HOMEFOOD Randomised Trial - Six-Month Nutrition Therapy in Discharged Older Adults Reduces Hospital Readmissions and Length of Stay at Hospital Up to 18 Months of Follow-Up.

BACKGROUND: Malnutrition is frequently observed in older adults and is associated with hospital readmissions, length of stay (LOS), and mortality in discharged patients. OBJECTIVE: The aim of this study was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence 1-, 6-, 12- and 18-months post-discharge in older Icelandic adults. DESIGN: Secondary analysis of a randomized controlled trial. PARTICIPANTS: Participants (>65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit. INTERVENTION: The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge. MEASUREMENTS: The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence. RESULTS: The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions per participant (1 month: 0.02 vs 0.19, P=0.015; 6 month: 0.33 vs 0.77, P=0.014; 0.62 vs 1.12, P=0.044) and a shorter LOS (1 month: 0.02 vs 0.92, P=0.013; 6 months: 2.44 vs 13.21; P=0.006; 12 months: 5.83 vs 19.40, P=0.034; 18 months: 10.42 vs 26.00, P=0.033) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence. CONCLUSION: A six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge. However, it did neither affect mortality, ER, nor need of long-term care residence in this group.

HOMEFOOD randomized trial-beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge.

BACKGROUND/OBJECTIVES: Malnutrition is common among older adults. Dietary intervention studies in older adults aiming to improve anthropometrics measures and physical function have been inconsistent. We aimed to investigate the effects of nutrition therapy in combination with home delivered meals and oral nutritional supplements (ONS) in community-dwelling older adults discharged from hospital. METHODS: A total of 106 participants (>65 years) were randomized into the intervention group (n = 53) and into the control group (n = 53). The intervention group received individual nutrition therapy (five in person visits and three phone calls) and freely delivered energy- and protein- rich foods, while the control group received standard care. Dietary intake, anthropometrics, and short physical performance battery (SPPB) were assessed at baseline and at endpoint. RESULTS: Energy intake at baseline was similar in both groups (~1500 kcal at the hospital) but there was a significant increase in energy intake and body weight in the intervention group (+919 kcal/day and 1.7 kg, P < 0.001 in both cases) during the study period, compared to a significant decrease in both measures among controls (-815 kcal/day and -3.5 kg, P < 0.001 in both cases). SPPB score increased significantly in the intervention group while no changes were observed among controls. CONCLUSIONS: Most Icelandic older adults experience substantial weight loss after hospital discharge when receiving current standard care. However, a 6-month multi-component nutrition therapy, provided by a clinical nutritionist in combination with freely delivered supplemental energy- and protein-dense foods has beneficial effects on body weight, physical function, and nutritional status. STUDY REGISTRATION: This study was registered at ClinicalTrials.gov ( NCT03995303 ).

HOMEFOOD randomised trial - Six-month nutrition therapy improves quality of life, self-rated health, cognitive function, and depression in older adults after hospital discharge.

BACKGROUND AND AIMS: Malnutrition is common among older adults and is related to quality of life, cognitive function, and depression. To what extent nutrition interventions can improve these outcomes remains unclear. The aim of this study was to investigate the effect of nutrition therapy on health-related quality of life (EQ-5D), self-rated health, cognitive function, and depression in community dwelling older adults recently discharged from hospital. METHODS: Participants (>65 years) were randomised into an intervention (n = 53) and a control group (n = 53). The intervention group received individualised nutrition therapy based on the nutrition care process including 5 home visits and 3 phone calls, in combination with freely delivered energy- and protein-rich foods and oral nutrition supplements for six months after hospital discharge. EQ-5D, self-rated health, Mini-Mental-State-Examination (MMSE), and the Centre for Epidemiologic Studies Depression - IOWA (CES-D) scale were measured at baseline and at endpoint. RESULTS: Two subjects dropped out, one from each arm. The control group experienced an increase in depressive symptoms and a decrease in self-rated health during the study period, while the intervention group experienced increases in cognitive function, self-rated health, and EQ-5D resulting in significant endpoint differences between the groups: EQ-5D (0.102, P = 0.001); self-rated health: 15.876 (P < 0.001); MMSE: 1.701 (P < 0.001); depressive symptoms: - 3.072 (P < 0.001); all in favour of the intervention group. Improvements during the intervention in MMSE, self-rated health, and CES-D were significantly related to body weight gain in a linear way. CONCLUSION: Cognitive function and mental well-being worsen or stagnate in older adults who receive standard care after hospital discharge. However, a six-month nutrition therapy improves these outcomes leading to statistically and clinically significant endpoint differences between the groups. As improvements were related to body weight gain after hospital discharge, we conclude that the increase in dietary intake, with focus on energy and protein density, and changes in body weight might have contributed to better cognitive function and mental well-being in older adults after the intervention.

