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.

Association of nutritional components with falls in oldest-old men: The Helsinki Businessmen Study (HBS).

INTRODUCTION: Falls are associated with increased morbidity and mortality in older people. We examined how nutritional factors are associated with self-reported falls in the oldest-old community-dwelling men. METHODS: Participants of the longitudinal and socioeconomically homogenous Helsinki Businessmen Study are men born in 1919-1934. A cross-sectional analysis from a random sample of 122 home-living oldest-old men who underwent medical examinations in 2017-2018 is reported here. Food and nutrient intakes were retrieved from 3-day food diaries, and the number of falls during past year was requested in the screening questionnaire. Nutritional status was assessed using Mini Nutritional Assessment Short Form (MNA-SF) and waist circumference was measured. Body composition was assessed with dual-energy X-ray absorptiometry (DXA)-scans, physical performance with short physical performance battery (SPPB), sarcopenia status using European Working Group on Sarcopenia in Older People's 2 (EWGSOP2) criteria, and frailty with phenotypic criteria. RESULTS: Mean age of participants was 87 years (range 83-99 years) and 30% reported at least one fall during past year. Falls were associated with higher waist circumference (p = .031), frailty (p < .001) and sarcopenia (p = .002), and inversely associated with SPPB total score (p = .002). Of nutritional factors, intakes of fish (p = .016), fish protein (p = .039), berry (p = .027) and vitamin D (p = .041), and snacking more protein between breakfast and lunch (p = .017) were inversely associated with falls. Red meat intake was associated with higher frequency of falls (p = .044). CONCLUSION: Higher waist circumference, but not body mass index, was associated with increased frequency of falls. Healthy dietary choices appeared protective from falls in these oldest-old men of similar socioeconomic status.

Associations of protein source, distribution and healthy dietary pattern with appendicular lean mass in oldest-old men: the Helsinki Businessmen Study (HBS).

PURPOSE: We explored how food and dietary intakes, protein daily distribution and source are associated with appendicular lean mass (ALM)/m2 of the oldest-old community-dwelling men. METHODS: Cross-sectional analyses of Helsinki Businessmen Study (HBS, mean age 87 years) participants who came to clinic visit in 2017/2018. Nutritional status, physical performance and fasting blood samples were measured. Food and dietary intakes were retrieved from 3-day food diaries. Body composition was measured and appendicular lean mass (ALM) per m2 was dichotomized as ALM/m2 < 7 kg/m2 and ≥ 7 kg/m2. Differences between lower and higher ALM were analyzed using t test or Mann-Whitney U test. Analysis of covariance was used to investigate independent associations with ALM/m2. RESULTS: Random sample of 130 participants took part in the medical examinations, 126 returned food diaries, and 102 underwent DXA-scan. ALM/m2 was associated with total protein (p = 0.033), animal protein (p = 0.043) and meat protein (p = 0.033) intakes. Protein distribution between daily meals differed at lunch; those with higher ALM/m2 ate more protein (p = .047) at lunch. Consumption of fruits, vegetables (p = 0.022) and meat (p = 0.006) was associated with ALM/m2. CONCLUSION: Protein intake, source and distribution as well fruit and vegetable intakes were associated with higher ALM in oldest-old men. STUDY REGISTRATION: The study is registered with ClinicalTrials.gov identifier: NCT02526082.

Macronutrient composition and sarcopenia in the oldest-old men: The Helsinki Businessmen Study (HBS).

BACKGROUND & AIM: Sarcopenia is associated with increased risk for several adverse health outcomes including frailty, disability, loss of independence, and mortality. We examined cross-sectional associations between sarcopenia and detailed dietary macronutrient composition in community-living oldest-old men (mean age 87). METHODS: Participants were invited to a clinic visit in 2017/2018 including assessments of sarcopenia status using European Working Group on Sarcopenia in Older People's 2 (EWGSOP2) criteria and detailed macronutrient, vitamin D and food intakes retrieved from 3-day food diaries. RESULTS: Of the 126 participants, 48 had probable sarcopenia and 27 sarcopenia. Sarcopenia was associated with lower energy (p = 0.020), total protein (p = 0.019), plant (p = 0.008) and fish proteins (p = 0.041), total fat (p = 0.015), monounsaturated fatty acids (MUFA) (p = 0.011), polyunsaturated fatty acids (p = 0.002), vitamin D intakes (p = 0.005) and, of fat quality indicators, MUFA: saturated fatty acid-ratio (p = 0.042). CONCLUSION: These findings suggest that sufficient energy and protein intakes, but also fat quality may be important along with healthy dietary patterns for prevention of sarcopenia in the oldest-old.

