INFLAMMATORY BOWEL DISEASE AND SARCOPENIA: A FOCUS ON MUSCLE STRENGTH - NARRATIVE REVIEW.

•Muscle strength decline is a crucial factor for the course of sarcopenia in inflammatory bowel disease (IBD) patients. •There is a need to discuss the association between IBD and sarcopenia focusing not only on changes of muscle mass, but also on muscle strength. •A narrative review was conducted in order to present the set of factors with impact in both muscle strength and IBD. •Inflammation, reduced nutrient intake and malabsorption, changes in body composition and gut microbiota dysbiosis are most likely the main factors with impact on muscle strength in IBD patients. Inflammation, changes in nutrient absorption and gut dysbiosis are common conditions in patients with inflammatory bowel disease. These factors may lead to variations in macro- and micronutrients and, particularly, to an imbalance of protein metabolism, loss of muscle mass and development of sarcopenia. This narrative review aims to present the set of factors with impact in muscle strength and physical performance that may potentially mediate the relation between inflammatory bowel disease and sarcopenia. Studies that associated changes in muscle strength, sarcopenia and inflammatory bowel disease were selected through a literature search in databases Medline, Pubmed and Scielo using relevant keywords: muscle strength, physical performance, sarcopenia and inflammatory bowel disease. Chronic inflammation is currently reported as a determinant factor in the development of muscle atrophy in inflammatory bowel disease. In addition, strength decline in inflammatory bowel disease patients may be also influenced by changes in body composition and by gut dysbiosis. Measures of muscle strength and physical performance should be considered in the initial identification of sarcopenia, particularly in patients with inflammatory bowel disease, for a timely intervention can be provided. Presence of proinflammatory cytokines, high adiposity, malabsorption and consequent deficits of macro and micronutrients, loss of muscle mass, and gut dysbiosis may be the main factors with impact in muscle strength, that probably mediate the relation between inflammatory bowel disease and sarcopenia.

Doença inflamatória intestinal e sarcopenia: um foco na força muscular - revisão narrativa / Inflammatory bowel disease and sarcopenia: a focus on muscle strength - narrative review

ABSTRACT Inflammation, changes in nutrient absorption and gut dysbiosis are common conditions in patients with inflammatory bowel disease. These factors may lead to variations in macro- and micronutrients and, particularly, to an imbalance of protein metabolism, loss of muscle mass and development of sarcopenia. This narrative review aims to present the set of factors with impact in muscle strength and physical performance that may potentially mediate the relation between inflammatory bowel disease and sarcopenia. Studies that associated changes in muscle strength, sarcopenia and inflammatory bowel disease were selected through a literature search in databases Medline, Pubmed and Scielo using relevant keywords: muscle strength, physical performance, sarcopenia and inflammatory bowel disease. Chronic inflammation is currently reported as a determinant factor in the development of muscle atrophy in inflammatory bowel disease. In addition, strength decline in inflammatory bowel disease patients may be also influenced by changes in body composition and by gut dysbiosis. Measures of muscle strength and physical performance should be considered in the initial identification of sarcopenia, particularly in patients with inflammatory bowel disease, for a timely intervention can be provided. Presence of proinflammatory cytokines, high adiposity, malabsorption and consequent deficits of macro and micronutrients, loss of muscle mass, and gut dysbiosis may be the main factors with impact in muscle strength, that probably mediate the relation between inflammatory bowel disease and sarcopenia.

