Anthropometric Measurements and Cognitive Impairment Rather Than Nutrition Status Are Associated With Sarcopenia in Long-Term Care Residents.

BACKGROUND: Sarcopenia is an important health problem in older adults. The aim was to study the association of anthropometric measurements, functional capacity, cognitive impairment, and nutrition status with sarcopenia in institutionalized older adults. METHODS: A cross-sectional study was undertaken, determining the calf circumference (CC), mid-upper arm muscle circumference (MUAMC), and body mass index (BMI) and administering the Pfeiffer test and Mini Nutritional Assessment Short Form (MNA-SF). Sarcopenia was diagnosed following criteria of the European Working Group on Sarcopenia in Older People. After bivariate analyses, a multivariate logistic regression model was constructed to determine the association of study variables with sarcopenia. RESULTS: The study group comprised 249 residents (mean age 84.9 ± 6.7 years). The prevalence of sarcopenia was 63%. The multivariate analysis with adjusted odds ratios (ORs) indicated that the risk of sarcopenia was significantly increased by being female (OR = 2.8; 95% CI 1.3-6.2), having moderate or severe cognitive impairment (Pfeiffer test score of 5-10) (OR = 2.4; 95% CI 0.9-6.4), and having a BMI < 22 kg/m2 (OR = 22.4; 95% CI 6.7-75.0). Moreover, a low CC (OR = 6.5; 95% CI 3.0-14.0) or MUAMC (OR = 3.9; 95% CI 1.7-9.3) also significantly increased the risk of sarcopenia. A negative association was observed between sarcopenia and MNA-SF, although it did not remain statistically significant in the multivariate analysis. CONCLUSIONS: The variables identified as risk factors for sarcopenia can assist in detecting individuals at higher risk who require special clinical attention.

Diagnóstico y prevalencia de sarcopenia en residencias de mayores: EWGSOP2 frente al EWGSOP1 / Diagnosis and prevalence of sarcopenia in long-term care homes: EWGSOP2 versus EWGSOP1

Antecedentes: la definición y metodología recomendadas para diagnosticar sarcopenia ha ido evolucionando. El consenso más utilizado es el del Grupo Europeo de Trabajo en Sarcopenia en Personas Mayores publicado en 2010 (EWGSOP1), que ha sido actualizado en 2019 (EWGSOP2). Objetivos: determinar la prevalencia de sarcopenia en personas mayores institucionalizadas usando el algoritmo del EWGSOP2 y comparar dichos resultados con los obtenidos en el Granada Sarcopenia Study al aplicar el algoritmo del EWGSOP1. Métodos: para evaluar la sarcopenia se midieron la masa muscular con un impedanciómetro, la fuerza muscular con un dinamómetro y la velocidad de la marcha en un recorrido de cuatro metros. Para la comparación de los resultados se realizó un análisis de sensibilidad y especificidad utilizando la versión 20 de SPSS. Resultados: según el EWGSOP2, el 60,1% tenía sarcopenia y el 58,1% tenía sarcopenia grave, resultados sin diferencias estadísticamente significativas al compararlos con los obtenidos según el EWGSOP1 (63% tenía sarcopenia y 61,2%, sarcopenia grave). Tampoco se hallaron diferencias significativas al comparar los sujetos con baja masa muscular según las fórmulas propuestas en uno y otro consenso, mientras que sí las hubo al comparar los sujetos con baja fuerza muscular debido a la variación en los puntos de corte. Conclusiones: la prevalencia de sarcopenia en personas mayores institucionalizadas es alta, destacando una gran mayoría de sujetos con baja fuerza muscular y bajo rendimiento físico. La utilización de la metodología propuesta por el EWGSOP2 no influyó en los resultados de prevalencia de sarcopenia obtenidos al aplicar el EWGSOP1

