Acute sarcopenia changes following hospitalization: influence of pre-admission care dependency level.

INTRODUCTION: Hospitalization is associated with acute changes in sarcopenia status in older people, but the influencing factors are not fully understood. Pre-admission care dependency level as a risk factor has not yet been investigated. OBJECTIVE: Evaluate if pre-admission care dependency level is an independent predictor of sarcopenia changes following hospitalization. SETTING AND SUBJECTS: Data came from the Sarcopenia 9+ EAMA Project, a European prospective multi-centre study. For this study, 227 hospitalised older people were included from four different hospitals in Belgium, Spain and Poland, between 18 February 2019 and 5 September 2020. METHODS: Sarcopenia status at admission and discharge were calculated using a combined score (desirability value) based on muscle mass (calf circumference), strength (grip) and function (walking speed). Ratio of admission to discharge status was the outcome (desirability ratio; 1.00 meaning no difference). Predictor variable was the pre-admission care dependency level, classified into three groups: independent older people living at home, dependent older people living at home and older people living in a care home. Linear regression models were applied, considering potential confounders. RESULTS: Mean desirability ratio for dependent older people living at home ('middle dependent group') was lower (0.89) compared to independent older people (0.98; regression coefficient -0.09 [95% CI -0.16, -0.02]) and care home patients (1.05; -0.16 [95% CI -0.01, -0.31]). Adjusting for potential confounders or using another statistical approach did not affect the main results. CONCLUSION: Dependent older people living at home were at higher risk of deterioration in sarcopenia status following hospitalization. In-depth studies investigating causes and potential interventions of these findings are needed.

DNA crosslinks, DNA damage and repair in peripheral blood lymphocytes of non-small cell lung cancer patients treated with platinum derivatives.

Lung cancer is the leading cause of cancer-related mortality in the world. Chemotherapy has been the mainstay of treatment for advanced non-small cell lung cancer (NSCLC) and platinum-based derivatives have been shown to improve overall survival. The aim of the present study was to investigate the DNA damage [single strand breaks (SSBs) and DNA crosslinks] and DNA repair in peripheral blood lymphocytes in patients with NSCLC treated with platinum derivatives using modified comet assay. Twenty patients in the final (4th) stage of NSCLC and 10 age-corresponding healthy controls participated in the study. Alkaline comet assay was performed according to the appropriate protocol. The DNA base excision repair (BER) activity of the controls was significantly higher compared to that of cancer patients, and the activity of DNA nucleotide excision repair (NER) was almost at the same level both in controls and patients. We observed changes in the amount of SSBs and DNA crosslinks during the course of chemotherapy. We found a significantly higher level of SSBs immediately after administration of chemotherapy. Similarly, we found the highest incidence of DNA crosslinks immediately or 1 day after chemotherapy (compared to measurement before chemotherapy). Moreover, we compared the levels of DNA repair in patients who survived chemotherapy with those in patients who died in the course of chemotherapy: the activity of BER was higher in the case of surviving patients, while the levels of NER were essentially the same. The data arising from the present study confirm the findings of other studies dealing with DNA damage and repair in cancer patients treated with chemotherapy. Moreover, our results indicated that despite the fact that cisplatin-DNA adducts are removed by the NER pathway, BER may also play a role in the clinical status of patients and their survival.

Dietary intake of energy and nutrients in relation to resting energy expenditure and anthropometric parameters of Czech pregnant women.

PURPOSE: The aim of this study was to evaluate the dietary intake of energy and nutrients (DIEN) of Czech pregnant women and to assess relationships with body size variables during pregnancy. METHODS: One hundred and fifty-two randomly recruited healthy pregnant Czech women, who were normoglycemic, euthyroid, nonsmokers, not anemic, and not users of chronic medications or abusers of alcohol or drugs from countryside and city with different education, were recruited for the study. Anthropometric parameters were measured and resting energy expenditure obtained by indirect calorimetry after 12 h of fasting during four phases of pregnancy. DIEN was evaluated from self-reported dietary intake records over 7 days. RESULTS: Positive correlations were demonstrated between measured resting energy expenditure and intake of energy, substrates and some minerals and vitamins, and negative correlations between DIEN and anthropometric parameters. Lower dietary intake of energy and differences between dietary intake of nutrients and recommended daily allowances during pregnancy of Czech women were documented. CONCLUSIONS: The difference between pregnancy body weight and ideal body weight was shown to be a determinant of DIEN. From recent knowledge on prevention of various pathological states, the supplementation or modification of nutritional intake of food with folate, iron, vitamin D, zinc, iodine and fiber for Czech pregnant women is recommended.

[The influence of faith on illness experience in the elderly; spiritual assessments]. / Vliv víry na prozívání nemoci u senioru, dotazníky spirituality.

