Frailty or sarcopenia: which is a better indicator of mortality risk in older adults?

BACKGROUND: Despite the different conditions, frailty and sarcopenia overlap regarding their common link: the assessment of walking speed and muscle strength. This study aimed to compare the frailty phenotype to the sarcopenia using different cut-off points for low grip strength to determine which better identifies mortality risk over a 14-year follow-up period. METHODS: 4597 participants in the English Longitudinal Study of Ageing. Frailty was measured using the Fried phenotype. Sarcopenia (European Working Group on Sarcopenia in Older People 2) was defined using different cut-off points for low grip strength (<36, <32, <30, <27 and <26 kg for men and <23, <21, <20 and <16 kg for women), low skeletal muscle mass index (<9.36 kg/m² for men and<6.73 kg/m² for women) and slowness (gait speed: ≤0.8 m/s). Cox models were run and adjusted for sociodemographic, behavioural and clinical factors. RESULTS: When the coexistence of frailty and sarcopenia is considered, only the cut-off points <36 kg for men and <23 kg for women to define low grip strength identified the risk of mortality among individuals classified as having probable sarcopenia (HR=1.17, 95% CI 1.02 to 1.34), sarcopenia (HR=1.31, 95% CI 1.07 to 1.60) and severe sarcopenia (HR=1.62, 95% CI 1.33 to 1.96). In this situation, frailty identified the mortality risk (HR=1.49, 95% CI 1.22 to 1.81), whereas pre-frailty did not. Sarcopenia using other cut-off points for defining low grip strength did not identify mortality risk. CONCLUSION: Sarcopenia using <36 kg for men and <23 kg for women as cut-off points seems to be better than the frailty phenotype for identifying the risk of mortality in older adults.

Factors of food choice and nutritional intake of Brazilian older adults according sociodemographic and health characteristics.

The rapid demographic transition in developing countries has always posed a challenge for the social and economic policies of these nations. The increase in longevity poses new challenges for understanding dietary consumption among different age groups at the old age population. The aim of this study was to evaluate the reasons for food choice and the composition of nutritional intake of older adults and its relationship to individual characteristics. Community-living older adults aged 60 and older were interviewed in their homes at the southeastern region of Brazil, between December 2021 and February 2022. The Food Choice Questionnaire and a Food Frequency Questionnaire were administered to obtain data on the reasons for food choice and nutritional intake. A structured interview was employed to gather information on individual characteristics. 168 older adults (mean age of 72.6 ± 8.9; 69.6% women) participated. The reasons for food choice differed significantly, with weight control being one of the least important and health being one of the most important. But older adults aged 80 and over valued the health criterion less than younger participants (60-69 years old). The intake of macronutrients and energy were below nutritional recommendations. Carbohydrate consumption was positively correlated with the mood motive. There was a relationship between the reasons for choosing food and/or the components of nutritional intake with: gender, age, living with a partner, self-report of depression/anxiety, self-perception of health and nutritional status anthropometric. The results are important to be considered in prevention policies and clinical-nutritional management, with special attention to the oldest-old.

Assessment of the components of sarcopenia and quality of life perceived of individuals on hemodialysis.

OBJECTIVES: to evaluate the prevalence of sarcopenia in individuals aged 50 years or older on hemodialysis; to verify the association between sarcopenia and sociodemographic, clinical, anthropometric factors, components of sarcopenia and quality of life (QoL); and to correlate the components of sarcopenia with QoL. METHODS: Participated 83 individuals on hemodialysis. Sarcopenia was established according to the current European consensus. Dynamometry to determine strength, calf circumference (CC) and appendicular skeletal muscle mass index (ASMMI) to obtain muscle mass and gait speed (GS) for physical performance. For QoL used the WHOQOL-bref. RESULTS: the prevalence of sarcopenia was 32.6% (CC) and 18.1% (ASMMI). There was no association between sarcopenia and QoL. Both handgrip strength (r=0.25) and GS (r=0.36) showed a correlation with physical domain. CONCLUSIONS: sarcopenia was expressive, and the aspects of functionality determine the physical impairment in this population.

Nutrition impact symptoms, sarcopenia, and malnutrition in hospitalized patients / Sintomas de impacto nutricional, sarcopenia e desnutrição em pacientes hospitalizados

INTRODUCTION: Nutrition Impact Symptoms (NIS) are common in hospitalized patients and can be aggravated in the presence of malnutrition. OBJECTIVE: To verify the presence of NIS and its association with sociodemographic and clinical variables, sarcopenia phenotype, and nutritional status of individuals hospitalized. METHODS: This is a cross-sectional study with hospitalized patients, of both sexes and ≥50 years old. Patient-Generated Subjective Global Assessment (PG-SGA), handgrip strength (HGS), gait speed GS), and anthropometric measurements were performed up to 48 hours after admission. NIS was obtained through PG-SGA and stratified into two groups: <3 and ≥3 symptoms. The chi-square test (χ2) was performed, and a 5% significance level was adopted. RESULTS: A total of 90 patients (65.4±9.67 years) were studied, with the majority of men (56.7%), older people (70.0%), married (68.9%), low economic class (72.2%), without work activity (70.5%), with two previous diseases (60.0%), overweight by body mass index (46.7%) and adequate adductor pollicis muscle thickness (83.3%). The most prevalent NIS were "dry mouth", "anorexia", and "smells sick" respectively 31.1%, 30.0%, and 16.7%. There was an association between NIS and SARC-F score (p=0.002), handgrip strength (p=0.016), the status of sarcopenia (p=0.020), PG-SGA (p<0.001), and economic status (p=0.020). CONCLUSION: The identification of NIS is common, and may infer negative nutritional status and functional performance of patients. The use of protocols to identify NIS during hospitalization should be considered to minimize the negative impact on nutritional status.