Background: the definition and methodology recommended for the diagnosis of sarcopenia has been changing. The mostly applied consensus is the one published by the European Working Group in Older People in 2010 (EWGSOP1), which was updated in 2019 (EWGSOP2). Objectives: assessing the prevalence of sarcopenia in institutionalized older adults using the EWGSOP2 algorithm and comparing these results with the EWGSOP1 algorithm results. Methods: in order to diagnose sarcopenia, muscle mass was assessed using an impedanciometer, muscle strength with a dynamometer and walking speed over a four-meter course. For the comparison of the results, a sensitivity and specificity analysis were performed with the version 20 of SPSS. Results: according to the EWGSOP2, 60.1% of the participants had sarcopenia and 58.1% had severe sarcopenia, results with no statistical differences when they are compared to the results according to the EWGSOP1 (63% had sarcopenia and 61.2%, severe sarcopenia). Neither were statistical differences found when comparing subjects with low muscle mass according to the formulas suggested by both consensus, while there were differences when comparing subjects with low muscle strength due to the variation of cut-off points. Conclusions: the prevalence of sarcopenia in institutionalized older adults is high, being remarkable that the majority of the participants had low muscle strength and low physical performance. The utilization of the methodology proposed by the EWGSOP2 did not have influence in the results of prevalence of sarcopenia obtained when the EWGSOP1 recommendations were applied

[Diagnosis and prevalence of sarcopenia in long-term care homes: EWGSOP2 versus EWGSOP1]. / Diagnóstico y prevalencia de sarcopenia en residencias de mayores: EWGSOP2 frente al EWGSOP1.

INTRODUCTION: Background: the definition and methodology recommended for the diagnosis of sarcopenia has been changing. The mostly applied consensus is the one published by the European Working Group in Older People in 2010 (EWGSOP1), which was updated in 2019 (EWGSOP2). Objectives: assessing the prevalence of sarcopenia in institutionalized older adults using the EWGSOP2 algorithm and comparing these results with the EWGSOP1 algorithm results. Methods: in order to diagnose sarcopenia, muscle mass was assessed using an impedanciometer, muscle strength with a dynamometer and walking speed over a four-meter course. For the comparison of the results, a sensitivity and specificity analysis were performed with the version 20 of SPSS. Results: according to the EWGSOP2, 60.1% of the participants had sarcopenia and 58.1% had severe sarcopenia, results with no statistical differences when they are compared to the results according to the EWGSOP1 (63% had sarcopenia and 61.2%, severe sarcopenia). Neither were statistical differences found when comparing subjects with low muscle mass according to the formulas suggested by both consensus, while there were differences when comparing subjects with low muscle strength due to the variation of cut-off points. Conclusions: the prevalence of sarcopenia in institutionalized older adults is high, being remarkable that the majority of the participants had low muscle strength and low physical performance. The utilization of the methodology proposed by the EWGSOP2 did not have influence in the results of prevalence of sarcopenia obtained when the EWGSOP1 recommendations were applied.

INTRODUCCIÓN: Antecedentes: la definición y metodología recomendadas para diagnosticar sarcopenia ha ido evolucionando. El consenso más utilizado es el del Grupo Europeo de Trabajo en Sarcopenia en Personas Mayores publicado en 2010 (EWGSOP1), que ha sido actualizado en 2019 (EWGSOP2). Objetivos: determinar la prevalencia de sarcopenia en personas mayores institucionalizadas usando el algoritmo del EWGSOP2 y comparar dichos resultados con los obtenidos en el Granada Sarcopenia Study al aplicar el algoritmo del EWGSOP1. Métodos: para evaluar la sarcopenia se midieron la masa muscular con un impedanciómetro, la fuerza muscular con un dinamómetro y la velocidad de la marcha en un recorrido de cuatro metros. Para la comparación de los resultados se realizó un análisis de sensibilidad y especificidad utilizando la versión 20 de SPSS. Resultados: según el EWGSOP2, el 60,1% tenía sarcopenia y el 58,1% tenía sarcopenia grave, resultados sin diferencias estadísticamente significativas al compararlos con los obtenidos según el EWGSOP1 (63% tenía sarcopenia y 61,2%, sarcopenia grave). Tampoco se hallaron diferencias significativas al comparar los sujetos con baja masa muscular según las fórmulas propuestas en uno y otro consenso, mientras que sí las hubo al comparar los sujetos con baja fuerza muscular debido a la variación en los puntos de corte. Conclusiones: la prevalencia de sarcopenia en personas mayores institucionalizadas es alta, destacando una gran mayoría de sujetos con baja fuerza muscular y bajo rendimiento físico. La utilización de la metodología propuesta por el EWGSOP2 no influyó en los resultados de prevalencia de sarcopenia obtenidos al aplicar el EWGSOP1.