RESUMO Inflamação, alterações na absorção de nutrientes e a disbiose intestinal são condições comuns em indivíduos com doença inflamatória intestinal. Estes fatores podem levar a variações corporais do teor de macro e micronutrientes e, em particular, a um desequilíbrio no metabolismo de proteínas com perda de massa muscular e desenvolvimento de sarcopenia. Esta revisão narrativa visa apresentar o conjunto de fatores com impacto na força e função muscular que podem potencialmente mediar a relação entre doença inflamatória intestinal e sarcopenia. Estudos que associaram as alterações de força muscular, sarcopenia e doença inflamatória intestinal foram selecionados, através de uma pesquisa bibliográfica nas bases de dados Medline, Pubmed e Scielo, usando palavras-chave relevantes: força muscular, desempenho físico, sarcopenia e doença inflamatória intestinal. A inflamação crónica é atualmente citada como um fator determinante no desenvolvimento de atrofia muscular nos casos de doença inflamatória intestinal. Além disso, o declínio de força em indivíduos com doença inflamatória intestinal, também pode ser influenciado pelas alterações na composição corporal e pela disbiose instestinal. Indicadores de força muscular e de desempenho físico devem ser considerados na identificação inicial de sarcopenia, principalmente em indivíduos com doença inflamatória intestinal, para que uma intervenção precoce possa ocorrer. A presença de citocinas pró-inflamatórias, elevada adiposidade corporal, má absorção intestinal com consequente déficit de macro e micronutrientes, perda de massa muscular e disbiose intestinal poderão ser os principais fatores com impacto na força muscular, que provavelmente medeiam a relação entre doença inflamatória intestinal e sarcopenia.

FODMAPs, inflammatory bowel disease and gut microbiota: updated overview on the current evidence.

PURPOSE: Based on the fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) hypothesis, the low-FODMAP diet has been suggested as a potential therapeutic approach for inflammatory bowel disease (IBD) with promising results on disease management. However, this diet implies a specific broad food restriction, which potentially increases the risk of nutritional deficiencies and may aggravate gut microbiota dysbiosis of IBD patients. The aim of the present study is to review the effect of individual FODMAPs on the human gut microbiota. In addition, this narrative review provides an updated overview of the use of the low-FODMAP diet in IBD, namely the implementation, advantages, limitations, and the impact on the gut microbiota. METHODS: The literature search strategy was applied to PubMed and Web of Science using relevant keywords, IBD, FODMAPs, Fructose, Lactose, Polyols, FOS, GOS, low-FODMAP diet and gut microbiota. RESULTS: Current data suggest that the low-FODMAP diet may effectively improve clinical outcomes in the management of IBD and ensure better quality of life for IBD patients. However, there is evidence highlighting some issues of concern, particularly the adequacy of the diet and the impact on the gut microbiota. The various FODMAP types differently modulate the gut microbiota. CONCLUSION: IBD management should be achieved with the least possible dietary restriction to avoid detrimental consequences, particularly on nutritional adequacy and gut microbiota. Thus, it is important to individualize and monitor the nutrition intervention. Further studies are required to better characterize the relationship between diet, the gut microbiota, and IBD to support the generalization of this approach for clinical practice in IBD therapy and management.

Prediction equations for estimating body weight in older adults.

BACKGROUND: Assessing body weight in older adults may be challenging. Hence, the present study aimed to develop and cross-validate updated and reproducible equations to estimate body weight in a large sample of older adults, namely among the older-old. METHODS: In total, 1456 individuals aged ≥ 65 years, from the Nutrition UP 65 study, were included in the present analysis. The participants were randomly assigned to one of two sub-samples: development (n = 991) and validation samples (n = 465). Prediction equations using height, mid-upper arm circumference (MUAC), waist circumference (WC), calf circumference (CC) and triceps skinfold thickness (TST) were generated for the development sample using multiple regression analysis and then validated using the validation sample. RESULTS: The model with five predictor variables generated the following equations: females 65-79 years: -114.682 + 0.522 × height (cm) + 0.620 × MUAC (cm) + 0.517 × WC (cm) + 0.893 × CC (cm) + 0.111 × TST (mm) (adjusted r2  = 0.883, standard error of the estimate (SEE) = 4.4); females ≥ 80 years: -110.806 + 0.494 × height (cm) + 0.637 × MUAC (cm) + 0.500 × WC (cm) + 0.986 × CC (cm) + 0.021 × TST (mm) (adjusted r2  = 0.890, SEE = 3.9); males 65-79 years: -114.875 + 0.558 × height (cm) + 0.073 × MUAC (cm) + 0.671 × WC (cm) + 0.717 × CC (cm) + 0.182 × TST(mm) (adjusted r2  = 0.820, SEE=5.0); and males ≥ 80 years: -128.789 + 0.546 × height (cm) + 0.202 × MUAC (cm) + 0.612 × WC (cm) + 1.236 × CC (cm) + 0.093 × TST (mm) (adjusted r2  = 0.906, SEE = 3.5). CONCLUSIONS: Body weight can be estimated with good accuracy in older adults using these sex- and age-specific equations generated from regression models using three to five anthropometric predictor variables.