The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans.

BACKGROUND: The "Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies" (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. METHODS: SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3-9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0-1.2 g/kg body weight, energy intake of 25-30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. RESULTS: Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. CONCLUSION: The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations.

Characteristics of incidence hip fracture cases in older adults participating in the longitudinal AGES-Reykjavik study.

Poor physical function and body composition my partly predict the risk of falls leading to fracture regardless of bone mineral density. INTRODUCTION: To examine the relationship between body composition, physical function, and other markers of health with hip fractures in older community-dwelling Icelandic adults. METHODS: A prospective cohort of 4782 older adults from the AGES-Reykjavik study. Baseline recruitment took place between 2002 and 2006, and information on hip fractures occurring through 2012 was extracted from clinical records. Using multivariate regression analyses, baseline measures of bone health, physical function, and body composition were compared between those who later experienced hip fractures and to those who did not. Associations with the risk of fractures were quantified using Cox regression. RESULTS: Mean age was 76.3 years at baseline. After adjustment for age, regression showed that male hip fracture cases compared with non-cases had (mean (95% confidence interval)) significantly lower thigh muscle cross-sectional area - 5.6 cm2 (- 10.2, - 1.1), poorer leg strength - 28 N (- 49, - 7), and decreased physical function as measured by longer timed up and go test 1.1 s (0.5, 1.7). After adjustment for age, female cases had, compared with non-cases, lower body mass index - 1.5 kg/m2 (- 2.1, - 0.9), less lean mass - 1.6 kg (- 2.5, - 0.8), thigh muscle cross-sectional area - 4.4 cm2 (- 6.5, - 2.3), and worse leg strength - 16 N (- 25, - 6). These differences largely persisted after further adjustment for bone mineral density (BMD), suggesting that body composition may contribute to the risk of fracture independent of bone health. When examining the association between these same factors and hip fractures using Cox regression, the same conclusions were reached. CONCLUSIONS: After accounting for age and BMD, older adults who later experienced a hip fracture had poorer baseline measures of physical function and/or body composition, which may at least partly contribute to the risk of falls leading to fracture.

Correction to: Characteristics of incidence hip fracture cases in older adults participating in the longitudinal AGES-Reykjavik study.

The original version of this article, published on 18 august 2020 contained a mistake. An author's name was misspelled.

Lifestyle and 25-hydroxy-vitamin D among community-dwelling old adults with dementia, mild cognitive impairment, or normal cognitive function.

