BMI and a diet containing meat, eggs, and milk were protective factors. The findings from this study provide support that adequate dietary protein can prevent sarcopenia in the elderly.

Study protocol: associations between dietary patterns, cognitive function and metabolic syndrome in older adults - a cross-sectional study.

BACKGROUND: Loss of cognitive function is a significant issue as the world's population ages. Preserving cognitive function maintains independence in older adults bringing major societal and financial benefits. Lifestyle factors such as diet are modifiable risk factors, which may help preserve cognitive function. Most nutrition research aimed at preserving cognitive function and metabolic health has focussed on individual nutrients and foods, not allowing for food combinations and interactions. A dietary pattern approach considers the entire diet including its complexity. Previous research investigating dietary patterns and cognitive function has not always considered relevant covariates such as physical activity and the Apolipoprotein E genotype, which are known to have associations with cognitive function. The aim of the REACH (Researching Eating, Activity and Cognitive Health) study is to investigate associations between dietary patterns, cognitive function and metabolic syndrome, accounting for a range of covariates. METHODS: This cross-sectional study design will recruit older, community-living adults (65-74 years) from Auckland, New Zealand. Dietary data will be collected via a 109-item food frequency questionnaire validated using a 4-day food record. Cognitive function will be assessed using the Montreal Cognitive Assessment (paper based) and the Computerised Mental Performance Assessment System (COMPASS) - a testing suite covering six domains. Additional data will include genetic (Apolipoprotein E ε4) and biochemical markers (fasting glucose, HbA1c, lipids profile), anthropometric measurements (weight, height, waist and hip circumference, body composition using dual X-ray absorptiometry), blood pressure, physical activity (International Physical Activity Questionnaire - short form) and health and demographics (questionnaire). Dietary patterns will be derived by principal component analysis. Associations between cognitive function and dietary patterns will be examined using multiple regression analysis. Covariates and interaction factors will include age, education, socio-economic status, physical activity, Apolipoprotein E ε4 genotype, family history of dementia or cognitive impairment, and lifestyle factors. Differences between participants with and without metabolic syndrome will also be examined. DISCUSSION: This study will bring new knowledge regarding associations between dietary patterns and cognitive function and metabolic health in older adults living in New Zealand. This is important for developing nutrition related recommendations to help older adults maintain cognitive function.

Nutritional and Pharmacological Interventions to Expedite Recovery Following Muscle-Damaging Exercise in Older Adults: A Narrative Review of the Literature.

Exercise-induced muscle damage (EIMD) manifests as muscle soreness, inflammation, and reductions in force generating capacity that can last for several days after exercise. The ability to recover and repair damaged tissues following EIMD is impaired with age, with older adults (≥50 years old) experiencing a slower rate of recovery than their younger counterparts do for the equivalent exercise bout. This narrative review discusses the literature examining the effect of nutritional or pharmacological supplements taken to counter the potentially debilitating effects of EIMD in older adults. Studies have assessed the effects of nonsteroidal anti-inflammatory drugs, vitamin C and/or E, or higher protein diets on recovery in older adults. Each intervention showed some promise for attenuating EIMD, but, overall, there is a paucity of available data in this population, and more studies are required to determine the influence of nutrition or pharmacological interventions on EIMD in older adults.

Effects of higher habitual protein intake on resistance-training-induced changes in body composition and muscular strength in untrained older women: A clinical trial study.

BACKGROUND: Aging is accompanied by progressive and accentuated decline in muscular strength and skeletal muscle mass, affecting health and functional autonomy. Both resistance training (RT) and diet are strategies that may contribute to improvement in the health of the elderly. AIM: The purpose of this study was to evaluate the effects of higher habitual protein intake on RT-induced changes in body composition and strength in untrained postmenopausal women. METHODS: Seventy older women were submitted to an RT program. Body composition, muscular strength, and dietary intake (24 h dietary recall) were performed pre- and post-intervention. To verify different intervention effects according to protein intake of the participants, the sample was separated into tertiles according to protein intake: low, moderate, and high protein intake. RESULTS: A time vs. group interaction ( p < 0.05) was observed, with high protein intake presenting greater increases compared with low protein intake, for skeletal muscle mass (5.3% vs. 1.3%), lower limb lean soft tissue (4.9% vs. 1.4%), upper lean soft tissue (4.9% vs. 1.2%), preacher curl (24% vs. 15.2%), and total strength (16.4% vs. 11.7%). A time vs. group interaction ( p < 0.05) was observed, with high protein intake presenting greater increases compared with moderate protein intake, for skeletal muscle mass (5.3% vs. 3.2%). In all groups, a main effect of time ( p < 0.05) was observed for knee extension and chest press. CONCLUSIONS: We conclude that intake of >1.0 g/kg/day of protein promotes gains in skeletal muscle mass and muscular strength after RT in untrained older women.

