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AN INDIVIDUALIZED LOW-INTENSITY WALKING CLINIC LEADS TO IMPROVEMENT IN FRAILTY CHARACTERISTICS IN OLDER VETERANS

S.E. Espinoza, B. Orsak, C.-P. Wang, D. MacCarthy, D. Kellogg, B. Powers, A. Conde, M. Moris, P.R. Padala, K.P. Padala

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Background: Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging. Objectives: The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty. Design: This was a clinical demonstration project/quality improvement project. Setting: Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS). Participants: Older Veterans, aged ≥60 years. Intervention: A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks. Measurements: Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria. Results: One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13-0.72, p = 0.01). Conclusions: Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.

CITATION:
S.E. Espinoza ; B. Orsak ; C.-p. Wang ; D. MacCarthy ; D. Kellogg ; B. Powers ; A. Conde ; M. Moris ; P.R. Padala ; K.P. Padala (2019): An Individualized Low-Intensity Walking Clinic Leads to Improvement in Frailty Characteristics in Older Veterans. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.16

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FRAILTY AND THE METABOLIC SYNDROME – RESULTS OF THE BERLIN AGING STUDY II (BASE-II)

N. Buchmann, D. Spira, M. König, I. Demuth, E. Steinhagen-Thiessen

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Background: Frailty and the metabolic Syndrome (MetS) are frequently found in old subjects and have been associated with increased risk of functional decline and dependency. Moreover, central characteristics of the MetS like inflammation, obesity and insulin resistance have been associated with the frailty syndrome. However, the relationship between MetS and frailty has not yet been studied in detail. Aim of the current analysis within the Berlin Aging Study II (BASE-II) was to explore associations between MetS and frailty taking important co-variables such as nutrition (total energy intake, dietary vitamin D intake), physical activity and vitamin D-status into account. Methods: Complete cross-sectional data of 1,486 old participants (50.2% women, 68.7 (65.8-71.3) years) of BASE-II were analyzed. MetS was defined following the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity in 2009. Frailty was defined according to the Fried criteria. Limitations in physical performance were assessed via questionnaire, muscle mass was measured using dual energy X-ray absorptiometry (DXA) and grip strength using a Smedley dynamometer. Adjusted regression models were calculated to assess the association between MetS and Frailty. Results: MetS was prevalent in 37.6% of the study population and 31.9% were frail or prefrail according to the here calculated frailty index. In adjusted models the odds of being frail/prefrail were increased about 50% with presence of the MetS (OR1.5; 95% CI 1.2,1.9; p= 0.002). Moreover the odds of being prefrail/frail were significantly increased with low HDL-C (OR: 1.5 (95%CI: 1.0-2.3); p = 0.037); and elevated waist circumference (OR: 1.65 (95%CI: 1.1-2.3); p = 0.008). Conclusion: The current analysis supports an association between MetS and frailty. There are various metabolic, immune and endocrine alterations in MetS that also play a role in mechanisms underlying the frailty syndrome. To what extent cytokine alterations, inflammatory processes, vitamin D supply and hormonal changes in age and in special metabolic states as MetS influence the development of frailty should be subject of further research.

CITATION:
N. Buchmann ; D. Spira ; M. König ; I. Demuth ; E. Steinhagen-Thiessen (2019): Frailty and the Metabolic Syndrome – Results of the Berlin Aging Study II (BASE-II). The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.15

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RELATING THE MNA MOBILITY SINGLE ITEM TO USUAL WALKING SPEED IN HOSPITALIZED AND COMMUNITY-DWELLING GERIATRIC PATIENTS

S. De Breucker, T. Mets, T. Pepersack

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Usual walking speed (WS) is a relatively easy and reproducible tool for detecting mobility impairment. For some reasons, however, geriatric patients might not be able to perform walking tests. Therefore, a subjective assessment could be an alternative method to screen for mobility impairment. In the present paper, we explore the use of the mobility item from the Mini Nutritional Assessment-short form (MNA-sf) to assess mobility and its congruence with walking speed in hospitalized and ambulatory patients. We analyzed retrospective data from 357 patients and found a highly significant correlation between WS and the MNA-sf mobility item. After dichotomization of the MNA-sf mobility score (mobility impairment ≤1 and no impairment >1), AUC for ROC curves showed that the mobility item derived from the MNA-sf reflects fairly well the mobility of geriatric hospitalized patients (AUC = 0.773), while it performs better in ambulatory patients (AUC = 0.838).

