Oral frailty is associated with mortality independently of physical and psychological frailty among older adults.

BACKGROUND: Although oral frailty is independently associated with an increased risk of mortality, evidence for the usefulness of screening tools for oral frailty is less than that for physical frailty screening tools. We aimed to investigate the relationship between oral frailty and mortality in older adults. METHODS: This prospective cohort study included 11,374 adults aged ≥65 years, who provided valid responses to a baseline mail survey questionnaire from the Kyoto-Kameoka study. Oral frailty status was evaluated using the Oral Frailty Index-8 (range, 0 [best] to 10 [worst]). Participants were classified into four categories according to the Oral Frailty Index-8: robust (score, 0-2), oral pre-frailty (score, 3), oral frailty (score, 4-6), and oral severe frailty (score ≥ 7). Physical and psychological frailty were evaluated using the validated frailty-screening index and defined as a score of ≥3 out of a possible 5 points. Mortality data were collected from 30 July 2011 to 30 November 2016. Hazard ratios (HR) for all-cause mortality were calculated using a multivariable Cox proportional hazards model. RESULTS: During the 5.3-year median follow-up period (57,157 person-years), 1184 deaths were recorded. After adjusting for confounders, including physical and psychological frailty, medical history, and lifestyle, in comparison with a robust oral status, oral pre-frailty (HR, 1.29; 95 % confidence interval [CI], 1.02-1.63), oral frailty (HR, 1.22; 95 % CI, 1.01-1.48), and oral severe frailty (HR, 1.43; 95 % CI, 1.16-1.76) were associated with higher HRs of mortality (p for trend = 0.002). CONCLUSION: Oral frailty is associated with mortality independent of physical and psychological frailty in older adults. The Oral Frailty Index-8 may be useful for identifying individuals at high risk of mortality.

Molecular geochemistry of radium: A key to understanding cation adsorption reaction on clay minerals.

Adsorption reactions of various cations on clay minerals have different effects on their environmental behaviors depending on the molecular-scale adsorption structure. Some cations form outer-sphere complexes via hydration, while others create inner-sphere complexes through dehydration. This preference dictates their environmental impact. However, the factors controlling these complex formations remain unclear. Furthermore, research on the adsorption preferences of radium (Ra) is lacking. Thus, this study conducted the first EXAFS study of Ra2+ adsorbed on clay minerals and showed that Ra2+ forms inner-sphere complexes on vermiculite, which can be surprising because Ra2+ is a divalent cation and prefers to be hydrated. In order to investigate the factors controlling the complex formations, this study conducted systematic EXAFS measurements and DFT calculations for alkali and alkaline earth metal cations. The results showed the importance of the size-matching effect between the adsorbed cation and the cavity of the tetrahedral sheets and that the complex formation can be estimated by the combination of the ionic radius and hydration enthalpy of the adsorbed cation. Furthermore, this study also analyzed environmental core samples. Their results showed the fixation of Ra2+ by clay minerals and the controlling factors can effectively predict cation environmental behavior.

Thigh muscle thickness on ultrasonography for diagnosing sarcopenia: The Kyoto-Kameoka study.

AIM: The Asian Working Group for Sarcopenia 2019 consensus reported that evidence for the diagnosis of sarcopenia based on ultrasonography findings is lacking. The revised European Working Group on Sarcopenia in Older People consensus stated that ultrasonography is reliable and valid for assessing muscle size in older adults. The present study aimed to determine the predictive accuracy of ultrasonography for sarcopenia in older adults in Japan. METHODS: A total of 1229 participants aged 65-91 years were included in this cross-sectional study. The thickness of the anterior compartment of the right thigh was assessed using B-mode ultrasonography. The measurement position was at the midpoint of the thigh. In addition, the grip strength, gait speed, Five-Time Sit-to-Stand Test, Short Physical Performance Battery score and skeletal muscle mass index were evaluated. Sarcopenia was diagnosed based on the Asian Working Group for Sarcopenia 2019 algorithm. We calculated the area under the receiver operating characteristic curve. RESULTS: The area under the receiver operating characteristic curves (95% confidence intervals) and cutoff values for the thigh muscle thickness in sarcopenia were 0.901 (0.856-0.946) and 4.0 cm in men, respectively, and 0.923 (0.851-0.995) and 3.1 cm in women, respectively. The area under the receiver operating characteristic curve for each subdomain of sarcopenia, such as grip strength and gait speed, ranged from 0.618 to 0.872. CONCLUSIONS: In the present study, the suggested cutoff mid-thigh muscle thicknesses on ultrasonography for predicting sarcopenia were 4.0 cm in men and 3.1 cm in women. Geriatr Gerontol Int 2024; 24: 156-161.