Dietary patterns and cognition in older persons.

PURPOSE OF REVIEW: The current article reviews recently published evidence of the important role that specific dietary patterns may hold on preventing cognitive impairment and dementia over aging. RECENT FINDINGS: Specific dietary patterns attributed to targeting cardiovascular risk factors may protect against the development of mild cognitive impairment (MCI) and dementia, especially Alzheimer's disease. Numerous epidemiological studies have strongly suggested that multinutrient approaches using the Mediterranean diet (Med diet), dietary approach to systolic hypertension (DASH) and the Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) are associated with a lower risk of cognitive impairment, MCI and Alzheimer's disease in older persons. This multinutrient approach seems to hold better outcomes than single nutrient intervention. There is only one randomized clinical trial (PREDIMED study) showing an improvement in cognitive performance over time in those undergoing a Med diet protocol. SUMMARY: Nutrition is an essential and modifiable risk factor that plays a role on preventing and/or delaying the onset of dementia. There is sufficient evidence to hypothesize testing neuroprotective dietary patterns on cognition in randomized clinical trials in older persons. Healthy dietary patterns such as the Med diet, DASH and MIND deserve further attention in randomized clinical trials on cognitive performance outcomes.

The role of nutrition in geriatric rehabilitation.

PURPOSE OF REVIEW: To highlight the importance of nutrition in older adults undergoing a rehabilitation program. Geriatric rehabilitation aims at the recovery of physical abilities for a largely independent life in the community. The term 'geriatric rehabilitation' is wide and includes inpatient and ambulatory care as well as rehabilitation programs in hospitals, also outside geriatric wards. The role of nutrition is therefore not clearly defined, but an association between declined functional status and low nutritional status is evident. RECENT FINDINGS: An association has been identified between malnutrition and low physical function or lower rehabilitation effect, respectively. In intervention trials with nutritional care (additional energy or protein), a number of benefits for muscle mass, muscle strength, physical function, or the outcomes quality of life and rehospitalization were identified. In this context, the combination of exercise and adequate nutrition seems to be beneficial. SUMMARY: Geriatric patients undergoing a rehabilitation program outside inpatient, ambulatory, or hospitalization care need an adequate supply of energy and nutrients. Malnutrition must be avoided, ideally before starting rehabilitation. Nutritional interventions are most beneficial in combination with exercise training.

Nutritional interventions in sarcopenia: where do we stand?

PURPOSE OF REVIEW: To document recent evidence regarding the role of nutrition as an intervention for sarcopenia. RECENT FINDINGS: A review of seven randomized controlled trials (RCTs) on beta-hydroxy-beta-methylbutyrate (HMB) alone on muscle loss in 147 adults showed greater muscle mass gain in the intervention group, but no benefit in muscle strength and physical performance measures. Three other review articles examined nutrition and exercise as combined intervention, and suggest enhancement of benefits of exercise by nutrition supplements (energy, protein, vitamin D). Four trials reported on nutrition alone as intervention, mainly consisting of whey protein, leucine, HMB and vitamin D, with variable results on muscle mass and function. Four trials examined the combined effects of nutrition combined with exercise, showing improvements in muscle mass and function. SUMMARY: To date, evidence suggests that nutrition intervention alone does have benefit, and certainly enhances the impact of exercise. Nutrients include high-quality protein, leucine, HMB and vitamin D. Long-lasting impact may depend on baseline nutritional status, baseline severity of sarcopenia, and long-lasting adherence to the intervention regime. Future large-scale multicentered RCTs using standardized protocols may provide evidence for formulating guidelines on nutritional intervention for sarcopenia. There is a paucity of data for nursing home populations.

Fast digestive proteins and sarcopenia of aging.

