Nutrient-rich, high-quality, protein-containing dairy foods in combination with exercise in aging persons to mitigate sarcopenia.

Sarcopenic declines in muscle mass and function contribute to the risk of falls, reduced mobility, and progression to frailty in older persons. Mitigation of sarcopenia can be achieved by consumption of higher quality protein in sufficient quantities, which current research suggests are greater than the recommended intakes of approximately 0.8 g/kg bodyweight/d. In addition, higher levels of physical activity and participation in exercise to support cardiovascular fitness and musculoskeletal function work additively with protein in attenuating sarcopenia. This narrative review provides evidence to support a recommendation for per-meal protein targets in older persons that are underpinned by knowledge of muscle protein turnover. Based on work examining acute dose-responses of muscle protein synthesis (MPS) to protein, a proposed per-meal target for protein intakes is set at approximately 0.4-0.6 g protein/kg bodyweight/meal for older persons. Habitual patterns of dietary protein intake tend to emphasize a skewed protein distribution, which would not maximize muscle anabolism. Observational studies show that more even patterns of protein intake are associated with increased muscle mass and improved muscle function. A food-based approach to achieving these protein targets would be advantageous, and the nutrient density of the protein-containing foods would be particularly important for older persons. Dairy foods provide high-quality protein and contain several nutrients of concern for older persons. This brief review provides an overview of the science underpinning why dairy foods should be a point of nutritional emphasis for older persons. Practical suggestions are provided for implementation of dairy foods into dietary patterns to meet the protein and other nutrient targets for older persons.

Alterations in Redox Homeostasis During Recovery From Unexplained Underperformance Syndrome in an Elite International Rower.

PURPOSE: To examine a diagnosis of unexplained underperformance syndrome (UUPS, or overtraining syndrome) in an international rower describing a full recovery and return to elite competition the same year. METHODS: On diagnosis and 4 and 14 mo postdiagnosis, detailed assessments including physiological, nutritional, and biomarkers were made. RESULTS: Clinical examination and laboratory results for hematology, biochemistry, thyroid function, immunology, vitamins, and minerals were unremarkable and did not explain the presentation and diagnosis. Redox biomarkers including hydroperoxides, plasma antioxidant capacity, red blood cell glutathione, superoxide dismutase, coenzyme Q10, vitamin E (α- and γ-tocopherol), and carotenoids (lutein, α-carotene, ß-carotene) provided evidence of altered redox homeostasis. The recovery strategy began with 12 d of training abstinence and nutritional interventions, followed by 6 wk of modified training. At 4 mo postintervention, performance had recovered strongly, resulting in the athlete's becoming European champion that same year. Further improvements in physiological and performance indices were observed at 14 mo postintervention. Physiologically relevant increases in concentrations of carotenoids were achieved at each postintervention time point, exceeding the reported critical-difference values. CONCLUSIONS: Increasing athlete phytonutrient intake may enhance recovery and tolerance of training and environmental stressors, reducing the risk of unexplained UUPS. Alterations in redox homeostasis should be considered as part of the medical management in UUPS. This is the first reported case study of an elite athlete with alterations in redox homeostasis in conjunction with a diagnosis of UUPS.

Description and Impact Evaluation of a Statewide Collaboration to Reduce Preventable Hospital Readmissions.

This article describes how a Medicare-funded Quality Improvement Organization collaborated with a hospital association and multiple cross-continuum partners on a statewide effort to reduce hospital readmissions. Interventions included statewide education on quality improvement strategies and community-specific technical assistance on collaboration approaches, data collection and analysis, and selection and implementation of interventions. Fifteen communities, comprising 16 acute care hospitals, 119 nursing homes, 70 home health agencies, and 32 other health care or social service providers, actively participated over a 4.5-year period. Challenges included problems with end-of-life discussions (80.0%), physician engagement (70.0%), staffing (70.0%), and communication between settings (60.0%). Thirty-day all-cause readmission rates in fee-for-service Medicare patients decreased in most hospital service areas across the state (22/24), and the aggregate statewide readmission rate dropped from 15.2/1000 to 12.1/1000, a relative decrease of 20.3% ( P < .001). Despite these positive findings, the specific impact of this collaboration could not be determined because of multiple confounding interventions.

Utility of daily troponin orders for identifying acute myocardial infarction patients for quality improvement.

BACKGROUND: Previous studies have demonstrated low rates of adherence to American College of Cardiology (ACC) and American Heart Association (AHA) guidelines for acute myocardial infarction (AMI). Quality improvement projects increase compliance with recommended therapies, but identification of AMI patients is a major challenge. OBJECTIVE: To determine the utility of a daily troponin list in identifying AMI patients for a quality improvement initiative to increase compliance with ACC/AHA-recommended therapies. DESIGN: Quality improvement initiative. METHODS AND RESULTS: During a 3-month period, the charts of patients with elevated troponin levels were screened for a diagnosis of AMI. For those patients with AMI, a clinical reminder about ACC/AHA-recommended therapies was placed in the chart. Nearly half (46%) of our hospital population had a troponin level measured during their clinical course. Of these, 26% had elevated troponin levels and 5% had AMI. All patients with AMI were identified using the daily troponin list with a sensitivity of 100% and a specificity of 78.4%. The daily troponin list captured more AMI patients than the admitting diagnosis. Use of the daily troponin list and targeted clinical reminders was associated with maintenance of a high (>95%) compliance with recommended therapies. CONCLUSIONS: A daily list of inpatients with a positive troponin identified all patients with AMI. Targeted reminders to clinicians regarding ACC/AHA-recommended therapies for AMI were associated with consistent adherence to guideline-recommended therapies.