Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status.

OBJECTIVE: To validate a revision of the Mini Nutritional Assessment short-form (MNA(R)-SF) against the full MNA, a standard tool for nutritional evaluation. METHODS: A literature search identified studies that used the MNA for nutritional screening in geriatric patients. The contacted authors submitted original datasets that were merged into a single database. Various combinations of the questions on the current MNA-SF were tested using this database through combination analysis and ROC based derivation of classification thresholds. RESULTS: Twenty-seven datasets (n=6257 participants) were initially processed from which twelve were used in the current analysis on a sample of 2032 study participants (mean age 82.3y) with complete information on all MNA items. The original MNA-SF was a combination of six questions from the full MNA. A revised MNA-SF included calf circumference (CC) substituted for BMI performed equally well. A revised three-category scoring classification for this revised MNA-SF, using BMI and/or CC, had good sensitivity compared to the full MNA. CONCLUSION: The newly revised MNA-SF is a valid nutritional screening tool applicable to geriatric health care professionals with the option of using CC when BMI cannot be calculated. This revised MNA-SF increases the applicability of this rapid screening tool in clinical practice through the inclusion of a "malnourished" category.

Impact of some isoenergetic snacks on satiety and next meal intake in healthy adults.

BACKGROUND: Choosing small portions especially of low energy foods is a standard recommendation for weight management. However, this can result in rapid return of hunger or an increase in the next meal size. Enhancing the satiating capacities of low energy foods may help to overcome these effects. The present study compared the satiating properties of small servings of four low energy foods [465 kJ (111 kcal)] including a drinking yogurt enhanced for satiety. METHODS: Thirty volunteers attended the laboratory to consume isoenergetic preloads of: a fibre-enriched drinking yogurt, a regular drinking yogurt, plain crackers, fresh banana; or an isovolumetric serving of water. Satiety was analysed using visual analogue scales, before and every 15 min after consumption for 60 min, when ad libitum food intake was measured. RESULTS: The yogurts and the banana were more satiating than water and crackers (P < 0.001 for yogurts and banana versus crackers and water). Only the fibre-enriched yogurt produced higher satiety scores than crackers at 60 min (P < 0.05). Mean + or - SD consumption at next meal was: fibre-enriched yogurt 2050 + or - 787 kJ (490 + or - 188 kcal); regular yogurt 2071 + or - 575 kJ (495 + or - 137 kcal); bananas 2178 + or - 603 kJ (520 + or - 144 kcal); crackers 2232 + or - 590 kJ (533 + or - 141 kcal); water 2519 + or - 741 kJ (602 + or - 177 kcal); (yogurts versus water: P = 0.001; bananas versus water: P = 0.013; crackers versus water: P = 0.064), demonstrating accurate energy compensation for the yogurts only. CONCLUSIONS: Although there were no significant differences between the different foods' satiating capacity, a trend for the following ranking was found: fibre-enriched yogurt > regular yogurt > banana > crackers > water. Overall, the fibre-enriched drinking yogurt tended to be more satiating than the other foods.

Lipoprotein phenotype and adhesion molecules correlate with diurnal triglyceride profiles in patients with coronary artery disease.

