Relationship between aging and excess body fat with markers of inflammation, skeletal muscle mass and strength in Mexican community-dwelling people.

INTRODUCTION: Aging is accompanied by changes in body composition, such as an increase in fat mass (FM), a decrease in skeletal muscle mass index (SMMI) and muscle strength, combined with a chronic inflammatory process (CI). OBJECTIVE: Determine the relationship between age and excess body fat with markers of chronic inflammation, skeletal muscle mass and strength. METHODS: A cross-sectional alitical study was carried out in a convenience sample of adults 45 to 59 years old (n = 100) and older adults 60 to 74 years old (n = 133). All participants had their body composition measured with an impedance meter. They were subsequently divided into two groups: (i) with excess fat (WEF), (ii) without excess fat (NEF), in order to relate excess fat and age with inflammation, muscle mass and strength. RESULTS: NEF adults and older adults had similar values of SMMI (9.1 ± 1.5 vs. 8.8 ± 1.3, p > 0.05) and strength (28 ± 8 vs. 27 ± 8.6, p > 0.05). Likewise, WEF adults showed significantly lower values than NEF adults in the SMMI (7.9 ± 0.8 vs. 9.1 ± 1.5, p < 0.05) and strength (28 ± 8 vs. 22 ± 5, p < 0.001). Also, WEF older adults presented significantly lower values in the SMMI (15.9 ± 1.8 vs. 22.8 ± 5.1, p < 0.05) and strength (17.9 ± 4.8 vs. 27 ± 8.6, p < 0.001). CONCLUSIONS: Our findings suggest that excess fat mass is a risk factor that has a significantly greater influence than aging per se on the index of skeletal muscle mass and strength.

Validation of SARC-F-Proxy for the Screening of Sarcopenia in Older Patients with Cognitive Impairment.

Objectives: The SARC-F is a validated questionnaire for the screening of sarcopenia in an older population. However, the clinical relevance of this self-reported questionnaire in patients with cognitive problems is questionable. This study aims to validate the SARC-F-Proxy as an alternative screening tool for sarcopenia in patients with cognitive impairment. Methods: This cross-sectional study included hospitalised community-dwelling older adults aged 60 years or older with confirmed cognitive impairment. Three SARC-F questionnaires were completed: one by patients, one by informal caregivers and one by formal caregivers. Muscle strength, mass and physical performance were measured by handgrip strength, anthropometric measurements, and gait speed respectively. The recently updated EWGSOP2 diagnostic criteria were used as the "gold standard" for diagnosis of sarcopenia. Results: The prevalence of sarcopenia using SARC-F-Proxy was 75.4% for SARC-F-Proxy-Formal caregiver and 66% for SARC-F-Proxy-Informal caregiver. SARC-F-Proxy had high sensitivity (85.9% for SARC-F-Proxy-Formal caregiver and 77% for SARC-F-proxy-informal caregiver) and low specificity (46.5% for SARC-F-Proxy-Formal caregiver and 54.7% for SARC-F-Proxy-Informal caregiver). Conclusions: the proxy-reported SARC-F questionnaire can be applied as a surrogate for the SARC-F in the screening of sarcopenia in hospitalised community-dwelling older people with known or suspected cognitive impairment. Second, the results in this study suggest a higher reliability when the proxy-reported questionnaire is performed by the formal caregiver.

Prevalence of dynapenia and presarcopenia related to aging in adult community-dwelling Mexicans using two different cut-off points.

