Comparison of Agreement between Several Diagnostic Criteria of Sarcopenia in Community-Dwelling Older Adults.

PURPOSE: Several diagnostic algorithms exist to detect sarcopenia in older adults. We compared the prevalence of sarcopenia according to the selected diagnostic algorithms. METHODS: This cross-sectional study compared the European Working Group of Sarcopenia in Older People (EWGSOP) 2010, updated EWGSOP 2019, the Foundation for National Institutes of Health (FNIH) and the International Working Group on Sarcopenia (IWGS) criteria in 778 outpatients of the Geriatric Clinic aged 60 to 89 years. Bioimpedance analysis (BIA) to estimate muscle mass, hand-held hydraulic dynamometer to measure muscle strength, the TUG test and gait speed to assess physical function were used. RESULTS: The prevalence of sarcopenia varied from 0% to 6.43% depending on the algorithm. For the majority of associations between the different definitions of sarcopenia the agreement was null or fair (Cohen's kappa between 0.2 and 0.4). Moderate agreement (Cohen's kappa between 0.4 and 0.6) was found for only three relationships. Nevertheless, for these three relationships, McNemar's test has given different results, indicating that even in the moderately agreeing algorithms, the shared diagnoses of sarcopenia concerned only part of subjects. CONCLUSIONS: According to diagnostic algorithms the prevalence of sarcopenia is low in independent community-dwelling older adults. The agreement between the different definitions is poor.

Aerobic and anaerobic power in relation to age and physical activity in 354 men aged 20-88 years.

We examined simultaneously the influence of age as well as both current and historical habitual physical activity (PA) on aerobic (physical working capacity - PWC) and anaerobic (Pmax) power in 354 men aged 20.2-87.6 yrs. All the participants performed the graded aerobic exercise test and 8-second explosive power tests on a bicycle ergometer. Current leisure time physical activity (LTPA) and lifetime historical LTPA were assessed. The decline in Pmax/kg (10.3% per decade) was higher than in PWC/kg (7.5% per decade). Correlation coefficients for current LTPA and aerobic indices were higher than for current LTPA and anaerobic indices. In a multiple stepwise regression, current LTPA had the main effect on PWC/kg, whereas age had the main effect on Pmax/kg. Aerobic power was related to all measures of historical PA questionnaire, while anaerobic power - only to those historical measures which pertained to adolescence and younger years of adulthood. We conclude that the age-associated decline in anaerobic power is steeper than that of aerobic power. Habitual endurance-type LTPA increases aerobic but not anaerobic fitness throughout the adult lifespan. Anaerobic fitness indices are higher in young active vs sedentary men but this difference is not discernible as early as in the middle age.

CHRODIS criteria applied to the MASK (MACVIA-ARIA Sentinel NetworK) Good Practice in allergic rhinitis: a SUNFRAIL report.

A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, is an example of a Good Practice focusing on the implementation of multi-sectoral care pathways using emerging technologies with real life data in rhinitis and asthma multi-morbidity. The European Union Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) has developed a checklist of 28 items for the evaluation of Good Practices. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries), a European Union project, assessed whether MASK is in line with the 28 items of JA-CHRODIS. A short summary was proposed for each item and 18 experts, all members of ARIA and SUNFRAIL from 12 countries, assessed the 28 items using a Survey Monkey-based questionnaire. A visual analogue scale (VAS) from 0 (strongly disagree) to 100 (strongly agree) was used. Agreement equal or over 75% was observed for 14 items (50%). MASK is following the JA-CHRODIS recommendations for the evaluation of Good Practices.

Simultaneous validation of ten physical activity questionnaires in older men: a doubly labeled water study.