BACKGROUND: Several studies have indicated that older adults with cognitive impairment have a poorer lifestyle than their healthy peers including lower 25-hydroxy-vitamin D levels (25OHD). AIM: To investigate the associations between lifestyle and 25OHD depending on cognitive status among old adults. METHODS: Community-dwelling old adults (65-96 years) participated in this cross-sectional study based on the Age-Gene/Environment-Susceptibility-Reykjavik-Study. The analytical sample included 5162 subjects who were stratified by cognitive status, i.e., dementia (n = 307), mild cognitive impairment (MCI, n = 492), and normal cognitive status (NCS, n = 4363). Lifestyle variables were assessed and 25OHD was measured. The associations between lifestyle and 25OHD were calculated using linear models correcting for potential confounders. RESULTS: According to linear regression models, 25OHD was significantly lower in older people with dementia (53.8 ± 19.6 nmol/L) than in NCS participants (57.6 ± 17.7 nmol/L). Cod liver oil (7.1-9.2 nmol/L, P < 0.001) and dietary supplements (4.4-11.5 nmol/L, P < 0.001) were associated with higher 25OHD in all three groups. However, physical activity ≥ 3 h/week (2.82 nmol/L, P < 0.001), BMI < 30 kg/m2 (5.2 nmol/L, P < 0.001), non-smoking (4.8 nmol/L, P < 0.001), alcohol consumption (2.7 nmol/L, P < 0.001), and fatty fish consumption ≥ 3x/week (2.6 nmol/L, P < 0.001) were related to higher 25OHD in NCS only, but not in participants with dementia or MCI. DISCUSSION: Older people living in Iceland with dementia are at higher risk for 25OHD deficiency when compared to healthy individuals. Physical activity reported among participants with dementia, and MCI is low and is not significantly associated with 25OHD. CONCLUSIONS: Lifestyle factors among NCS participants are associated with 25OHD levels. Importantly, healthy lifestyle should be promoted among individuals with MCI and dementia.

Obesity, Physical Function, and Training Success in Community-Dwelling Nonsarcopenic Old Adults.

OBJECTIVES: Obesity-related physiological changes can limit improvements of obese subjects after training. The aim was to investigate obesity, muscular strength, and physical function in community-dwelling nonsarcopenic old adults. METHODS: Nonsarcopenic subjects (N=229, 73.7 ± 5.7 years; 21% normal weight, 42% overweight, and 37% obese based on body mass index (BMI)) participated in a 12-week resistance exercise program. Leisure time physical activity (LTPA), body composition (dual-energy X-ray absorptiometry), quadriceps strength (maximum voluntary isometric contraction; absolute and relative to body weight), and physical function in terms of 6-minutes-walk-for-distance (6MWD) and timed up and go (TUG) were measured baseline and endpoint. RESULTS: At baseline, normal weight participants had lower absolute quadriceps strength (-43 ± 22 N, P=0.015) than obese, but better quadriceps strength relative to body weight (1.4 ± 0.7 N/kg, P < 0.001), 6MWD (53 ± 27 m, P < 0.001), and TUG (-1.4 ± 0.7 sec, P ≤ 0.001). LTPA was positively associated with 6MWD and TUG (both P < 0.05), but based on general linear models, differences in LTPA between BMI categories did not explain differences in 6MWD and TUG between BMI categories. During the program, dropout (11.9%) and attendance (85%) were similar between BMI groups. After the intervention, body composition and physical function significantly improved in all three BMI categories; however, normal weight participants lost more body fat (-1.53 ± 0.78%, P=0.014), gained more lean mass (0.70 ± 0.36 kg, P < 0.001) and relative quadriceps strength (0.31 ± 0.16 N/kg, P=0.017), and improved more on the 6MWD (24 ± 12 m, P < 0.001) but gained less grip strength (-2.4 ± 1.3 N/kg, P=0.020) compared to obese. There were no differences in TUG or absolute quadriceps strength changes between the BMI strata. Physical function at baseline as well as training success of overweight participants was located between the normal weight and obesity groups. CONCLUSION: Nonsarcopenic obese community-dwelling old adults have lower physical function than their normal weight counterparts. This difference is not explained by lower LTPA. A 12-week resistance exercise program improves body composition and physical function in normal weight, overweight, and obese old adults; however, obese participants experience less favorable changes in body composition and physical function than normal weight individuals. This trial is registered with NCT01074879.

Gender, Success, and Drop-Out during a Resistance Exercise Program in Community Dwelling Old Adults.