Self-Perception of Economic Means Is Associated with Dietary Choices, Diet Quality and Physical Health in the Oldest Old Men from the Highest Socioeconomic Group.

INTRODUCTION: Self-perception of economic means may affect dietary choices, diet quality, and health behavior. We examined these associations in the oldest-old men from the highest socioeconomic class. METHODS: The participants in this cross-sectional analysis were the oldest- old home-dwelling men (n = 314, mean age 87 years, range 82-97 years) from the longitudinal Helsinki Businessmen Study cohort. They responded to a postal health and nutrition questionnaire, whereupon dietary intakes were assessed using 3-day food diaries and two diet quality indices. The questionnaire also included items about health, exercise, falls, and economic means. RESULTS: Higher self-perception of economic means was linearly associated with higher fish intake (p = 0.021), fruit and vegetable intakes (p = 0.027), use of alcohol (p = 0.003), overall diet quality according to IDQ (p = 0.008), self-perceived physical condition (p = 0.002) and inversely associated with body weight (p = 0.011), weight loss (p = 0.008), blood glucose levels (p = 0.020), and falls (p = 0.029). CONCLUSION: Self-perception of economic means was associated with dietary choices and physical health even among affluent older men. This information is important, because self-perception of economic means, however real, may affect health and nutrition behavior of older people.

Nutrition, Daily Walking and Resilience Are Associated with Physical Function in the Oldest Old Men.

BACKGROUND: Maintaining good physical functioning in old age is of utmost importance for healthy and active aging. We examined physical function and associated factors in the oldest-old men. SUBJECTS AND METHODS: The participants of this cross sectional analysis of a longitudinal study were the oldest old men( n=394, mean age 88 years, range 82-97 years) from the Helsinki Business Men cohort who responded to a postal health and nutrition survey in 2016. Physical function was defined using the respective subscale (Physical Function, PF) in the RAND-36 health-related quality of life (HRQoL) instrument. Resilience was measured with validated Finnish version of Resilience scale. Diet quality was assessed using Mediterranean diet adherence score (MeDi) and Diet quality index (DQI) which is designed to show adherence to Finnish dietary recommendations. Food and dietary intakes were retrieved using 3-day food records (obtained from a sub-group of the respondents). The participants were divided into quartiles corresponding to their PF scores and health and nutrition indicators were calculated into these PF quartiles. Furthermore, a linear regression model was used to determine factors associated with PF. RESULTS: PF quartiles were positively associated with lower age, daily walking habit, cognition, diet quality, resilience, alcohol use and negatively associated with blood glucose levels, weight loss, body weight (BW) and falls. Polyunsaturated to saturated fat ratio and berry intake were also associated with PF. In a linear regression model PF was positively associated (p < .001, adjusted R2 = .560) with MeDi, cognition, resilience, vitality (RAND-36), and negatively with age and BW. CONCLUSION: MeDi, exercise, resilience, cognition, use of alcohol, fat quality and lower age were positively associated with PF in the oldest-old men. Weight loss, falls and interestingly BW were negatively associated with PF.

Happiness of the oldest-old men is associated with fruit and vegetable intakes.

BACKGROUND: Positive emotions and happiness may improve health and prolong life. Diet quality, Mediterranean dietary pattern, fruit and vegetable, chocolate, and fish consumption have been linked to positive affect, improved mood, and reduced risk of depression. We examined the associations between diet, nutrition, and perceived happiness in the oldest-old men. METHODS: The participants in this cross-sectional analysis were the oldest-old, home-dwelling men (n = 338, mean age 88 years, range 82-97 years) from the longitudinal Helsinki Businessmen Study cohort. In 2016, a postal health and nutrition survey was performed. Happiness was evaluated using the Visual Analog Scale of Happiness (0-100 mm). The nutrition survey included a 3-day food diary, Mediterranean Diet Adherence score, and Index of Diet Quality designed to measure adherence to Finnish dietary recommendations. The participants were divided into quartiles according to happiness scores, and diet quality scores, food intakes, and other indicators were compared between the happiness quartiles. RESULTS: Happiness was linearly associated with total fruit and vegetable intakes (p = 0.002) and inversely associated with age (p = 0.016), blood glucose levels (p = 0.049), skipping lunch (p = 0.023), reduced food intake (p = 0.002), and weight loss (p = 0.016). CONCLUSIONS: Fruit and vegetable intakes indicated happiness in the oldest-old men while reduced food intakes and weight loss were inversely associated with happiness. Maintaining good nutrition and increasing fruit and vegetable consumption may be important for psychological health of older people.