Urinary Sodium Excretion and Adherence to the Mediterranean Diet in Older Adults.

Despite the well-known benefits of the Mediterranean Diet (MedDiet), data on the sodium intake is scarce. This study aimed to quantify the association between sodium excretion and the adherence to the MedDiet in the elderly. A representative sample of 1500 Portuguese adults (≥65 years) was assessed (1321 were eligible for the present analysis). A 24 h urine sample was collected and analysed for creatinine and sodium. Excessive sodium intake was defined as above 2000 mg/day. The adherence to the MedDiet was assessed by the PREDIMED. A binary logistic regression model was conducted to evaluate the association between urinary sodium excretion and the adherence to the MedDiet. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Excessive sodium excretion was observed in 80.0% of men and 91.5% of women whereas a high adherence to the MedDiet was reported by 42.2% of women and 46.4% of men. After adjusting for confounders, excessive sodium excretion was associated with a high adherence to the MedDiet in men (OR = 1.94; 95% CI: 1.03-3.65) but not in women. These results show that the MedDiet can be an important source of sodium and highlight the need for implementing strategies to reduce sodium intake when following a MedDiet.

Association Between Anthropometric Indicators of Nutrition Status and Length of Hospital Stay in Hospitalized Patients.

BACKGROUND: Undernutrition is associated with increased hospital length of stay (LOS). Anthropometrics is required for undernutrition screening and diagnosis. However, the measurements which are more strongly associated with LOS are to be specified. This study aims to measure the independent association of weight, triceps skinfold thickness (TST), mid-upper arm circumference (MUAC), adductor pollicis muscle thickness (APMT), mid-upper arm muscle area (AMA), mid-upper arm muscle circumference (AMC), and body mass index (BMI) with LOS and investigating whether these indicators had similar validity in predicting LOS. METHODS: Six hundred ninety-five patients participated in a prospective observational study. Participants were dichotomized indicators studied according to the 5th and 25th percentiles described in the literature (for APMT only the 5th percentile was used). Cox regression analysis was used to estimate adjusted hazard ratios (HRs) and corresponding 95% CIs. RESULTS: Patients that presented values <5th percentile for TST (HR, 0.759; 95% CI, 0.579-0.995), MUAC (HR, 0.822; 95% CI, 0.687-0.983), APMT (HR, 0.791; 95% CI, 0.671-0.933), AMA (HR, 0.797, 95% CI, 0.660-0.962), and AMC (HR, 0.746; 95% CI, 0.611-0.911) showed a lower probability of being discharged to usual residence. Patients whose TST values were <25th percentile also presented lower probability of being discharged to usual residence (HR, 0.798; 95% CI, 0.673-0.946). No associations were found between weight and BMI with LOS. CONCLUSION: Depletion of TST, MUAC, APMT, AMA, and AMC was associated with lower probability of being discharged to usual residence. A thicker TST was independently associated with this outcome and thus TST should be considered for undernutrition screening and diagnosis.

Adherence to a Mediterranean Dietary Pattern status and associated factors among Portuguese older adults: Results from the Nutrition UP 65 cross-sectional study.

OBJECTIVES: The aim of this study was to evaluate adherence to the Mediterranean dietary pattern (MDP) and its associated factors in older Portuguese adults. METHODS: A cross-sectional observational study was designed. In the context of the Nutrition UP 65 study, a national cluster sample of 1407 Portuguese individuals ≥65 y of age was analyzed. Adherence to the MDP was evaluated with the Portuguese version of the Prevention with Mediterranean Diet tool. The association between an individual's characteristics and adherence to the MDP was analyzed through hierarchical logistic regression analysis. RESULTS: In this study, 43% of participants adhered to the MDP (n = 609). Higher educational level (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.54-3.69), living in the center (OR, 1.35; 95% CI, 1.01-1.79), being married or living in a common-law marriage (OR, 1.54; 95% CI, 1.20-1.97), and body mass index (ORpreobese, 1.52; 95% CI, 1.02-2.25) were related with increased odds of adherence to the MDP. Otherwise, lower adherence to the MDP was found for participants who were ≥80 y of age (OR, 0.70; 95% CI, 0.52-0.94), who lived in Madeira (OR, 0.35; 95% CI, 0.14-0.89) and Azores (OR, 0.28; 95% CI, 0.08-0.99), who rated their health as moderate (OR, 0.65; 95% CI, 0.50-0.84) or as bad or very bad (OR, 0.63; 95% CI, 0.45-0.90), and those who reported six or more comorbidities (OR, 0.62; 95% CI, 0.39-0.97). CONCLUSIONS: Of the sample, 57% did not adhere to the Mediterranean diet. Potentially modifiable factors associated with lower adherence to the MDP were lower educational and health status.

