Association Between Gut Microbiota and Delirium in Acutely Ill Older Adults.

Our aim was to investigate the association between gut microbiota and delirium occurrence in acutely ill older adults. We included 133 participants 65+ years consecutively admitted to the emergency department of a tertiary university hospital, between September 2019 and March 2020. We excluded candidates with ≥24-hour antibiotic utilization on admission, recent prebiotic or probiotic utilization, artificial nutrition, acute gastrointestinal disorders, severe traumatic brain injury, recent hospitalization, institutionalization, expected discharge ≤48 hours, or admission for end-of-life care. A trained research team followed a standardized interview protocol to collect sociodemographic, clinical, and laboratory data on admission and throughout the hospital stay. Our exposure measures were gut microbiota alpha and beta diversities, taxa relative abundance, and core microbiome. Our primary outcome was delirium, assessed twice daily using the Confusion Assessment Method. Delirium was detected in 38 participants (29%). We analyzed 257 swab samples. After adjusting for potential confounders, we observed that a greater alpha diversity (higher abundance and richness of microorganisms) was associated with a lower risk of delirium, as measured by the Shannon (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.60-0.99; p = .042) and Pielou indexes (OR = 0.69; 95% CI = 0.51-0.87; p = .005). Bacterial taxa associated with pro-inflammatory pathways (Enterobacteriaceae) and modulation of relevant neurotransmitters (Serratia: dopamine; Bacteroides, Parabacteroides: GABA) were more common in participants with delirium. Gut microbiota diversity and composition were significantly different in acutely ill hospitalized older adults who experienced delirium. Our work is an original proof-of-concept investigation that lays a foundation for future biomarker studies and potential therapeutic targets for delirium prevention and treatment.

Body composition affects the accuracy of predictive equations to estimate resting energy expenditure in older adults: An exploratory study.

BACKGROUND: To investigate the accuracy of ten different predictive equations to estimate resting energy expenditure (REE) in a sample of Brazilian older adults and develop a predictive equation for estimating REE based on body composition data. METHODS: A cross-sectional study with thirty-eight Brazilian older adults aged 60-84 years, who had their REE measured by indirect calorimetry (IC) and BC assessed by dual-energy x-ray absorptiometry (DXA). REE was compared to the estimation of ten predictive equations, and the differences between BC and anthropometric-based equations were investigated using Bland-Altman plots and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured REE. RESULTS: The sample was composed of 57.9% men, with a mean age of 68.1 (5.8) years, and a mean REE by IC of 1528 (451) kcal. The highest accuracy was 47.4% obtained by Luhrmann and Fredrix equations, and the lowest accuracy was 13.2% reached by Weigle equation. In general, the proportion of underestimation was higher than overestimation. All anthropometric-based equations presented a good agreement with REE from IC. For those equations derived from BC, however, three of them reached only a moderate agreement. In terms of accuracy, all equations presented lower than 50% of accurate prediction of REE. CONCLUSIONS: In this sample of older adults, previous predictive equations to estimate REE did not show good accuracy, and those based on BC presented even worse results, showing that changes in BC related to aging could impact the accuracy of these equations.

Effect of proteins, amino acids, and other nitrogenated supplements on the skeletal muscle mass in people living with HIV (PLWH): A systematic review.

BACKGROUND & AIMS: Skeletal muscle losses (both quantitative and qualitative) and the consequent risk of sarcopenia are important issues in people living with HIV (PLWH), even when treated with antiretroviral therapies (ART). We aimed to conduct a systematic review (SR) investigating the effects of dietary interventions with proteins, amino acids, and other nitrogenated compounds on the skeletal muscle of PLWH. METHODS: We searched the published literature until August 24th, 2020, including clinical trials predominantly with AIDS-free PLWH treated with ART. RESULTS: From the 82 studies initially selected, 75 were excluded for the following reasons: nutritional interventions different from nitrogenated compounds; non-nutritional interventions; lack of information on body composition; and studies with most participants with AIDS. From the publications included (n = 7), the majority were performed with small and heterogeneous samples. None of the studies included any new-generation ART or pre- or post-exposition drugs. Two studies found benefits of supplementation on muscle mass; one was performed in a very unfavorable socioeconomic setting, and the supplementation was based on food-derived substances. The other study supplemented creatine, and its benefits were found only when combined with physical exercise training and only by one of the methods of body composition analysis (DXA). CONCLUSIONS: Our results showed that nutritional interventions with proteins, amino acids, or other nitrogenated compounds could not improve the skeletal muscle mass in PLWH. Further studies are needed, with bigger sample sizes and more precise control of ART schemes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number CRD42019139981.

Covid-19 Social Distancing, Lifestyle and Health Outcomes Among Persons Living with HIV (PLWH): A Web-based Survey.