BACKGROUND AND AIM: To assess the relationships between different diurnal triglyceride (TG) profiles (p) and the atherogenicity of the lipoprotein phenotype and adhesion molecule concentrations in patients with coronary artery disease (CAD). METHODS AND RESULTS: Repeated measurements of fasting TG and TGp were made in 29 CAD patients; fasting cholesterol levels (total-C, VLDL, LDL, HDL and small dense LDL) and soluble cell adhesion molecules (sCAM) (ICAM-1 and E-selectin) were measured once. Three different TGps were defined: fasting (137.0 +/- 60.7 mg/dL) and all other TG levels <200 mg/dL (LL; n=7); a fasting TG level <200 mg/dL (147.0 +/- 49.9 mg/dL) and maximum TG levels >200 mg/dL (LH; n=13); and both fasting (225.1+/-76.2 mg/dL) and maximum TG levels >200 mg/dL (HH; n=9). We then analysed the associations between the TGp types and the lipoprotein phenotype and CAMs. LL had significantly lower values than LH (p<0.05 for all parameters except sE-selectin) and HH (p<0.05 for all parameters) of VLDL (11.2 +/- 5.8, 18.8 +/- 9.4, 28.1 +/- 8.8 mg/dL), LDL-5 (11.6 +/- 3.3, 16.4 +/- 4.5, 22.1 +/-7.9 mg/dl) and LDL-6 (12.0 +/- 3.2, 17.0 +/- 5.7, 25.7 +/- 9.6 mg/dL), sICAM-1 (209.4 +/- 30.3, 267.5 +/- 60.6, 273.4 +/- 59.1 ng/dL) and sE-selectin (25.1 +/- 17.6, 35.5 +/- 11.5, 48.5 +/- 20.2 ng/dL). CONCLUSION: Although the differences in fasting TG levels between the LL and LH groups were not significantly different, LH had a more atherogenic lipoprotein phenotype and higher concentrations of adhesion molecules. TGp measurements seem to be suitable for identifying CAD patients with an unfavourable diurnal TG and atherosclerosis-prone lipoprotein metabolism.

Size and blood flow of central and peripheral arteries in highly trained able-bodied and disabled athletes.

In a cross-sectional study, central and peripheral arteries were investigated noninvasively in high-performance athletes and in untrained subjects. The diastolic inner vessel diameter (D) of the thoracic and abdominal aorta, the subclavian artery (Sub), and common femoral artery (Fem) were determined by duplex sonography in 18 able-bodied professional tennis players, 34 able-bodied elite road cyclist athletes, 26 athletes with paraplegia, 17 below-knee amputated athletes, and 30 able-bodied, untrained subjects. The vessel cross-sectional areas (CSA) were set in relation to body surface area (BSA), and the cross-section index (CS-index = CSA/BSA) was calculated. Volumetric blood flow was determined in Sub and Fem via a pulsed-wave Doppler system and was set in relation to heart rate to calculate the stroke flow. A significantly increased D of Sub was found in the racket arm of able-bodied tennis players compared with the opposite arm (19%). Fem of able-bodied road cyclist athletes and of the intact limb in below-knee amputated athletes showed similar increases. D of Fem was lower in athletes with paraplegia (37%) and in below-knee amputated athletes proximal to the lesion (21%) compared with able-bodied, untrained subjects; CS-indexes were reduced 57 and 31%, respectively. Athletes with paraplegia demonstrated a larger D (19%) and a larger CS-index in Sub (54%) than able-bodied, untrained subjects. No significant differences in D and CS-indexes of the thoracic and abdominal aorta were found between any of the groups. The changes measured in Sub and Fem were associated with corresponding alterations in blood flow and stroke flow in all groups. The study suggests that the size and blood flow volume of the proximal limb arteries are adjusted to the metabolic needs of the corresponding extremity musculature and underscore the impact of exercise training or disuse on the structure and the function of the arterial system.

Haemoglobin, haematocrit and red blood cell indices in elite cyclists. Are the control values for blood testing valid?

BACKGROUND: In international cycling and cross-country skiing competitions, blood tests are used to unmask the performance enhancing misuse of erythropoietin. Haematocrit (cycling) and haemoglobin (cross-country skiing) limits have been set by international sporting federations (haematocrit 50%, haemoglobin 18.5 g/dl). Athletes tested above these cut-off values are declared unfit for competition. To investigate the validity of these regulations, we studied haemoglobin, haematocrit and red blood cell indices of elite cyclists before erythropoietin became commercially available. MATERIAL AND METHODS: We investigated 523 blood samples of 92 male elite cyclists (age 16-31 years) from 1978 to 1987. Haematocrit, haemoglobin and red blood cell count were analysed automatically, erythrocyte indices were calculated. RESULTS: Haemoglobin (-0.3 +/- 1 g/dl), haematocrit (-1.2 +/- 2.8%) and red blood cell count (-0.2 +/- 0.4 x 10(6)/mm3) decreased significantly (p < 0.05) with increasing training workload. The erythrocyte indices showed no significant change. Fifty-four blood samples (10.3%) showed a haematocrit above 50%, one sample presented a haemoglobin mass higher than 18.5 g/dl. During periods of increased workload, less athletes tested above the haematocrit limit. CONCLUSION: The current haematocrit limit used in blood tests might lead to a high number of false positive tests.