CITATION:
S. De Breucker ; T. Mets ; T. Pepersack (2019): Relating the MNA mobility single item to usual walking speed in hospitalized and community-dwelling geriatric patients. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.14

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RELATIONSHIP BETWEEN GRIP STRENGTH AND NONALCOHOLIC FATTY LIVER DISEASE IN MEN LIVING WITH HIV REFERRED TO A METABOLIC CLINIC

P. Debroy, J.E. Lake, A. Malagoli, G. Guaraldi, for the Modena HIV Metabolic Cohort Team

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This study aimed to assess the relationship between grip strength (GS) and nonalcoholic fatty liver (NAFLD) in treated HIV-infected men. We included 169 HIV-infected men. GS was assessed using a hand-grip dynamometer. NALFD was defined by liver-spleen attenuation ratio <1.1 on computed tomography. Mean (SD) age was 57 (6) years and BMI 24.5 (2.9) kg/m2. NAFLD was diagnosed in 33% of men; sarcopenia was present in 28%. Mean (SD) hand grip strength in the dominant hand was 37.5 (7.6) kg. In multivariate logistic regression, intermediate and low GS were associated with higher risk of NAFLD (OR 3.05; CI 1.27-7.61, p=0.01; OR 2.47; CI 1.01-6.19, p=0.05, respectively). GS has an inverse association with NAFLD prevalence in HIV-infected men. Specific mechanisms through which muscle weakness and NAFLD are related require further exploration but are not accounted for merely by the burden of comorbid illness, HIV disease stage, or ART exposure.

CITATION:
P. Debroy ; J.E. Lake ; A. Malagoli ; G. Guaraldi ; for the Modena HIV Metabolic Cohort Team ; (2018): Relationship between grip strength and nonalcoholic fatty liver disease in men living with HIV referred to a metabolic clinic. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.37

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SERUM VITAMIN D AND AGE-RELATED MUSCLE LOSS IN AFRO-CARIBBEAN MEN: THE IMPORTANCE OF AGE AND DIABETIC STATUS

J. Hwang, J.M. Zmuda, A.L. Kuipers, C.H. Bunker, A.J. Santanasto, V.W. Wheeler, I. Miljkovic

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Background: Prospective studies examining the potential association of vitamin D with age-related muscle loss have shown inconsistent results. Objective: To examine the association between baseline serum 25-hydroxyvitamin D (25(OH)D), 1,25-dihydroxyvitamin D (1,25(OH)2D), and prospective change in lean mass with aging in African ancestry population. We also determined if associations were modulated by age and diabetes mellitus (DM). Design: Prospective observational cohort study. Setting: Data were collected from a random sub-sample of 574 men, participants of the Tobago Bone Health Study (TBHS). Participants: 574 Afro-Caribbean men, aged 43+ years (mean age: 59.1 ± 10.5), who were randomly selected as the participants in both the baseline and the follow-up visits. Measurements: Baseline fasting serum 25(OH)D was measured using liquid chromatography mass spectrometry (LC-MS/MS), and and 1,25(OH)2D was measured using radioimmunosassay (RIA). Changes in dual-energy X-ray absorptiometry (DXA)-measured appendicular lean mass (ALM), and total body lean mass (TBLM) were measured over an average of 6.0 ± 0.5 years. The associations of 25(OH)D and 1,25(OH)2D with ALM and TBLM were assessed by multiple linear regression model after adjusting for potential confounders. Results: When stratifying all men into two groups by age, greater baseline 25(OH)D and 1,25(OH)2D levels were associated with smaller losses of ALM and TBLM in older (age 60+ years) but not in younger (age 43 – 59 years) men. When stratifying by DM status, the associations of 25(OH)D and 1,25(OH)2D with declines in ALM and TBLM were statistically significant only in prediabetic, but not among normal glycemic or diabetic men. Conclusion: Higher endogenous vitamin D concentrations are associated with less lean mass loss with aging among older and prediabetic Afro-Caribbean men independent of potential confounders. Our findings raise a possibility that maintaining high serum vitamin D level might be important for musculoskeletal health in elderly and prediabetic African ancestry men.

CITATION:
J. Hwang ; J.M. Zmuda ; A.L. Kuipers ; C.H. Bunker ; A.J. Santanasto ; V.W. Wheeler ; I. Miljkovic (2018): Serum Vitamin D and Age-related Muscle Loss in Afro-Caribbean Men: The Importance of Age and Diabetic Status. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.40

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THE GROWTH HORMONE RELEASING HORMONE ANALOGUE, TESAMORELIN, DECREASES MUSCLE FAT AND INCREASES MUSCLE AREA IN ADULTS WITH HIV

S. Adrian, A. Scherzinger, A. Sanyal, J.E. Lake, J. Falutz, M.P. Dubé, T. Stanley, S. Grinspoon, J.-C. Mamputu, C. Marsolais, T.T. Brown, K.M. Erlandson