Prevalence and Diagnosis of Sarcopenia in Residential Facilities: A Systematic Review.

Assessing sarcopenia, the age-related loss of muscle mass and function, in institutionalized older adults is a challenging task. Data on its prevalence in residential facilities are scant and highly variable. Our objective was to report the prevalence of sarcopenia in older adults living in residential facilities (nursing/long term-care homes and assisted-living facilities) and review the criteria and methodologies used to diagnose sarcopenia in this setting. Bibliographic searches were carried out in 6 electronic databases (Medline via PubMed, Web of Science, Scopus, CINAHL, LILACS, and Cochrane) with the use of the Medical Subject Heading terms "Sarcopenia" and "Residential Facilities." We included studies that evaluated the prevalence of sarcopenia among older adults (aged ≥60 y) living in residential facilities. Forty-four studies were identified, of which 21 studies were included after applying eligibility criteria. The reported prevalence of sarcopenia ranged widely between 17.7% and 73.3% in long term-care homes and between 22% and 87% in assisted-living facilities. Most studies (n = 14) followed the consensus on sarcopenia diagnosis published by the European Working Group on Sarcopenia in Older People. In the other 7 studies, sarcopenia was diagnosed according to muscle mass, which was measured via 5 different techniques, most frequently bioelectrical impedance analysis, establishing cutoff scores for low muscle mass with the use of 5 different indexes, most frequently the skeletal muscle index. There are major differences in study design, methodology, and the approach to sarcopenia diagnosis in this setting, which would, in part, explain the enormous variability in the reported prevalence data. The lack of consensus on the correct diagnostic approach hampers the implementation of appropriate nutritional interventions.

Dietary Intake and Associated Factors in Long-Term Care Homes in Southeast Spain.

Diet is a key modifiable factor in the management of malnutrition and age-related diseases such as sarcopenia, an important issue in long-term care homes. The objectives of this study were to evaluate the dietary intake of residents, define dietary patterns, and analyze their association with sex, diet texture, nutritional status, and the presence of sarcopenia. Intake was assessed by the precise weighing method, dietary patterns were defined a posteriori by cluster analysis, and nutritional status and sarcopenia were evaluated by applying the MNA-SF test and EWGSOP algorithm, respectively. A regular diet was consumed by 63% of participants; 56% were at risk of malnutrition and 63% were diagnosed with sarcopenia. Intake of potassium, magnesium, zinc, iodine, vitamin D, E, folic acid, and fiber was low in >80% of participants. Protein intake was <1 g/kg/day in 56% of participants and <25 g/meal in 100%. Two dietary patterns were identified, but neither fully met recommendations. The risk of a poorer diet was higher in females and residents with sarcopenia and was lower in those consuming regular diets. In conclusion, action is required to improve the inadequate nutritional intake of long-term care residents.

[Menus offered in long-term care homes: quality of meal service and nutritional analysis].