OBJECTIVE: The purpose of this study was to simultaneously validate 10 physical activity (PA) questionnaires in a homogenous population of healthy elderly men against the reference method: doubly labeled water (DLW). DESIGN: Cross-sectional study. SETTING: Community-based sample from Lyon, France. PARTICIPANTS: Nineteen healthy old men (age 73.4 +/- 4.1 years), recruited from various associations for elderly people in Lyon, agreed to participate in the study. MEASUREMENTS: The questionnaire-derived measures (scores) were compared with two validation measures: DLW and maximal oxygen uptake (VO2max). With the DLW method three parameters were calculated: (1) total energy expenditure (TEE), (2) physical activity level (PAL), i.e., the ratio of TEE to resting metabolic rate, (3) energy expenditure of PA. RESULTS: Relative validity. Correlation between the questionnaires and TEE ranged from 0.11 for the Yale Physical Activity Survey (YPAS) total index to 0.63 for the Stanford usual activity questionnaire. This questionnaire also gave the best correlation coefficients with PAL (0.75), and with VO2max (0.62). Significant results with TEE measured by the DLW method were also obtained for college alumni sports score, Seven Day Recall moderate activity, and Questionnaire d'Activité Physique Saint-Etienne sports activity (r = 0.54, r = 0.52, and r = 0.54, respectively). Absolute validity. No difference was found between PA measured by the Seven Day Recall or by the YPAS and DLW, on a group basis. The limits of agreement were wide for all the questionnaires. CONCLUSIONS: Only a few questionnaires demonstrated a reasonable degree of reliability and could be used to rank healthy older men according to PA. Correlation coefficients were best when the Stanford Usual Activity Questionnaire was compared with all the validation measures. The two questionnaires reporting recent PA, the Seven Day Recall, and YPAS accurately assessed energy expenditure for the group. The individual variability was high for all the questionnaires, suggesting that their use as a proxy measure of individual energy expenditure may be limited.

Quadriceps muscle function in relation to habitual physical activity and VO2max in men and women aged more than 65 years.

The relationship of quadriceps maximal muscle power (Pmax), corresponding optimal shortening velocity (v(opt)), and relative fatigability (Pmax%D) to maximal oxygen uptake (VO2max) and habitual physical activity (PA) was examined in healthy community-dwelling subjects (29 women and 25 men) aged more than 65 years old. PA was evaluated by a questionnaire and expressed using two activity indices: mean habitual daily energy expenditure (MHDEE) and the daily energy expenditure corresponding to leisure time sports activities (Sports Activity). In women, Pmax correlated positively with VO2max (r = .56) and with Sports Activity (rho = .41). Both Sports Activity and Pmax were significant independent predictors of VO2max and accounted for 62% of variance in VO2max. In men, v(opt) was significantly negatively related to MHDEE (r = -.59) and to Sports Activity (rho = -.40). Neither in women nor in men was Pmax%D correlated with VO2max or PA indices. The different relationship of Pmax and v(opt) with VO2max and PA indices suggests that habitual PA may be sufficient in active older women, but not in men, to positively influence quadriceps muscle function. These gender differences may suggest different approaches in exercise programming for elderly women and men.

The symptomatology of upper respiratory tract infections and exercise in elderly people.

PURPOSE: To analyze, both by a retrospective and prospective study design, the relationship of maximal oxygen consumption (VO2max) and physical activity (PA) to upper respiratory tract infections (URTI) symptomatology in elderly subjects. METHODS: 61 (33 men and 28 women) healthy and weight-stable active elderly volunteers aged 66-84 yr participated in the study. PA was evaluated by a questionnaire QAPSE (Questionnaire d'Activite Physique Saint-Etienne) and expressed by two QAPSE activity indices: MHDEE (mean habitual daily energy expenditure) and sports activity (daily energy expenditure corresponding to leisure time sports activities). Log books for daily recording of URTI symptomatology were used in prospective design. RESULTS: In a 1-yr retrospective study a significant correlation was found between number of weeks with URTI per year and Sports activity index (r = -0.27, P = 0.037). In a prospective 12-month follow-up, the number of episodes per year and number of days with URTI per year were significantly negatively associated with sports activity index (r = -0.29, P = 0.022 and r = -0.26, P = 0.041, respectively). CONCLUSIONS: In healthy active elderly subjects the symptomatology of URTI over long periods of time is inversly related to energy expenditure utilized during moderately intensive physical exercise.

Relationship of physical activity and fitness to lipid and lipoprotein (a) in elderly subjects.

PURPOSE: To determine, both by a cross-sectional and longitudinal study design, the relationship of maximal oxygen consumption (VO2max) and physical activity (PA) to blood lipids and lipoprotein(a) [Lp(a)] in a population of healthy and weight-stable elderly volunteers aged 66-84 yr. METHODS: In a cross-sectional study in 52 subjects (23 men and 29 women), all independent variables (age, anthropometric, VO2max, and PA indices) were used in a multiple stepwise regression analysis to select variables influencing lipid and lipoprotein parameters. In a prospective nonintervention study, 38 subjects (17 men and 21 women) were reexamined after 6 months. RESULTS: In a cross-sectional study, sports activity index contributed significantly to total cholesterol (TC), low density lipoprotein (LDL) cholesterol (LDL-C), TC/high density lipoprotein (HDL) cholesterol (HDL-C) ratio, and LDL-C/HDL-C ratio variance in men, whereas VO2max accounted for 23% variance of apolipoprotein A-I in women. In a prospective study, there was no indication that any measured variable was correlated with absolute or relative changes in PA indices in the total group or when analyzed by gender. CONCLUSIONS: These data confirm that favorable relationship between PA/fitness and blood lipid profile is visible in elderly people but spontaneous changes in habitual PA are not a sufficient stimulus to alter serum lipid and lipoprotein levels in this population. Furthermore, there is no direct association between Lp(a) levels and PA, fitness, or body composition in the elderly men and women.

