Effects of nutritional supplementation and resistance training on muscle strength in free living elders. Results of one year follow.

PURPOSE: To assess the effects of a one year nutritional supplementation and resistance training program on muscle strength and walking capacity in the elderly. MATERIAL AND METHODS: Elderly subjects from two outpatient clinics received a nutritional supplement, that provided 400 Kcal, 15 g/protein and 50% of vitamin DRVs per day. Half the subjects receiving and not receiving the supplement were randomly assigned to a resistance exercise training program with two sessions per week. Every six months, body composition using DEXA, limb muscle strength, maximal inspiratory and expiratory pressures and walking capacity were assessed. RESULTS: One hundred forty nine subjects were considered eligible and 101 (31 supplemented and trained, 28 supplemented, 16 trained and 26 without supplementation nor training) completed the year of follow up. Overall compliance with the supplement was 48 22 % and trained subjects attended 56 21% of programmed sessions. No changes in fat free mass were observed in any of the groups, but fat mass increased from 22.5 7.3 to 23.2 7.3 kg in all groups (p < 0.001). Upper and lower limb strength and walking capacity increased significantly in trained subjects whether supplemented or not. Maximal inspiratory pressure and right hand grip strength increased only in the supplemented and trained group. CONCLUSIONS: Resistance training improved muscle strength and walking capacity.

The impact of nutritional supplementation and resistance training on the health functioning of free-living Chilean elders: results of 18 months of follow-up.

Body composition changes and loss of functionality in the elderly are related to substandard diets and progressive sedentariness. The aim of this study was to assess the impact of an 18-mo nutritional supplementation and resistance training program on health functioning of elders. Healthy elders aged > or = 70 y were studied. Half of the subjects received a nutritional supplement. Half of the supplemented and nonsupplemented subjects were randomly assigned to a resistance exercise training program. Every 6 mo, a full assessment was performed. A total of 149 subjects were considered eligible for the study and 98 (31 supplemented and trained, 26 supplemented, 16 trained and 25 without supplementation or training) completed 18 mo of follow-up. Compliance with the supplement was 48%, and trained subjects attended 56% of programmed sessions. Activities of daily living remained constant in the supplemented subjects and decreased in the other groups. Body weight and fat-free mass did not change. Fat mass increased from 22.2 +/- 7.6 to 24.1 +/- 7.7 kg in all groups. Bone mineral density decreased less in both supplemented groups than in the nonsupplemented groups (ANOVA, P < 0.01). Serum cholesterol remained constant in both supplemented groups and in the trained groups, but it increased in the control group (ANOVA, P < 0.05). Upper and lower limb strength, walking capacity and maximal inspiratory pressure increased in trained subjects. In conclusion, patients who were receiving nutritional supplementation and resistance training maintained functionality, bone mineral density and serum cholesterol levels and improved their muscle strength.

Low serum folate but normal homocysteine levels in patients with atherosclerotic vascular disease and matched healthy controls.

Mild hyperhomocysteinemia has been considered a cardiovascular risk factor. However, recent prospective studies have not demonstrated that hyperhomocysteinemia or the underlying genetic defect on methylentetrahydrofolate reductase is associated with a higher risk of coronary or peripheral artery disease. We compared serum homocysteine, folate, and vitamin B(12) levels of patients with coronary and peripheral vascular disease with those of age- and sex-matched healthy individuals. Subjects taking multivitamins, with diabetes mellitus, or serum creatinine levels over 1.5 mg/dL were excluded from the study. Homocysteine was measured by fluorimetric high-performance liquid chromatography. Serum folate and vitamin B(12) levels were measured by an ion-capture method. We studied 32 patients with peripheral vascular disease (10 female), aged 69.6 +/- 11 y, 24 age- and sex-matched control subjects, 52 patients with coronary artery disease (7 female), aged 59.5 +/- 10.4 y, and 42 age- and sex-matched control subjects. Serum homocysteine levels were 11.7 +/- 7.4 and 9.3 +/- 4.5 micromol/L in vascular patients and in the control counterparts, respectively (not significant). The levels for coronary patients and the control counterparts were 9.0 +/- 3.9 and 8.6 +/- 3.6 micromol/L, respectively (not significant). Folate levels were 4.48 +/- 2.42 and 7.14 +/- 4.04 ng/mL in vascular patients and control subjects, respectively (P < 0.02); the levels in coronary patients and control counterparts were 5.15 +/- 1.9 and 6.59 +/- 2.49 ng/mL, respectively (P < 0.01). No differences in vitamin B(12) or tocopherol levels were observed between patients and control subjects. There were no differences in homocysteine levels, but lower serum folate levels were observed when comparing patients with atherosclerotic vascular disease and healthy control subjects.

