Body composition affects the accuracy of predictive equations to estimate resting energy expenditure in older adults: An exploratory study.

BACKGROUND: To investigate the accuracy of ten different predictive equations to estimate resting energy expenditure (REE) in a sample of Brazilian older adults and develop a predictive equation for estimating REE based on body composition data. METHODS: A cross-sectional study with thirty-eight Brazilian older adults aged 60-84 years, who had their REE measured by indirect calorimetry (IC) and BC assessed by dual-energy x-ray absorptiometry (DXA). REE was compared to the estimation of ten predictive equations, and the differences between BC and anthropometric-based equations were investigated using Bland-Altman plots and Lin's concordance correlation. Accuracy was evaluated considering ±10% of the ratio between estimated and measured REE. RESULTS: The sample was composed of 57.9% men, with a mean age of 68.1 (5.8) years, and a mean REE by IC of 1528 (451) kcal. The highest accuracy was 47.4% obtained by Luhrmann and Fredrix equations, and the lowest accuracy was 13.2% reached by Weigle equation. In general, the proportion of underestimation was higher than overestimation. All anthropometric-based equations presented a good agreement with REE from IC. For those equations derived from BC, however, three of them reached only a moderate agreement. In terms of accuracy, all equations presented lower than 50% of accurate prediction of REE. CONCLUSIONS: In this sample of older adults, previous predictive equations to estimate REE did not show good accuracy, and those based on BC presented even worse results, showing that changes in BC related to aging could impact the accuracy of these equations.

Factors related to malnutrition and their association with frailty in community-dwelling older adults registered at a geriatric clinic.

BACKGROUND: We hypothesized that factors related to malnutrition, namely low muscle mass, appetite loss, and adiposity, are associated with frailty and pre-frailty in community-dwelling older adults. AIMS: To identify the prevalence of frailty and pre-frailty in a Brazilian convenience sample and test the association between these conditions and malnutrition-related factors. METHODS: This is a cross-sectional analysis of an ongoing community project. We studied 106 older adults (≥60 years old). Frailty (dependent variable) was screened using the FRAIL-BR scale. The independent variables were appetite loss (AL), screened from the SNAQ questionnaire; sarcopenia risk, investigated by SARC-F; body adiposity, estimated by the body mass index (BMI); visceral adiposity, estimated by waist circumference (WC) and the combination of these two indicators. The associations were investigated using multinomial logistic regression models. MAIN RESULTS: We found, from our sample, 30.2 % pre-frail and 31.1 % frail participants. The frail and pre-frail were older than the non-frail; the frail ones presented a higher proportion of sarcopenia risk and a higher proportion of AL. From the multiple regression models, frailty conditions showed significant association with the AL (OR = 0.68; p = 0.012 and OR = 0.64; p = 0.009 for pre-frail and frail, respectively) and with sarcopenia risk (OR = 3.24; p = 0.001 and OR = 5.34; p < 0.011 for pre-frail and frail respectively). The adiposity indicated by waist circumference, and age, remained in the final model only as adjusting variables but without statistical significance. CONCLUSIONS: in our convenience sample of older adults, frailty and pre-frailty showed significant association with appetite loss and sarcopenia risk, but not with adiposity indicators. Future studies are needed to better understand our findings.

The association between appetite loss, frailty, and psychosocial factors in community-dwelling older adults adults.