Usefulness of the prognostic inflammatory and nutritional index (PINI) in hospitalized elderly patients.

The prognostic inflammatory and nutritional index (PINI) is a simple scoring system of overall health which aggregates two blood markers of inflammatory (C-reactive protein and alpha(1)-acid glycoprotein) and of nutritional (albumin and transthyretin) states. This study was undertaken with a view to evaluate, in comparison to currently used predictive approaches, the potential usefulness of PINI to forecast hospital mortality and outcome of patients hospitalized in an acute geriatric unit. 1,066 elderly patients, aged 82.7 +/- 6.6 years and fulfilling inclusion criteria, were enrolled in the study. Logistic regression analysis and calculation of relative risk (RR) were carried out for epidemiological data with a cut-off value of 25 for PINI. Immediate mortality (7.9%) of admissions) was predicted by PINI > or = 25 (RR = 4.34). Only 387 patients (36.3%) could rejoin their residence location (home or family). A sizeable proportion of acute patients (55.8%) failed to recover and/or developed diseased states requiring chronic care management. Incapacity to return home was predicted by PINI > or = 25 (RR = 2.04). Hypoalbuminaemia < or = 30 g/L was not found a predictor of mortality but was associated with total disability (RR = 9.08). The optimal PINI cut-off value to predict mortality was calculated at 8.8 using the ROC analytic approach. We conclude that the PINI formula is helpful to predict both nearest lethality and chronic institutionalization. This scoring system should take a place within the battery of tests used to identify and to follow up acutely ill elderly patients at risk of major complications.

Decision support systems for chemical structure representation, reaction modeling, and spectra simulation.

The choice of an appropriate structure coding scheme is the secret to success in QSAR studies. Depending on the problem at hand, 2D or 3D descriptors have to be chosen; the consideration of electronic effects might be crucial, conformational flexibility has to be of special concern. Artificial neural networks, both with unsupervised and with supervised learning schemes, are powerful tools for establishing relationships between structure and physical, chemical, or biological properties. The EROS system for the simulation of chemical reactions is briefly presented and its application to the degradation of s-triazine herbicides is shown. It is further shown how the simulation of chemical reactions can be combined with the simulation of infrared spectra for the efficient identification of the structure of degradation products.

Lack of correlation between 6-month fluctuations in habitual physical activity and testosterone. Concentrations in elderly subjects.

BACKGROUND: To examine the influence of long-term modifications in habitual physical activity (PA) on resting total testosterone (TT) concentrations in a group of healthy elderly subjects. EXPERIMENTAL DESIGN: 6-month prospective study. SETTING: University research departments of exercise physiology and geriatric medicine. PARTICIPANTS: thirty-one independent, community dwelling elderly subjects (16 men and 15 women) aged > 65 who volunteered to participate. INTERVENTIONS: correlational study. MEASURES: PA was evaluated by a questionnaire QAPSE (Questionnaire d Activité Physique Saint-Etienne) and expressed by two activity indices: mean habitual daily energy expenditure (MHDEE) and daily energy expenditure corresponding to leisure time sports activities (Sports activity index). RESULTS: Changes in resting TT concentrations were not related to changes in MHDEE (r = -0.28; p = 0.30 and r = -0.001; p=0.99) and Sports activity (r = -0.30; p = 0.26 and r = -0.05; p = 0.85) in men and women, respectively. Similarly, relative (%) changes in TT were not related to relative changes in MHDEE (r = -0.16; p=0.55 and r = 0.17; p=0.55) and Sports activity (r = -0.11; p=0.68 and r = 0.02; p = 0.92). CONCLUSIONS: The levels of habitual PA undertaken by an average senior do not appear to affect TT levels in healthy active elderly men and women.

[Relation between physical activity, muscle function and IGF-1, testosterone and DHEAS concentrations in the elderly]. / Relations entre l'activité physique, la fonction musculaire et les concentrations en IGF-1, testostérone et DHEAS lors de l'avancée en âge.