BACKGROUND: Resistance exercise training can be effective against sarcopenia. We identified predictors of drop-out and compared physical outcomes between men and women after such training. METHODS: Subjects (N = 236, 73.7 ± 5.7 years) participated in a 12-week resistance exercise program. Outcome variables were measured at baseline and endpoint. RESULTS: Drop-out was 11.9% and not significantly different between genders. Drop-outs were significantly older and had poorer strength and physical function in comparison to completers. Anthropometrics, QoL, and cognitive function were not related to drop-out. According to multivariate analysis, gait speed and physical activity were the strongest predictors of drop-out. After the training, gains in lean mass or appendicular muscle were significantly higher in men than women; however relative gains in appendicular muscle as well as absolute improvements in strength and function were similar in men and women, respectively. CONCLUSIONS: Participants who drop out are older, have poorer physical function, and are less physically active. Old women do not drop out more frequently than men and show meaningful improvements in relevant outcomes similar to men after such a training program. The trial is registered at the US National Library of Medicine (NCT01074879).

Insulin-Like Growth Factor-1 and Resistance Exercise in Community Dwelling Old Adults.

BACKGROUND: Insulin-like growth factor-1 (IGF-1) is related to the preservation of lean body mass. Its decline during ageing is thought to make old adults more susceptible to sarcopenia and functional dependency. The aim of the present study was to investigate circulating total IGF-1 in old adults who engaged in a 12-weeks of progressive resistance training. DESIGN: Intervention study. SETTING: Community. PARTICIPANTS: Old Icelandic adults (N = 235, 73.7 ± 5.7 years, 58.2% female). INTERVENTION: Twelve-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum) designed to increase strength and muscle mass of major muscle groups. MEASUREMENTS: IGF-1. RESULTS: At baseline IGF-1 was significantly associated with lean body mass and appendicular muscle mass (also when corrected for age, gender and various covariates). After the training IGF-1 decreased significantly from 112.1 ± 35.6 to 106.1 ± 35.2 µg/L during the course of the study. On and individual level, IGF-1 decreased in 59% and increased in 39% of the participants. Changes in IGF-1 were inversely related to changes in lean body mass (rho = -0.176, P = 0.013 ) and appendicular muscle mass (rho = -0.162, P = 0.019) also when corrected for protein intake, age, gender, and other covariates. CONCLUSION: Serum total IGF-1 decreases after 12 weeks of resistance exercise in community dwelling old adults. When looked at IGF-1 changes for participants individually it becomes clear that IGF-1 response to resistances exercise is highly variable. Changes in IGF-1 are negatively related to changes in lean body mass during training, which supports the hypothesis that IGF-1 is redistributed from circulation into tissue during periods of active muscle building.

C-Reactive Protein and Resistance Exercise in Community Dwelling Old Adults.

OBJECTIVES: C-reactive protein (CRP), an acute phase reactant, has been associated with atherosclerosis and has also been discussed as a target for intervention. The effects of resistance exercise on CRP are currently not clear. The present analysis investigated the response of CRP to resistance exercise in old adults. DESIGN: Intervention study. SETTING: Community. PARTICIPANTS: Old Icelandic adults (N = 235, 73.7 ± 5.7 years, 58.2% female). INTERVENTION: Twelve-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum) designed to increase strength and muscle mass of major muscle groups. MEASUREMENTS: C-reactive protein (CRP). RESULTS: Mean CRP levels were 7.1 ± 4.6 mg/dL at baseline, thirty-six (15.6%) subjects had abnormally high CRP (>10 mg/L) values at baseline. After the resistance exercise program the overall changes in CRP were minor and not significant. However, CRP decreased considerably in participants with high CRP at baseline (-4.28 ± 9.41 mg/L; P = 0.015) but increased slightly in participants with normal CRP (0.81 ± 4.58 mg/L, P = 0.021). CONCLUSIONS: Our study shows that the concentrations of circulating CRP decreased considerably after a 12-week resistance exercise program in participants with abnormally high CRP at baseline, possibly reducing thus risk for future disease. CRP changed little in participants with normal CRP at the start of the study.

Bioavailability of long-chain n-3 fatty acids from enriched meals and from microencapsulated powder.