Extended X-ray absorption fine structure spectroscopy measurements and ab initio molecular dynamics simulations reveal the hydration structure of the radium(II) ion.

Radium is refocused from the viewpoint of an environmental pollutant and cancer therapy using alpha particles, where it mainly exists as a hydrated ion. We investigated the radium hydration structure and the dynamics of water molecules by extended X-ray absorption fine structure (EXAFS) spectroscopy and ab initio molecular dynamics (AIMD) simulation. The EXAFS experiment showed that the coordination number and average distance between radium ion and the oxygen atoms in the first hydration shell are 9.2 ± 1.9 and 2.87 ± 0.06 Å, respectively. They are consistent with those obtained from the AIMD simulations, 8.4 and 2.88 Å. The AIMD simulations also revealed that the water molecules in the first hydration shell of radium are less structured and more mobile than those of barium, which is an analogous element of radium. Our results indicate that radium can be more labile than barium in terms of interactions with water.

Rational design of a disulfide bridge increases the thermostability of microbial transglutaminase.

Microbial transglutaminase (MTG) has numerous industrial applications in the food and pharmaceutical sectors. Unfortunately, the thermostability of MTG is too low to tolerate the desired conditions used in many of these commercial processes. In a previous study, we used protein engineering to improve the thermostability of MTG. Specifically, we generated a T7C/E58C mutant of MTG from Streptomyces mobaraensis that displayed enhanced resistance to thermal inactivation. In this study, a rational structure-based approach was adopted to introduce a disulfide bridge to further increase the thermostability of MTG. In all, four new mutants, each containing a novel disulfide bond, were engineered. Of these four mutants, D3C/G283C showed the most promising thermostability with a significantly higher ∆T50 (defined as the temperature of incubation at which 50% of the initial activity remains) of + 9 °C by comparison to wild-type MTG. Indeed, D3C/G283C combined enhanced thermostability with a 2.1-fold increased half-life at 65 °C compared with the wild-type enzyme. By structure-based rational design, we were able to create an MTG variant which might be useful for expanding the scope of application in food. KEY POINTS: • Microbial transglutaminase (MTG) is an enzyme used in many food applications • The applicability of MTG to various industrial processes other than the food sector is being investigated • Improvement of thermostability was confirmed for the disulfide bridge mutant D3C/G283C.

Marking actinides for separation: Resonance-enhanced multiphoton charge transfer in actinide complexes.

Precise separation and purification of f-block elements are important and challenging especially for the reduction of nuclear waste and the recycling of rare metals but are practically difficult mainly because of their chemical similarity. A promising way to overcome this difficulty is controlling their oxidation state by nonchemical processes. Here, we show resonance-enhanced multiphoton charge transfer in actinide complexes, which leads to element-specific control of their oxidation states owing to the distinct electronic spectra arising from resonant transitions between f orbitals. We observed oxidation of trivalent americium in nitric acid. In addition, we found that the coordination of nitrates is essential for promoting the oxidation reaction, which is the first finding ever relevant to the primary process of photoexcitation via resonant transitions of f-block elements. The resonance-enhanced photochemical process could be used in the nuclear waste management, as it would facilitate the mutual separation of actinides, such as americium and curium.

Lanthanide extraction using a thiodiglycolamic acid extractant: effect of S-donor on lanthanide separation.

Liquid-liquid extraction of lanthanide (Ln) ions was investigated using N,N-dioctylthiodiglycolamic acid (DOTDGAA), which is a sulfur donor ligand with an amide group and a carboxyl group connected by a thioether chain. The extraction performance and selectivity of DOTDGAA for Ln ions were compared with those of N,N-dioctyldiglycolamic acid (DODGAA), which is also an oxygen donor ligand with a similar chemical structure, to assess the effect of the soft/hard donor atom on Ln separation. DOTDGAA quantitatively extracted all Ln ions while being selective toward the light and middle Ln ions, in contrast to the selectivity of DODGAA for heavier Ln ions. Slope analysis demonstrated that the Ln3+ transfer using DOTDGAA proceeded through a proton-exchange reaction, forming a 1:3 complex, Ln(DOTDGAA)3. The back-extraction of Ln ions from the extracting phase was successfully achieved under acidic conditions.