INTRODUÇÃO: Sintomas de impacto nutricional (SIN) são comuns em pacientes hospitalizados e estes podem ser agravados na presença da desnutrição. OBJETIVO: Verificar a presença de SIN e sua associação com as variáveis sociodemográficas, clínicas, fenótipo de sarcopenia e estado nutricional de indivíduos hospitalizados. MÉTODOS: Trata-se de estudo transversal com pacientes internados, de ambos os sexos e idade ≥ 50 anos. Realizou-se Avaliação Subjetiva Global produzida pelo Paciente (ASG-PPP), força de preensão palmar (FPP), velocidade de caminhada (VC) e medidas antropométricas até 48 horas da admissão. Os SIN foram obtidos por meio da ASG-PPP e compilados em <3 ou ≥3 sintomas. Realizou-se o teste de qui-quadrado (χ2). Adotou-se nível de significância de 5%. RESULTADOS: Um total de 90 pacientes (65,4±9,67 anos), sendo a maioria homem (56,7%), idoso (70,0%), casado (68,9%), classe econômica baixa (72,2%), sem atividade de trabalho (70,5%), com uma a duas doenças pregressas (60,0%), excesso de peso ao índice de massa corporal (46,7%) e adequada espessura do músculo adutor do polegar (83,3%). Os SIN "boca seca", "anorexia" e "cheiros enjoam" foram os mais prevalentes, respectivamente 31,1%, 30,0% e 16,7%. Houve associação dos SIN com as variáveis que compõem o fenótipo de sarcopenia: o escore SARC-F (p=0,002) e FPP (p=0,016), status de sarcopenia (p=0,020), ASG-PPP (p<0,001) e classe econômica (p=0,020). CONCLUSÃO: A identificação de SIN é comum, podendo inferir negativamente no estado nutricional e desempenho funcional dos pacientes. Considerar o uso de protocolos para identificação dos SIN durante a hospitalização a fim de minimizar a repercussão negativa no estado nutricional.

Assessment of the components of sarcopenia and quality of life perceived of individuals on hemodialysis / Evaluación de componentes de sarcopenia y calidad de vida percibida de individuos en hemodiálisis / Avaliação dos componentes da sarcopenia e qualidade de vida percebida de indivíduos em hemodiálise

ABSTRACT Objectives: to evaluate the prevalence of sarcopenia in individuals aged 50 years or older on hemodialysis; to verify the association between sarcopenia and sociodemographic, clinical, anthropometric factors, components of sarcopenia and quality of life (QoL); and to correlate the components of sarcopenia with QoL. Methods: Participated 83 individuals on hemodialysis. Sarcopenia was established according to the current European consensus. Dynamometry to determine strength, calf circumference (CC) and appendicular skeletal muscle mass index (ASMMI) to obtain muscle mass and gait speed (GS) for physical performance. For QoL used the WHOQOL-bref. Results: the prevalence of sarcopenia was 32.6% (CC) and 18.1% (ASMMI). There was no association between sarcopenia and QoL. Both handgrip strength (r=0.25) and GS (r=0.36) showed a correlation with physical domain. Conclusions: sarcopenia was expressive, and the aspects of functionality determine the physical impairment in this population.

RESUMEN Objetivos: evaluar la prevalencia de sarcopenia en individuos de 50 años o más en hemodiálisis, verificar la asociación entre la sarcopenia y factores sociodemográficos, clínicos, antropométricos, componentes de la sarcopenia y la calidad de vida (CV), y para correlacionar los componentes de la sarcopenia con la CV. Métodos: Participaron 83 individuos en hemodiálisis. La sarcopenia se estableció de acuerdo con el consenso europeo vigente. Dinamometría para determinar la fuerza, la circunferencia de la pantorrilla (CP) y el índice de masa muscular esquelética apendicular (IMMEA) para obtener la masa muscular y la velocidad de la marcha (VM) para el rendimiento físico. Para CV el WHOQOL-bref. Resultados: la prevalencia de sarcopenia fue de 32,6% (CP) y 18,1% (IMMEA). No hubo asociación entre sarcopenia y CV. Tanto la fuerza de prensión manual (r=0,25) como la VM (r=0,36) se correlacionaron con el dominio físico. Conclusiones: la sarcopenia fue significativa y los aspectos de funcionalidad, determinan el deterioro físico en esta población.

RESUMO Objetivos: avaliar a prevalência de sarcopenia em indivíduos com 50 anos ou mais em hemodiálise, verificar a associação entre a sarcopenia e os fatores sociodemográficos, clínicos, antropométricos, componentes da sarcopenia e qualidade de vida (QV), e correlacionar os componentes da sarcopenia com a QV. Métodos: Participaram 83 indivíduos em hemodiálise. A sarcopenia foi estabelecida segundo consenso europeu vigente. A dinamometria para determinação da força, a circunferência da panturrilha (CP) e o índice de massa muscular esquelética apendicular (IMMEA) para a obtenção da massa muscular e a velocidade de caminhada (VC) para o desempenho físico. Para QV utilizou-se WHOQOL-bref. Resultados: a prevalência de sarcopenia foi de 32,6% (CP) e 18,1% (IMMEA). Não houve associação entre a sarcopenia e QV. Tanto a força de preensão manual (r=0,25) quanto a VC (r=0,36) apresentaram correlação com domínio físico. Conclusões: a sarcopenia foi expressiva e os aspectos da funcionalidade determinam o comprometimento físico nessa população.

European Working Group on Sarcopenia in Older People 2010 (EWGSOP1) and 2019 (EWGSOP2) criteria or slowness: which is the best predictor of mortality risk in older adults?