BACKGROUND: Despite the potential benefits of long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFAs), intake is often low because of low consumption of oily seafood. Microencapsulated fish oil powder can improve tolerance and acceptance of LC n-3 PUFAs. Bioavailability is important to achieve efficacy. We investigated the bioavailability of LC n-3 PUFAs from microencapsulated powder in comparison with meals enriched with liquid fish oil. METHODS: Participants (N=99, age⩾50 years) of this 4-week double-blinded dietary intervention were randomized into three groups. Group 1 (n=38) received 1.5 g/d eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) as ready-to-eat meals enriched with liquid fish oil; group 2 (n=30) received the same amount of these LC n-3 PUFAs as microencapsulated fish oil powder and regular meals; and group 3 (n=31) was the control group, which received placebo powder and regular meals. Blood samples were taken from fingertips at baseline and at the end point. RESULTS: Seventy-seven subjects (77.8%) completed the study. The amount of EPA in blood doubled in both groups that received LC n-3 PUFAs (P<0.05), but it did not change in the control group. The changes in DHA were less but still significant in both intervention groups. According to multivariate analysis, both intervention groups had higher end-point LC n-3 PUFA concentrations compared with placebo, but differences between intervention groups were not significant. CONCLUSION: Bioavailability of LC n-3 PUFAs in encapsulated powder is very similar to the bioavailability of LC n-3 PUFAs in ready-to-eat meals enriched with liquid fish oil. Thus, encapsulated powder can be considered useful to increase LC n-3 PUFA concentrations in blood.

Muscular strength and physical function in elderly adults 6-18 months after a 12-week resistance exercise program.

AIMS: Benefits of resistance exercise in elderly people are well documented; however, sustaining these benefits can be difficult and adherence is often poor. Muscular strength and physical function usually decline after a supervised resistance exercise program (REP). We investigated these changes in older adults during an observational follow-up and whether leisure time physical activity (LTPA) or unsupervised resistance exercise (RE) limit these changes. METHODS: Subjects (N = 236, 73.7 ± 5.7 years, 58.2% female) had participated in a supervised 12-week REP. Quadriceps strength and timed-up-and-go performance (TUG) at follow-up were compared to values before and after REP. Multivariate statistics were used to predict changes in strength or function. RESULTS: Two hundred and eleven (90.3%) participants completed REP and 149 (63.1%) completed follow-up (11.4 ± 2.9 months). Quadriceps strength at follow-up decreased significantly compared to after REP (-27N), but was higher than before REP (+ 30N). TUG did not decrease during follow-up and was better than before REP (-0.9 seconds). LTPA (+ 38.0N, p < 0.001) and RE (+31.6N, p = 0.006) predicted strength at follow-up, although they did not completely prevent loss of strength during follow-up. CONCLUSIONS: quadriceps strength declines after a 12-week resistance exercise program in older adults. Neither LTPA nor RE completely prevents loss of quadriceps strength during follow-up, although they limited the loss. TUG did not change during follow-up and was better at follow-up than before the start of the resistance exercise program.

Changes in body composition and use of blood cholesterol lowering drugs predict changes in blood lipids during 12 weeks of resistance exercise training in old adults.

PURPOSE: Aging is associated with an impairment of blood lipids. The present study investigated the response of blood lipids to resistance exercise in old adults. The particular aim was to investigate whether the response of blood lipids is associated with changes in body composition of blood lipid medication. METHODS: Subjects (N = 236, 73.7 ± 5.7 years, 58.2 % female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80 % of the 1-repetition maximum), designed to increase strength and muscle mass of major muscle groups. Body composition, drug use, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were assessed at baseline and endpoint. RESULTS: The concentrations of HDL (-6 mg/dl), LDL (-18 mg/dl), TC (-26 mg/dl) and TG (-12 mg/g) decreased significantly during the study period. A reduction in fat mass by 1 kg predicted a reduction in TG (5.0 mg/dl, P = 0.017) and a gain in lean body mass by 1 kg predicted also a reduction in TG (-4.5 mg/dl, P = 0.023). The use of blood cholesterol lowering drugs predicted greater reductions in TC (-16.9 mg/dl, P = 0.032) and LDL (-11.8 mg/dl, P = 0.038) during training. CONCLUSIONS: TG, TC, LDL and HDL decreased significantly after 12 weeks of progressive resistance exercise in old adults. Changes in body composition, i.e., reduction in fat mass and gain in lean body mass improved the blood lipid profile. Use of blood lipid lowering drugs was associated with greater reductions in TC and LDL after the training.