Effects of supplementation with folic acid and antioxidant vitamins on homocysteine levels and LDL oxidation in coronary patients.

Hyperhomocysteinemia is an important cardiovascular risk factor. Serum homocysteine levels are specially dependent on folate nutritional status. In addition, the oxidative modification of low-density lipoproteins (LDLs) in the endothelial microenvironment is a damaging factor that can be modified with fat-soluble antioxidant vitamins. The present study was done to assess the effect of a supplementation of folic acid and antioxidant vitamins on homocysteine levels and in vitro LDL oxidation in patients with coronary artery disease. Twenty-three patients with angiographically proven coronary artery disease were given supplements for 15 d consisting of one capsule twice a day of a multivitamin preparation containing 0.65 mg folic acid, 150 mg alpha-tocopherol, 150 mg ascorbic acid, 12.5 mg beta-carotene, and 0.4 microgram vitamin B12. Serum lipids, vitamin and homocysteine levels, and in vitro LDL oxidation were measured before and after the supplementation period. During the supplementation period, serum folate levels increased from 5.0 +/- 1.5 to 10.8 +/- 3.8 ng/mL (P < 0.001), vitamin B12 increased from 317.4 +/- 130.4 to 334.5 +/- 123.8 pg/mL (P < 0.05), and alpha-tocopherol increased from 8.2 +/- 5.1 to 13.7 +/- 7.9 mg/L (P < 0.001). Serum homocysteine levels decreased from 8.7 +/- 4.3 to 6.3 +/- 2.2 mumol/L (P < 0.001). In vitro LDL oxidation decreased from 2.6 +/- 1.1 to 1.6 +/- 1.1 nmol malondialdehyde/mg protein (P < 0.001). In comparing patients with healthy controls, basal levels of folate were lower in the patients, whereas vitamin B12, alpha-tocopherol, and homocysteine levels were similar. No changes in serum lipid levels or body weight were observed. In conclusion, a short-term supplementation with folic acid and antioxidant vitamins can reduce serum homocysteine levels and in vitro LDL oxidation in patients with coronary artery disease.

[Nutritional status and energy expenditure in elders of differing socioeconomic level]. / Estado nutritivo y gasto energético en ancianos de distinto nivel socioeconómico.

BACKGROUND: Income and socioeconomic status can influence nutritional status of individuals. Since elders are a more vulnerable group to nutritional deficiencies, socioeconomic status could have a special relevance on nutrition of elderly people. AIM: To assess the influence of socioeconomic status on the nutritional status of elders. MATERIAL AND METHODS: Elders of both sexes of high socioeconomic level and age and sex matched elders of low socioeconomic status were studied. Anthropometry, body composition using double beam X ray absorptiometry, resting energy expenditure using an open circuit indirect calorimeter, routine biochemistry, blood levels of folic acid, vitamin B12 and homocysteine were measured in all subjects. RESULTS: Fourteen female elders of high socioeconomic level, 14 females of low level and 12 males of each level were studied. Mean age of females and males was 71.5 +/- 3.7 and 73.9 +/- 4.2 years old respectively. Males and females of high socioeconomic status were taller than their counterparts of low status. Females of high socioeconomic status had a lower body mass index than their pairs of low status (26.3 +/- 3.8 and 30.2 +/- 5.6 kg/m2 respectively p < 0.02). Men of high economic status had a higher fat mass than their pairs of low level (20.3 +/- 3.5 and 15.1 +/- 5.5 kg respectively, p < 0.005). No differences in resting energy expenditure in women of differing socioeconomic level were observed. Men of high level had a higher energy expenditure that their counterparts of low level (36.0 +/- 4.9 and 32.8 +/- 2.2 Kcal/kg lean body mass/day respectively, p < 0.02). Low level male elders had higher serum total cholesterol and triglycerides. Folic acid, vitamin B12 and homocysteine levels were within normal limits. Dietary intake showed deficiencies in calorie, protein and vitamin intake in all subjects. CONCLUSIONS: In this group of elders, low socioeconomic level did not produce a significant impact on nutritional status.

[Serum homocysteine levels in healthy Chilean adults]. / Niveles de homocisteína en adultos sanos chilenos.