Study on Phenanthroline Carboxamide for Lanthanide Separation: Influence of Amide Substituents.

Phenanthroline carboxamide compounds are promising for lanthanide intra-series separation. This paper presents a study on the effect of structure modification of phenanthroline carboxamides on the extraction of the whole lanthanide series. The study consists of theoretical calculations, extraction experiments of the 14 stable lanthanides, and extended X-ray absorption fine structure (EXAFS) analyses of Nd and Dy complexes. Tridentate monocarboxamides and tetradentate dicarboxamides show different trends in series extraction, although both preferentially extract the light lanthanides. The amide substituents, although not directly coordinating the metal ions, were also found to impact the distribution ratio, most probably due to a modification in the internal polarity of the molecules. This latter effect, if extrapolated to other nitrogen-based ligands such as pyridines or triazines, can be used to further fine-tune extractants for a process improvement.

Association of bioelectrical phase angle with aerobic capacity, complex gait ability and total fitness score in older adults.

PURPOSE: This study aimed to examine the association between whole-body or segmental phase angle (PhA) based on bioelectrical impedance analysis (BIA) and aerobic capacity (endurance), complex gait ability, and total fitness age score (FAS). METHODS: A total of 426 community-dwelling older adults (332 women and 94 men) aged 60 to 93 years participated in this study. PhA and appendicular skeletal mass index (ASMI) were obtained by an eight-electrode standing BIA. Aerobic capacity was assessed using the shuttle stamina walk test (SSTw); complex gait ability, using the timed-up-and-go test (TUG). FAS was obtained using the previously validated multi-dimensional equations based on 7-year longitudinal data. SSTw, TUG, and FAS were compared between the low PhA (<4.4° for women and <5.2° for men) and normal PhA groups. Pearson's correlation between PhA and SSTw, TUG, and FAS was determined. Multiple linear regression analysis was conducted using SSTw, TUG, and FAS as dependent variables. Age, sex, height, body mass index (BMI), ASMI, and PhA were entered into the linear model. RESULTS: SSTw and TUG results and FAS were significantly lower in the low PhA group (P < 0.05). PhA was significantly correlated with SSTw, TUG, and FAS (P < 0.001), and leg PhA showed a stronger correlation than whole-body or arm PhA. PhA at 50 kHz had higher correlation coefficients with SSTw, TUG, or FAS compared with PhA at 5 or 250 kHz. Multiple regression analyses indicated that leg PhA at 50 kHz was a significant predictor of SSTw, TUG, and FAS, independent of age, sex, height, BMI, and ASMI. CONCLUSION: Our results indicate that leg PhA is associated with multi-dimensional physical fitness in community-dwelling older adults. PhA is a highly informative biomarker of skeletal muscle and exercise physiology in clinical settings.

Effect of introducing a disulfide bridge on the thermostability of microbial transglutaminase from Streptomyces mobaraensis.

Microbial transglutaminase (MTG) has been used extensively in academic research and the food industry through cross-linking or posttranslational modification of proteins. In our previous paper, the activity-increased MTG mutants were obtained by means of rational mutagenesis and random mutagenesis coupled with the newly developed screening system. In addition, the improvement of heat resistance of MTG is needed to expand further its industrial applications. Here, a structure-based rational enzyme engineering approach was applied to improve the thermostability of MTG by introducing an artificial disulfide bridge. As a result of narrowing down candidates using a rational approach, we successfully engineered a disulfide bridge into the N-terminal region of MTG by substituting Thr-7 and Glu-58 with cysteine. The T7C/E58C mutant was observed to have a de novo disulfide bridge and showed an increased melting temperature (Tm value) of 4.3 °C with retained enzymatic activity. To address the benefit-gained reason, we focused on the Cß temperature factor of the amino-acid residues that might form a disulfide bridge in MTG. Introducing the disulfide bridge had no remarkable effect on the mutant aiming to stabilize the high temperature factor. On the other hand, the mutation was effective on the relatively stable region. The introduction of a disulfide bridge may therefore be effective to stabilize further the relatively stable part. This finding is considered to be useful for the rational design of mutants aiming at heat resistance of proteins.Key Points• Microbial transglutaminase (MTG) is used as a binder in the food industry.• MTG has the potential for use in the manufacturing of various commercial materials.• Enhanced thermostability was observed for the disulfide bridge mutant, T7C/G58C.