Sodium and potassium urinary excretion and their ratio in the elderly: results from the Nutrition UP 65 study.

BACKGROUND: We aimed to describe urinary sodium and potassium excretion and their ratio in a representative sample of Portuguese elderly population, according to sociodemographic characteristics and weight status. METHODS: A cluster sampling approach was used, representing older Portuguese adults (≥65 years) according to age, sex, education level, and regional area within the Nutrition UP 65 study. This cross-sectional evaluation was conducted in 2015 and 2016. From a sample size of 1,500 participants, 1,318 were eligible for the present analysis, 57.3% were women, and 23.5% were aged ≥80 years. Sodium and potassium consumption was evaluated through one 24 h urinary excretion. Inadequate sodium intake was defined as ≥2,000 mg/day, inadequate potassium intake was considered as <3,510 mg/day, and inadequate sodium-to-potassium ratio was defined as >1, according to the World Health Organization cutoffs. RESULTS: The proportion of the participants with an inadequate intake was 80.0% in women and 91.5% in men (sodium), 96.2% of women and 79.4% of men (potassium), and 98.4% of women and 99.1% of men (sodium-to-potassium ratio). Higher sodium adequacy was observed among the older elderly, unmarried, with lower household income, and underweight/normal weight. Higher potassium adequacy was observed in the younger elderly, married, and with higher income. CONCLUSION: The majority of the Portuguese elderly population was classified as having inadequate sodium, potassium, and sodium-to-potassium ratio urinary excretion. Therefore, strategies for reducing sodium and increasing potassium intake are priorities in the Portuguese elderly population.

A Cross-Sectional Study on the Association between 24-h Urine Osmolality and Weight Status in Older Adults.

Data on the association between hydration and body weight in the elderly are scarce. The objective of this work was to quantify the association between 24-h urine osmolality and weight status in the elderly. A cross-sectional study was conducted within the Nutrition UP 65 study. A quota sampling was implemented to achieve a nationally representative sample of Portuguese older adults (≥65 years) according to age, sex, education and region. From a sample size of 1500 participants, 1315 were eligible for the present analysis, 57.3% were women and 23.5% were aged ≥80 years. Participants were grouped using tertiles of 24-h urine osmolality by sex. World Health Organization cutoffs were used to classify participants according to weight status. Multinomial multivariable logistic regression models were conducted to evaluate the association of tertiles of osmolality with weight status, adjusting for confounders. Odds Ratios (OR) and respective 95% Confidence Intervals (95% CI) were calculated. Being in the 3rd urine osmolality tertile (highest) was associated with a higher risk of being obese in men, OR = 1.97, 95% CI = 1.06, 3.66. No such association was found in women. These results highlight the need for implementing studies in order to clarify the association between hydration and weight status in the elderly.

Association between serum 25-hidroxyvitamin D concentrations and ultraviolet index in Portuguese older adults: a cross-sectional study.