Upper respiratory tract infection in athletes: influence of lifestyle, type of sport, training effort, and immunostimulant intake.

Epidemiological evidence suggests that heavy acute or chronic exercise is related to an increased incidence of upper respiratory tract infections in athletes, while moderate exercise is believed to be protective. During the past years, many groups have investigated the association between changes within the immune system and exercise at different intensity levels. Although following strenuous exercise, some immunologic alterations were quite consistent and reproducible, e.g. neutrophilia, lymphopenia, and depression of natural killer cell activity, some findings were divergent or strongly dependent on the study design and athletes investigated. Lately, interesting results in the field of psychoneuroimmunolgy as well as new insights in the relationship between macro- and micronutrient and the immune system have brought up new fields of research interest. There is growing evidence that e.g. lifestyle factors, the coping with daily stress, and dietary behavior are important cofactors in the immune response to exercise. The present work gives a short review on the literature dealing with URTI in athletes with special reference to the above mentioned cofactors. In addition, the results of a recent investigation concerning training and associated lifestyle patterns in German athletes are presented.

Concurrent reductions of serum leptin and lipids during weight loss in obese men with type II diabetes.

The aim of the study was to examine the effects of weight reduction by exercise and diet on metabolic control in obese subjects with insulin resistance, particularly investigating if changes in serum leptin concentrations were directly associated with improvements in metabolic control. Twenty obese men (48 +/- 8 yr; body mass index 32. 1 +/- 3.9 kg/m(2)) with previously diagnosed type II diabetes mellitus were assigned to a 4-wk intervention program of exercise (2, 200 kcal/wk) and diet (1,000 kcal/day; 50% carbohydrates, 25% protein, 25% fat; polyunsaturated-to-saturated fatty acid ratio 1.0). Intervention induced significant reductions in body weight and serum leptin levels, and improvements in lipoprotein profile and glucose control. Reductions in leptin levels were directly associated with reductions in serum triglycerides and cholesterol, a finding that was independent of improvements in glucose control. These data show that serum leptin concentrations can be reduced with caloric restriction and exercise in male patients with type II diabetes, and they suggest a direct relationship between leptin and lipoprotein metabolism that is not solely due to weight reduction.

Relation of leisure-time physical activity to structural and functional arterial properties of the common carotid artery in male subjects.

The structure and function of central arteries are altered with advancing age. These changes comprise arterial dilation, intima-media thickening and increase in stiffness. Arterial wall hypertrophy and increased stiffness are associated with major cardiovascular disease. In contrast to this, physical activity has been found to be inversely related to the incidence of major cardiovascular disease and mortality in humans. However, conflicting data exist on the effect of physical activity on arterial stiffness and very little data about its association with structural arterial properties. We therefore investigated the association of the self-selected leisure-time physical activity (LTPA), assessed by a self-administered questionnaire, with the structure and function of the common carotid artery, examined with high-resolution ultrasound, in 51 male subjects aged between 16 and 78 years. We found that men with a higher level of LTPA (> 38.1 MET*h/week = H-LTPA) (metabolic equivalent value; 1 MET= energy expended by a person at rest, i.e. approximately 3.5 ml oxygen uptake/kg body mass or 1 kcal/kg per h) had a significantly lower arterial stiffness (P = 0.02) than men with lower levels ( < 38.1 MET*h/week = L-LTPA) (4.32+/-1.17 versus 5.75+/-1.21 x 10(6) cm(-2)). In multiple regression analyses, with several atherosclerotic risk factors as correlating variables with arterial stiffness, LTPA persisted as an independent predictor of arterial stiffness (adjusted R2=0.19) in addition to apolipoprotein B level (adjusted R2 = 0.33). The study could not, however, show an association of LTPA with reduced intima-media thickness (L-LTPA = 0.66+/-0.15 versus H-LTPA 0.66+/-0.14) or arterial dilation of diastolic diameter (L-LTPA = 6.34 + 0.64 versus H-LTPA 6.08+/-0.69). However, the positive association of LTPA with several parameters, which correlated inversely with intima-media thickness, may be taken as an indicator for a possible positive (not visible in an ultrasonic examination of the common carotid artery) effect of LTPA on the arterial wall structure.