BACKGROUND: Appetite loss (AL) in older adults can reduce energy and nutrient intake, increasing the risk of weight loss, sarcopenia, frailty, and ultimately, mortality. The identification of associated factors to AL is important to plan different interventions. AIMS: To identify the association between appetite loss, frailty, and psychosocial factors in community-dwelling older adults. METHODS: Cross-sectional analysis of the cohort study MiMiCS-FRAIL based in Jundiai City, São Paulo, Brazil. Patients 60+ years old were evaluated from January 2019 to August 2020. The AL (dependent variable) was evaluated through the SNAQ questionnaire; the independent variables were: frailty (identified by frailty index-36; FI-36) which is based on the accumulation of deficits; depressive symptoms (GDS scale); ethnicity, and years of formal schooling, both used as proxies of socioeconomic status. The associations were investigated using logistic regression models (crude and multiple). MAIN RESULTS: The final sample included 122 older adults, 58.2% of women, mean age of 71.7 years, 80.3% White, and low educational level (5.8 ± 4.3 years of formal schooling). We found 19.6% of the sample presenting AL. The final regression models showed independent and significant association between AL and age (OR = 1.11; 95%IC = 1.03-1.20; p < 0.01), being non-White (OR = 6.47; 95%IC = 1.63-25.58; p < 0.01), and presence of depressive symptoms (OR = 8.38; 95%IC = 2.31-30.47; p < 0.01). However, years of formal schooling, gender, and FI-36 remained statistically non-significant in the model. CONCLUSION: Our data pointed to the presence of depressive symptoms and social variables as significant factors associated with AL. Further studies with more robust samples or longitudinal design will clarify some unanswered questions of our study.

O ambiente inflamatório e os acometimentos de saúde em pessoas em idades relacionadas à menopausa e à andropausa / The inflammatory environment and health involvments in persons in ages related to menopause and andropause

Introdução: O aumento da expectativa de vida da população faz com que as pessoas passem a viver por mais tempo com doenças crônicas não transmissíveis (DCNT). Dentre as mulheres, as fases da vida que mais se destacam pelos acometimentos em saúde são aquelas relacionadas à menopausa; além do risco aumentado para o desenvolvimento da síndrome metabólica (SM), há destaque para os transtornos mentais comuns (TMC) e as doenças articulares (DA). Já entre os homens, uma vez que a andropausa não é tão claramente identificada como a menopausa, acaba-se atribuindo essa ocorrência à idade e às baixas concentrações séricas de testosterona. Todavia, em ambos os sexos, um processo de inflamação sistêmica crônica e de baixo grau (ISBG) tem sido apontado como um importante fator associado ao desenvolvimento e agravo de todas as condições acima mencionadas. A ISBG decorre de alterações próprias do envelhecimento no sistema imune (SI), particularmente a imunossenescência, mas também por outros fatores externos ao SI, em especial as modificações na gordura corporal e no ambiente intestinal. Nesse contexto, estudar a relação e fatores associados a essas condições permite o delineamento de estratégias de intervenção em saúde. Objetivos: Investigar, em pessoas a partir 40 anos de idade, a prevalência e as associações entre desfechos em saúde relacionados a DCNT, incluindo fatores relacionados à ISBG. Métodos: O presente estudo, que consistiu na elaboração de três manuscritos, foi desenvolvido a partir de dados do Inquérito de Saúde de São Paulo de 2015, um estudo transversal, de base populacional e com amostra representativa dos moradores da área urbana do município de São Paulo. No primeiro manuscrito, foi investigada a associação entre a presença de TMC, DA, Índice de massa corporal (IMC) e outras doenças crônicas. As análises incluíram também dados sociodemográficos (idade, escolaridade, raça/etnia); essas associações foram testadas por modelos de regressão logística múltipla. No segundo manuscrito foram testadas as associações entre TMC e DA com o potencial inflamatório da dieta (identificado a partir do cálculo do Índice Inflamatório da Dieta), o nível de atividade física (utilizando o International Physical Activity Questionnaire- IPAq) classificado conforme recomendação da Organização Mundial da Saúde (OMS), a presença de outras doenças crônicas e o IMC. As análises também incluíram variáveis sociodemográficas (faixa etária, escolaridade, raça/etnia). O terceiro manuscrito consistiu em uma subamostra não representativa do banco de dados do estudo ISA, com participantes que tiveram a composição corporal avaliada por DEXA (raios-x de dupla energia), de onde se obteve a massa magra apendicular e o total de gordura corporal. Foi também avaliada a força de preensão manual, que determina a qualidade do músculo esquelético. Foi realizada a dosagem de marcadores inflamatórios (TNF-α) e de permeabilidade intestinal (LPS, zonulina e iFABP). Ainda, esses participantes tiveram realizadas as dosagens de HDL-c plasmático, glicemia de jejum e triacilglicerol, além das medidas de pressão arterial. Esses parâmetros foram utilizados para a classificação da síndrome metabólica (SM). As associações, mediações e direções entre essas variáveis foram testadas a partir de modelos generalizados de equações estruturais. Principais Resultados: Manuscrito 1. A prevalência de TMC entre as mulheres investigadas no estudo esteve entre 26,9% e 38,0%, a de DA ficou entre 18,7% e 31,1%. Foram encontradas associações entre TMC e DA (OR = 1,998; p<0,001), idade entre 56 e 60 anos (OR= 0,542; p=0,018), e a presença de três diagnósticos de outras doenças crônicas não transmissíveis (OR= 2,696; p= 0,027). Manuscrito 2. Avaliando simultaneamente as associações entre TCM, DA, potencial inflamatório da dieta, e o nível de atividade física, observou-se que as associações entre TMC, DA e número de diagnósticos de outras doenças crônicas foram mantidas, e o maior tercil do escore do índice inflamatório da dieta se mostrou positivamente associado a presença de TCM (OR=2,240; p=0,006). O nível de atividade física não apresentou significância, porém permaneceu ajustando os modelos. Manuscrito 3. A síndrome metabólica foi identificada em 45,8% dos participantes, e associações diretas foram observadas entre TNF-α e massa gorda corporal, e entre a permeabilidade intestinal e a massa muscular apendicular. Conclusões: Os resultados aqui apresentados confirmaram uma associação significativa entre transtornos mentais e aspectos inflamatórios, representados pela presença de doenças articulares e outras doenças crônicas, além do potencial inflamatório da dieta. A atividade física mostrou uma associação marginal protetora em relação à inflamação sistêmica e consequentemente aos transtornos mentais. Finalmente, componentes da composição corporal, massa gorda e massa magra apendicular, se mostraram diretamente associados a marcadores inflamatórios e a presença de síndrome metabólica.

