Association of Calf Circumference with Clinical and Biochemical Markers in Older Adults with COVID-19 Admitted at Intensive Care Unit: A Retrospective Cross-Sectional Study.

BACKGROUND: COVID-19 is an infectious disease characterized by a severe catabolic and inflammatory state, leading to loss of muscle mass. The assessment of muscle mass can be useful to identify nutritional risk and assist in early management, especially in older adults who have high nutritional risks. The aim of this study was to evaluate the association of calf circumference (CC) with clinical and biochemical markers and mortality in older adults with COVID-19 admitted to the intensive care unit (ICU). METHODS: A retrospective cross-sectional study was conducted in a public hospital. CC was adjusted for body mass index (BMI), reducing 3, 7, or 12 cm for a BMI of 25-29.9, 30-39.9, and ≥40 kg/m2, respectively, and classified as reduced when <33 cm for women and <34 cm for men. Pearson's correlation between BMI and CC was performed to assess the association between variables. Regression analysis was adjusted for sex, age, and BMI variables. Cox regression was used to assess survival related to CC. RESULTS: A total of 208 older adults diagnosed with COVID-19 admitted to ICU were included, of which 84% (n = 176) were classified as having reduced CC. These patients were older, with lower BMI, higher nutritional risk, malnourished, and higher concentration of urea and urea-creatinine ratio (UCR) compared with the group with normal CC. There was an association between edematous patients at nutritional risk and malnourished with reduced CC in the Cox regression, either adjusted or not for confounding. CONCLUSIONS: CC was not associated with severity, biochemical markers, or mortality in older adults with COVID-19 admitted to the ICU, but it was associated with moderately malnourished patients assessed by subjective global assessment (SGA).

C-reactive protein, but not neutrophil-lymphocyte ratio, is inversely associated with muscle strength only in older men: NHANES 1999-2002.

To evaluate the association of inflammation (C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) levels) with muscle strength in older adults. We also aimed to evaluate whether these associations are sex-specific. A cross-sectional study was performed with data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002. A total of 2387 individuals over 50 years of both sexes were evaluated, according to the eligibility criteria for the strength test. Muscle strength was measured by Kinetic Communicator isokinetic dynamometer; while the NLR was obtained by the ratio of the total neutrophil for lymphocyte count and CRP was quantified by latex nephelometry. Linear regression analyses, crude and adjusted for confounders, were used to estimate the coefficients and 95 % confidence intervals for peak strength (muscle strength) by tertiles of NLR and CRP. There was no association between NLR and peak strength for both sexes. CRP levels were inversely associated with peak force in men [2nd tertile ß = -3.33 (-15.92; 9.25); 3rd tertile ß = -24.69 (-41.18; -8.20), p for trend = 0.005], but not in women [2nd tertile ß = -3.22 (-15.00; 8.56); 3rd tertile ß = -9.23 (-28.40; -9.94), p for trend = 0.332]. In conclusion, NLR levels were not associated with muscle strength in both sexes. CRP levels were inversely associated with muscle strength in older men, but not in women, suggesting that the association between inflammation and muscle strength in older adults can be sex-specific.

Effects of whey protein supplementation on adiposity, body weight, and glycemic parameters: A synthesis of evidence.

AIMS: The aim of this review was to analyze the evidence of whey protein supplementation on body weight, fat mass, lean mass and glycemic parameters in subjects with overweight or type 2 diabetes mellitus (T2DM) undergoing calorie restriction or with ad libitum intake. DATA SYNTHESIS: Overweight and obesity are considered risk factors for the development of chronic noncommunicable diseases such as T2DM. Calorie restriction is a dietary therapy that reduces weight and fat mass, promotes the improvement of glycemic parameters, and decreases muscle mass. The maintenance of muscle mass during weight loss is necessary in view of its implication in preventing chronic diseases and improving functional capacity and quality of life. The effects of increased protein consumption on attenuating muscle loss and reducing body fat during calorie restriction or ad libitum intake in overweight individuals are discussed. Some studies have demonstrated the positive effects of whey protein supplementation on improving satiety and postprandial glycemic control in short term; however, it remains unclear whether long-term whey protein supplementation can positively affect glycemic parameters. CONCLUSIONS: Although whey protein is considered to have a high nutritional quality, its effects in the treatment of overweight, obese individuals and those with T2DM undergoing calorie restriction or ad libitum intake are still inconclusive.