OBJECTIVES: To estimate the prevalence of dynapenia, presarcopenia, and sarcopenia in a Mexican community using two different cutoffs. MATERIALS AND METHODS: This cross-sectional study included 724 subjects (521 women and 203 men) adults ≥ 50 years community-dwelling from Mexico City. We determined the prevalence of different muscle-related syndromes. Muscle strength was measured with handgrip strength and muscle mass was estimated by bioelectrical impedance. For the diagnosis of sarcopenia and presarcopenia, two criteria were used: (1) the cut-off points proposed by the European Working Group on Sarcopenia in Older People (EWGSOP) and (2) the cut-off points less than two standard deviations for gender-specific mean of Mexicans young adults. RESULTS: Muscle mass decreases with age, but not as rapid as muscle strength. With the specific Mexican cut-off points, the general prevalences were: 27.4% for dynapenia (n = 199), 12.8% for presarcopenia (n = 93), and 6.6% for sarcopenia (n = 48). In contrast, the prevalences were higher when we used the cut-off points for Caucasians (EWGSOP): 33.9% for dynapenia (n = 246), 38.1% for presarcopenia (n = 276), and 15.2% for sarcopenia (n = 110). CONCLUSIONS: Diagnoses of dynapenia, presarcopenia, and sarcopenia should be estimated from cut-off points of the specific population; otherwise, it might be overestimated or underestimated. Early diagnosis of any of these conditions in community can prevent the occurrence of adverse effects.

The effects of a low-carbohydrate diet on oxygen saturation in heart failure patients: a randomized controlled clinical trial.

INTRODUCTION: Nutritional therapy in heart failure (HF) patients has been focused on fluid and sodium restriction with the aim of decreasing volume overload. However, these recommendations are not well established and sometimes controversial. OBJECTIVE: To evaluate the effect of the consumption of a low-carbohydrate diet on oxygen saturation, body composition and clinical variables during two months of follow-up in chronic, stable heart failure patients. METHODS: In a parallel group randomized controlled clinical trial, 88 ambulatory patients were randomly assigned to a low-carbohydrate diet group (40% carbohydrates, 20% protein and 40% fats [12% saturated, 18% monounsaturated and 10% polyunsaturated]) or a standard diet group (50% carbohydrates, 20% protein and 30% fats [10% saturated, 10% monounsaturated and 10% polyunsaturated]) for two months. Diets were normocaloric in both groups. At baseline and at two months of follow-up, the variables evaluated were: oxygen saturation, dietary intake, body composition and handgrip strength. RESULTS: After two months of follow-up, the low-carbohydrate diet group decreased the carbohydrate consumption and had improved oxygen saturation (93.0 ±4.4 to 94.6 ± 3.2, p = 0.02), while the standard diet group had decreased (94.90 ± 2.4 to 94.0 ± 2.9, p = 0.03). There were also differences between the groups at the end of the study (p = 0.04). No significant differences showed in handgrip strength in both groups, low-carbohydrate diet group (26.4 ± 8.3 to 27.2 ± 8.3 kg, p = 0.07) and standard diet group (25.4 ± 8.9 to 26.1 ± 9.5 kg, p = 0.14). CONCLUSIONS: Low-carbohydrate diet may improve the oxygen saturation in patients with chronic stable heart failure.

The effects of a low-carbohydrate diet on oxygen saturation in heart failure patients: a randomized controlled clinical trial / Efecto de una dieta baja en hidratos de carbono sobre la saturación de oxígeno en pacientes con insuficiencia cardiaca: ensayo clínico aleatorizado

Introduction: Nutritional therapy in heart failure (HF) patients has been focused on fluid and sodium restriction with the aim of decreasing volume overload. However, these recommendations are not well established and sometimes controversial. Objective: To evaluate the effect of the consumption of a low-carbohydrate diet on oxygen saturation, body composition and clinical variables during two months of follow-up in chronic, stable heart failure patients. Methods: In a parallel group randomized controlled clinical trial, 88 ambulatory patients were randomly assigned to a low-carbohydrate diet group (40% carbohydrates, 20% protein and 40% fats [12% saturated, 18% monounsaturated and 10% polyunsaturated]) or a standard diet group (50% carbohydrates, 20% protein and 30% fats [10% saturated, 10% monounsaturated and 10% polyunsaturated]) for two months. Diets were normocaloric in both groups. At baseline and at two months of follow-up, the variables evaluated were: oxygen saturation, dietary intake, body composition and handgrip strength. Results: After two months of follow-up, the low-carbohydrate diet group decreased the carbohydrate consumption and had improved oxygen saturation (93.0 ± 4.4 to 94.6 ± 3.2, p = 0.02), while the standard diet group had decreased (94.90 ± 2.4 to 94.0 ± 2.9, p = 0.03). There were also differences between the groups at the end of the study (p = 0.04). No significant differences showed in handgrip strength in both groups, low-carbohydrate diet group (26.4 ± 8.3 to 27.2 ± 8.3 kg, p = 0.07) and standard diet group (25.4 ± 8.9 to 26.1 ± 9.5 kg, p = 0.14). Conclusions: Low-carbohydrate diet may improve the oxygen saturation in patients with chronic stable heart failure (AU)

