Relationship between frailty, nutrition, body composition, quality of life, and gender in institutionalized older people.

Our aim was to explore the relationship between frailty, nutrition, body composition, and how gender modifies this relationship among long-term care facility residents. We further investigated how body composition correlates with health-related quality of life (HRQoL) in both genders. In all, 549 residents (> 65 years of age) were recruited from 17 long-term care facilities for this cross-sectional study. Demographic information, diagnoses, use of medications, and nutritional supplements were retrieved from medical records. Participants' frailty status, cognition, nutritional status, HRQoL, and body composition were determined. Energy, protein, and fat intakes were retrieved from 1- to 2-day food diaries. The final sample consisted of 300 residents (77% women, mean age 83 years). The majority of participants, 62% of women and 63% of men, were identified as frail. Frail participants in both genders showed lower body mass index (p = 0.0013), muscle mass (MM) (p < 0.001), poorer nutritional status (p = 0.0012), cognition (p = 0.0021), and lower HRQoL (p < 0.001) than did prefrail participants. Women had higher fat mass, whereas men exhibited higher MM. The HRQoL correlated with the MM in both women, r = 0.48 [95% CI 0.38, 0.57] and men r = 0.49 [95% CI 0.38, 0.58]. Interventions aimed at strengthening and retaining MM of long-term residents may also support their HRQoL.

Associations between Nutritional Status, Frailty and Health-Related Quality of Life among Older Long-Term Care Residents in Helsinki.

OBJECTIVES: The aim of this study was to examine how nutritional status modifies the association between frailty and health-related quality of life (HRQoL) among older nursing home residents. We also investigated how residents' energy intake is linked to frailty score. DESIGN AND PARTICIPANTS: A total of 486 older (> 65 years of age) nursing home residents living in Helsinki, Finland were included to this cross-sectional study. METHODS: We collected data on the residents' background information, HRQoL by 15D, nutritional status by Mini Nutritional Assessment (MNA), frailty status (Fried's phenotype criteria; pre-frail: 1-2 criteria and frail: 3-5) and energy intake (one- or two-day food records). RESULTS: The frail residents were more often malnourished and had lower HRQoL than those in the prefrail group. Energy and protein intakes were significantly lower among frail women than prefrail women. Energy intake was linearly associated with frailty points. When residents in the frail and prefrail groups were divided according to their nutritional status, both nutritional status and frailty were associated with HRQoL, but there was no interaction. CONCLUSIONS: Both nutritional status and frailty were associated with HRQoL, and lower energy intake indicated a higher frailty score. An adequate energy intake may promote residents' HRQoL and prevent frailty in long-term care.

Associations between Nutritional Status and Health-Related Quality of Life among Long-Term Care Residents in Helsinki.

OBJECTIVES: We evaluated the associations between nutritional status and health-related quality-of-life (HRQoL) among older long-term care residents in Helsinki. DESIGN AND PARTICIPANTS: All 3767 older (≥65 years) long-term care residents in Helsinki in 2017 were invited to participate in this cross-sectional study. After refusals and exclusions of residents without sufficient information, 2160 residents remained. MEASUREMENTS: Data on characteristics, nutritional status (Mini Nutritional Assessment, MNA) and HRQoL (15D) were collected by trained nurses. RESULTS: Of the participants, 64% were at-risk of malnutrition and 18% suffered from malnutrition. Residents in the "malnourished" group were more dependent in activities of daily living (ADL) functioning, suffered more often from dementia, had lower cognitive level, used less medications, and were eating more often inadequately. HRQoL was statistically significantly associated with MNA total score in both female and male residents. There was a curvilinear correlation between MNA and 15D score in females: 0.50 (95% CI 0.46 to 0.53) and males: 0.56 (95% CI 0.50 to 0.61). In partial correlation analysis, all dimensions of 15D, except for sleeping and breathing, were positively associated with MNA score. In these analyses no significant differences emerged between males and females when the results were adjusted for age and dementia. CONCLUSIONS: Nutrition plays an important role in HRQoL among older long-term care residents.