Spiritual life of the elderly patients is very important, but in practice the medical staff hardly thinks about the spiritual needs. According to foreign studies, a lively faith has a positive curative effect. The aim of our work was the evaluation of the influence of faith to the survival of illness in the elderly and the description of spiritual assessments. FICA assessment is an easy screening test which can be used for obtaining spiritual anamnesis in health care institutions.

Anthropometric measured fat-free mass as essential determinant of resting energy expenditure for pregnant and non-pregnant women.

OBJECTIVE: There is conflicting evidence as to whether anthropometric parameters are related to resting energy expenditure (REE) during pregnancy. The aim of this prospective longitudinal study was to precisely assess a major anthropometric determinant of REE for pregnant and non-pregnant women with verification of its use as a possible predictor. METHODS: One hundred fifty-two randomly recruited, healthy, pregnant Czech women were divided into groups G1 and G2. G1 (n = 31) was used for determination of the association between anthropometric parameters and REE. G2 (n = 121) and a group of non-pregnant women (G0; n = 24) were used for verification that observed relations were suitable for the prediction of REE during pregnancy. The women in the study groups were measured during four periods of pregnancy for REE by indirect calorimetry and anthropometric parameters after 12 h of fasting. RESULTS: Associations were found in all groups between measured REE by indirect calorimetry and anthropometric parameters such as weight, fat mass, fat-free mass (FFM), body surface area, and body mass index (P < 0.0001). The best derived predictor, REE/FFM (29.5 kcal/kg, r = 0.70, P < 0.0001), in group G1 was statistically verified in group G2 and compared with G0. CONCLUSION: Anthropometrically measured FFM with its metabolically active components is an essential determinant of REE in pregnancy. REE/FFM can be used for the prediction of REE in pregnant and non-pregnant woman.

Effect of the Exercise Dance for Seniors (EXDASE) program on lower-body functioning among institutionalized older adults.

OBJECTIVE: The authors conducted a randomized control trial to examine the effect of the Exercise Dance for Seniors (EXDASE) program on lower-body functioning among older individuals from residential care facilities in the Czech Republic. METHOD: Participants were randomly assigned into an experimental or control group. The experimental group completed a 3-month EXDASE program. Lower-body functioning was assessed using four performance-based measures. A 2 (group) x 2 (test) general linear model for repeated measures was used to explore whether differences in performance could be attributed to the intervention. RESULTS: The authors found Group x Test interactions for the chair stand test, F(1, 50) = 14.37, p < .001, the 2-minute step test, F(1, 50) = 7.33, p = .009, the chair sit-and-reach test, F(1, 50) = 5.28, p = .026, and the timed up-and-go test, F (1, 44) = 6.59, p = .014, indicating that the experimental group outperformed the control group from pretest to posttest. DISCUSSION: A relatively simple dance-based exercise can support lower-body functioning in previously sedentary, frail older adults.

New equation for the prediction of resting energy expenditure during pregnancy.

OBJECTIVE: The equation for the prediction of resting energy expenditure (REE) during pregnancy is unknown. The aim of this prospective longitudinal study was to determine a new equation for prediction of REE in pregnancy. METHODS: A total of 152 randomly recruited healthy pregnant Czech women (nonsmokers, not users of chronic medications or abusers of alcohol or drugs, normoglycemic, euthyroid, and not anemic) were divided into two cohorts: group 1 (n=31) was used for determination of the equation for calculation of pregnant REE and group 2 (n=121) for cross-validation of this formula. The REE of the pregnant women in both study groups was examined by indirect calorimetry (REE-IC) along with anthropometry after 12h of fasting in four periods of pregnancy. A statistical comparison of three basic equations (Harris Benedict, Schofield, and Kleiber) was used for the prediction of REE. RESULTS: Through correlation analysis and linear regression, a new predictive equation of REE during pregnancy (P REE) was derived from the Harris Benedict equation. We observed high concordance between values from P REE and REE-IC in group 2. Analysis of alternative predictive equations of REE with the addition of kilocalories and a corrected multiplication factor for each stage of pregnancy expressed low concordance. CONCLUSIONS: The equation for REE in kilocalories during pregnancy, P REE=346.43943+13.962564 x W + 2.700416 x H - 6.826376 x A (W, weight; H, height; A, age), with SD 116 kcal/d, corresponds closely to REE-IC and maternal changes in each phase of pregnancy. P REE can be applied for prediction of REE during gestation.

Serum lipids and neopterin in urine as new biomarkers of malnutrition and inflammation in the elderly.