OBJECTIVES: to analyse the accuracy of grip strength and gait speed in identifying mortality; to compare the association between mortality and sarcopenia defined by the EWGSOP1 and EWGSOP2 using the best cut-off found in the present study and those recommended in the literature and to test whether slowness is better than these two definitions to identify the risk of death in older adults. METHODS: a longitudinal study was conducted involving 6,182 individuals aged 60 or older who participated in the English Longitudinal Study of Ageing. Sarcopenia was defined based on the EWGSOP1 and EWGSOP2 using different cut-off for low muscle strength (LMS). Mortality was analysed in a 14-year follow-up. RESULTS: compared with the LMS definitions in the literature (<32, <30, <27 and < 26 kg for men; <21, <20 and < 16 kg for women), the cut-off of <36 kg for men (sensitivity = 58.59%, specificity = 72.96%, area under the curve [AUC] = 0.66) and < 23 kg for women (sensitivity = 68.90%, specificity = 59.03%, AUC = 0.64) as well as a low gait speed (LGS) ≤0.8 m/s (sensitivity = 53.72%, specificity = 74.02%, AUC = 0.64) demonstrated the best accuracy for mortality. Using the cut-off found in the present study, probable sarcopenia [HR = 1.30 (95%CI: 1.16-1.46)], sarcopenia [HR = 1.48 (95%CI: 1.24-1.78)] and severe sarcopenia [HR = 1.78 (95%CI: 1.49-2.12)] according to EWGSOP2 were better predictors of mortality risk than EWGSOP1. LGS ≤0.8 m/s was a better mortality risk predictor only when LMS was defined by low cut-off. CONCLUSIONS: using LMS <36 kg for men and < 23 kg for women and LGS ≤ 0.8 m/s, EWGSOP2 was the best predictor for mortality risk in older adults.

Accuracy of the Global Leadership Initiative on Malnutrition to identify malnutrition in hospitalized patients / Acurácia do Global Leadership Initiative on Malnutrition para identificar a desnutrição em pacientes hospitalizados

ABSTRACT Objective: The Global Leadership Initiative on Malnutrition, introduced as a useful method in the diagnosis of malnutrition, is supported by little evidence in hospitalized individuals. Therefore, we reviewed this method with two objectives: 1) to compare the diagnostic accuracy of the Global Leadership Initiative on Malnutrition criteria with the Patient-Generated Subjective Global Assessment; 2) to determine the prevalence of malnutrition and its associated factors. Methods: Cross-sectional study, conducted with individuals hospitalized between April 2019 and July 2021. Sociodemographic, clinical and anthropometric information was investigated. Global Leadership Initiative on Malnutrition was the index test and Patient-Generated Subjective Global Assessment the standard reference to assess malnutrition. For diagnostic accuracy, measurements of sensitivity, specificity, area under the curve and kappa agreement were considered. Results: A total of 105 individuals participated (age 65.9±9.9 years). The prevalence of malnutrition in the total sample was 48.6% and 67.6% according to the Global Leadership Initiative on Malnutrition and Patient-Generated Subjective Global Assessment criteria, respectively. An association was observed between malnutrition and the variables that stand behind hospitalization, metabolic stress and anthropometric indicators (p<0.05). The comparison showed sensitivity and specificity values for the Global Leadership Initiative on Malnutrition criteria of 67.6% (95% CI: 56.1-77.3) and 91.2% (95% CI: 77.0-96.9) (total sample) and 71.7% (95% CI: 58.4-82.0) and 95.5% (95% CI: 78.2-99.2) (elderly), respectively. An agreement of 49% was observed, raising to 55% when the elderly were assessed separately. Conclusion: The Global Leadership Initiative on Malnutrition criteria presented adequate sensitivity conditions and specificity to diagnose malnutrition, moderate agreement with the reference standard and good applicability in hospitalized patients' clinical practice. Prevalence of malnutrition was high, regardless of the method used, and was associated with the reason for hospitalization, metabolic stress and anthropometric indicators.

RESUMO Objetivo: O Global Leadership Initiative on Malnutrition, apresentado como um método útil no diagnóstico de desnutrição, possui poucas evidências acerca de indivíduos hospitalizados. Portanto, exploramos esse método com dois objetivos: 1) comparar a acurácia diagnóstica dos critérios Global Leadership Initiative on Malnutrition com a Avaliação Subjetiva Global Produzida pelo Paciente; 2) determinar a prevalência de desnutrição e seus fatores associados. Métodos: Estudo transversal, realizado com indivíduos hospitalizados entre abril de 2019 a julho de 2021. Informações sociodemográficas, clínicas e antropométricas foram investigadas. Global Leadership Initiative on Malnutrition foi o index test e Avaliação Subjetiva Global Produzida pelo Paciente a referência padrão para avaliar desnutrição. Para acurácia diagnóstica considerou-se as medições de sensibilidade, especificidade e área sob a curva e concordância kappa. Resultados: Participaram 105 indivíduos (65,9±9,9 anos). A prevalência de desnutrição na amostra total foi de 48,6% e 67,6% de acordo com os critérios Global Leadership Initiative on Malnutrition e Avaliação Subjetiva Global Produzida pelo Paciente, respectivamente. Associações foram encontradas entre desnutrição e as variáveis motivo de internação, estresse metabólico e indicadores antropométricos (p<0,05). A comparação mostrou valores de sensibilidade e especificidade para os critérios Global Leadership Initiative on Malnutrition de 67,6% (IC 95%: 56,1-77,3) e 91,2% (IC 95%: 77,0-96,9) (amostra total) e 71,7% (IC 95%: 58,4-82,0) e 95,5% (IC 95%: 78,2-99,2) (idosos), respectivamente. Observou-se concordância de 49,0%, sendo 55,0% quando os idosos foram analisados separadamente. Conclusão: Os critérios Global Leadership Initiative on Malnutrition apresentaram condições adequadas de sensibilidade e especificidade para diagnosticar desnutrição, concordância moderada com o padrão de referência e boa aplicabilidade na prática clínica em hospitalizados. A prevalência de desnutrição foi elevada, independentemente do método utilizado, e apresentou relação com o motivo de internação, estresse metabólico e indicadores antropométricos.

The Role of Sarcopenic Obesity in Cancer and Cardiovascular Disease: A Synthesis of the Evidence on Pathophysiological Aspects and Clinical Implications.