Neutrophil-to-lymphocyte ratio is not associated with risk of sarcopenia in elderly COVID-19 patients.

BACKGROUND: To assess the existence of association between neutrophil to lymphocyte ratio (NLR) and the risk of sarcopenia in COVID-19 patients. METHODS: A retrospective cross-sectional study was conducted in a university hospital with patients with an active COVID-19 infection admitted to the nursing ward or intensive care unit (ICU) between September to December 2020. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F). Biochemical analyses were assessed by circulating of C-reactive protein, D-dimer, neutrophils, lymphocytes count and NLR. Sixty-eight patients were evaluated and divided into tertiles of NLR values and the association between NLR and sarcopenia risk were tested using the linear regression analyses and p<0.05 were considered as significant. RESULTS: Sixty-eight patients were evaluated and divided in NLR tertiles being the 1st (men=52.2%; 71.1±9.0 y; NLR: 1.1-3.85), 2nd (women=78.3%; 73.2±9.1 y; NLR: 3.9-6.0) and 3rd (men=72.7%; 71.7±10.4 y; NLR: 6.5-20.0). There was a difference between the tertiles in relation to the first to the biochemical parameters of total neutrophils count (p=0.001), C-reactive protein (p=0.012), and D-dimer (p=0.012). However, no difference was found in linear regression analysis between tertiles of NLR and SARC-F, if in total sample (p=0.054) or divided by sex, if men (p=0.369) or women (p=0.064). CONCLUSION: In elderly patients hospitalized with COVID-19, we do not find an association between the risk of sarcopenia and NLR.

Neutrophil-to-lymphocyte ratio is not associated with risk of sarcopenia in elderly COVID-19 patients / La proporción de neutrófilos a linfocitos no está asociada con el riesgo de sarcopenia en pacientes ancianos con COVID-19

Background: To assess the existence of association between neutrophil to lymphocyte ratio (NLR) and the risk of sarcopenia in COVID-19 patients. Methods: A retrospective cross-sectional study was conducted in a university hospital with patients with an active COVID-19 infection admitted to the nursing ward or intensive care unit (ICU) between September to December 2020. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs and Falls (SARC-F). Biochemical analyses were assessed by circulating of C-reactive protein, D-dimer, neutrophils, lymphocytes count and NLR. Sixty-eight patients were evaluated and divided into tertiles of NLR values and the association between NLR and sarcopenia risk were tested using the linear regression analyses and p<0.05 were considered as significant. Results: Sixty-eight patients were evaluated and divided in NLR tertiles being the 1st (men=52.2%; 71.1±9.0 y; NLR: 1.1–3.85), 2nd (women=78.3%; 73.2±9.1 y; NLR: 3.9–6.0) and 3rd (men=72.7%; 71.7±10.4 y; NLR: 6.5–20.0). There was a difference between the tertiles in relation to the first to the biochemical parameters of total neutrophils count (p=0.001), C-reactive protein (p=0.012), and D-dimer (p=0.012). However, no difference was found in linear regression analysis between tertiles of NLR and SARC-F, if in total sample (p=0.054) or divided by sex, if men (p=0.369) or women (p=0.064). Conclusion: In elderly patients hospitalized with COVID-19, we do not find an association between the risk of sarcopenia and NLR. (AU)