We investigated changes in lifestyle, depressive symptoms, self-perception of health, and body weight changes of persons living with HIV (PLWH) during the COVID-19 social distancing (SD). In a Web-based cross-sectional survey, participants (n = 406) were questioned about lifestyle and health status before and during SD. Most responders were men, 50 + years old, high education level; 49.8% had their income reduced during SD. About 9% were diagnosed with COVID-19, of whom 13.5% required hospitalization. During SD: - most participants did not change their food intake, although 25% replaced healthy foods with unhealthy ones; -more than half mentioned poor sleep quality; -about 50% increased their sedentary behavior. Depressive symptoms (reported by 70.9%) were associated with sedentary behavior, poor sleep quality, and reduced income. About one-third had a negative perception of their health status, which was inversely associated with practicing physical exercises and positively associated with sedentarism and poor sleep quality. More than half increased their body weight, which was associated with a lower intake of vegetables. The older age reduced the odds of the three outcomes. Carefully monitoring PLWH regarding SD will enable early interventions toward health.

RESUMEN: En este trabajo investigamos los cambios en el estilo de vida, síntomas depresivos, autopercepción de salud y cambios en el peso corporal de las personas que viven con el VIH (PVCV) durante el distanciamiento social (DS) de COVID-19. En una encuesta transversal en línea, se preguntó a los participantes (n = 406) sobre el estilo de vida y el estado de salud antes y durante el DS. La mayoría de los encuestados eran hombres, mayores de 50 años, con alto nivel educativo. El 49,8% tuvo una disminución en sus ingresos durante el DS. El 9,1% fue diagnosticados con COVID-19, de los cuales 13,5% requirió hospitalización. Durante el DS: - la mayoría de los participantes no cambió su ingesta de alimentos, aunque el 25% reemplazó los alimentos saludables por los no saludables; más de la mitad mencionó mala calidad del sueño; cerca del 50% aumentó su comportamiento sedentario. Los síntomas depresivos (referidos por el 70,9%), fueron incrementados por el sedentarismo, la mala calidad del sueño y reducción de la renta. Cerca de un tercio tenía una percepción negativa de su estado de salud, que se redujo con la práctica de ejercicio físico y aumentó con el sedentarismo y la mala calidad del sueño. Más de la mitad aumentó su peso corporal, lo que se asoció con una menor ingesta de vegetales. Una edad más avanzada redujo las probabilidades de los tres desenlaces. El monitoreo cuidadoso de las PVCV con respecto al DS permitirá intervenciones tempranas para la salud.

The association between appetite loss, frailty, and psychosocial factors in community-dwelling older adults adults.

BACKGROUND: Appetite loss (AL) in older adults can reduce energy and nutrient intake, increasing the risk of weight loss, sarcopenia, frailty, and ultimately, mortality. The identification of associated factors to AL is important to plan different interventions. AIMS: To identify the association between appetite loss, frailty, and psychosocial factors in community-dwelling older adults. METHODS: Cross-sectional analysis of the cohort study MiMiCS-FRAIL based in Jundiai City, São Paulo, Brazil. Patients 60+ years old were evaluated from January 2019 to August 2020. The AL (dependent variable) was evaluated through the SNAQ questionnaire; the independent variables were: frailty (identified by frailty index-36; FI-36) which is based on the accumulation of deficits; depressive symptoms (GDS scale); ethnicity, and years of formal schooling, both used as proxies of socioeconomic status. The associations were investigated using logistic regression models (crude and multiple). MAIN RESULTS: The final sample included 122 older adults, 58.2% of women, mean age of 71.7 years, 80.3% White, and low educational level (5.8 ± 4.3 years of formal schooling). We found 19.6% of the sample presenting AL. The final regression models showed independent and significant association between AL and age (OR = 1.11; 95%IC = 1.03-1.20; p < 0.01), being non-White (OR = 6.47; 95%IC = 1.63-25.58; p < 0.01), and presence of depressive symptoms (OR = 8.38; 95%IC = 2.31-30.47; p < 0.01). However, years of formal schooling, gender, and FI-36 remained statistically non-significant in the model. CONCLUSION: Our data pointed to the presence of depressive symptoms and social variables as significant factors associated with AL. Further studies with more robust samples or longitudinal design will clarify some unanswered questions of our study.

The dietary inflammatory index (DII®) and its association with cognition, frailty, and risk of disabilities in older adults: A systematic review.