Obesity is globally a serious public health concern and is associated with a high risk of cardiovascular disease (CVD) and various types of cancers. It is important to evaluate various types of obesity, such as visceral and sarcopenic obesity. The evidence on the associated risk of CVD, cancer and sarcopenic obesity, including pathophysiological aspects, occurrence, clinical implications and survival, needs further investigation. Sarcopenic obesity is a relatively new term. It is a clinical condition that primarily affects older adults. There are several endocrine-hormonal, metabolic and lifestyle aspects involved in the occurrence of sarcopenic obesity that affect pathophysiological aspects that, in turn, contribute to CVD and neoplasms. However, there is no available evidence on the role of sarcopenic obesity in the occurrence of CVD and cancer and its pathophysiological interplay. Therefore, this review aims to describe the pathophysiological aspects and the clinical and epidemiological evidence on the role of sarcopenic obesity related to the occurrence and mortality risk of various types of cancer and cardiovascular disease. This literature review highlights the need for further research on sarcopenic obesity to demonstrate the interrelation of these various associations.

Rastreamento do risco de sarcopenia em adultos com 50 anos ou mais hospitalizados / Screening the risk of sarcopenia in adults aged 50 years or older hospitalized

Resumo Objetivo Rastrear o risco de sarcopenia em indivíduos hospitalizados por meio dos instrumentos SARC-F e SARC-Calf e verificar a associação entre o risco de sarcopenia com as variáveis sociodemográficas, clínicas e as variáveis que compõem o fenótipo de sarcopenia. Métodos Trata-se de um estudo transversal. Características sociodemográficas, clínicas e todas as variáveis que compõem o fenótipo de sarcopenia (força de prensão palmar, massa muscular e velocidade de marcha) foram investigadas. Para o rastreamento e diagnóstico da sarcopenia adotou-se o algoritmo e critérios propostos pelo European Working Group on Sarcopenia in Older People (EWGSOP2). Resultados Participaram 90 indivíduos. A maioria encontrava-se sem sinais sugestivos de sarcopenia, tanto pelo SARC-F (58,9%) quanto pelo SARC-Calf (68,9%), com força de preensão palmar (FPP) (28,59±9,21;26,74±10,60) e índice de massa muscular esquelética apendicular (IMMEA) (9,31±1,78;9,58±1,62) normais e com baixa velocidade de marcha (VM) (0,69±0,26; 0,68±0,44), respectivamente. O SARC-F apresentou associação significativa com as variáveis sexo (p=0,032), FPP (p<0,001), VM (p=0,001) e sarcopenia (p<0,001). Quando da adição da circunferência da panturrilha (CP), foi encontrado associação com as variáveis grupo etário (p=0,029), atividade laboral (p=0,008), FPP (p<0,001), IMMEA (p=0,033), VM (p=0,019) e sarcopenia (p<0,001). Conclusão O risco de sarcopenia foi observado em aproximadamente um terço dos pacientes avaliados. Sugere-se o uso rotineiro nos hospitais da ferramenta de rastreamento de sarcopenia SARC-Calf, uma vez que apresentou associação com os três fatores preditivos da sarcopenia, além de ser um instrumento de aplicação ágil, baixo custo e não invasivo. A investigação do diagnóstico da sarcopenia deve ser encorajada na prática clínica.

Abstract Objective To screen the risk of sarcopenia in hospitalized individuals using the SARC-F and SARC-Calf instruments and verify the association between the risk of sarcopenia with the sociodemographic and clinical variables and those that make up the sarcopenia phenotype. Methods This is a cross-sectional study. Sociodemographic, clinical characteristics, and all variables (handgrip strength, muscle mass and gait speed) that construct the sarcopenia phenotype were investigated. For the screening and diagnosis of sarcopenia, the algorithm, and criteria proposed by the European Working Group on Sarcopenia in Older People (EWGSOP2). Results A total of 90 individuals participated. Most were without risk of sarcopenia, both by SARC-F (58.9%) and by SARC-Calf (68.9%), with normal handgrip strength (HGS) (28.6±9.2; 26.7±10.6) and appendicular skeletal muscle mass index (ASMI) (9.3±1.78; 9.6±1.6) and with low gait speed (GS) (0.69±0.26; 0.68±0.4), respectively. SARC-F showed a significant association with the variables gender (p=0.032), HGS (p<0.001), GS (p=0.001) and sarcopenia (p<0.001). When adding the calf circumference (CC), an association was found with the variables age group (p=0.029), work activity (p=0.008), HGS (p<0.001), ASMI (p=0.033), GS (p=0.019) and the sarcopenia (p<0.001). Conclusion The risk of sarcopenia was observed in approximately one-third of the evaluated patients. It is suggested the routine use in hospitals of the sarcopenia screening tool SARC-Calf, since it was associated with the three predictive factors of sarcopenia, in addition,it is an instrument of agile application, low cost and non-invasive. When a possible, investigation of the diagnosis of sarcopenia should be encouraged in clinical practice.

Comprometimento do apetite e fatores associados em pessoas idosas hospitalizadas com câncer / Impairment of appetite and associated factors in older adults hospitalized with cancer