Objetivo: Evaluar la existencia de asociación entre la relación neutrófilos a linfocitos (RNL) y el riesgo de sarcopenia en pacientes con COVID-19. Métodos: Se realizó un estudio transversal retrospectivo en un hospital universitario con pacientes con infección activa por COVID-19 ingresados en sala de enfermería o unidad de cuidados intensivos (UCI) entre septiembre a diciembre de 2020. El riesgo de sarcopenia se evaluó utilizando: fuerza, ayuda para caminar, levantarse de una silla, subir escaleras y caídas (SARC-F). Los análisis bioquímicos se evaluaron mediante circulación de proteína C reactiva, dímero D, neutrófilos, recuento de linfocitos y RNL. Sesenta y ocho pacientes fueron evaluados y divididos en terciles de valores de RNL y la asociación entre RNL y el riesgo de sarcopenia se evaluó mediante análisis de regresión lineal; p<0,05 se consideró significativo. Resultados: Sesenta y ocho pacientes fueron evaluados y divididos en terciles de RNL, siendo el primero (hombres=52,2%; 71,1±9,0años; RNL: 1,1-3,85), el segundo (mujeres=78,3%; 73,2±9,1años; RNL: 3,9-6,0) y el tercero (hombres=72,7%; 71,7±10,4años; RNL: 6,5-20,0). Hubo diferencia entre los terciles con relación al primero en los parámetros bioquímicos de recuento de neutrófilos totales (p=0,001), proteínaC reactiva (p=0,012) y dímeroD (p=0,012). Sin embargo, no se encontró diferencia en el análisis de regresión lineal entre terciles de RNL y SARC-F, si en muestra total (p=0,054) o dividida por sexo, si hombres (p=0,369) o mujeres (p=0,064). Conclusiones: En pacientes ancianos hospitalizados con COVID-19 no encontramos asociación entre el riesgo de sarcopenia y RNL. (AU)

Krill Oil Supplementation Does Not Change Waist Circumference and Sagittal Abdominal Diameter in Overweight Women: A Pilot Balanced, Double-Blind, and Placebo-Controlled Clinical Trial.

An excess of body fat is one of the biggest public health concerns in the world, due to its relationship with the emergence of other health problems. Evidence suggests that supplementation with long-chain polyunsaturated fatty acids (omega-3) promotes increased lipolysis and the reduction of body mass. Likewise, this clinical trial aimed to evaluate the effects of supplementation with krill oil on waist circumference and sagittal abdominal diameter in overweight women. This pilot, balanced, double-blind, and placebo-controlled study was carried out with 26 women between 20 and 59 years old, with a body mass index >25 kg/m2. The participants were divided into the control (CG) (n = 15, 3 g/daily of mineral oil) and krill oil (GK) (n = 16, 3 g/daily of krill oil) groups, and received the supplementation for eight weeks. Food intake variables were obtained using a 24 h food recall. Anthropometric measurements (body mass, body mass index, waist circumference, and sagittal abdominal diameter) and handgrip strength were obtained. After the intervention, no changes were found for the anthropometric and handgrip strength variables (p > 0.05). Regarding food intake, differences were found for carbohydrate (p = 0.040) and polyunsaturated (p = 0.006) fatty acids, with a reduction in the control group and an increase in krill oil. In conclusion, supplementation with krill oil did not reduce the waist circumference and sagittal abdominal diameter. Therefore, more long-term studies with a larger sample size are necessary to evaluate the possible benefits of krill oil supplementation in overweight women.

Acute Supplementation of Yerba Mate Extract Did Not Change Muscle Strength in Physically Active Men Following the Strength Muscle Test: A Pilot Clinical Trial.

Polyphenol supplementation may be useful during exercise. However, there is no evidence indicating yerba mate (YM) increases muscle strength. Thus, this study sought to evaluate the effect of acute YM supplementation on muscle strength following the strength test. In a crossover and pilot clinical trial, ten men were divided into two groups, receiving either supplementation with YM or a placebo. One hour after consumption of beverages, the participants were submitted to tests of one-repetition maximum (1 RM) on the bench press and leg press. The average age of the participants was 25.5 ± 4.1 years, and the average body mass index was 24.4 ± 2.9 kg/m². YM was not able to increase muscle strength when compared to the placebo in either the 1RM leg press exercise (YM: 225 ± 56.2 kg, vs. placebo: 223 ± 64.3 kg, p = 0.743, Cohen's d = 0.03) or in the 1 RM bench press exercise (YM: 59.5 ± 20.7 kg vs. placebo: 59.5 ± 21.5 kg, p = 1.000, Cohen's d = 0.) In conclusion, acute intake of YM did not change muscle strength in physically active men.

Acute supplementation with whey protein or collagen does not alter appetite in healthy women: a randomised double-blind and crossover pilot study.