Solvent Extraction of Technetium(VII) and Rhenium(VII) Using a Hexaoctylnitrilotriacetamide Extractant.

Liquid-liquid extraction for the removal of pertechnetate (99TcO4-) and perrhenate (ReO4-) is reported based on using the tripodal extractant N,N,N',N',N″,N″-hexa-n-octylnitrilotriacetamide (HONTA) composed of three amide groups and a tertiary amine. The extraction behaviors were compared with those using alkyldiamideamines (ADAAM(Oct) and ADAAM(EH)), and the commercial amine-type extractant, trioctylamine (TOA). HONTA quantitatively extracted 99TcO4- and ReO4- in the pH range from 1.0 to 2.5 by the co-extraction of protons. The extraction performance of the extractants was improved in the order of HONTA > ADAAM(Oct) > ADAAM(EH) > TOA. 99TcO4- and ReO4- in the extracting phase were successfully stripped using neutral aqueous solutions as the receiving phase, and the extraction ability of HONTA was maintained after five repeated uses.

Association between Mixing Ability of Masticatory Functions Measured Using Color-Changing Chewing Gum and Frailty among Japanese Older Adults: The Kyoto-Kameoka Study.

The relationship between mixing ability of masticatory functions and frailty has not been well evaluated. This study investigated the prevalence of physical and comprehensive frailty and its association with mixing ability in 1106 older adults aged ≥65 years who underwent physical examination as part of the Japanese Kyoto-Kameoka Study. Mixing ability was assessed using color-changing chewing gum (1-5 points, 5 representing the best mixing ability). Participants were divided into four groups (5 points, 4 points, 3 points, and 1 or 2 points). The modified Japanese versions of the Cardiovascular Health Study (mJ-CHS) criteria and the validated Kihon Checklist (KCL) were used to assess physical and comprehensive frailty, respectively. Multivariate logistic regression was used to evaluate the association between frailty and mixing ability. The prevalence of physical and comprehensive frailty was 11.8% and 27.9%, respectively. After adjusting for confounders, the odds ratios of physical and comprehensive frailty comparing the highest to the lowest chewing gum score groups were 3.64 (95% confidence interval (CI): 1.62 to 8.18; p for trend = 0.001) and 2.09 (95% CI: 1.09 to 4.03; p for trend = 0.009), respectively. Mixing-ability tests involving chewing gum may be an indicator associated with both physical and comprehensive frailty.

Effects of Capsinoids on Daily Physical Activity, Body Composition and Cold Hypersensitivity in Middle-Aged and Older Adults: A Randomized Study.

Sedentary/inactive lifestyle leads middle-aged and older adults to metabolic syndrome and frailty. Capsinoids from nonpungent chili pepper cultivar have been reported to reduce body fat mass, promote metabolism, and improve unidentified complaints of chills. Additionally, they have an anti-inflammation effect; therefore, we hypothesized that continuous oral ingestion of capsinoids alleviates age-related inflammation in the brain and improves the physical activity (PA) in middle-aged and older adults. In our double-blind human study, 69 participants (17 male, 52 female; mean age: 74.1 ± 7.7 years; range: 52-87 years) were administered either 9 mg of capsinoids which were extracted from pepper fruit variety CH-19 Sweet (Capsicum anuum L.) (CP group), or a placebo (PL group) daily over a 3 month period. In an animal study, PA and inflammation-related mRNA expression in the brain were examined in 5-week (young) and 53-week (old) aged mice fed a diet with or without 0.3% dihydrocapsiate, a type of capsinoids, for 12 weeks. In a human study, capsinoids intake did not increase the amount of light-to-moderate PA less than 6.0 metabolic equivalents (METs) (CP: 103.0 ± 28.2 at baseline to 108.2 ± 28.3 at 12 weeks; PL: 104.6 ± 19.8 at baseline to 115.2 ± 23.6 at 12 weeks, METs × hour/week); however, in participants exhibiting an inactive lifestyle, it showed significant increase (CP: 84.5 ± 17.2 at baseline to 99.2 ± 24.9 at 12 weeks; PL: 99.7 ± 23.3 at baseline to 103.8 ± 21.9 at 12 weeks). The energy expenditure in physical activity also improved in the inactive CP group (CP: 481.2 ± 96.3 at baseline to 562.5 ± 145.5 at 12 weeks; PL: 536.8 ± 112.2 at baseline to 598.6 ± 127.6 at 12 weeks; kcal/day). In all participants, CP showed reduced waist circumference, percent body fat, and visceral fat volume; in addition, chills were eased in subjects aged 80 years and older. The older mice fed capsinoids showed increased locomotion activity, decreased inflammation, and oxidative stress in the brain. The results suggest that the continuous oral ingestion of capsinoids gains PA through anti-inflammation effect in the brain as well as reduces fat accumulation and chills in inactive and older humans.