Resumo Objetivo Investigar o comprometimento do apetite em pessoas idosas hospitalizadas com câncer e sua associação com estado nutricional e presença de caquexia. Métodos Estudo transversal realizado com pessoas idosas de ambos os sexos, diagnosticadas com neoplasia maligna, de julho de 2017 a março de 2019 em um hospital universitário. A amostra final foi composta por 90 pacientes. O comprometimento do apetite foi identificado pelo Questionário de Apetite e Sintomas para Pacientes com Câncer (CASQ) e o estado nutricional pela Avaliação Subjetiva Global Produzida pelo Próprio Paciente (ASG-PPP). A presença de caquexia foi avaliada pela perda de peso >5% nos últimos 6 meses; ou índice de massa corporal (IMC) <20 kg/m2 e perda de peso >2%; ou índice de músculo esquelético apendicular consistente com sarcopenia e perda de peso >2%. Resultados Houve predomínio de indivíduos do sexo masculino (56,7%), autodeclarados não brancos (56,7%), com tumores localizados no trato gastrointestinal (75,6%) e mediana de idade de 67 anos. 75,6% dos indivíduos apresentaram comprometimento do apetite, 57,8% suspeita de desnutrição ou desnutrição de algum grau, 54,4% caquexia e 92,2% necessidade de intervenção nutricional. Houve associação entre as categorias do CASQ com estado nutricional (p=0,001) e presença de caquexia (p=0,050). Após análise de regressão logística, a desnutrição permaneceu associada ao comprometimento do apetite [OR: 4,68 (IC 95%: 1,50-14,56), p=0,008]. Conclusão A presença de desnutrição aumentou as chances de comprometimento do apetite, o que reforça a necessidade da triagem e intervenção nutricional precoces, a fim de reduzir e/ou evitar os agravos nutricionais.

Abstract Objective To investigate appetite impairment in older adults hospitalized with cancer and its association with nutritional status and cachexia. Method A cross-sectional study, conducted with older adults men and women diagnosed with malignant neoplasia from July 2017 to March 2019 at a university hospital. The final sample consisted of 90 patients. Appetite was evaluated using the Cancer Appetite and Symptom Questionnaire (CASQ) and nutritional status was determined using the Patient-Generated Subjective Global Assessment (PG-SGA). Presence of cachexia was assessed by weight loss >5% in the last 6 months; or body mass index (BMI) <20 kg/m2 and weight loss >2%; or appendicular skeletal muscle index consistent with sarcopenia and weight loss >2%. Results There was a predominance of male (56.7%) self-declared non-white individuals (56.7%), with tumors in the gastrointestinal tract (75.6%) and median age of 67.0 years. 75.6% of the individuals have impaired appetite, 57.8% suspected malnutrition or malnutrition of some degree, 54.4% cachexia and 92.2% needed nutritional intervention. There was significant association between CASQ categories with nutritional status (p= 0.001) and presence of cachexia (p=0.050). After logistic regression analysis, malnutrition remained associated with impaired appetite assessed by CASQ score [OR: 4.68 (CI 95%: 1.50-14.56), p=0.008] Conclusion The presence of malnutrition increased the chances of appetite impairment, which reinforces the need for early nutritional screening and intervention, in order to reduce and/or avoid nutritional problems.

Malnutrition and nutrition impact symptoms (NIS) in surgical patients with cancer.

BACKGROUND AND AIM: Nutrition impact symptoms (NIS) are common in cancer patients and the negative impacts on nutritional status indicate the need for research, diagnosis and nutritional intervention in order to reduce the risk of malnutrition. We aimed to verify the presence of malnutrition, the need for nutritional intervention, NIS and their influence on the nutritional status of surgical patients with cancer. METHODS: This cross-sectional study was carried out in a public tertiary hospital, from March 2017 to October 2019. Nutritional status, the need for nutritional intervention and NIS were assessed through the Patient-Generated Subjective Global Assessment (PG-SGA) in the first 48 hours of hospital admission. RESULTS: Among the 135 patients evaluated, 55.6% were elderly and 51.1% were male; patients had a median age of 62 years and a predominance of cancer located in the lower gastrointestinal tract (35.6%). Malnutrition and the need for nutritional intervention were identified in 60.0% and 90.4% of cases, respectively. The presence of three or more NIS was reported by 51.9% of patients. Significant differences in NIS were observed according to sex, PG-SGA classification and PG-SGA score. After logistic regression analysis, it was determined that the symptoms that increased the chances of malnutrition were anorexia, constipation, strange taste, mouth sores and others (depression, dental or financial problems). CONCLUSION: Malnutrition, the need for nutritional intervention and the presence of three or more NIS were elevated in the patients evaluated. Malnutrition was associated with the presence of NIS, indicating the need for attention and care in antineoplastic treatment.

Gait speed and malnutrition in hospitalized patients and the quality of life of their caregivers.

OBJECTIVE: To verify the age, nutritional status, and gait speed in hospitalized individuals, and their association with the quality of life of their caregivers. METHODS: Observational cross-sectional study with 54 patients and their respective caretakers in a university hospital in the Brazilian Midwest. The analyses were carried out using the SPSS software, with p < 0.05. RESULTS: The Social Relations domain had the highest mean score (71.45±18.64). The lowest score was in the Physical domain (57.80±12.01). According to a subjective nutritional evaluation, 72.2% presented some degree of malnutrition. Most were classified with low gait speeds (82%). There was a significant correlation between age and the Physical and General Quality of Life domains. The Environment domain was significantly correlated to the gait speed. CONCLUSION: The age and the gait speed of the patient were related to the quality of life of the caregiver, but the nutritional state was not affected.

Spatial index relating urban environment to health lifestyle and obesity risk in men and women from different age groups.

The challenge in the search for relationships between urban space, physical mobility, and health status, is detecting indicators able to link the environment with healthy life habits. Therefore, the objective was to design an urban index for the identification of urban environment propensity for physical activity (PA) and to determine how it relates to lifestyle and anthropometric parametrization of obesity. Participants (N = 318-60.4% women and 39.6% men) were recruited from a mid-sized city with epidemiology and morbidity rates below the average for the mid-west region of Brazil. Body mass index (BMI) was measured and a questionnaire was applied to gather information about PA and life habits. The spatial urban health index (SUHI) was designed in a geographic information system using data from demographic, environmental and urban physical features. The relationship between BMI and PA was verified with multiple linear regression, controlled for SUHI levels. Regarding the BMI of the population, 69.5% were classified in the eutrophic or overweight ranges, with no effect of gender and age. The SUHI classified 63.7% of the urban area favorable to PA. The PA routine was adequate (≥3 sessions with ≥1 h each) for ~80% of the population, as well as healthy habits such as non smoking (~94%) and non alcohol abuse (~55%). The SUHI strengthens the relationships of BMI to weekly frequency (r = -0.68; t = -9.4; p<0.001) and session duration (r = -0.66; t = -2.8; p<0.001) for the whole group by improving the explanatory coefficient in ~25% (R2Adj = 0.61 to R2Adj = 0.85). The SUHI indicated that the urban environment is able to promote healthy life habits by diminishing the "obesogenic" features of the city when physical structures are planned to facilitate PA, whatever the gender and age group.