Protein quality has an important role in increasing satiety. Evidence suggests that whey protein (WP) provides satiety via gastrointestinal hormone secretion. Hydrolysed collagen supplementation can also stimulate the production of incretins and influence satiety and food intake. Thus, we sought to compare the effect of acute supplementation of WP or hydrolysed collagen on post-intervention appetite and energy consumption. This was a randomised, double-blind, crossover pilot study with ten healthy adult women (22·4 years/old) who were submitted to acute intake (single dose) of a beverage containing WP (40 g of concentrated WP) or hydrolysed collagen (40 g). Subjective appetite ratings (feelings of hunger, desire to eat and full stomach) were measured using the Visual Analog Scale (VAS), energy intake was quantified by ad libitum cheese bread consumption 2 hours after supplementation and blood was collected for leptin and glucose determination. There was no difference between treatment groups in the perception of hunger (P = 0·983), desire to eat (P = 0·326), full stomach feeling (P = 0·567) or food consumption (P = 0·168). Leptin concentrations at 60 min post supplementation were higher when subjects received hydrolysed collagen (P = 0·006). Acute supplementation with hydrolysed collagen increased leptin levels in comparison with WP, but had no effect on appetite measured by feelings of hunger, desire to eat, full stomach feeling (VAS) or energy consumption.

Effects of High-Speed Versus Traditional Resistance Training in Older Adults.

BACKGROUND: The losses of strength, agility, balance, and functionality caused by aging are harmful to the elderly population. Resistance training (RT) may be an efficient tool to mitigate such neuromuscular decline and different RT methods can be used. Therefore, it is important to investigate the different responses to different training methods. HYPOTHESIS: Eight weeks of traditional resistance training (TRT) are expected to promote similar results to high-speed training (HST) in physical functional performance (PFP) and quality of life in the elderly. STUDY DESIGN: A clinical trial. LEVEL OF EVIDENCE: Level 3. METHODS: Participants (n = 24) with a mean age of 67.8 ± 6.3 years completed 8 weeks of RT. They were allocated into HST (n = 12) and TRT (n = 12). TRT involved training with 10 to 12 repetitions at controlled velocity until momentary muscle failure, while HST involved performing 6 to 8 repetitions at 40% to 60% of 1 repetition maximum (1RM) at maximum velocity. Pre- and posttraining, the participants were tested for (1) maximum strength in the 45° leg press and chest press; (2) PFP in the 30-second chair stand, timed-up-and-go (TUG), and medicine ball throw test; and (3) quality of life. RESULTS: Both groups improved muscle strength in the 45° leg press, with greater increases for TRT (HST: +21% vs TRT: +49%, P = 0.019). There was no change in chest press strength for HST (-0.6%) (P = 0.61), but there was a significant increase for the TRT group (+21%, P = 0.001). There was a similar improvement (P < 0.05) for both groups in TUG (HST: 7%; TRT: 10%), chair stand (HST: 18%; TRT: 21%), and medicine ball throwing performance (HST: 9%; TRT: 9%), with no difference between groups (P = 0.08-0.94). Emotional aspect significantly increased by 20% (P = 0.04) in HST and 50% (P = 0.04) in TRT. CONCLUSION: Both TRT and HST are able to promote improvements in functional performance in the elderly with greater in strength gains for TRT. Therefore, exercise professionals could choose based on individual characteristics and preferences. CLINICAL RELEVANCE: The findings provide important insights into how health care professionals can prescribe HST and TRT, considering efficiency, safety, and individual aspects.

No effect of intradialytic neuromuscular electrical stimulation on inflammation and quality of life: a randomized and parallel design clinical trial.

Neuromuscular electrical stimulation (NMES) elicits muscle contraction and has been shown to improvement of quality of life. However, if NMES improvement the quality of life and attenuate the inflammation is not fully understood. Therefore, our aim sought to assess the effects of short-term of intradialytic NMES on inflammation and quality of life in patients with chronic kidney disease patients undergoing hemodialysis. A randomized clinical trial conducted with parallel design enrolled adult hemodialysis patients three times a week during 1 month. Patients were randomly assigned to two groups (control group, n = 11; 4F/7 M) or (NMES group, n = 10; 4F/6 M). Pre-and post-intervention, was measured the high-sensitivity C reactive protein, interleukin-6, interleukin-10, and TNFα by the ELISA, and quality of life was applied using the SF-36. During each hemodialysis session, NMES was applied bilaterally at thigh and calves for 40 min. There was not change in cytokines (hs-CRP, IL-6, IL-10, and TNFα) concentrations time × group interaction. In addition, no difference was found in eight domains of quality of life. In addition, the groups did not differ for muscle strength and muscle mass. In conclusion, we found that intradialytic NMES did not change inflammation neither quality of life.