Comprehensive geriatric intervention in community-dwelling older adults: a cluster-randomized controlled trial.

BACKGROUND: In longevity societies, one of the most serious social issues is sarcopenia and/or frailty. Preventing them is important for maintaining independence and quality of life in the older population. This study investigated the effect of a self-monitoring comprehensive geriatric intervention programme (CGIP) on physical function and muscle size in community-dwelling older adults. We compared the effects of a CGIP using weekly class-styled (CS) sessions and a home-based (HB) programme. METHODS: The 526 participants were randomized into one of two groups (CS 251, HB 275) based on their residential districts. We conducted a 12 week CGIP, which consisted of low-load resistance exercise, physical activity increments, oral function improvements, and a nutritional guide. All participants were encouraged to attend two 90 min lectures that included instructions on the CGIP. They were provided with exercise materials (triaxial-accelerometers/pedometers, ankle weights, and elastic bands) and diary logs. The CS group attended 90 min weekly sessions and independently executed the programme on other days, whereas the HB group only received instructions on how to execute the programme. Physical functions, such as knee extension strength (KES), normal and maximum walking speed, the timed up-and-go test, and anterior thigh muscle thickness (MT), were measured and analysed using intention-to-treat analysis before and after the 12 week intervention. RESULTS: Of the 526 participants identified, 517 (CS 243 age 74.0 ± 5.4 women 57.2%, HB 274 age 74.0 ± 5.6 women 58.8%) were enrolled. Nine (CS 8, HB 1) were excluded from the analysis because they did not participate in the pre-intervention measurements. Both interventions significantly improved KES (CS 18.5%, HB 10.6%), normal walking speed (CS 3.7%, HB 2.8%), and MT (CS 3.2%, HB 3.5%). Greater improvement of KES was observed in the CS group (P = 0.003). Maximum walking speed (CS 4.7%, HB 1.8%; P = 0.001) and timed up-and-go (CS -4.7%, HB -0.2%; P < 0.001) significantly improved in the CS group only. CONCLUSIONS: The intervention was effective in preventing sarcopenia and/or frailty. Most physical functions and MT improved after both interventions. The HB intervention is cost-effective and may help prevent sarcopenia and/or frailty in the large older population.

Estimation of Energy Intake by a Food Frequency Questionnaire: Calibration and Validation with the Doubly Labeled Water Method in Japanese Older People.

Accurate assessments of a target population's energy intake (EI) are essential to prevent poor nutritional status. However, self-reported dietary records (DRs) or food frequency questionnaires (FFQs) are not always accurate, thereby requiring validation and calibration studies. This study aimed to validate the EI estimated by a FFQ using the doubly labeled water (DLW) method. Participants were 109 Japanese older adults (50 women and 59 men) aged 65-88 years. The EI was obtained by a DR and 47-item FFQ over 1 year. The total energy expenditure (TEE) was measured by DLW for ~2 weeks. EI was significantly lower than TEE (p < 0.01); ratios of EI assessed by DR and FFQ against TEE were 0.91 ± 0.17 and 0.82 ± 0.22, respectively. TEE was significantly and moderately correlated with the EI estimated by the DR (r = 0.45, p < 0.01) and FFQ (r = 0.37, p < 0.01). Furthermore, the EI correlation coefficients estimated by DR and the FFQ in this study were not significantly different (p = 0.46). The EI/TEE ratio was significantly and negatively correlated with the body mass index (BMI). In conclusion, EI estimated with a DR or FFQ modestly correlated with TEE, and calibrating EI with a developed equation in this study can attenuate the underestimation of EI.

Engineering an Automaturing Transglutaminase with Enhanced Thermostability by Genetic Code Expansion with Two Codon Reassignments.