Gait speed and malnutrition in hospitalized patients and the quality of life of their caregivers / Velocidad de la marcha y desnutrición en pacientes hospitalizados y calidad de vida de sus cuidadores / Velocidade de marcha e desnutrição em paciente hospitalizados e qualidade de vida de seus cuidadores

ABSTRACT Objective: To verify the age, nutritional status, and gait speed in hospitalized individuals, and their association with the quality of life of their caregivers. Methods: Observational cross-sectional study with 54 patients and their respective caretakers in a university hospital in the Brazilian Midwest. The analyses were carried out using the SPSS software, with p < 0.05. Results: The Social Relations domain had the highest mean score (71.45±18.64). The lowest score was in the Physical domain (57.80±12.01). According to a subjective nutritional evaluation, 72.2% presented some degree of malnutrition. Most were classified with low gait speeds (82%). There was a significant correlation between age and the Physical and General Quality of Life domains. The Environment domain was significantly correlated to the gait speed. Conclusion: The age and the gait speed of the patient were related to the quality of life of the caregiver, but the nutritional state was not affected.

RESUMEN Objetivo: Verificar la relación de la edad, estado nutricional y velocidad de la marcha de indivíduos hospitalizados con la calidad de vida de sus cuidadores. Métodos: Estudio observacional del tipo transversal con 54 pacientes y sus respectivos cuidadores en un hospital universitario del Medio oeste de Brasil. Análisis han sido realizadas en el programa SPSS considerando p < 0,05. Resultados: El dominio Relaciones sociales obtuvo la calificación media más elevada (71,45±18,64) y la más baja ha sido del dominio Físico (57,80±12,01). Segundo evaluación nutricional subjetiva, 72,2% presentaban alguno grado de desnutrición. La mayoría ha sido clasificada con baja velocidad de la marcha (82%). Se encontró correlación significativa entre la edad y los dominios Físico y Calidad de vida general. El dominio Ambiente se ha correlacionado significativamente con la velocidad de marcha. Conclusión: La edad y la velocidad de la marcha del paciente han estado relacionadas con la calidad de vida del cuidador, pero no encontramos impacto en el estado nutricional.

RESUMO Objetivo: Verificar a relação da idade, estado nutricional e velocidade de marcha de indivíduos hospitalizados com a qualidade de vida de seus cuidadores. Métodos: Estudo observacional do tipo transversal com 54 pacientes e seus respectivos cuidadores em um hospital universitário da região Centro-Oeste do Brasil. Análises foram realizadas no programa SPSS considerando p < 0,05. Resultados: O domínio Relações sociais obteve o escore médio mais elevado (71,45±18,64) e o mais baixo foi do domínio Físico (57,80±12,01). Segundo avaliação nutricional subjetiva, 72,2% apresentavam algum grau de desnutrição. A maioria foi classificada com baixa velocidade de marcha (82%). Encontrou-se correlação significativa entre a idade e os domínios Físico e Qualidade de vida geral. O domínio Ambiente correlacionou-se significativamente com a velocidade de marcha. Conclusão: A idade e a velocidade de marcha do paciente estiveram relacionadas com a qualidade de vida do cuidador, porém não encontramos impacto no estado nutricional.

Fatores Associados à Qualidade de Vida Relacionada à Saúde de Pacientes com Câncer em Tratamento Clínico / Factors Associated with Health-Related Quality of Life of Cancer Patients Undergoing Clinical Treatment / Factores Asociados con la Calidad de Vida Relacionada con la Salud de los Pacientes con cáncer en Tratamiento Clínico

Introdução: Estado nutricional, qualidade de vida relacionada à saúde (QVRS) e apetite preservados proporcionam maior sobrevida aos pacientes oncológicos. Suas oscilações são comuns durante o tratamento, mas pouco se conhece sobre os fatores interferentes na QVRS. Objetivo: Avaliar os fatores associados à QVRS de pacientes com câncer. Método: Estudo transversal com 110 pacientes com câncer em tratamento clínico. Foram coletadas as variáveis sociodemográficas, clínicas, QVRS, estado nutricional e apetite. Os instrumentos utilizados foram o European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, a Avaliação Subjetiva Global (ASG) e o Cancer Appetite and Symptom Questionnaire. Para análise estatística, considerou-se o nível de significância de 5%. Resultados: A maioria era do sexo feminino (62,72%) com média de idade igual a 74,41±24,54 anos, casada (70,0%), sem atividade de trabalho (51,82%) e pertencente à classe econômica B (54,54%). O tipo de câncer mais prevalente nessa população foi o câncer de mama (30,0%), com estadiamento IV (34,44%) e ausência de metástases (53, 64%). O comprometimento do apetite foi identificado como fator associado à QVRS, apresentando diferença significativa na saúde global e na QV (p<0,001). A função emocional foi a mais prejudicada. A fadiga foi o sintoma que apresentou maior pontuação. Conclusão: O comprometimento do apetite apresentou associação com a saúde global e a QV dos pacientes em tratamento oncológico.