Ursolic acid has no additional effect on muscle strength and mass in active men undergoing a high-protein diet and resistance training: A double-blind and placebo-controlled trial.

BACKGROUND: Ursolic acid (UA) is thought to have an anabolic effect on muscle mass in humans. This study sought to compare the effects of UA and a placebo on muscle strength and mass in young men undergoing resistance training (RT) and consuming a high-protein diet. METHODS: A clinical, double-blind, placebo-controlled trial was conducted for 8 weeks. The Control + RT group (CON n = 12) received 400 mg/d of placebo, and the UA + RT group (UA n = 10) received 400 mg/d of UA. Both groups ingested ~1.6 g/kg of protein and performed the same RT program. Pre- and post-intervention, both groups were evaluated for anthropometric measures, body composition, food intake and muscle strength. RESULTS: Food intake remained unchanged throughout the study. Both groups showed significant increases in body weight (CON Δ: 2.12 ± 0.47 kg, p = 0.001 vs. UA Δ: 2.24 ± 0.67 kg, p = 0.009), body mass index (BMI) (CON Δ: 0.69 ± 0.15 kg/m2, p = 0.001 vs. UA Δ: 0.75 ± 0.23, p = 0.011) and thigh circumference (CON Δ: 1.50 ± 0.36, p = 0.002 vs. UA Δ: 2.46 ± 0.50 cm, p = 0.003 vs. UA 1.84 ± 0.82 cm, p = 0.001), with differences between them. There was no difference in the arm, waist and hip circumferences. Both groups showed increases in muscle mass (CON Δ: 1.12 ± 0.26, p = 0.001 vs. UA Δ: 1.08 ± 0.28 kg, p = 0.004), but there was no significant difference between them. Additionally, there were significant increases in the one repetition maximum test in the bench press and in the 10-repetition maximum test in the knee extension (CON Δ: 5.00 ± 2.09, p = 0.036 vs. UA Δ: 7.8 ± 1.87, p = 0.340 and CON Δ: 3.58 ± 1.15, p = 0.010 vs. UA Δ: 1.20 ± 0.72, p = 0.133), respectively, with no difference between them. CONCLUSIONS: Ursolic acid had no synergic effect on muscle strength and mass in response to RT in physically active men consuming a high-protein diet. BRAZILIAN CLINICAL TRIALS REGISTRY (REBEC): RBR-76tbqs.

Acute Caffeinated Coffee Consumption Does not Improve Time Trial Performance in an 800-m Run: A Randomized, Double-Blind, Crossover, Placebo-Controlled Study.

INTRODUCTION: Studies evaluating caffeinated coffee (CAF) can reveal ergogenic effects; however, studies on the effects of caffeinated coffee on running are scarce and controversial. AIM: To investigate the effects of CAF consumption compared to decaffeinated coffee (DEC) consumption on time trial performances in an 800-m run in overnight-fasting runners. METHODS: A randomly counterbalanced, double-blind, crossover, placebo-controlled study was conducted with 12 healthy adult males with experience in amateur endurance running. Participants conducted two trials on two different occasions, one day with either CAF or DEC, with a one-week washout. After arriving at the data collection site, participants consumed the soluble CAF (5.5 mg/kg of caffeine) or DEC and after 60 min the run was started. Before and after the 800-m race, blood pressure and lactate and glucose concentrations were measured. At the end of the run, the ratings of perceived exertion (RPE) scale was applied. RESULTS: The runners were light consumers of habitual caffeine, with an average ingestion of 91.3 mg (range 6⁻420 mg/day). Time trial performances did not change between trials (DEF: 2.38 + 0.10 vs. CAF: 2.39 + 0.09 min, p = 0.336), nor did the RPE (DEC: 16.5 + 2.68 vs. CAF: 17.0 + 2.66, p = 0.326). No difference between the trials was observed for glucose and lactate concentrations, or for systolic and diastolic blood pressure levels. CONCLUSION: CAF consumption failed to enhance the time trial performance of an 800-m run in overnight-fasting runners, when compared with DEC ingestion. In addition, no change was found in RPE, blood pressure levels, or blood glucose and lactate concentrations between the two trials.