Effects of whey proteins and carbohydrates on the efficacy of resistance training in elderly people: double blind, randomised controlled trial.

BACKGROUND/OBJECTIVES: A few previous studies indicate that protein supplementation increases gains in muscle mass and strength during a resistance exercise program. The purpose of this study was to investigate whether whey protein supplementation results in greater increases in lean body mass, muscle strength and physical function in elderly individuals during 12 weeks of resistance exercise when compared to isocaloric carbohydrate supplementation. SUBJECTS/METHODS: A total of 161 men and women, 65-91 years old, participated in a randomized, controlled, double-blind intervention study, involving dietary supplementation and a 12-week resistance exercise program, designed to increase muscle mass and strength of all major muscle groups. Participants exercised three times a week and received either 20 g of whey protein (n=83) or isocaloric carbohydrate (n=78) in liquid form immediately after each workout. Data were obtained at baseline and end point. RESULTS: The primary outcomes, lean body mass, strength and physical function increased significantly during the course of the study. Type of dietary supplementation did not influence gains in lean body mass (P=0.365), quadriceps strength (P=0.776) or performance during a 6-min walk (P=0.726) or a timed up-and-go test (P=0.151). Twenty participants discontinued the intervention. CONCLUSIONS: Ingestion of 20 g of whey protein immediately after resistance exercise three times per week, does not lead to greater gains in lean body mass, strength and physical function in elderly people with sufficient energy and protein intakes when compared to isocaloric carbohydrate.

Relationship between BMI and body fatness in three European countries.

BACKGROUND/OBJECTIVES: Body fatness and heart disease risk factors can differ considerably between ethnities for a given body mass index (BMI). Information is lacking on differences between various Caucasian populations within Europe. The aim was to investigate the differences in anthropometrics and risk factors between adults from Iceland, Spain and Ireland. SUBJECT/METHODS: This was a secondary analysis of the baseline data from the SEAFOODplus YOUNG intervention study, in which 324 subjects (20-40 years, BMI 27.5-32.5 kg/m(2), from Iceland, Spain and Ireland) participated. Fasting glucose, insulin, blood lipids and body compossition were measured, insulin resistance was calculated using the homeostasis model assessment of insulin resistance. RESULTS: Although age and BMI did not differ between Spanish, Irish and Icelandic subjects, Irish subjects had significantly higher waist circumference (3.2 and 6.7 cm) and body fat percentage (4.4 and 2.0%) compared with Icelandic and Spanish participants, respectively. Irish participants had also more unfavorable cardio-metabolic risk factors compared with Spanish and Icelandic subjects. However, correction for waist attenuated the observed differences considerably, in particular for total cholesterol, low-density lipoprotein and triglycerides. CONCLUSIONS: Despite having near identical BMI and age, our results show that study participants from different populations within Europe differ considerably in cardio-metabolic risk factors, partly due to differences in body fat distribution.

Effects of two different types of fast food on postprandial metabolism in normal and overweight subjects.