Localization and concentrations of beta-endorphin and beta-lipotrophin in human placenta.

Immunohistochemical staining of placental tissue for beta-endorphin immunoreactivity was positive in the syncytiotrophoblast in both early and term pregnancy. Cation-exchange liquid chromatography and radioimmunoassay revealed peaks of beta-endorphin and beta-lipotrophin and a third immunoreactive peak of unknown nature. The concentration of beta-endorphin was higher in the placental tissue than it was in the maternal or cord plasma. beta-Lipotrophin was not detected in all placentae studied. We did not find any effect of gestational age on tissue concentrations of endorphins in the placenta, nor was there any significant difference in the placental endorphin content between placentae collected at elective caesarean section before labour and after spontaneous vaginal delivery.

Beta-endorphin in maternal and umbilical cord plasma at elective cesarean section and in spontaneous labor.

Concentration of beta-endorphin in relation to the mode of delivery and anesthesia was studied in maternal and umbilical cord plasma in 30 healthy women at term pregnancy. At elective cesarean section under epidural anesthesia, the mean maternal beta-endorphin level rose from 9.8 +/- 2.7 pmol/L (SE) before induction to 15.5 +/- 3.7 pmol/L at the time of delivery (P less than .02). Under general anesthesia the mean beta-endorphin level increased more, from 14.6 +/- 7.2 to 34.4 +/- 7.8 pmol/L (P less than .02), reaching the mean beta-endorphin value of the second stage of normal labor, 39.4 +/- 7.0 pmol/L. In the cord arterial and venous plasma, the mean beta-endorphin value was significantly higher after spontaneous labor (40.9 +/- 11 and 40.1 +/- 9.2 pmol/L, respectively) than at elective cesarean section under epidural (14.3 +/- 1.9 and 12.4 +/- 3.6 pmol/L, respectively) or general anesthesia (11.9 +/- 2.2 and 13.4 +/- 2.2 pmol/L, respectively). Thus cesarean section under general anesthesia proved to be more stressful for the mother than that under epidural anesthesia, when beta-endorphin release is used as the measure of stress. The mode of anesthesia did not seem to influence the plasma beta-endorphin level in the newborn infant. Normal delivery by vaginal route increased the release of beta-endorphin both to the maternal and the fetoplacental circulation.

Pain and plasma beta-endorphin level during labor.

Plasma concentration of beta-endorphin was observed during labor in 16 women and correlated with pain assessed subjectively using pain scores. Ten women did not receive any medication during the follow-up. A concomitant increase in pain score and plasma beta-endorphin level was found with advancing labor. In the remaining six women, epidural anesthesia was used to relieve pain. During epidural anesthesia, plasma beta-endorphin levels and pain scores decreased concomitantly. The same effect was found after a repeated dose of the anesthetic. These findings showed a correlation between pain and the secretion of beta-endorphin during labor, but the mode of action of beta-endorphin remains unsolved.

Beta-endorphin and beta-lipotrophin in human ovary.

The presence of beta-endorphin (beta-E) and beta-lipotrophin (beta-LPH) in human ovary was studied by liquid chromatography and radioimmunoassay, and by immunoperoxidase staining. The mean concentrations (+/- S.E., N=8) of beta-E and beta-LPH in follicular fluid samples collected during the late follicular phase of normal cycles were 1.9 +/- 0.4 pmol/l and 2.9 +/- 0.8 pmol/l, respectively. After hyperstimulation with clomiphene and gonadotropin for in vitro fertilization, the mean concentrations of beta-E and beta-LPH in follicular fluid did not increase significantly, being 3.2 +/- 0.6 and 4.1 +/- 1.0 pmol/l, respectively (N=13). beta-E or beta-LPH were not found in three corpora lutea analysed. Immunohistochemical staining of ovarian tissue did not reveal any beta-E immunoreactivity. Thus the origin of beta-E and beta-LPH in the follicular fluid remained unclear. In 7 women, blood samples were collected from the peripheral and ovarian veins at laparotomy. No significant concentration excess of beta-E or beta-LPH was found in the ovarian venous plasma, suggesting that human ovaries do not secrete significant amounts of beta-E or beta-LPH into the peripheral circulation. It seems that the role of endorphins in the human ovary is less significant than previously proposed for sheep, rat or mouse ovary.