BACKGROUND & AIMS: Systemic inflammation is considered an important issue in older adults and is associated with adverse health outcomes, such as frailty and cognitive impairment. Diet is a critical associated factor, and the dietary inflammatory index (DII®) is proposed as a promising tool to identify the association between diet and health outcomes. Our aims were: (i) to investigate the association between the DII® and frailty, cognition, and the consequent risk of disability in older adults; (ii) to discuss particularities of the use of DII® with older adults. METHODS: The research question was based on the PICOS strategy: Population = older adults; Intervention or Exposure = DII; Comparison = any comparator; Outcomes = frailty, cognition, and risk of disability; Type of study = cohort, cross-sectional or case-control studies. We searched publications in two electronic databases (PUBMED and Web of Science) up to May 20th, 2020. RESULTS: Seven studies met our criteria. Three investigated cognition (one cohort and two cross-sectional), and four investigated frailty or risk of disability (one cohort and three cross-sectional); none of the studies investigated both outcomes (frailty and cognition) simultaneously. The studies presented some issues, mainly concerning: (i) the collection of dietary data and calculation of the DII; (ii) the study design; (iii) calculation of the sample size; (iv) eligibility criteria; (v) time for follow-up; (vi) and choice of covariates. CONCLUSION: despite the issues, the use of DII resulted in a significant association, or predictive value, with variables related to frailty and cognitive decline. Further studies, with sensitivity analysis of the different components of this index, are needed. DII showed to be a promising tool in the investigation of geriatric syndromes. This systematic review was registered in PROSPERO (CRD42020155672).

Relationship of evening meal with sleep quality in obese individuals with obstructive sleep apnea.

PURPOSE: To determine the relationship between habitual food intake, resting energy expenditure and sleep pattern in obstructive sleep apnea (OSA) patients. METHODS: Forty-five OSA obese males were included in the study. All participants were submitted to nocturnal polysomnography, body composition measurements by plethysmography, resting energy expenditure (REE) analysis by indirect calorimetry and they filled in a 3-day food record. RESULTS: No differences in body composition, REE and food intake were found between the moderate and severe OSA groups. A trend towards higher energy intake in the severe OSA group was observed, compared to the moderate group (p = 0.08). Significant associations between apnea-hypopnea index (AHI) with body weight, body mass index (BMI) and resting energy expenditure (REE) were found. Higher food intake in the evening period was positively correlated with sleep stage NREM1, arousal index, and AHI and negatively correlated with sleep stage NREM3 and sleep efficiency. A multivariate linear regression showed energy intake at breakfast to be a significant negative predictor of AHI; protein intake (g/kg) showed a positive association, while energy intake at breakfast and at dinner were negative predictors of sleep efficiency; and energy intake at dinner was a negative predictor of stage NREM1 sleep. CONCLUSIONS: We conclude that higher amounts of food intake during the evening period may diminish sleep quality in moderate and severe sleep apnea patients. In addition, despite observing no differences between OSA severity groups, a moderate correlation between REE and sleep quality and OSA exists.

Nutrition and Alzheimer Disease.

We gathered some theoretic and practical concepts related to the importance of nutrition in the prevention and management of Alzheimer disease (AD). Besides the role of nutrients in brain development and functioning, some nutrients exert special control in the development of AD, due to their participation in neurotransmitter synthesis, their modulation in epigenetics mechanisms, and as antioxidants. In addition, some non-nutrient food-derived substances have shown potential in the control of neuroinflammation and consequently in the prevention of AD. Finally, it is important to be aware of the nutritional status and food intake patterns of the patient with AD.

Nutritional Strategies in the Management of Alzheimer Disease: Systematic Review With Network Meta-Analysis.

BACKGROUND: Alzheimer disease (AD) is the major cause of dependency and disability in the elderly. Numerous studies have sought to achieve its prevention and/or management examining a role for modifiable risk factors, such as nutrition. This work aims to investigate the effects of food and/or nutrients in the management of AD at different stages. METHODS: Electronic databases were searched for clinical trials examining the effect of nutrient intervention in individuals with AD, compared with placebo, published up to 2014. The outcomes investigated were neuropsychological assessment scales, neuroimaging, and biomarkers. The Cochrane tool was employed to assess risk of bias. Pairwise meta-analyses were performed in a random-effect model by estimating the weighted mean differences with 95% confidence interval (CI) for each outcome measure. The Network meta-analysis was undertaken on cognitive outcome. RESULTS: Selected studies used antioxidants, B-vitamins, inositol, medium-chain triglyceride, omega-3, polymeric formulas, polypeptide, and vitamin D. AD outcome measurements were mainly restricted to cognitive state and functional abilities. Estimate treatment effects from pairwise meta-analyses showed large but nonsignificant effect in the supplementation with proline-rich polypeptide [weighted mean difference 6.93 (95% CI -3.04, 16.89); P = .17] and B-vitamins [weighted mean difference 0.52 (95% CI -0.05, 1.09); P = .07) on cognitive function measured by the Mini-Mental State Examination. The other nutrients supplementation did not show any significant effect on any outcome measures. CONCLUSIONS: Isolated nutrient supplementations show no convincing evidence of providing a significant benefit on clinical manifestations or neuropathology of AD. During the initial stages of AD, nutrient supplementation did not show any effect when delivered individually, probably because of their synergistic function on brain, at different domains.