In the present study, we simultaneously incorporated two types of synthetic components into microbial transglutaminase (MTG) from Streptoverticillium mobaraense to enhance the utility of this industrial enzyme. The first amino acid, 3-chloro-l-tyrosine, was incorporated into MTG in response to in-frame UAG codons to substitute for the 15 tyrosine residues separately. The two substitutions at positions 20 and 62 were found to each increase thermostability of the enzyme, while the seven substitutions at positions 24, 34, 75, 146, 171, 217, and 310 exhibited neutral effects. Then, these two stabilizing chlorinations were combined with one of the neutral ones, and the most stabilized variant was found to contain 3-chlorotyrosines at positions 20, 62, and 171, exhibiting a half-life 5.1-fold longer than that of the wild-type enzyme at 60 °C. Next, this MTG variant was further modified by incorporating the α-hydroxy acid analogue of Nε-allyloxycarbonyl-l-lysine (AlocKOH), specified by the AGG codon, at the end of the N-terminal inhibitory peptide. We used an Escherichia coli strain previously engineered to have a synthetic genetic code with two codon reassignments for synthesizing MTG variants containing both 3-chlorotyrosine and AlocKOH. The ester bond, thus incorporated into the main chain, efficiently self-cleaved under alkaline conditions (pH 11.0), achieving the autonomous maturation of the thermostabilized MTG. The results suggested that synthetic genetic codes with multiple codon reassignments would be useful for developing the novel designs of enzymes.

Validity of a triaxial accelerometer and simplified physical activity record in older adults aged 64-96 years: a doubly labeled water study.

BACKGROUND: The aim was to examine the validity of a triaxial accelerometer (ACCTRI) and a simplified physical activity record (sPAR) in estimating total energy expenditure (TEE) and physical activity level (PAL) in older adults with the doubly labeled water (DLW) method. METHODS: A total of 44 Japanese elderly individuals (64-96 years), of which 28 were community-dwelling healthy adults with or without sporting habits (S or NS group) and 16 were care home residents with frailty (F group), were included in the study. Basal metabolic rate (BMR) was measured by indirect calorimetry, TEE was obtained by the DLW method, and PAL was calculated as TEE/BMR. Daily step count was monitored by a pedometer (Lifecorder). The 24-h average metabolic equivalent was assessed by ACCTRI and sPAR. RESULTS: The TEEDLW in men was 2704 ± 353, 2308 ± 442, and 1795 ± 338 kcal d-1, and that in women was 2260 ± 208, 1922 ± 285, and 1421 ± 274 kcal d-1 for the S, NS, and F groups, respectively. ACCTRI and sPAR systematically underestimated actual TEE (- 14.2 ± 11.6 and - 15.3 ± 12.3% for ACCTRI and sPAR, respectively). After diet-induced thermogenesis was taken into account for ACCTRI and sPAR, TEEDLW was significantly correlated with TEEACCTRI (R2 = 0.714) and TEEsPAR (R2 = 0.668). PALDLW was also significantly correlated with PALACCTRI (R2 = 0.438) and PALsPAR (R2 = 0.402). CONCLUSIONS: Age, living conditions, frailty, and sporting habits contribute to TEE and PAL in the elderly population. ACCTRI and sPAR underestimated TEE and PAL, and adequate corrections are required. The corrected ACCTRI and sPAR are both useful tools to estimate TEE and PAL.

Sex Difference in the Association Between Protein Intake and Frailty: Assessed Using the Kihon Checklist Indexes Among Older Adults.

BACKGROUND: Dietary protein intake is inversely associated with physical frailty risk. However, it is unknown whether an association exists between dietary protein intake and comprehensive frailty. OBJECTIVE: To evaluate the association between protein intake and comprehensive frailty in older Japanese adults. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study included 5638 Japanese participants (2707 men and 2931 women) aged ≥65 years from Kameoka City, Kyoto, Japan. MEASUREMENTS: Dietary intake was estimated using a validated self-administered food frequency questionnaire. Comprehensive frailty was assessed using a 25-item Kihon Checklist (KCL), which comprised instrumental activities of daily living, mobility disability, malnutrition, oral or eating function, socialization and housebound, cognitive function, and depression domains. A KCL score of 4 to 6 was defined as prefrailty, and ≥7 as frailty. RESULTS: In women, but not in men, protein intake showed a lower prevalence for prefrailty (Q1-Q4, 40.2%, 34.3%, 34.3%, and 36.0%). Higher protein intake was associated with lower prevalence of frailty both in men (32.5%, 28.4%, 28.3%, and 27.3%) and women (35.7%, 31.4%, 27.6%, and 28.2%). Moreover, higher dietary protein intake decreased the odds ratio (OR) for frailty after adjustment for potential confounding factors in both men (OR for highest vs lowest quartile, 0.62; 95% CI, 0.43-0.89; P for trend = 0.016) and women (OR 0.64; 95% CI, 0.45-0.91; P for trend = 0.017). CONCLUSIONS/IMPLICATIONS: The higher dietary protein intake may be inversely associated with the prevalence of comprehensive frailty in Japanese men and women. Future studies are needed to examine associations of dietary protein intake within KCL domains.