Introduction: Protected nutritional status, health-related quality of life (HRQOL) and appetite provide longer survival for cancer patients. Oscillations are common during treatment, but little is known about factors interfering with HRQOL. Objective: To assess the factors associated with the HRQOL of patients with cancer. Method: A cross-sectional study with 110 cancer patients undergoing clinical treatment. Sociodemographic, clinical, HRQOL, nutritional status and appetite variables were collected. The instruments used were the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the Subjective Global Assessment (SGA) and the Cancer Appetite and Symptom Questionnaire. For statistical analysis, the level of significance was 5%. Results: The majority were female (62.72%) with a mean age of 74.41±24.54 years, married (70.0%), without working activity (51.82%) and belonging to economic class B (54.54%). The most prevalent type of cancer in this population was breast cancer (30.0%), with staging IV (34.44%) and absence of metastasis (53.64%). The appetite impairment was identified as a factor associated with HRQOL, presenting significant difference in the global health and QoL (quality of life). Emotional function was the most damaged. Fatigue was the symptom that presented the highest score. Conclusion: Appetite impairment was associated with the global health and QoL of cancer patients in oncologic treatment.

Introducción: Estado nutricional, calidad de vida relacionada con la salud (CVRS) y apetito conservado proporcionan una supervivencia más larga para los pacientes con cáncer. Sus oscilaciones son comunes durante el tratamiento, pero se sabe poco sobre los factores de interferencia en la CVRS. Objetivo: Evaluar los factores asociados con la CVRS de los pacientes con cáncer. Método: estudio transversal con 110 pacientes con cáncer en tratamiento clínico. Incluimos variables sociodemográficas, clínicas, de CVRS, estado nutricional y apetito. Los instrumentos utilizados fueron el Cuestionario básico 30 de la Organización Europea para la Investigación y el Tratamiento del Cáncer, la Evaluación global subjetiva (EGS) y el cuestionario sobre el apetito y los síntomas del cáncer. Se consideró nivel de significancia del 5%. Resultados: La mayoría era mujeres (62,72%) con una edad media de 74,41±24,54 años, casada (70,0%), sin actividad laboral (51,82%) y perteneciente a clase económica B (54,54%). El tipo de cáncer más frecuente era el cáncer de mama (30,0%), estadificación IV (34,44%) y sin metástasis (53,64%). El deterioro del apetito fue identificado como factor asociado con la CVRS, mostrando diferencia significativa en lo generale de salud y CV. La función emocional fue la más deteriorada. Fatiga fue el síntoma con el puntaje más alto. Conclusión: El deterioro del apetito se asoció con la salud general y CV de los pacientes en tratamiento contra el cáncer.

Clinical, dietary and demographic characteristics interfering on quality of life of cancer patients.

OBJECTIVE: To estimate the dietary intake of cancer patients and its relation with clinical and demographic characteristics, and to assess the contribution of dietary intake, appetite/symptoms and clinical and demographic characteristics to their quality of life. METHODS: The consumption of energy and macronutrients of patients was estimated. The relation between dietary intake and clinical and demographic characteristics was evaluated by analysis of variance. The intake of energy and macronutrient of the patients was compared to the nutritional recommendations using 95% confidence interval. The Cancer Appetite and Symptom Questionnaire (CASQ) and the European Organization for Research and Treatment of Cancer (EORTC QLQ C-30) were used to assess appetite/symptoms and quality of life, respectively. The psychometric properties of the instruments were estimated. A structural equation model was prepared. RESULTS: In this study, 772 cancer patients (63.1% women) participated. There was a significant relation between dietary intake and work activity, economic class, specialty field of cancer, type of treatment and nutritional status. Patients' energy and macronutrients intake was below recommended values. Both CASQ and EORTC QLQ C-30 were refined to fit the data. In the structural model, impaired appetite, more symptoms, presence of metastasis, being female and of higher economic classes were characteristics that significantly contributed to interfering in patients' quality of life. CONCLUSION: The dietary intake of oncology patients did not reach the recommended values. Different characteristics impacted on quality of life of patients and should be considered in clinical and epidemiological protocols.

Cross-cultural psychometric assessment of an appetite questionnaire for patients with cancer.

OBJECTIVE: To evaluate the psychometric properties, along with cross-cultural invariance analysis, of the Cancer Appetite and Symptom Questionnaire (CASQ). METHOD: Data from 555 United Kingdom (UK) cancer patients were used to evaluate the psychometric properties of the CASQ. Construct validity was assessed through factorial and convergent validity. We conducted a confirmatory factor analysis using as indices the chi-square ratio by degrees of freedom (χ2/df), the comparative fit index (CFI), the goodness of fit index (GFI), and the root mean square error of approximation (RMSEA). Convergent validity was estimated by the items' average variance extracted (AVE). Reliability was estimated by composite reliability and internal consistency. Factorial invariance analysis of the CASQ was evaluated by multigroup analysis (∆χ2) using the UK and Brazilian samples. RESULTS: All items showed adequate psychometric sensitivity in the UK sample. One item was removed and four correlations were included between errors with an appropriate fit of the model (χ2/df = 2.674, CFI = 0.966, GFI = 0.964, RMSEA = 0.055). The reliability of the CASQ was adequate and the convergent validity was low. The factorial structure of the CASQ differed across countries, and a lack of measurement invariance for the two countries was observed (λ: ∆χ2 = 64.008, p < 0.001; i: ∆χ2 = 3515.047, p < 0.001; Res: ∆χ2 = 4452.504, p < 0.001). CONCLUSION: The CASQ showed adequate psychometric properties in the UK sample. The ability to estimate loss of appetite and the presence of symptoms was different between UK and Brazilian patients.

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30: factorial models to Brazilian cancer patients.

Objective To evaluate the psychometric properties of the seven theoretical models proposed in the literature for European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), when applied to a sample of Brazilian cancer patients. Methods Content and construct validity (factorial, convergent, discriminant) were estimated. Confirmatory factor analysis was performed. Convergent validity was analyzed using the average variance extracted. Discriminant validity was analyzed using correlational analysis. Internal consistency and composite reliability were used to assess the reliability of instrument. Results A total of 1,020 cancer patients participated. The mean age was 53.3±13.0 years, and 62% were female. All models showed adequate factorial validity for the study sample. Convergent and discriminant validities and the reliability were compromised in all of the models for all of the single items referring to symptoms, as well as for the "physical function" and "cognitive function" factors. Conclusion All theoretical models assessed in this study presented adequate factorial validity when applied to Brazilian cancer patients. The choice of the best model for use in research and/or clinical protocols should be centered on the purpose and underlying theory of each model.