[Freiburg Questionnaire of physical activity--development, evaluation and application]. / Freiburger Fragebogen zur körperlichen Aktivität--Entwicklung, Prüfung und Anwendung.

Aim of the present study was to design a questionnaire to assess health related physical activity, to validate the instrument and to apply it to a population sample. Reliability of the questionnaire was evaluated by test-retest investigations with intervals of two weeks and six months. High correlations between the repeated administrations reflect a good reliability of our instrument. Only gardening and cycling, as well as the depending basic and total activity, showed typically seasonal variations. Validity was established by correlating physical activity data with maximum oxygen uptake. Maximum oxygen uptake correlated with sport activities (partial correlation coefficient: r = 0.422, p < 0.01). Evaluated data were consistent. People rating themselves as "more active than their coevals" were indeed more active in sport (r = 0.334, p < 0.01) and total activity (r = 0.282, p < 0.05). Studying activity patterns of a population sample of adult residents of Freiburg (systematic random sampling, n = 612, 20-98 years) we found total physical activity of 9.2 hours per week (median), with activities of low to moderate intensities dominating. Age and gender are important determinants of the activity patterns. According to the recommendation of Paffenbarger (2000 kcal/week total physical activity) 40% of the residents of Freiburg did not reach the recommended energy expenditure. Compared to the recommendation of the American College of Sports Medicine (1000 kcal/week by training) 63% of the population sample were not active enough.

Influence of 4 weeks' intervention by exercise and diet on low-density lipoprotein subfractions in obese men with type 2 diabetes.

Insulin resistance is associated with dyslipoproteinemia characterized by increased serum triglycerides, reduced high-density lipoprotein 2 (HDL2) cholesterol, and increased small, dense low-density lipoprotein (LDL) subfraction particles. Physical activity and weight reduction are known to improve insulin resistance and dyslipoproteinemia, but their influence on LDL subfractions in diabetic patients is unknown. Therefore, we investigated the effect of a 4-week intervention program of exercise (2,200 kcal/wk) and diet (1,000 kcal/d: 50% carbohydrate, 25% protein, and 25% fat; polyunsaturated/saturated fat ratio, 1.0) on glycemic control and HDL and LDL subfractions in 34 obese patients with non-insulin-dependent diabetes (age, 49 +/- 9 years; body mass index [BMI], 33.1 +/- 5.1 kg/m2). Reductions in body weight (P < .001) and improvements in fasting blood glucose, insulin, fructosamine (P < .001), and free fatty acids (P < .01) by intervention were associated with reductions in serum cholesterol and apolipoprotein B (apo B) concentrations in very-low-density lipoprotein (VLDL) (P < .01), intermediate-density lipoprotein (IDL), and small, dense (>1.040 g/mL) LDL particles (P < .001). These data underlie the positive influence of weight reduction induced by exercise and diet on insulin resistance and lipoprotein metabolism in obese diabetic patients, particularly showing improvements of the LDL subfraction profile with a decrease of small, dense LDL particles. This is of particular importance, as these particles have been shown to be associated with coronary artery disease.

Structural, functional, and hemodynamic changes of the common carotid artery with age in male subjects.