Immunoreactive corticotropin-releasing factor and corticotropin during pregnancy, labor and puerperium.

Concentrations of immunoreactive corticotropin releasing factor (CRF) and corticotropin (ACTH) in the plasma were studied in healthy pregnant women. Concentration of CRF was near the detection limit of the assay (2.5 pmol/l) until the 16th week of pregnancy, increasing thereafter significantly towards term: the mean values (+/- S.E.) at weeks 8-11, 12-15, 16-19, 20-23, 24-27, 28-31, 32-35, and 36-40 were 2.9 +/- 0.42, 2.9 +/- 0.72, 5.2 +/- 1.1, 10.2 +/- 5.8, 14.6 +/- 2.0, 32.8 +/- 4.8, 63.6 +/- 9.2, and 187 +/- 39 pmol/l, respectively. The mean concentration of CRF did not increase during labor, and it decreased rapidly after delivery. On the contrary, the mean plasma level of ACTH increased only slightly during late pregnancy, but during labor the increase was significant. These findings suggest that CRF in maternal circulation is not primarily involved in the regulation of maternal ACTH secretion, and the stress of labor does not increase the release of CRF, which probably originates mainly from the placenta.

Plasma corticotropin-releasing hormone, corticotropin, and endorphins at rest and during exercise in eumenorrheic and amenorrheic athletes.

The hypothalamic-pituitary response to exercise was studied in 12 amenorrheic and in 9 eumenorrheic athletes by comparing the concentrations of corticotropin-releasing hormone (CRH), corticotropin (ACTH), and endorphins (beta-endorphin + beta-lipotropin) in plasma at rest and during an acute exercise on a bicycle ergometer requiring 80% and 100% of the maximal oxygen uptake (VO2 max). Plasma CRH levels did not change during the exercise, and the mean CRH values did not differ between the amenorrheic and eumenorrheic groups. In both groups, significant increases in the response to exercise were found in the concentrations of ACTH and endorphins. The only significant difference between the groups was a larger mean pre-exercise concentration of endorphins in amenorrheic than in eumenorrheic athletes (4.8 +/- 0.8 standard error [SE] and 2.9 +/- 0.2 pmol/l, respectively). It is concluded that in amenorrheic athletes the capacity of the anterior pituitary to secrete ACTH and endorphins in response to exercise does not significantly differ from that in eumenorrheic athletes, although basal endorphin secretion may be increased.

Plasma beta-endorphin and the menstrual cycle.

beta-Endorphin (beta-E) takes part in the regulation of luteinizing hormone (LH) and prolactin secretion, but little is known about its role in the menstrual cycle. Using a specific assay, plasma concentration of beta-E was followed in healthy women in the periovulatory period and before and during menstruation. The mean concentration of beta-E in the eight women studied showed an increase at the midcycle, being 3.2 +/- 0.5 (standard error) pmol/l on day LH -1 and rising to 4.6 +/- 0.7 pmol/l on day LH 0 and further to 7.5 +/- 1.2 pmol/l on day LH +1. Thereafter, the mean beta-E level remained at 5.3 +/- 0.8 pmol/l and 5.2 +/- 0.4 pmol/l on days LH +2 and LH +3, respectively. Ten additional women were studied before and during menstruation. The highest mean plasma concentration of beta-E, 5.1 +/- 0.9 pmol/l, was found at the onset of menstruation, declining to 3.3 +/- 0.6 pmol/l and 2.9 +/- 0.6 pmol/l on the second and fifth days of menstruation, respectively. These findings suggest that beta-E secretion increases at the time of ovulation. At the onset of menstruation, pain may increase endorphin secretion.