Background: The increase in population life expectancy allows individuals to live longer time periods with noncommunicable diseases (NCD). Among women, the life phases that stand out the most by the health compliment are those related to menopause, with emphasis to the common mental disorders (CMD), and the joint diseases (JD), and an increased risk for the metabolic syndrome presentation. Among men, once andropause is not as clearly identified as menopause, the occurrence of these conditions is attributed to age and to the low level of circulating testosterone. The called low-grade systemic inflammation (LGSI) has been pointed as an important factor associated to the development and worsening of all the mentioned conditions. The LGSI results from the immune system (IS) proper alterations, but also from factor aside IS, especially the body fat and gut environment changes. In this context, investigating the relations and factors associated to those conditions allows designing health intervention strategies. Aims: To investigate, in persons aged 40+ years old, the prevalence and associations between CMD related outcomes, with emphasis on the factors associated to the LGSI. Methods: The present study, which is constituted of three manuscript elaboration, was developed from data of the 205 Health Survey of São Paulo, a population-based cross-sectional study, with representative sample of urban residents of the city of São Paulo. In the first manuscript, associations of CMD, JD, and other chronic conditions, and body mass index (BMI), were investigated. The analysis also included sociodemographic data (age, schooling, race/ethnicity); these associations were testes by multiple logistic regression models. In the second manuscript, associations were tested between CMD and JD, with the inflammatory potential of the diet (identified from the Dietary Inflammatory Index calculation), the leisure physical activity level [classified according to WHO (World Health Organization) proposition using the International Physical Activity Questionnaire- IPAq], the presence of other chronic conditions and BMI. Analysis also included sociodemographic variables (age intervals, schooling, race/ethnicity). Third manuscript consisted of a sub-sample, which was not representative of the Health Survey of São Paulo, with participants who had their body composition evaluated by DXA (dual energy x-ray), from which appendicular muscle mass and total body fat were obtained. Also, handgrip strength, that determinate skeletal muscle quality, was evaluated. Inflammatory (TNF-α) and gut permeability (LPS, zonulin and iFABP) were evaluated. Yet, these participants had plasmatic HDL-c, fasting blood glucose and triacylglycerol, and arterial blood pressure evaluated. These parameters were used for the metabolic syndrome (MS) classification. Associations, mediations, and directions among those variables were tested by Generalized Structural Equation Models. Main results: Manuscript 1. The prevalence of CMD among investigated women was found between 26.9% and 38.0%, and from 18.7% to 31.1% for JD. Associations were found between CMD and DA (OR= 1.998; p<0.0001), age from 56 to 60 years old (OR= 0.542; p=0,018), and the presence of the diagnostics of three chronic conditions other than JD (OR= 2.696; p=0.027). Manuscript 2. Simultaneously evaluating the associations between CMD, JD, and dietary inflammatory potential, physical activity level, and the number of other chronic conditions diagnosis, and the higher dietary inflammatory index score presented positively associated to the presence of CMD (OR= 2.240; p=0.006). Physical activity level did not present significant associations, but it adjusted the models. Manuscript 3. Metabolic Syndrome was identified in 45.8% of the participants, and direct associations were observed between TNF-α and body fat mass, and from gut permeability and the appendicular muscle mass. Conclusions: The here presented results confirm a significant association between common mental disorders and inflammatory aspects, represented by the presence of joint diseases and other chronic conditions, and also the dietary inflammatory potential. Physical activity presented marginal protective association in relation to systemic inflammation, and consequently to common mental disorders. Finally, body composition components, body fat and appendicular muscle mass, were directly associated to inflammatory markers and to the presence of metabolic syndrome.