BACKGROUND/OBJECTIVES: The aim was to investigate the effects of a conventional and an unconventional fast-food meal on postprandial metabolism in normal and in overweight subjects. SUBJECTS/METHODS: Twenty-five healthy normal (n = 12) and overweight (n = 13) volunteers (21-39 years) participated in this randomized, dietary cross-over study and received two test meals (matched in energy and energy giving nutrients) after an overnight fast with 1 week between test days. The conventional fast-food meal was a hamburger meal (hamburger, bacon, cola drink, calculated glycemic load = 48.7), the unconventional fast food was a salmonburger meal (fiber-rich sourdough rye bread, salad with vinegar, orange juice, glycemic load = 46.0). Blood samples were taken before and after the meal and analyzed for glucose (before 20, 40, 60 and 80 min) and insulin (before 1, 2 and 3 h). RESULTS: Postprandial increases in glucose and insulin were 44% lower after the unconventional meal (P<0.001 and P = 0.003, respectively). The difference between meals in insulin response (that is, conventional meal higher than unconventional) correlated with body mass index (BMI) (r = 0.538, P = 0.006). CONCLUSIONS: Unconventional fast food can have less effect on blood insulin and glucose postprandially compared with conventional fast food matched in energy and energy giving nutrients. The difference between meals in insulin response is associated with higher BMI. Thus, improvement in food quality might help to control postprandial increases in blood glucose and blood insulin.

Effect of 12-week resistance exercise program on body composition, muscle strength, physical function, and glucose metabolism in healthy, insulin-resistant, and diabetic elderly Icelanders.

BACKGROUND: Insulin is a stimulator of skeletal muscle protein anabolism and insulin resistance might therefore negatively affect muscle protein metabolism. We investigated muscle mass and physical function before and after a resistance exercise program in participants with prediabetes or type 2 diabetes mellitus (T2DM) in comparison to healthy controls. METHODS: This was a secondary analysis of a randomized controlled intervention designed to investigate resistance training among older adults. Glucose metabolism status was not a selection criteria for the trial, and group designation was done retrospectively. Participants (N = 237, 73.7 ± 5.7 y, 58.2% women) participated in a 12-week resistance exercise program (3 times/week; three sets, six to eight repetitions at 75%-80% of the one-repetition maximum), designed to increase strength and muscle mass of major muscle groups. Body composition, muscular strength, timed up and go test, 6-minute walk for distance, and blood chemical variables were measured at baseline and endpoint. RESULTS: Participants completing the study (n = 213) experienced significant changes in muscle strength or muscle function, which did not differ significantly between healthy (n = 198), prediabetic (n = 20), and T2DM participants (n = 17). Changes in serum glucose during the intervention differed by group: only glucose improved significantly in the prediabetic group, glucose and triacylglycerol improved significantly in the healthy group, whereas no serum parameter improved significantly in the T2DM group. CONCLUSIONS: A 12-week resistance exercise program improves muscle strength and muscle function to a similar extent in healthy, prediabetic, and T2DM elderly people. However, according to our data, T2DM participants do not experience favorable changes in fasting glucose or HbA(1C).

Physical function predicts improvement in quality of life in elderly Icelanders after 12 weeks of resistance exercise.

BACKGROUND: Little is known about the effects of resistance training on health related quality of life (HRQL) in the elderly. AIM: The main purpose of the study was to investigate the effects of resistance training on strength, body composition, functional capacity and HRQL in independent living elderly people. We hypothesised that resistance training would improve lean mass, muscle strength, physical function and HRQL. METHODS: Subjects (N = 237, 73.7±5.7 yrs, 58.2% female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum) designed to increase strength and muscle mass of major muscle groups. Body composition, quadriceps- and grip strength, timed up and go test (TUG), six minute walk for distance (6MW) and HRQL were measured at baseline and endpoint. RESULTS: Two hundred-and-four participants completed the study. Although the increase in lean mass was small (+0.8 kg, P<0.01), quadriceps strength (+53.5 N), grip strength (+3.0 lb), TUG (-0.6 sec), 6MW (+33.6 m) and HRQL (+1.2 t-score) improved significantly (all P<0.01). Changes in 6MW predicted improvement in HRQL after 12 weeks. CONCLUSIONS: Our study shows that a 12-week resistance exercise program significantly improves lean mass, muscle strength, physical function and HRQL in elderly individuals, and that improvements in physical function predict improvements in HRQL. Our study indicates that resistance training should be promoted for the elderly as it has the potential to improve physical performance, thereby prolonging healthy, independent aging.