Immunoreactive beta-endorphin is demonstrable in the secretory but not in the proliferative endometrium.

The presence of immunoreactive beta-endorphin (ir beta-E) in the endometrium was studied by immunoperoxidase staining of tissue sections at various stages of the menstrual cycle. Ir beta-E was found in the endometrium during the secretory phase of the cycle, from the fourth postovulatory day to the desquamating phase, but not in the proliferative phase or during the first three postovulatory days of the cycle. Ir beta-E was located in the cytoplasm of the epithelial cells of the glands. Samples of endometrium were homogenized, and peptides were extracted with Sep Pak C18 cartridge, followed by purification of ir beta-E by cation-exchange high-pressure liquid chromatography. In samples of secretory endometrium, a peak of ir beta-E was found with identical location of that of reference beta-E. The concentration of ir beta-E in the secretory endometrium varied from 5.0 to 12.6 pg/g of tissue. The appearance of ir beta-E in the endometrium during the secretory phase may have importance in the early events of reproduction.

Beta-endorphin and corticotropin release is dependent on a threshold intensity of running exercise in male endurance athletes.

Relationship between the intensity of running exercise on a treadmill and the changes in the concentrations of beta-endorphin + beta-lipotropin (beta-E + beta-LPH) and adrenocorticotropic hormone (ACTH) in plasma were studied in 10 experienced male endurance athletes. At random order, the subjects run on a treadmill six exercises which required on an average (mean +/- S.E.) 50 +/- 0.8%, 58 +/- 0.8%, 69 +/- 1.1%, 80 +/- 0.7%, 92 +/- 1.0% and 98 +/- 0.5% of their maximal oxygen consumption. Plasma levels of beta-E + beta-LPH and ACTH did not show any significant changes during the 50-80%-tests. During the 92% test, the mean levels (+/- S.E.) of beta-E + beta-LPH and ACTH increased significantly (p less than 0.001), from 3.0 +/- 0.4 to 8.0 +/- 1.2 pmol/l and from 3.1 +/- 0.5 to 8.9 +/- 1.3 pmol/l, respectively, and during the 98% test, from 3.7 +/- 0.6 pmol/l to 20.4 +/- 1.5 pmol/l, and from 3.6 +/- 0.6 to 21.8 +/- 1.5 pmol/l, respectively. Increases in the plasma levels of beta-E + beta-LPH and ACTH were always accompanied by an increase in the blood lactate level. We conclude that intensive running with an anaerobic response causes an increase in the concentrations of beta-endorphin and ACTH in plasma in endurance athletes, whereas slight aerobic exercise did not elicit any response.

Response of plasma endorphins to running exercises in male and female endurance athletes.

We studied the responses of plasma concentrations of beta-endorphin, beta-lipotropin, and corticotropin to an exhaustive graded treadmill exercise, to an anaerobic treadmill exercise, and to a sub-maximal outdoor running exercise in 5 male and in 5 female endurance athletes. During the graded treadmill exercise, the mean plasma level (+/- SE) of beta-endorphin in men rose from 1.2 +/- 0.1 to 8.1 +/- 0.7 pmol.l-1, beta-lipotropin rose from 1.6 +/- 0.5 to 7.4 +/- 1.4 pmol.l-1, and corticotropin rose from 4.9 +/- 1.0 to 31 +/- 3.3 pmol.l-1. In women, the mean level of beta-endorphin rose from 1.2 +/- 0.2 to 8.2 +/- 1.8 pmol.l-1, beta-lipotropin rose from 1.4 +/- 0.1 to 8.1 +/- 2.0 pmol.l-1, and corticotropin rose from 3.3 +/- 0.4 to 28 +/- 7.9 pmol.l-1. Concentrations of endorphins and corticotropin increased significantly also during the anaerobic exercise test. In response to sub-maximal running exercise, no significant change was found. These results showed a relationship between the intensity of exercise and the secretion of pro-opiomelanocortin-related peptides, and there were no differences between the groups of trained men and women.