Association between joint diseases and common mental disorders in women at ages related to menopause: Data from the São Paulo City Health Survey, SP, Brazil.

OBJECTIVES: To investigate the association between joint diseases (JD) and common mental disorders (CMD) in women at ages related to menopause. STUDY DESIGN: Cross-sectional, population-based study (São Paulo City Health Survey, SP, Brazil). The sample was composed of 1191 women, 40 years and older. MAIN PARAMETERS INVESTIGATED: Dependent variable (outcome): Presence of CMD, investigated by the Self Reporting Questionnaire-20 (SRQ-20). INDEPENDENT VARIABLES: Presence of JD; other self-reported chronic conditions different from JD (OCC); age categories (40-45, 46-50, 51-55, 56-60, 61+ years old); Adjusting variables: years of formal education and ethnicity (skin color), used as proxies of socioeconomic status. The associations were investigated using simple and multiple logistic regression models. MAIN RESULTS: The prevalence of CMD was 30.4%, and JD was 21.4%. Considering only the women presenting CMD, the prevalence of JD was 31.6%. The final regression model showed an independent association between JD and CMD (OR = 1.998; p < 0.001), age between 56 and 60 years (OR = 0.542; p = 0.018), and having three OCC (OR = 2.696; p = 0.027). CONCLUSIONS: Our data showed that JD in women of the ages related to menopause was significantly and independently associated with CMD. Interestingly, the 56 to 60 years' age interval showed a very particular feature, with opposite association's direction, which demands further investigations.

EFFECTS OF SYNBIOTIC SUPPLEMENTATION ON GUT FUNCTIONING AND SYSTEMIC INFLAMMATION OF COMMUNITY-DWELLING ELDERS - SECONDARY ANALYSES FROM A RANDOMIZED CLINICAL TRIAL.

BACKGROUND: Aging is a complex process marked by alterations on gut functioning and physiology, accompanied by an increase on the inflammatory status, leading to a scenario called "inflammaging". OBJECTIVE: To evaluate the effects of a synbiotic substance on systemic inflammation, gut functioning of community-dwelling elders. METHODS: This is a secondary analysis from a randomized clinical trial, lasting 24 weeks, including 49 elders, distributed into two groups: SYN (n=25), which received a synbiotic substance (Frutooligossacaride 6g, Lactobacillus paracasei LPC-31 109 to 108 UFC, Lactobacillus rhamnosus HN001 109 to 108 UFC, Lactobacillus acidophilus NCFM 109 to 108 UFC e Bifidobacterium lactis HN019 109 to 108 UFC), or PLA (n=24), receiving placebo. The evaluations consisted of serum IL-10 e TNF-α (after overnight fasting), evaluation of chronic constipation (by Rome III Criteria) and faeces types (by Bristol Stool Form Scale). Data were compared before and after the supplementation time, and between groups. RESULTS: No significant differences were found between baseline and final values of serum inflammatory markers. Some subtle beneficial changes were observed in SYN, concerning both gut functioning and faeces types. CONCLUSION: From our data, synbiotic supplementation showed a subtle benefit in gut functioning in apparently healthy community-dwelling elders. Our findings can suggest that the benefits in healthy individuals were less expressive than the ones presented in studies with individuals previously diagnosed as dysbiosis. Future studies, comparing elders with and without gut dysbiosis can confirm our findings.