BACKGROUND: Institutionalization is a risk factor for malnutrition. Low energy intake and/or nutrient deficiencies are considered to be the main causes. OBJECTIVE: To evaluate the quality of meals and meal service as well as the nutritional value of the main menus (regular menu, menu for diabetics, and pureed menu) offered in three long-term care (LTC) homes located in the metropolitan area of Granada (Spain). METHODS: Cross-sectional study. A validated "quality of meals and meal service" set of indicators was applied. The menus were assessed by weighed food records on 14 consecutive days. The results were compared with the dietary reference intakes (DRIs) and the recommended number of servings. RESULTS: Important deficiencies in the quality of meals and meal service have been reported. Average energy varies from 1,788 to 2,124 kcal/day in the regular menus, from 1,687 to 1,924 kcal/day in the menus for diabetics, and from 1,518 to 1,639 kcal/day in the pureed menus. Average protein varied from 71.4 to 75.4 g/day, from 72.6 to 76.1 g/day, and from 50.5 to 54.7 g/day, respectively. None of the menus complied with the recommendations for fiber, potassium, magnesium, iodine, vitamin D, vitamin E, folate, nor for vegetables, fruit, milk products, olive oil, legumes, or nuts. CONCLUSIONS: It is necessary to ensure the implementation of regular routines for controlling the quality of meals and meal service as well as the nutritional value of the menus offered in LTC homes.

Menus offered in long-term care homes: quality of meal service and nutritional analysis / Menús ofertados en residencias de mayores: calidad del servicio de las comidas y análisis nutricional

Background: Institutionalization is a risk factor for malnutrition. Low energy intake and/or nutrient deficiencies are considered to be the main causes. Objective: To evaluate the quality of meals and meal service as well as the nutritional value of the main menus (regular menu, menu for diabetics, and pureed menu) offered in three long-term care (LTC) homes located in the metropolitan area of Granada (Spain). Methods: Cross-sectional study. A validated «quality of meals and meal service» set of indicators was applied. The menus were assessed by weighed food records on 14 consecutive days. The results were compared with the dietary reference intakes (DRIs) and the recommended number of servings. Results: Important deficiencies in the quality of meals and meal service have been reported. Average energy varies from 1,788 to 2,124 kcal/ day in the regular menus, from 1,687 to 1,924 kcal/day in the menus for diabetics, and from 1,518 to 1,639 kcal/day in the pureed menus. Average protein varied from 71.4 to 75.4 g/day, from 72.6 to 76.1 g/day, and from 50.5 to 54.7 g/day, respectively. None of the menus complied with the recommendations for fiber, potassium, magnesium, iodine, vitamin D, vitamin E, folate, nor for vegetables, fruit, milk products, olive oil, legumes, or nuts. Conclusions: It is necessary to ensure the implementation of regular routines for controlling the quality of meals and meal service as well as the nutritional value of the menus offered in LTC homes (AU)

Introducción: la institucionalización es un factor de riesgo de malnutrición. Se considera que las principales causas son una baja ingesta energética y/o deficiencias nutricionales. Objetivo: evaluar la calidad de las comidas y el servicio de comidas así como el valor nutricional de los principales menús (menú basal, menú para diabéticos y menú triturado) ofrecidos en tres residencias de mayores de la provincia de Granada (España). Método: estudio transversal. Se aplicó el set de indicadores denominado «calidad de las comidas y el servicio de comidas». Los menús se evaluaron por registro de pesada de alimentos durante 14 días consecutivos. Los resultados se compararon con las ingestas dietéticas de referencia (DRI) y el número de raciones recomendadas. Resultados: se encontraron importantes deficiencias en la calidad de las comidas y el servicio de las mismas. La energía media varió de 1.788 a 2.124 kcal/día en los menús basales, de 1.687 a 1.924 kcal/día en los menús para diabéticos, y de 1.518 a 1.639 kcal/día en los menús triturados. La proteína media varió de 71,4 a 75,4 g/día, de 72,6 a 76,1 g/día, y de 50,5 a 54,7 g/día, respectivamente. Ninguno de los menús cumplió las recomendaciones de fibra, potasio, magnesio, yodo, vitaminas D y E y folato, ni de verduras, fruta, productos lácteos, aceite de oliva, legumbres o frutos secos. Conclusiones: es necesario asegurar la implementación de protocolos de actuación que permitan controlar la calidad de las comidas y el servicio de las mismas, así como el valor nutricional de los menús ofertados en las residencias (AU)

Evaluación de Nutrire(R): una herramienta on-line para realizar estudios de evaluación del estado nutricional / Evaluation of Nutrire(R): An On-Line Tool for Carrying Out Evaluation Studies to Assess Nutritional Status