Plasma endogenous opioids and dexamethasone suppression test in depression.

Plasma levels of beta-endorphin plus beta-lipotropin were determined in 35 hospital patients with depression and in 23 controls before and after administration of 1 mg of dexamethasone (dxm). Dxm suppressed opioid secretion in both groups. The opioid levels of the patients were significantly higher than those of the controls both before and after dxm. All the controls were cortisol suppressors. Among the patients the post-dxm opioid levels of cortisol nonsuppressors (n = 14) were higher than those of cortisol suppressors (n = 21). A significant correlation between the opioid and cortisol levels was found in the patients. There was a significant association between the use of neuroleptics and high opioid levels, but the difference between the patients and the controls was not explained by the effect of any single class of drugs. The results support the concept of hypersecretion of corticotropin-releasing factor in depression.

Response of plasma immunoreactive beta-endorphin and corticotropin to isometric exercise in uncomplicated pregnancy and in pregnancy-induced hypertension.

The response of plasma immunoreactive beta-endorphin (ir-beta E) and corticotropin to isometric exercise was studied in 10 women with pregnancy-induced hypertension (PIH) and in nine healthy women subjected to a handgrip test in the third trimester of gestation. The mean basal concentration of corticotropin was higher in the PIH than in the control group, 3.8 +/- 0.3 (SE) pmol/l and 2.2 +/- 0.2 pmol/l, respectively (p = 0.002). No significant difference was found in the basal ir-beta E level, 6.9 +/- 0.9 pmol/l and 6.1 +/- 1.0 pmol/l, respectively. In response to the handgrip test, the corticotropin and ir-beta E concentrations rose significantly in all subjects (p = 0.001 and p = 0.02, respectively) without any significant differences between the groups. These findings indicate that an isometric exercise is sufficient to increase the secretion of ir-beta E and corticotropin during pregnancy. Increased basal concentration of corticotropin in women with PIH may be explained by significantly increased circulating corticotropin-releasing hormone, 1451 +/- 323 pmol/l, as compared to 528 +/- 190 pmol/l in the control group.

Plasma beta-endorphin, beta-lipotropin and corticotropin in polycystic ovarian disease.

In 9 women with polycystic ovarian disease (PCOD) and in 11 control subjects at the follicular phase of the normal cycle, blood samples were collected at 15-min intervals during a 2 h period of bed rest for the assay of beta-endorphin, beta-lipotropin, corticotropin, cortisol and prolactin. During the study period, the plasma levels of these hormones decreased more significantly in the PCOD than in the control group, suggesting that the PCOD patients had a more significant stress response to the puncture of the vein than the control subjects. The second hour of the study period was considered to represent resting levels of hormones. The mean resting levels (+/- S.E.) of the hormones between the PCOD and control groups, respectively, were as follows: beta-E, 2.0 +/- 0.4 vs. 1.1 +/- 0.1 pmol/l, p less than 0.05; beta-LPH, 3.4 +/- 0.6 vs. 2.1 +/- 0.5 pmol/l, N.S.; corticotropin, 2.0 +/- 0.3 vs. 1.1 +/- 0.5 pmol/l, p less than 0.05; cortisol, 176 +/- 24 vs. 128 +/- 16, N.S.; and prolactin; 3.9 +/- 0.6 vs. 5.6 +/- 1.2 ng/ml, N.S. These results confirm the previous findings on increased circulating levels of beta-E in PCOD. A concomitant increase of the plasma level of corticotropin suggests that the basal secretion of both beta-E and corticotropin from the anterior pituitary gland is increased in women with PCOD.

High-performance liquid chromatographic determination of tocopherols and tocotrienols and its application to diets and plasma of Finnish men. I. Analytical method.