PURPOSE OF REVIEW: The speed of dietary protein digestion influences postprandial amino acid availability which is crucial for improving altered anabolic response of skeletal muscle one feature of sarcopenia during aging. RECENT FINDINGS: By analogy with carbohydrate and in reference to their absorption rate, dietary proteins can be classified as 'fast' or 'slow' proteins depending on matrix food structure and technological processes, which can influence amino acids availability and their subsequent metabolic actions. 'Fast' digestive proteins have been shown to stimulate muscle protein synthesis and to improve muscle function in several recent studies involving older patients. These new aspects may be applied for improving health through preservation or restoration of muscle protein mass and function in clinical situations (obesity, rheumatoid arthritis and cancer cachexia). SUMMARY: Using fast digestive proteins is of major interest to overcome 'anabolic resistance' of aging for limiting sarcopenia. Fast proteins' action on muscle anabolism may be stimulated by other nutrients like vitamin D or omega 3 fatty acids or by combination with exercise. The beneficial impact of the 'fast' protein concept beyond the amount of dietary protein on muscle preservation is a promising therapeutic perspective to improve mobility and quality of life of older patients affected with chronic disease.

The final word on nutritional screening and assessment in older persons.

PURPOSE OF REVIEW: To provide an updated perspective of how nutritional screening and assessment in older persons should be performed and reasonably implemented in the near future. RECENT FINDINGS: Although nutritional screening and assessment should be fast and easy procedures, there is increasing evidence that more time should be dedicated to them. This is probably an answer to the claim to a medicine being more preventive than curative. Increasing interest is currently given to healthy aging and nutritional status is more likely to be addressed for its implications on functional status and disability. Important prognostic conditions, such as frailty, sarcopenia, and cachexia, which are closely linked to the nutritional domain, are at the top of the agenda. Therefore, body composition is a key issue and functional status is suggested as primary endpoint of nutrition trials. In this scenario, there is also a rationale for systematic assessment of inflammation, protein intake, and vitamin D status as potential contributing factors to reduced muscle mass and function. SUMMARY: A 'second-generation' multidimensional nutritional screening and assessment including the evaluation of body composition, frailty, sarcopenia, and cachexia could be hypothesized. Nutritional assessment should be also completed by the systematic evaluation of inflammation, protein intake, and vitamin D status.

Updates in nutrition and polypharmacy.

PURPOSE OF REVIEW: Medications have the potential to affect nutritional status in negative ways, especially as the number of medications increase. The inter-relation between polypharmacy and malnutrition is complex and not fully delineated in previous studies. More research has been done and compiled in the last year, which helps to clarify this relationship. This review brings together the most recent literature with the previous research to help healthcare providers to better assess and manage medication therapy in older adults. RECENT FINDINGS: Recent evidence confirms a synergistic negative effect of polypharmacy and malnutrition on outcomes of older adults. In addition, several drug classes, including common antihypertensive agents, acetylcholinesterase inhibitors, multivitamins, proton pump inhibitors, HMG-CoA reductase inhibitors (statins), antiplatelet agents and metformin, have been implicated in important drug-nutrient interactions. These are reviewed in detail here. Ongoing research endeavors are described. SUMMARY: Healthcare practitioners can use this review to identify potentially inappropriate medications and patients at highest risk of experiencing a medication-related adverse reaction in order to systematically deprescribe these high-risk medications.

Geriatric nutritional risk index as a prognostic factor in patients with diffuse large B cell lymphoma.

The geriatric nutritional risk index (GNRI) is a simple and well-established nutritional assessment tool that is a significant prognostic factor for various cancers. However, the role of the GNRI in predicting clinical outcomes of diffuse large B cell lymphoma (DLBCL) patients has not been investigated. To address this issue, we retrospectively analyzed a total of 476 patients with newly diagnosed de novo DLBCL. We defined the best cutoff value of the GNRI as 96.8 using a receiver operating characteristic curve. Patients with a GNRI < 96.8 had significantly lower overall survival (OS) and progression-free survival (PFS) than those with a GNRI ≥ 96.8 (5-year OS, 61.2 vs. 84.4%, P < 0.001; 5-year PFS, 53.7 vs. 75.8%, P < 0.001). Multivariate analysis showed that performance status, Ann Arbor stage, serum lactate dehydrogenase, and GNRI were independent prognostic factors for OS. Among patients with high-intermediate and high-risk by National Comprehensive Cancer Network-International Prognostic Index (NCCN-IPI), the 5-year OS was significantly lower in patients with a GNRI < 96.8 than in those with a GNRI ≥ 96.8 (high-intermediate risk, 59.5 vs. 75.2%, P = 0.006; high risk, 37.4 vs. 64.9%, P = 0.033). In the present study, we demonstrated that the GNRI was an independent prognostic factor in DLBCL patients. The GNRI could identify a population of poor-risk patients among those with high-intermediate and high-risk by NCCN-IPI.