OBJECTIVE: Lower amounts of circulating anabolic hormones are thought to accelerate the age related decline in muscle mass and function. Replacement therapies are promising interventions but there are problems with these therapies. Thus alternative strategies should be developed. The age related changes in hormonal status may be probably influenced by exercise. The purpose of this study was: a) to confirm with other methods, more adapted for elderly people, the results of a previous study that has shown relationship between physical activity (PA) and quadriceps muscle function with dehydroepiandrosterone sulphate (DHEAS), insulin like growth factor-1 (IGF-1). Quadriceps muscle power (Pmax) is measured in this new work with a recently developed leg extensor machine and, b) to complete the results of the first study examining simultaneously the relationship between PA, Pmax and cardiorespiratory fitness (VO2max) with DHEAS, IGF-1 and testosterone in a group of healthy elderly people. METHODS: Fifty independent, community dwelling elderly subjects (25 mens and 25 womens) aged from 66 to 84 volunteered to participate in the study. PA was evaluated by the questionnaire and expressed using two activity indices: mean habitual daily energy expenditure (MHDEE) and the daily energy expenditure corresponding to leisure time sports activities (Sports Activity). Pmax and optimal shortening velocity (vopt) were measured on a Ergopower dynamometer. The Pmax was expressed relative to body mass, Pmax/kg (W kg-1), and relative to the mass of the two quadriceps muscles, Pmax/Quadr (W.kgQuadr-1). VO2max has been measured during a maximal treadmill exercise. RESULTS: In women, IGF-1 correlated significantly with MHDEE (r = 0.54, P = 0.004), Pmax/kg (r = 0.54, P = 0.004) and Pmax/Quadr (r = 0.46, P = 0.02), whereas DHEAS with MHDEE (r = 0.54, P = 0.004), Sports Activity (r = 0.65, P < 0.001), VO2max (r = 0.46, P = 0.02), Pmax/kg (r = 0.46, P = 0.02) and Pmax/Quadr (r = 0.55, P = 0.004). No such correlation was found in men. CONCLUSION: These findings confirm that in healthy elderly women physical activity, cardiorespiratory fitness and quadriceps muscle function are similarly related to levels of circulating DHEAS and IGF-1 suggesting a favourable influence of exercise on anabolic hormonal production in the elderly.

[Sarcopenia: definition and clinical implications]. / Sarkopenia--definicja i implikacje kliniczne.

Age-related decrease in skeletal muscle mass has been referred to as sarcopenia. This reduction in muscle mass is a direct cause of the age-related decrease in muscle strength and power. Reduced muscle strength and power is a major cause of functional dependence in the elderly, contributing also to the increase in the prevalence of many age-associated chronic diseases.

[Aging, physical activity and free radicals]. / Starzenie sie, aktywnosc fizyczna i wolne rodniki.

A growing amount of evidence indicates that increasing with age imbalance between pro- and antioxidants is implicated in a premature ageing and a variety of diseases. Physical activity influences both the production of reactive oxygen species and physiological antioxidant defences. This paper reviews the current literature on the influence of physical exercise on the oxidative stress markers and antioxidant defence system in the elderly people.

[Methods of evaluating physical activity in the elderly]. / Metody oceny aktywnosci ruchowej u osób w podeszlym wieku.

Various methods measuring physical activity (PA) that have been used so far in older population are described. Different PA questionnaires and their potential application in routine PA assessment in that age group are discussed.

[Physio-pathologic aspects of aging--possible influence of physical training on physical fitness]. / Fizjo-patologiczne aspekty starzenia sie--mozliwosci oddzialywania przez trening fizyczny na sprawnosc fizyczna.

Two physiological parameters seem to be of major importance in maintaining physical functioning in the elderly: a capacity to perform aerobic exercises (endurance fitness) and an ability to do anaerobic work, especially maximal muscle force and power. Regular physical activity helps in maintaining these parameters at levels enabling normal functioning at everyday's living, contributing therefore to preservation of functional autonomy and independence in the elderly.

[Aging and so called "youth hormones". Potential influence of exercise training]. / Starzenie sie a tzw. "hormony mlodosci". Potencjalny wplyw treningu fizycznego.

Plasma levels of dehydroepiandrosterone sulphate (DHEAS), insulin-like growth factor-I (IGF-I), and testosterone decline with ageing. These hormones share some biological activities which counteract the aging processes: increase in fat-free mass, decrease of adipose tissue and globally increased fitness and well being. It seems that lower levels of these hormones may reflect partially lower physical activity and fitness of older subjects. If further longitudinal studies confirm this, regular participation in exercise training would become a useful alternative to hormone replacement therapy.