Efeitos da suplementação com simbióticos sobre a função intestinal e a inflamação sistêmica de idosos inseridos na comunidade - análises secundárias de um estudo clínico-randomizado / Effects of synbiotic supplementation on gut functioning and systemic inflammation of community-dwelling elders - secondary analyses from a randomized clinical trial

ABSTRACT BACKGROUND: Aging is a complex process marked by alterations on gut functioning and physiology, accompanied by an increase on the inflammatory status, leading to a scenario called "inflammaging". OBJECTIVE: To evaluate the effects of a synbiotic substance on systemic inflammation, gut functioning of community-dwelling elders. METHODS: This is a secondary analysis from a randomized clinical trial, lasting 24 weeks, including 49 elders, distributed into two groups: SYN (n=25), which received a synbiotic substance (Frutooligossacaride 6g, Lactobacillus paracasei LPC-31 109 to 108 UFC, Lactobacillus rhamnosus HN001 109 to 108 UFC, Lactobacillus acidophilus NCFM 109 to 108 UFC e Bifidobacterium lactis HN019 109 to 108 UFC), or PLA (n=24), receiving placebo. The evaluations consisted of serum IL-10 e TNF-α (after overnight fasting), evaluation of chronic constipation (by Rome III Criteria) and faeces types (by Bristol Stool Form Scale). Data were compared before and after the supplementation time, and between groups. RESULTS: No significant differences were found between baseline and final values of serum inflammatory markers. Some subtle beneficial changes were observed in SYN, concerning both gut functioning and faeces types. CONCLUSION: From our data, synbiotic supplementation showed a subtle benefit in gut functioning in apparently healthy community-dwelling elders. Our findings can suggest that the benefits in healthy individuals were less expressive than the ones presented in studies with individuals previously diagnosed as dysbiosis. Future studies, comparing elders with and without gut dysbiosis can confirm our findings.

RESUMO CONTEXTO: O envelhecimento é um processo complexo marcado por alterações no funcionamento e fisiologia intestinais, acompanhado de alterações no estado inflamatório, o que leva ao quadro denominado inflammaging. OBJETIVO: Avaliar os efeitos de uma substância simbiótica sobre o funcionamento intestinal e a inflamação sistêmica de idosos inseridos na comunidade. MÉTODOS: Trata-se de uma análise secundária de um estudo clínico randomizado, com 24 meses de duração, que incluiu 49 idosos, distribuídos em dois grupos: SIM (n=25), que receberam uma substância simbiótica (Frutooligossacaride 6g, Lactobacillus paracasei LPC-31 109 to 108 UFC, Lactobacillus rhamnosus HN001 109 to 108 UFC, Lactobacillus acidophilus NCFM 109 to 108 UFC e Bifidobacterium lactis HN019 109 to 108 UFC), ou PLA (n=24), que receberam placebo. As avaliações foram realizadas antes e após o período de suplementação, e incluíram: concentrações de IL-10 e TNF-α no soro (após uma noite de jejum); investigação de constipação crônica (pelo Critério de Roma III) e dos tipos de fezes (pela Escala de Bristol). Os dados foram comparados entre antes e após a suplementação, e entre os grupos. RESULTADOS: Não foram encontradas diferenças significativas entre valores iniciais e finais nos marcadores de inflamação; alguns benefícios sutis foram observados no grupo SIM, no funcionamento intestinal e nos tipos de fezes. CONCLUSÃO: A suplementação com simbióticos mostrou um benefício sutil nessa população. Nossos resultados apontam que idosos aparentemente saudáveis não se beneficiam tanto da suplementação de simbióticos quanto pessoas previamente identificadas com disbiose. Estudos futuros, comparando idosos com e sem disbiose poderão confirmar esses achados.