Introducción: Nutrire(R) es un programa informático, fruto de tres proyectos de innovación docente de la Universidad de Granada (España), que permite la valoración del estado nutricional mediante a partir de parámetros antropométricos, dietéticos y bioquímicos. Objetivo: El objetivo de este trabajo es presentar los resultados obtenidos de la evaluación global del programa por alumnos y egresados para poder analizar sus puntos fuertes y débiles que sirvan con posterioridad para realizar las modificaciones oportunas. Material y Métodos: Se ha realizado una encuesta anónima a 128 alumnos de 3 titulaciones de grado y 1 de postgrado de la Universidad de Granada. Se incluye 6 preguntas sobre navegabilidad y diseño y 5 sobre contenidos académicos del programa. Asimismo, se han entrevistado a 20 egresados que lo han utilizado en su actividad profesional. Resultados: La puntuación media obtenida en los alumnos fue de 4,1 sobre 5. Como aspectos positivos destacan: facilidad de uso, incorporación de fotografías de alimentos para elegir el tamaño de ración/ porción. Como aspectos de mejora señalan: incorporar más fotos de alimentos, el poder instalar el programa para su uso en un ordenador. Según los egresados, el principal punto fuerte es tener reunido en un solo programa los tres aspectos de la evaluación del estado nutricional. Como puntos débiles señalan la falta de algún nutriente, como los azucares, en la base de datos nutricional. Conclusión: Nutrire(R) es un programa de fácil utilización, muy bien valorada por los alumnos y por los egresados para realizar estudios de evaluación del estado nutricional

Introduction: Nutrire(R) is a computer programme, a product of three innovation teaching projects of the University of Granada (Spain), designed to carry out the assessment of the nutritional status by anthropometric, dietetic and biochemical parameters. Objectives: The main aim of this study is to present its overall results and to analyze its strengths and weaknesses and to carry out the modifications to improve the programme. Material and Method: An anonymous survey was carried out on 128 students from three different degrees and one the Master’s degree. The survey included 6 questions on navigability and design and 5 about the academic content of the programme. Twenty post-graduates who had used the programme in their professional life were also interviewed. Results and Discussion: The average marking of the students was 4.1 out of 5. The main positive aspects which stood out were the ease of use of the computer programme, and the inclusion of photographs of foodstuffs which facilitated the choice of size of portion when evaluating a diet. Negative aspects that were commented on were the necessity to include more photos of foodstuffs, and the impossibility of using the programme without the internet. According to the post-graduates the main benefit of the programme is to have the three principal aspects of the assessment of the nutritional status. The weak points commented on are that the table showing the composition of the foodstuffs does not give information on simple sugars. Conclusion: Nutrire(R) is an easy tool to use and highly valued by both under-graduates and graduates to evaluate nutritional status

Effect of a Mediterranean Diet Intervention on Dietary Glycemic Load and Dietary Glycemic Index: The PREDIMED Study.

Objective. To compare the one year effect of two dietary interventions with MeDiet on GL and GI in the PREDIMED trial. Methods. Participants were older subjects at high risk for cardiovascular disease. This analysis included 2866 nondiabetic subjects. Diet was assessed with a validated 137-item food frequency questionnaire (FFQ). The GI of each FFQ item was assigned by a 5-step methodology using the International Tables of GI and GL Values. Generalized linear models were fitted to assess the relationship between the intervention group and dietary GL and GI at one year of follow-up, using control group as reference. Results. Multivariate-adjusted models showed an inverse association between GL and MeDiet + extra virgin olive oil (EVOO) group: ß = -8.52 (95% CI: -10.83 to -6.20) and MeDiet + Nuts group: ß = -10.34 (95% CI: -12.69 to -8.00), when comparing with control group. Regarding GI, ß = -0.93 (95% CI: -1.38 to -0.49) for MeDiet + EVOO, ß = -1.06 (95% CI: -1.51 to -0.62) for MeDiet + Nuts when comparing with control group. Conclusion. Dietary intervention with MeDiet supplemented with EVOO or nuts lowers dietary GL and GI.