BACKGROUND: Hyperhomocysteinemia is a newly recognized cardiovascular risk factor that is present in 10 to 20% of European and North American individuals. AIM: To measure homocysteine levels in healthy adults in Chile. SUBJECTS AND METHODS: Serum homocysteine levels were measured in healthy adults using a fluorimetric HPLC method. Folic acid, vitamin. B12, serum lipids, creatinine and glucose were also assessed. All subjects answered a dietary habits questionnaire. RESULTS: One hundred twenty eight subjects (90 female) aged 22 to 78 years old were studied. Homocysteine levels were 9.7 +/- 6.0 and 7.0 +/- 3.1 mumol/l in men and women respectively (p < 0.001). Folic acid levels were 6.1 +/- 2.7 and 6.1 +/- 2.9 ng/ml in men and women, and 24% of individuals had values below 4 ng/ml. Vitamin B12 levels were 393 +/- 147 and 393 +/- 163 pg/ml in the same groups. There was a negative correlation between homocysteine and folic acid levels and a positive correlation between homocysteine and creatinine levels. CONCLUSIONS: Homocysteine levels in healthy Chilean individuals are similar to those reported abroad. Low folic acid levels were found in 24% of subjects.

[Intestinal permeability in alcoholic patients without liver damage]. / Permeabilidad intestinal en alcohólicos sin daño hepático.

BACKGROUND: Chronic alcoholism may increase intestinal permeability. However, there are few studies of intestinal permeability in chronic alcoholic subjects. AIM: To study intestinal permeability in chronic alcoholic patients without clinical evidences of liver damage, during early abstinence, and in normal subjects. METHODS: Thirty seven male subjects were studied, 18 controls and 19 alcoholics. All subjects underwent an anthropometric assessment and dietary history. Lactulose/mannitol test was performed during the third day of abstinence in alcoholics. After an 8 hour overnight fast, subjects drank 200 ml of a solution containing 5 g lactulose and 5 g mannitol. Subsequently, urine was collected during the following 5 hours, where both sugars were measured by gas chromatography. RESULTS: Median values of lactulose/mannitol ratio were similar in alcoholics and controls (0.011, range 0.005-0.071 vs 0.014, range 0.005-0.027 respectively). However, absolute urinary excretion of both lactulose and mannitol was lower in alcoholics. There was no relationship between nutritional status and urinary excretion of lactulose, mannitol or lactulose/mannitol ratio. CONCLUSION: In these alcoholic patients, no changes were observed in intestinal permeability.

[Results after two years of an alcoholic rehabilitation program]. / Resultados a dos años de un programa de rehabilitación de enfermos alcohólicos.

BACKGROUND: Alcoholism is a serious public health problem in Chile and the best treatment strategy for this problem is far from being clear. AIM: To assess the long term results of an alcoholism rehabilitation program. PATIENTS AND METHODS: One hundred eighty two alcoholics admitted for treatment of their alcoholism were followed during two years in a special clinic. The effects of length of alcoholism, withdrawal symptoms on admission and the presence of histological liver damage on long term outcome were assessed using life table analysis. RESULTS: During the two years period, 75% of patients were lost from control and 63% relapsed in their alcoholic ingestion. None of the above mentioned parameters had an effect on relapse or loss from follow up. CONCLUSIONS: There are high attrition and failure rates and the length of alcoholism, degree of initial withdrawal and liver damage do not influence the long term results of this program.

Controlled trial on nutrition supplementation in outpatients with symptomatic alcoholic cirrhosis.

A controlled trial on nutrition supplementation in ambulatory patients with decompensated alcoholic liver disease was carried out during 1 year. Fifty-one patients were studied; 26 were assigned to an experimental group receiving a daily supplement of 1000 kcal and 34 g of proteins given as a casein-based enteral nutrition product and 25 to a control group receiving one placebo capsule. Patients were examined in a special clinic once a month or more if required. Sixty-eight percent of patients admitted to alcohol ingestion or had alcohol in urine samples on at least one occasion. Dietary recalls showed a significantly higher protein and caloric intake in case patients subjects (p < .0001). Nine patients died during the study, three case patients and six control patients (p = NS). The frequency of hospitalizations was significantly less in the experimental group. This difference was attributed to a reduction in severe infections. Mid-arm circumference, serum albumin concentration, and hand grip strength improved earlier in case patients, although both groups had a significant improvement in these parameters. Bilirubin and aspartate aminotransferase decreased and prothrombin time increased significantly in both groups during the study period, without differences between groups. It is concluded that nutrition support decreases nutrition-associated complications in patients with alcoholic liver disease.