BACKGROUND: The older population is a risk group for hypovitaminosis D. The Ultraviolet Index (UVI) can be an indicator of potential for cutaneous synthesis of vitamin D but physiological and other environmental factors also influence vitamin D synthesis and status. Knowledge about vitamin D status in Portuguese older adults is limited. This study aims to explore the association between Ultraviolet Index and serum 25-hidroxyvitamin D3 [25(OH)D] levels accounting for other potential influential factors. METHODS: A cross-sectional study was conducted between December 2015 and June 2016, in 1497 Portuguese older adults (≥ 65 years) within Nutrition UP 65 project. For each participant, serum 25(OH)D was determined and the mean UVI (mUVI) in the respective residence district was calculated for the previous 30 days. Stepwise linear regression analyses were conducted for the following periods of blood collection: between December and June, December and March and April and June. Standardized regression coefficients (Sß) and 95% confidence intervals were calculated. RESULTS: The median 25(OH)D concentration was 35.9 nmol/L. The UVI was independently and positively associated with 25(OH)D in the models for December-June (Sß = 0.244, 95% CI: 0.198; 0.291, P < 0.001) and April-June (Sß = 0.295, 95% CI: 0.299; 0.362, P < 0.001) and independently and negatively associated in December-March period (Sß = -0.149, 95% CI: -0.211; -0.087, P < 0.001). CONCLUSIONS: In this sample with high vitamin D deficiency frequency, the UVI was a predictor of 25(OH)D levels but the direction of the association varied according to the blood collection period. Our results suggest that accounting for the time of year in future research regarding vitamin status and related public health recommendations may be relevant.

Comparison of Jamar and Bodygrip Dynamometers for Handgrip Strength Measurement.

Guerra, RS, Amaral, TF, Sousa, AS, Fonseca, I, Pichel, F, and Restivo, MT. Comparison of Jamar and Bodygrip dynamometers for handgrip strength measurement. J Strength Cond Res 31(7): 1931-1940, 2017-Studies that compared the agreement between Jamar and other models of dynamometers for handgrip strength (HGS) measurement have exhibited variability in the provided results. The lack of comparability between dynamometers led to the development of the Bodygrip dynamometer. This study aims to examine the reliability of the Bodygrip for HGS measurement, to compare it with the Jamar, and to explore the HGS differences between instruments considering the ergonomic effect of using the Bodygrip with 2 different handles. A cross-sectional study was conducted in free-living (n = 114, 18-89 years) and inpatient (n = 50, 65-93 years) volunteers. Nondominant HGS was tested randomly with the Jamar and Bodygrip, the latter using 2 different handles-curved and straight types. Handgrip strength was obtained for each participant under the same conditions. Each individual performed 2 HGS measurements with each dynamometer, and the maximum HGS value was considered for dynamometers comparison. Differences in the maximum HGS value between the 2 devices (Jamar-Bodygrip), intraclass correlation coefficients (ICCs), Bland and Altman plots, and limits of agreement were obtained. Correlation between the highest HGS measurement obtained for the nondominant hand with the Jamar and with the Bodygrip using each handle was excellent (ICCs: 0.93-0.95). Mean differences of -0.5 (limits of agreement: -4.6; 3.5) kgf with the curved handle and of 1.0 (-7.7; 9.7) kgf with the straight handle for the free-living participants were obtained, whereas for inpatients these values were -1.0 (-3.8; 1.9) kgf and 2.1 (-3.3; 7.5) kgf, respectively, for the curved and straight handles. The Bodygrip is comparable to the Jamar in free-living adults and in hospitalized older adults, exhibiting excellent interinstrument reliability. The Bodygrip with the curved handle produces results closer to the Jamar when compared with Bodygrip with the straight handle, which emphasizes the importance of grip handle ergonomics to measurement reliability.

Vitamin D status and associated factors among Portuguese older adults: results from the Nutrition UP 65 cross-sectional study.