Aging of the common carotid artery (CCA) is associated with different principal structural, functional, and hemodynamic changes, which are often influenced by several atherosclerotic risk factors, so that it is difficult to estimate the exclusive effect of aging on this process. Studies dealing with vascular aging of the CCA usually assess only single, dimensional, or functional parameters, although it is likely that there are interactions and probably differences between them. Moreover, regional vascular blood flow characteristics are often not taken into consideration. Therefore, the aim of the study was to assess the age-related multiparametric changes of the CCA properties with ultrasound in 69 male subjects between the ages of 16 and 75 (42.4+/-16.5 years), who were screened for the absence of major atherosclerotic risk factors or existing vascular disease. As a result, the intima media thickness (0.052 mm/10 y) and diastolic diameter (0.17 mm/10 y) increased nearly linearly with age (r=0.60, P<0.001; and r=0.46, P<0.001, respectively). The absolute diastolic/systolic diameter change diminished by 0.10 mm/10 y (r=-0. 73, P<0.001) and peak expansion velocity dropped by 0.12 cm/s per 10 years (r=-0.62, P<0.001) highly significantly with age. The peak blood flow velocity decreased continuously with age (r=-0.67, P<0. 00) by 9.3 cm/s per 10 years. According to multiple regression analysis, peak blood flow velocity seems to reflect the changes of several structural and functional parameters in one; intima-media thickness was determined by diastolic arterial diameter and age as independent variables. The data indicate that a multiparametric assessment may contribute to a better understanding of vascular aging and might be the basis for further studies to evaluate the association of atherosclerotic risk factors and/or major vascular disease with local changes in the CCA.

Heart rate deflection compared to 4 mmol x l(-1) lactate threshold during incremental exercise and to lactate during steady-state exercise on an arm-cranking ergometer in paraplegic athletes.

The deflection point (DP) of the heart rate in relation to the work rate (WR) of 8 male endurance-trained paraplegics and 11 male physically active sports students was investigated during nonsteady-state incremental arm cranking ergometry (IT) and compared to the 4 mmol x l(-1) blood lactate concentration threshold and to blood lactate concentration in steady-state exercise (SST). Heart rate, and lactate concentration from capillary blood, were determined at rest, during IT and SST. The DP was calculated by linear regression analysis of the heart rate during IT. The SST consisted of three consecutive exercise intensities over a period of 8 min at exercise intensities of 10 W below, and at 10 W above the work rate at deflection point (WRDP). No difference was found between the paraplegics and non-handicapped subjects regarding heart rate and blood lactate concentration at rest and during exercise. A DP was established in all the paraplegics and in 72.7% of the non-handicapped subjects, but lactate accumulation was observed in 75% of the paraplegics and in 62.5% of the non-handicapped subjects at the lowest intensity of SST. In summary, endurance-trained paraplegics with an injury level below T5 showed heart rate and blood lactate concentration values comparable to non-handicapped subjects during IT. A linear increase at moderate exercise intensities and a levelling-off at higher to maximal intensities could be identified in all the paraplegics and in 72.7% of non-handicapped subjects. The determination of the anaerobic threshold by DP should be applied with caution, since no causal relationship of DP and the anaerobic threshold was found and the WRDP tended to overestimate threshold values.

Assessment of carotid wall motion and stiffness with tissue Doppler imaging.

In this study, the wall motion of the common carotid artery was characterized by measuring wall-motion velocity (Wv) with tissue Doppler imaging (TDI) in 78 male and female subjects (16-75 y) with no history of cardiovascular disease. The near and far arterial wall showed essentially different Wv patterns. To assess the vascular systolic distension, the Wv of the near and far arterial walls were measured and a Wv index was calculated by subtracting the far Wv from the near Wv. Aging was associated with a 2.0-2.5-fold decrease of peak Wv index. Corrected for carotid diameter and blood pressure, the peak Wv index and mean systolic acceleration to the peak Wv correlated highly with arterial distensibility (r = 0.81 resp. r = 0.75) and compliance (r = 0.73 resp. r = 0.68). This study demonstrates the feasibility of TDI in the characterization of wall motion patterns and in the assessment of common carotid artery stiffness.

Catecholamines, heart rate, and oxygen uptake during exercise in persons with spinal cord injury.