Cross-cultural psychometric assessment of an appetite questionnaire for patients with cancer / Avaliação psicométrica transcultural de um questionário de apetite para pacientes com câncer

Abstract Objective To evaluate the psychometric properties, along with cross-cultural invariance analysis, of the Cancer Appetite and Symptom Questionnaire (CASQ). Method Data from 555 United Kingdom (UK) cancer patients were used to evaluate the psychometric properties of the CASQ. Construct validity was assessed through factorial and convergent validity. We conducted a confirmatory factor analysis using as indices the chi-square ratio by degrees of freedom (χ2/df), the comparative fit index (CFI), the goodness of fit index (GFI), and the root mean square error of approximation (RMSEA). Convergent validity was estimated by the items' average variance extracted (AVE). Reliability was estimated by composite reliability and internal consistency. Factorial invariance analysis of the CASQ was evaluated by multigroup analysis (∆χ2) using the UK and Brazilian samples. Results All items showed adequate psychometric sensitivity in the UK sample. One item was removed and four correlations were included between errors with an appropriate fit of the model (χ2/df = 2.674, CFI = 0.966, GFI = 0.964, RMSEA = 0.055). The reliability of the CASQ was adequate and the convergent validity was low. The factorial structure of the CASQ differed across countries, and a lack of measurement invariance for the two countries was observed (λ: ∆χ2 = 64.008, p < 0.001; i: ∆χ2 = 3515.047, p < 0.001; Res: ∆χ2 = 4452.504, p < 0.001). Conclusion The CASQ showed adequate psychometric properties in the UK sample. The ability to estimate loss of appetite and the presence of symptoms was different between UK and Brazilian patients.

Resumo Objetivos Avaliar as propriedades psicométricas, juntamente com a análise de invariância transcultural, do Questionário de Apetite e Sintoma para Pacientes com Câncer (Cancer Appetite and Symptom Questionnaire, CASQ). Métodos Dados de 555 pacientes com câncer do Reino Unido foram utilizados para avaliar as propriedades psicométricas do CASQ. A validade de construto foi estimada por meio das validades fatorial e convergente. Realizou-se análise fatorial confirmatória utilizando como índices a razão de qui-quadrado pelos graus de liberdade (χ2/gl), o comparative fit index (CFI), o goodness of fit index (GFI) e o root mean square error of aproximation (RMSEA). A validade convergente foi estimada pela variância extraída média (VEM). A confiabilidade foi estimada pela confiabilidade composta e consistência interna. A análise de invariância fatorial do CASQ foi avaliada por análise multigrupos (∆χ2) usando as amostras do Reino Unido e do Brasil. Resultados Todos os itens apresentaram adequada sensibilidade psicométrica na amostra do Reino Unido. Um item foi removido e foram incluídas quatro correlações entre erros, o que resultou em ajustamento adequado do modelo à amostra (χ2/df = 2,674, CFI = 0,966, GFI = 0,964, RMSEA = 0,055). A confiabilidade do CASQ foi adequada e a validade convergente foi baixa. A estrutura fatorial do CASQ diferiu entre os países, e uma falta de invariância foi observada para os dois países (λ: ∆χ2 = 64,008, p < 0,001; i: ∆χ2 = 3515,047, p < 0,001; Res: ∆χ2 = 4452,504, p < 0,001). Conclusão O CASQ apresentou adequadas propriedades psicométricas na amostra do Reino Unido. A capacidade de estimar a falta de apetite e a presença de sintomas foi diferente entre pacientes do Reino Unido e do Brasil.

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30: factorial models to Brazilian cancer patients / European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30: modelos fatoriais em pacientes brasileiros com câncer

ABSTRACT Objective To evaluate the psychometric properties of the seven theoretical models proposed in the literature for European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), when applied to a sample of Brazilian cancer patients. Methods Content and construct validity (factorial, convergent, discriminant) were estimated. Confirmatory factor analysis was performed. Convergent validity was analyzed using the average variance extracted. Discriminant validity was analyzed using correlational analysis. Internal consistency and composite reliability were used to assess the reliability of instrument. Results A total of 1,020 cancer patients participated. The mean age was 53.3±13.0 years, and 62% were female. All models showed adequate factorial validity for the study sample. Convergent and discriminant validities and the reliability were compromised in all of the models for all of the single items referring to symptoms, as well as for the "physical function" and "cognitive function" factors. Conclusion All theoretical models assessed in this study presented adequate factorial validity when applied to Brazilian cancer patients. The choice of the best model for use in research and/or clinical protocols should be centered on the purpose and underlying theory of each model.

RESUMO Objetivo Avaliar as propriedades psicométricas dos sete modelos teóricos propostos na literatura para o European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), quando aplicados em uma amostra de pacientes brasileiros com câncer. Métodos As validades de conteúdo e de construto (fatorial, convergente, discriminante) foram avaliadas. Foi realizada análise fatorial confirmatória. A validade convergente foi avaliada pela variância média extraída. A validade discriminante foi analisada por meio de análise correlacional. A consistência interna e a confiabilidade composta foram utilizadas para avaliar a confiabilidade do instrumento. Resultados Participaram do estudo 1.020 pacientes com câncer. A média de idade foi 53,3±13,0 anos, e 62% eram do sexo feminino. Todos os modelos mostraram validade fatorial adequada para a amostra de estudo. As validades convergente e discriminante e a confiabilidade foram comprometidas em todos os modelos para todos os itens isolados referentes aos sintomas, bem como para os fatores "função física" e "função cognitiva". Conclusão Todos os modelos teóricos avaliados neste estudo apresentaram validade fatorial adequada para pacientes brasileiros com câncer. A escolha do melhor modelo para uso em pesquisa e/ou protocolos clínicos deve ser baseada na finalidade e na teoria subjacente de cada modelo.