A HPLC Method is described for the determination of tocopherols and tocotrienols in human diets and plasma. After a room-temperature saponification diet samples were extracted with n-hexane. A direct hexane extraction was used for plasma samples. Using a normal-phase column at elevated temperature and a fluorescence detector complete separation of all four tocopherols, alpha-, beta-, gamma-tocotrienols and BHA and good reproducibility and sensitivity were obtained. The recovery of tocopherols added to diet samples was 99% for alpha-tocopherol, 95% for beta-tocopherol, 99% for gamma-tocopherol and 80% for delta-tocopherol. The recovery of alpha-tocopherol added into plasma was 99%.

Tocopherols and tocotrienols in Finnish foods: human milk and infant formulas.

Individual tocopherols and tocotrienols in human milk, mother's milk substitutes and other infant formulas have been determined by an HPLC method. 107 human milk samples (23 colostral, 22 transitional and 62 mature) obtained from six healthy mothers throughout the lactation were found to contain all the tocopherols, although delta-tocopherol occurred only in traces. A high content of alpha-tocopherol was found in colostrum (average 1.90 +/- 1.62 (SD) mg/100 g), as compared with transitional (0.65 +/- 0.22 mg/100 g) and mature milk (0.47 +/- 0.16 mg/100 g). The content of beta-tocopherol averaged 0.05 +/- 0.03, 0.02 +/- 0.01 and 0.02 +/- 0.01 and gamma-tocopherol 0.11 +/- 0.09, 0.07 +/- 0.04 and 0.07 +/- 0.04 mg/100 g in colostral, transitional and mature milk respectively. The alpha-tocopherol equivalents thus were 1.93, 0.66 and 0.49 mg/100 g; their ratios to the contents of polyunsaturated fatty acids meet the nutritional need of the newborn and young infant: 5.7, 2.1 and 1.4 mg/g in colostral, transitional and mature milk. Mother's milk substitutes and gruel and porridge powders are enriched with tocopherol acetate to vitamin E levels similar to or higher than those in human milk: substitutes contained on average 1.4 mg alpha-tocopherol equivalents/100 g and reconstituted powders 1.1 mg/100 g. The ratio of vitamin E to polyunsaturated fatty acids of these infant formulas was higher than the recommended value of 0.6 mg/g. The average values for alpha-tocopherol equivalents in fruit-berry and meat-vegetable infant formulas were 0.46 and 0.38 mg/100 g.

High-performance liquid chromatographic determination of tocopherols and tocotrienols and its application to diets and plasma of Finnish men. II. Applications.

The composed one-day diets and plasma of 40 Finnish men screened for a selenium supplementation study were analyzed for tocopherols and tocotrienols. The men were divided into a low-Se group (in the screening phase plasma Se levels less than 70 micrograms/l and plasma alpha-tocopherol levels less than 1.2 mg/100 ml) and a high-Se group (plasma Se greater than 70 micrograms/l, plasma alpha-tocopherol not determined before the study). In the low-Se group plasma levels of alpha-tocopherol averaged 0.97 +/- 0.18 mg/100 ml. The daily dietary intake of alpha-tocopherol was 6.1 +/- 2.7 mg and that of total vitamin E 7.3 +/- 3.1 mg of alpha-tocopherol equivalents. In the high-Se group the corresponding average values were 1.16 +/- 0.21 mg of alpha-tocopherol/100 ml of plasma, 8.8 +/- 4.3 mg of alpha-tocopherol/day and 10.3 +/- 5.1 mg of alpha-tocopherol equivalents/day. The overall average for the contribution of alpha-tocopherol to the total dietary tocopherols was 44.6 +/- 11.0%. In the plasma samples alpha-tocopherol accounted for 92.0 +/- 2.1%, beta-tocopherol for 2.7 +/- 0.7% and gamma-tocopherol for 5.3 +/- 2.1% of the total amount of tocopherols.