OBJECTIVE: Levels of serum lipids are influenced by malnutrition and inflammation. The study aimed to find the relation of the lipidogram to positive and negative markers of inflammation in geriatric patients. Attention was paid to neopterin in urine as a non-protein positive bioindicator of inflammation. METHODS: It was a local, monocentric, prospective clinical study in hospitalized patients older than 80 y. The study included 101 patients (54 women, 47 men). The average age of the entire group was 85.37 +/- 4.88 y. The dependence of the values of total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triacylglycerols (TAGs) on C-reactive protein (CRP), neopterin in urine, and prealbumin was examined. RESULTS: When we compared CRP and serum lipids, we found a statistically significant negative correlation between levels of CRP and total cholesterol (P < 0.05), HDL (P < 0.01), and LDL (P < 0.05). Also the level of neopterin in urine was negatively correlated with levels of total cholesterol (P < 0.05) and HDL (P < 0.01). A statistically highly significant interaction was demonstrated between levels of prealbumin and total cholesterol (P < 0.001), HDL (P < 0.001), LDL (P < 0.001), and TAG (P < 0.05). CONCLUSION: A significant negative correlation between levels of inflammation markers (neopterin in urine, CRP) and total cholesterol and HDL was found. LDL was influenced to a lesser extent. A close relation between serum lipids and prealbumin was also demonstrated. Total cholesterol, HDL, and LDL can be considered novel biomarkers of malnutrition and inflammation in geriatric patients.

Hypocholesterolemia in clinically serious conditions--review.

BACKGROUND: Cholesterol is an essential component of cell membranes, precursor of steroids, biliary acids and other components of serious importance in live organism. Cholesterol synthesis is a complicated and energy-demanding process. Real daily need of cholesterol and mechanisms of decline cholesterol levels in critical ill are unknown. During stressful situations a significant hypocholesterolaemia may be found. Hypocholesterolemia has been known for a number of years to be a significant prognostic indicator of increased morbidity and mortality connected with a whole spectrum of pathological conditions. The aim of article is the elucidation of the role and importance of hypocholesterolaemia during the intensive care. METHODS AND RESULTS: We examined studies that are engaged in problems of hypocholesterolemia in critically ill. Very low levels of total as well as LDL cholesterol are most frequently found in serious polytrauma, after extensive surgery, in serious infections, in protracted hypovolemic shock. It is still not clear whether hypocholesterolemia reflects only a serious metabolic disorder, which results from a life-threatening condition, or whether it has an active role in evolution and outcome. CONCLUSIONS: Hypocholesterolemia is commonly observed in critically ill patients. Nevertheless, it is not known whether it is a secondary manifestation of disease, or whether it actively contributes to deterioration of the disease. Although the contribution of hypocholesterolemia to mortality is modest compared with known risk factors such as increased severity of illness and the development of nosocomial infection, low serum lipid concentrations represent a potential therapeutic target in sepsis.

A changed view of serum prealbumin in the elderly: prealbumin values influenced by concomitant inflammation.

AIMS: We are currently witnessing changes in views on the evaluation of serum proteins. A decrease may signal not only malnutrition. It may also be an indicator of simultaneously occurring inflammatory disease. Prealbumin, due to its short half-life, is a suitable indicator of changes in protein-energy balance, but its levels show, as with other serum proteins, a decrease in the case of inflammation too. The present study aimed to determine the prealbumin values of hospitalized geriatric patients and how they are affected by inflammatory disease. METHODS: In 101 patients aged over 80 years, the relationships were compared between prealbumin and C-reactive protein in the whole group and then in the subgroups with normal and increased C-reactive protein. RESULTS: In 67.33 % of hospitalized geriatric patients prealbumin was below the limit of the norm. A statistically highly significant dependence (p < 0.001) was demonstrated between a decrease in prealbumin and an increase in C-reactive protein in the whole group. In the subgroup with normal C-reactive protein, no statistically significant decrease in prealbumin was demonstrated, whereas in the subgroup with increased C-reactive protein a significant decrease in prealbumin (p < 0.001 for the whole group, p < 0.01 men, p < 0.05 women) was found. CONCLUSIONS: The study demonstrated subnormal mean initial values of prealbumin and a highly statistically significant negative correlation between a decrease in prealbumin and an increase in C-reactive protein in the whole group. We confirm that in inflammation there is a statistically significant decrease in serum concentration of prealbumin.

Present state of evaluating malnutrition in the elderly - analysing indicators.

OBJECTIVES: Malnutrition in old age is a significant problem. The study presents a survey of the basic methods used in the diagnosis of malnutrition in the elderly such as nutritional anamnesis, anthropometrical, laboratory a functional examinations and indicating specific differences as compared with a younger population. METHODS: We conducted a search of Czech and foreign literature (using PubMed, Medline) focused on diagnostic methods and examinations of nutritional markers especially by geriatric patients published from 1994 to 2006. RESULTS AND CONCLUSIONS: The examinations we presented are simple, non-invasive methods, which can we use especially for out-patient monitoring of geriatric patients to recognize nutrition disorders. Timely diagnosis of malnutrition in the elderly can prevent patients from worsing self-sufficiency and quality of life of the seniors, increasing the risk of institutionalisation, prolonging hospitalisations due to increased rates of complications and increasing the treatment costs and mortality of geriatric patients.