OBJECTIVES: To evaluate vitamin D status and its associated factors in Portuguese older adults from the Nutrition UP 65 study. DESIGN: Cross-sectional observational study. PARTICIPANTS AND METHODS: Nationwide cluster sample of 1500 Portuguese subjects ≥65 years old. Participants were classified, according to US Institute of Medicine cut-offs, as presenting normal 25-hydroxyvitamin D (25(OH)D) levels (≥50.0 nmol/L), at risk of inadequacy (30.0-49.9 nmol/L) or at risk of deficiency (<30 nmol/L). The association between individuals' characteristics and 25(OH)D levels was analysed through multinomial logistic regression analysis. RESULTS: Median 25(OH)D serum value was 36.1 (interquartile range (IQR): 35.5) nmol/L. According to the used cut-offs, 39.6% of participants were at risk of 25(OH)D deficiency and 29.4% were at risk of 25(OH)D inadequacy. In the adjusted model, having higher skin pigmentation and waist circumference >88 cm for women and >102 cm for men were associated with higher odds of 25(OH)D deficiency. Otherwise, living in Lisbon Metropolitan Area and in Madeira, 1-12 years of schooling, being married or in a common-law marriage, monthly income ≥€1000, alcohol consumption, medication or supplements with vitamin D supplement use, and blood samples collected in spring or summer were associated with lower odds of being at risk of 25(OH)D deficiency. In this model, season of blood sample collection, medication or supplements use, and waist circumference were the factors more strongly associated with 25(OH)D levels. CONCLUSIONS: Despite using the conservative Institute of Medicine cut-offs, over two-thirds of these study participants presented inadequate 25(OH)D levels, warranting the implementation of corrective measures. Potentially modifiable factors were strongly associated with 25(OH)D levels in this study. These findings may be particularly relevant to the development of public health policies in southern European countries.

Triceps skinfold compressibility in hospitalized patients / Compresibilidad del pliegue cutáneo del tríceps entre los pacientes hospitalizados

Objective: To explore triceps skinfold (TSF) compressibility and its associated factors among hospitalized patients. Methods: A cross-sectional study was conducted among hospitalized adult patients. Evolution of tissue compressibility during two seconds was registered and 120 TSF values were obtained using a digital calliper. Compressibility was determined according to the difference between the initial value and the final value (TSF difference) and according to time (τ). Multivariable linear regression models were performed in order to identify factors associated with TSF compressibility. Results: One hundred and six patients (30.2% aged ≥ 65 years) composed the study sample. Compressibility based on TSF difference was independently associated with TSF thickness (regression coefficient, 95% confidence interval [CI] = 0.38, 0.01-0.05, p = 0.002) and nutritional risk (regression coefficient, 95% CI = 0.23, 0.12-1.23, p = 0.018), but time of compressibility (τ) was not significantly associated with any of the studied variables. Conclusions: Among a sample of hospitalized patients, undernutrition risk and higher TSF thickness were factors independently associated with higher compressibility assessed by the difference between the initial and final TSF value. Time of compressibility (τ) was not affected by any of the studied factors (AU)

Objetivo: explorar la compresibilidad del pliegue cutáneo del tríceps (PCT) y sus factores asociados entre los pacientes hospitalizados. Métodos: se realizó un estudio transversal en pacientes adultos hospitalizados. Se registró la evolución de la compresibilidad del tejido durante dos segundos y se obtuvieron 120 valores del PCT utilizando un calibrador digital. La compresibilidad se determinó según la diferencia entre el valor inicial y el valor final (diferencia PCT) y según el tiempo (τ). Se realizaron modelos de regresión lineal múltiple con el fin de identificar los factores asociados con la compresibilidad del PCT. Resultados: ciento seis pacientes (30,2% ≥ 65 años) compusieron la muestra del estudio. La compresibilidad basada en la diferencia de PCT se asoció independientemente con el espesor del PCT (coeficiente de regresión, intervalo de confianza 95% [IC] = 0,38, 0,01-0,05, p = 0,002) y el riesgo nutricional (coeficiente de regresión, IC del 95% = 0,23, 0,12-1,23, p = 0,018), pero el tiempo de compresibilidad (τ) no se asoció significativamente con ninguna de las variables estudiadas. Conclusiones: entre una muestra de pacientes hospitalizados, el riesgo de desnutrición y el mayor espesor del PCT fueron factores asociados independientemente con una mayor compresibilidad evaluada por la diferencia entre el valor inicial y final del PCT. El tiempo de compresibilidad (τ) no se vio afectado por ninguno de los factores estudiados (AU)

ESPEN diagnostic criteria for malnutrition - A validation study in hospitalized patients.