The purpose of this study was to investigate the influence of different injury levels in persons with spinal cord injury (SCI) on epinephrine (Epi) and norepinephrine (NE) at rest and during graded wheelchair exercise and the related changes in heart rate and O2 uptake (VO2). Twenty tetraplegics (Tetra), 10 high-lesion paraplegics (HLPara), 20 paraplegics with SCI below T5 (MLPara), and 18 able-bodied, nonhandicapped persons (AB) were examined. Because of the higher level of interruption of the sympathetic pathways, Tetra persons showed lower Epi and NE at rest and only slight increases during exercise compared with all other groups; the Tetra subjects' impaired cardiac sympathetic innervation caused restricted cardioacceleration and strongly reduced maximal VO2. When compared with AB persons, HLPara had comparable NE but lower Epi levels as a result of partial innervation of the noradrenergic system and denervation of the adrenal medulla. MLPara subjects showed an augmented basal and exercise-induced upper spinal thoracic sympathetic activity compared with AB subjects. The increase in heart rate in relation to VO2 was higher in HLPara because of a smaller stroke volume as a result of venous blood pooling. The different exercise response in persons with SCI is a result of the interruption of pathways in the spinal cord to the peripheral sympathetic nervous system in addition to the motor paralysis.

Crystallization and preliminary X-ray diffraction data of two different human low-density lipoprotein (LDL) subfractions.

Human LDL subfractions LDL-2 (d = 1.031-1.034 g/ml) and LDL-5 (d = 1.040-1.044 g/ml) were crystallized in two different crystal forms by using polyethylene glycol as a precipitant. Both fractions were from one donor. Crystals of LDL-5 were yellow, hexagonal, and showed no dichroism. Crystals of LDL-2 were of the same color, had a rodlike shape with notches at both ends, and were highly dichroitic. LDL-2 crystals diffracted to a resolution of 29 A by using synchrotron radiation. Indexing in P1 resulted in preliminary parameters for the reduced cell of a = 171 A, b = 438 A, c = 519 A, alpha = 102 degrees, beta = 99 degrees, gamma = 91. These dimensions are consistent with the size of LDL particles. Using Fourier transform infrared spectroscopy (FTIR) and agarose gel electrophoresis, we could further confirm that the crystals consist of LDL. The FTIR spectrum showed bands characteristic for lipids and protein. Dissolved crystals exhibited a mobility similar to native LDL in agarose gels and could be stained with anti-human apolipoprotein B (apoB).

Stage duration and increase of work load in incremental testing on a cycle ergometer.

Any variation of the test protocol for incremental testing (IT) in cycle ergometry may affect the accuracy of the determination of anaerobic threshold (AnT). For lactate threshold concepts, indicating the maximum lactate steady-state (max Lass), the formation of the quasi-steady-state (QSS=95% of steady-state level) is evident. Previous studies have not specified the time that it takes for blood lactate to stabilize following incremental changes in WL. The purpose of this study was to identify the minimum duration of exercise necessary to establish QSS following various increments in WL (10, 20, 30, 40 and 50 W). Eight male endurance-trained cyclists [relative maximal oxygen consumption = 64.8 (4.2) ml x kg(-1) x min(-1)] performed three different exercise tests on a cycle ergometer: (1) an exhaustive IT with a starting WL of 100 W, followed by 20-W increments every 3 min; (2) a threshold test with 20-W increments every 9 min to determine the MaxLaSS; and (3) five incremental exercise tests (from 100/110 W, with 20-W increments every 3 min) with a final 10-, 20-, 30-, 40- or 50- W increment lasting 10 min, at 10 W below MaxLaSS (T10-T50 experiments). The time constant of lactate kinetics (tau), the time constant of lactate elimination, and the time taken to elicite QSS, defined as 95% of the time taken to reach steady-state level (t95%), were calculated in the T10-T50 experiments. The tau and t95% increased significantly with WL increment size: the correlation was not linear. Smaller WL increments required proportionally longer durations. Mean (SD) t95% values (min:s) were 1:57 (0:27) (T10), 2:58 (0.16) (T20), 4:08 (0:23) (T30), 4:45 (0:45) (T40) and 5:06 (0:43) (T50). The application of these references in IT protocols may lead to an extension of total test duration, particularly with smaller increments. Therefore, lactate threshold modelling, the training status of the athletes and comparability with lactate measurements obtained during training events should be considered. IT protocols not accomplishing QSS criteria may effect an underestimation of WL-related lactate values and an overestimation of lactate thresholds, which indicate MaxLaSS, especially in highly trained athletes. This suggests that the establishment of an increment-size-dependent t95% may reduce protocol-related influences on AnT and standardize the use of the AnT in IT procedures in the training management of elite cyclists.