Comprehensive geriatric intervention program with and without weekly class-style exercise: research protocol of a cluster randomized controlled trial in Kyoto-Kameoka Study.

OBJECTIVE: The number of long-term care (LTC) users and the associated expenditures in Japan are increasing dramatically. The national government recommends LTC prevention through activation of communities. However, there is no clear evidence of the effect of population-based comprehensive geriatric intervention program (CGIP) for restraints of LTC users and the associated expenditures in the future. The aims of the current paper are to describe the study protocol and progress of a cluster randomized controlled trial (RCT) with a CGIP in Kameoka City. METHODS: The cluster RCT involved random allocation of regions as intervention (n=4,859) and nonintervention (n=7,195). Participants were elderly persons aged ≥65 years without LTC certification who had responded to a mailing survey. The residents living in intervention regions were invited to a physical check-up, and 1,463 people participated (30.3%). These individuals were invited to the CGIP, and 526 accepted. The CGIP comprised instructions on: 1) low-load resistance training using bodyweight, ankle weights, and elastic bands; 2) increasing daily physical activity; 3) oral motor exercise and care; and 4) a well-balanced diet based on a program from Ministry of Health, Labour and Welfare. We allocated the intervention regions randomly into home-based self-care program alone (HB group, 5 regions, n=275) and home-based program+weekly class-style session (CS group, 5 regions, n=251). We evaluated the effects of the CGIP at 12 weeks and at 12 or 15 months on physical function, and are conducting follow-up data collection for an indefinite period regarding LTC certification, medical costs, and mortality. RESULTS AND DISCUSSION: The study was launched with good response rates in each phase. Participants of both groups significantly increased their step counts by ~1,000 per day from the baseline during the CGIP. This RCT will provide valuable information and evidence about effectiveness of a community-based CGIP.

Sociodemographic and physical predictors of non-participation in community based physical checkup among older neighbors: a case-control study from the Kyoto-Kameoka longitudinal study, Japan.

BACKGROUND: It is difficult to obtain detailed information on non-participants in physical and health examination checkups in community-based epidemiological studies. We investigated the characteristics of non-participants in a physical and health examination checkup for older adults in a nested study from the Japanese Kyoto-Kameoka Longitudinal Study. METHODS: We approached a total of 4831 people aged ≥65 years in 10 randomly selected intervention regions. Participants responded to a mail-based population survey on needs in the sphere of daily life to encourage participation in a free face-to-face physical checkup examination; 1463 participants (706 men, 757 women) participated in the physical checkup. A multiple logistic regression model was performed to investigate the adjusted odds ratios (aOR) of non-participation based on sociodemographic status apart from psychological and physiological frailty as assessed by the validated Kihon Checklist. RESULTS: There was a significant, inverse relationship between non-participation and frequently spending time alone among individuals who lived with someone or other family structure (aOR = 0.53, standard error [SE] 0.08 in men, aOR = 0.66, SE 0.09 in women). Very elderly (over 80 years old) women, poorer health consciousness and current smoking in both sexes and poor self-rated health in men, were significantly related to higher non-participation rates. In both sexes, individuals who did not participate in community activities were significantly more likely to be non-participants than individuals who did (aOR = 1.94, SE 0.23 in men, aOR = 3.29, SE 0.39 in women). Having low IADL and physical functioning scores were also associated with higher rates of non-participation. CONCLUSION: Health consciousness and lack of community activity participation were predictors of non-participation in a physical checkup examination among older adults. In addition, lower IADL and physical functioning/strength were also predictors of non-participation. On the contrary, older inhabitants living with someone tended to participate in the physical checkup examination for social interchange when they were frequently alone in the household. This study suggests the importance of considering aging especially for women and poor sociodemographic background and physical frailty for both sexes so that older people can access health programs without difficulty. TRIAL REGISTRATION: UMIN000008105 . Registered 26 April 2012. Retrospectively registered.