BACKGROUND & AIMS: The European Society for Clinical Nutrition and Metabolism (ESPEN) released a consensus statement for undernutrition diagnosis: ESPEN diagnostic criteria for malnutrition (EDC). The EDC lacks validation and therefore, the present study aims to assess the concurrent and predictive validity of this tool in a cohort of inpatients. METHODS: A prospective observational study took place in a university hospital. Concurrent validity of EDC was evaluated using the Patient Generated Subjective Global Assessment (PG-SGA) nutrition status classification as the reference method. Sensitivity, specificity, positive and negative predictive values were determined. The EDC predictive validity was assessed by its independent association with length of hospital stay (LOS), applying Cox proportional hazards ratio method. RESULTS: Of the 632 included patients, 455 participants (72%) were nutritionally-at-risk (Nutritional Risk Screening initial screening). For those that had screened positive, 260 (57.1%) and 55 participants (12.1%) were undernourished according to PG-SGA and to EDC, respectively. Compared to PG-SGA, the EDC revealed a sensitivity of 17.1% and a specificity of 98.3%. Positive and negative predictive values were respectively 89.1% and 58.9%. Undernutrition evaluated by EDC was independently associated with lower hazard ratio for being discharged home over time, 0.695 (95% confidence interval: 0.509; 0.950). CONCLUSIONS: The EDC could be used in clinical settings to confirm undernutrition suggested by other methods. The independent association of undernutrition by EDC with LOS shows this method is of clinical relevance.

Nutritional Strategies Facing an Older Demographic: The Nutrition UP 65 Study Protocol.

BACKGROUND: The population of Portugal is aging. The lack of data on older adults' nutritional status and the lack of nutrition knowledge amongst health professionals, caregivers, and older adults themselves, remains a challenge. OBJECTIVE: The Nutrition UP 65 study aims to reduce nutritional inequalities in the older Portuguese adult population and improve knowledge regarding older Portuguese adults' nutritional status, specifically relating to undernutrition, obesity, sarcopenia, frailty, hydration, sodium, and vitamin D statuses. METHODS: A representative sample of older Portuguese adults was selected. Sociodemographic, lifestyle, anthropometric, functional, and clinical data were collected. Sodium excretion, hydration, and vitamin D statuses were assessed. RESULTS: Data collection (n=1500) took place between December, 2015 and June, 2016. Results will be disseminated in national and international scientific journals, and via Portuguese media. CONCLUSIONS: Nutrition UP 65 results will provide evidence for the design and implementation of effective preventive public health strategies regarding the elderly. These insights may represent relevant health gains and costs savings.

Sarcopenia among hospitalized patients - A cross-sectional study.

BACKGROUND & AIMS: Data on the prevalence of sarcopenia among hospitalized older patients are scarce and there is no available information on the burden of sarcopenia among younger patients. The present study aims to increase the knowledge about the frequency of sarcopenia among hospitalized patients and to evaluate the influence of different diagnostic criteria in these estimates. METHODS: A cross-sectional study was conducted in hospitalized adult patients. Sarcopenia was defined, according to the European Working Group on Sarcopenia in Older People (EWGSOP), as the presence of both low muscle mass, assessed by Bioelectrical Impedance Analysis (BIA), adjusted for height, and low muscle function (hand grip strength). Two other criteria were applied, also using hand grip strength for evaluating muscle function, one that also assessed muscle mass by BIA, but adjusted for weight, and another which estimated muscle mass based on mid-arm muscle circumference. Nutritional status was evaluated by Patient-Generated Subjective Global Assessment. The degree of agreement between the different diagnostic criteria was assessed using kappa. Multivariable logistic regression models were used in order to identify factors associated with sarcopenia. RESULTS: 608 hospitalized adult patients aged ≥18 years composed the study sample. According to EWGSOP's criteria, 25.3% patients were sarcopenic. However, depending on age and on the applied criteria, frequency of sarcopenia varied from 5% to 41.1% for men and from 4.9% to 38.3% for women. There was 95.7% (k = 0.89) agreement between criteria that estimated muscle mass by BIA. According to EWGSOP criteria approximately 20% of the non-undernourished patients were sarcopenic. Furthermore, 29.5% of overweight and 18.7% of obese patients were sarcopenic. Factors associated with sarcopenia were male gender, age ≥65 years, moderate or severe dependence, being undernourished and admitted to a medical ward. CONCLUSIONS: Sarcopenia is frequent among hospitalized patients and varies widely depending on the applied diagnostic criteria. Sarcopenia was identified in a considerable proportion of patients aged under ≥65 years and in non-undernourished, namely among overweight and obese.