Introducción: la terapia nutricional en pacientes con insuficiencia cardiaca (IC) ha sido enfocada en la restricción de líquidos y de sodio con el objetivo de reducir la sobrecarga de volumen. Sin embargo, estas recomendaciones no están bien establecidas y en algunos casos son controvertidas. Objetivo: evaluar el efecto del consumo de una dieta baja en hidratos de carbono sobre la saturación de oxígeno, composición corporal y variables clínicas durante dos meses de seguimiento en pacientes con insuficiencia cardiaca estable. Métodos: ensayo clínico aleatorizado paralelo en 88 pacientes ambulatorios que fueron asignados aleatoriamente al grupo dieta baja en hidratos de carbono (40% hidratos de carbono, 20% proteínas y 40% lípidos [12% saturadas, 18% monoinsaturadas y 10% poliinsaturadas]) o al grupo dieta estándar (50% hidratos de carbono, 20% proteínas y 30% lípidos [10% saturadas, 10% monoinsaturadas y 10% poliinsaturadas]) por dos meses. Las dietas fueron normocalóricas en ambos grupos. En la medición basal y a los dos meses de seguimiento, las variables evaluadas fueron: saturación de oxígeno, ingesta dietética, composición corporal y fuerza de presión de mano. Resultados: después de dos meses de seguimiento, el grupo de dieta baja en hidratos de carbono disminuyó el consumo de hidratos de carbono y mejoró la saturación de oxígeno (93.0 ± 4.4 to 94.6 ± 3.2, p = 0.02), mientras que el grupo de dieta estándar disminuyó (94.90 ± 2.4 to 94.0 ± 2.9, p = 0.03). También se observó diferencia entre los grupos al fi nal del estudio (p = 0.04). No se observaron diferencias estadísticamente significativas en fuerza de mano en ambos grupos: dieta baja en hidratos de carbono (26.4 ± 8.3 to 27.2 ± 8.3 kg, p = 0.07) y dieta estándar (25.4 ± 8.9 to 26.1 ± 9.5 kg, p = 0.14). Conclusiones: la dieta baja en hidratos de carbono mejora la saturación de oxígeno en pacientes con insuficiencia cardiaca estable (AU)

Cachexia assessed by bioimpedance vector analysis as a prognostic indicator in chronic stable heart failure patients.

BACKGROUND: This study explored whether the cachectic state assessed by bioimpedance vector analysis provides additional prognostic information about mortality from all causes. METHODS: We included 519 consecutive patients with stable chronic heart failure (mean age 62.5 ± 16.4 y; 286 males). Cachexia was identified in those subjects who fell outside the right lower quadrant of the reference curve of 95% on the resistance/reactance graph [bioelectrical impedance vectorial analysis (BIVA)-cachexia]. Clinical, anthropometric, and biochemical data were also evaluated. RESULTS: Patients with BIVA-cachexia (n = 196, 37.8%) were older and had significantly lower ejection fraction, handgrip strength, serum albumin, total cholesterol, and triglycerides. The frequency of patients with body mass index < 20, decreased muscle strength, hypoalbuminemia, anemia, anorexia, New York Heart Association functional classes III/IV and edema, as well as creatinine levels, resistance/height, and impedance index was significantly higher in the cachexia group. During 29 ± 11 mo of follow-up, 39 (19.9%) patients with BIVA-cachexia and 38 (11.7%) patients without BIVA-cachexia (P < 0.0001) died. CONCLUSIONS: The cachectic state is an independent risk factor for mortality in chronic heart failure patients. BIVA could represent a valuable tool to assess presence of cachexia as changes in body cell mass in heart failure patients because provide information additional to weight loss.