[Red wine in medicine: panacea, fashion or ... risk factor?]. / Czerwone wino w medycynie: panaceum, moda czy ... czynnik ryzyka?

Red wine has been a subject of much interest of professionals representing different fields of medicine. However, most of scientific studies have been searching for the reason of so called French paradox, which means that in France and other mediterranean countries the morbidity and mortality due to ischaemic heart disease is significantly lower than in other developed countries, in spite of relatively high consumption of fat and saturated fatty acids. The cardio-protective mechanism of red wine, although incompletely understood, is connected on one hand with the presence of ethanol which increases high-density lipoprotein cholesterol (HDL) and inhibits platelet aggregation, and on the other hand with the presence of polyphenols that have desirable biological properties. These include flavonoids, phenolic acids and stilbenes which are reputed to have antioxidant, vasorelaxing and antiplatelet properties. There is a considerable body of evidence indicating that regular consumption of red wine at moderate doses (200-400 ml a day) exerts a protective effect against ischaemic heart disease, other cardiovascular diseases, and perhaps diabetes, osteoporosis or some cancers. But, since alcohol intake involves a potential danger (risk of dependence, alcoholism, many organic diseases, migraine, allergies) medical recommendations of red wine consumption should be formulated very carefully.

Nutritional status and quality of life in different populations of older people in Poland.

BACKGROUND/OBJECTIVES: To estimate the potential association of three distinct nutritional status measures (body mass index (BMI), calf circumference (CC) and the Mini Nutritional Assessment (MNA)) with health-related quality of life (HRQL) assessed with Euroqol 5D questionnaire in different populations of elderly people in Poland. SUBJECTS/METHODS: The study group was comprised of 1003 community-dwelling subjects from the urban environment, 890 subjects from the rural environment and 879 subjects from an institutional environment (nursing homes). Bivariate and multivariate associations were identified between nutritional status measures and HRQL adjusted for demographic and social variables, health status, physical function and mental status. RESULTS: Nutrition status indices (BMI, CC and MNA) were generally higher in the urban than in the rural environment and clearly worse in institutionalised elderly. In both community-dwelling groups, BMI and CC were negatively related to several Euroqol scores. In institutional residents, of opposite relationships were observed: higher values of these variables were connected with less frequent reporting of problems in Euroqol. In all the three groups, associations between HRQL scores and MNA were very similar: higher values of MNA were significantly connected with less frequent reporting of problems in Euroqol. CONCLUSIONS: BMI and CC, as overweight/obesity measures, are independent predictors of lower HRQL in urban and rural community-dwelling seniors and higher HRQL in institutionalised elderly. Poor nutritional state as measured by MNA is a similar determinant of well-being in all the three environments. This different relationship of popular overweight/obesity measures to HRQL should be taken into account while designing care for older people.

Validation of the modified mini nutritional assessment short-forms in different populations of older people in Poland.

OBJECTIVE: To assess the usefulness in different populations of elderly people in Poland of both modified versions of Mini Nutritional Assessment Short-Forms (MNA-SFs) with a three-category scoring classification: one using BMI (MNA-SF-BMI) and another using calf circumference (MNA-SF-CC). SETTING AND PARTICIPANTS: A group of 932 community-dwelling subjects from the urban environment, 812 subjects from the rural environment and 859 subjects from an institutional environment (nursing homes). MEASUREMENTS: Agreement between both MNA-SFs and the MNA full form. RESULTS: MNA-SF-BMI correctly classified 84.12%, 82.51% and 81.84% of subjects from urban, rural and institutional environment, respectively. For MNA-SF-CC those values were 82.4%, 71.8% and 76.6%, respectively. The sensitivity and specificity of MNA-SF-BMI and MNA-SF-CC against full MNA in screening for "at risk/malnutrition" and "malnutrition" were generally very high, except for relatively lower sensitivity (74.1%) when screening for "malnutrition" with MNA-SF-CC in nursing homes. CONCLUSION: Both MNA-SFs can be recommended as screening tools in assessing the nutritional state of the community-dwelling and institutionalised elderly in Poland. The full version of the MNA confirmed the results of MNA-SFs in this group. The "classic" MNA-SF using BMI was found to perform better than the MNA-SF-CC. The MNA-SF-CC should be used only when measuring BMI is not possible. While using MNA-SF-CC in nursing homes, a higher MNA-SF-CC cut-point of eleven should be rather used in this population to screen for "at risk/malnutrition".