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Background: Tesamorelin, a growth hormone-releasing hormone analogue, decreases visceral adipose tissue in people living with HIV, however, the effects on skeletal muscle fat and area are unknown. Objectives: The goals of this exploratory secondary analysis were to determine the effects of tesamorelin on muscle quality (density) and quantity (area). Design: Secondary, exploratory analysis of two previously completed randomized (2:1), clinical trials. Setting: U.S. and Canadian sites. Participants: People living with HIV and with abdominal obesity. Tesamorelin participants were restricted to responders (visceral adipose tissue decrease ≥8%).Intervention: Tesamorelin or placebo. Measurements: Computed tomography scans (at L4-L5) were used to quantify total and lean density (Hounsfield Units, HU) and area (centimeters2) of four trunk muscle groups using a semi-automatic segmentation image analysis program. Differences between muscle area and density before and after 26 weeks of tesamorelin or placebo treatment were compared and linear regression models were adjusted for baseline and treatment arm. Results: Tesamorelin responders (n=193) and placebo (n=148) participants with available images were similar at baseline; most were Caucasian (83%) and male (87%). In models adjusted for baseline differences and treatment arm, tesamorelin was associated with significantly greater increases in density of four truncal muscle groups (coefficient 1.56-4.86 Hounsfield units; all p<0.005), and the lean anterolateral/abdominal and rectus muscles (1.39 and 1.78 Hounsfield units; both p<0.005) compared to placebo. Significant increases were also seen in total area of the rectus and psoas muscles (0.44 and 0.46 centimeters2; p<0.005), and in the lean muscle area of all four truncal muscle groups (0.64-1.08 centimeters2; p<0.005). Conclusions: Among those with clinically significant decrease in visceral adipose tissue on treatment, tesamorelin was effective in increasing skeletal muscle area and density. Long term effectiveness of tesamorelin among people with and without HIV, and the impact of these changes in daily life should be further studied.

CITATION:
S. Adrian ; A. Scherzinger ; A. Sanyal ; J.E. Lake ; J. Falutz ; M.P. Dubé ; T. Stanley ; S. Grinspoon ; J.-C. Mamputu ; C. Marsolais ; T.T. Brown ; K.M. Erlandson (2018): The Growth Hormone Releasing Hormone Analogue, Tesamorelin, Decreases Muscle Fat and Increases Muscle Area in Adults with HIV. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.45

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ADHERENCE TO A MEDITERRANEAN DIET IS NOT ASSOCIATED WITH RISK OF SARCOPENIC SYMPTOMOLOGY: A CROSS-SECTIONAL ANALYSIS OF OVERWEIGHT AND OBESE OLDER ADULTS IN AUSTRALIA

A. Stanton, J. Buckley, A. Villani

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Adherence to a Mediterranean Diet (MedDiet) is inversely associated with sarcopenia. The aim of this study was to examine the association between adherence to a MedDiet and sarcopenic symptomology in obese older adults. For confirmation of sarcopenia, low appendicular skeletal muscle (ASM: males, ≤7.25kg/m2; females, ≤5.5kg/m2) accompanied low handgrip strength (males, ≤30kg; females, ≤20kg) or low physical performance (Short Physical Performance Battery [SPPB]: ≤8; or gait speed: ≤0.8m/sec). Adherence to a MedDiet was determined using the Mediterranean Diet Adherence Screener (MEDAS). Sixty-five older adults were included. Adherence to a MedDiet was not associated with a decreased risk of sarcopenic symptomology (SPPB: OR = 0.20; 95% CI: 0.01-3.1; P = 0.234; Muscle strength: OR = 1.81; 95% CI: 0.32-10.15; P = 0.499; Gait speed: OR = 0.58; 95% CI: 0.13-2.50; P = 0.468). Future research should investigate whether a Mediterranean-style intervention can prevent or improve sarcopenic symptomology, including in non-Mediterranean populations.

CITATION:
A. Stanton ; J. Buckley ; A. Villani (2018): Adherence to a Mediterranean Diet is not associated with risk of sarcopenic symptomology: A cross-sectional analysis of overweight and obese older adults in Australia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.46

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DECREASED HANDGRIP STRENGTH IS ASSOCIATED WITH IMPAIRMENTS IN EACH AUTONOMOUS LIVING TASK FOR AGING ADULTS IN THE UNITED STATES

R. McGrath, K. M. Erlandson, B.M. Vincent, K.J. Hackney, S.D. Herrmann, B.C. Clark

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Objectives: The primary purpose of this study was to determine the time-varying associations between decreased handgrip strength (HGS) and individual instrumental activities of daily living (IADL) impairments for a nationally-representative sample of aging adults in the United States. Design: Longitudinal-Panel. Setting: Detailed interviews were completed in person and core interviews were typically completed over the telephone. Participants: A total of 15,336 participants aged at least 50 years who participated in the 2006 wave of the Health and Retirement Study were followed biennially for 8-years. Measurements: A hand-held dynamometer assessed HGS and performance in IADLs were self-reported. Results: Every 5-kilogram decrease in HGS was associated with an increased odds ratio for the following IADL impairments: 1.11 (95% confidence interval (CI): 1.09, 1.13) for using a map, 1.10 (CI: 1.07, 1.12) for grocery shopping, 1.09 (CI: 1.05, 1.14) for taking medications, 1.07 (CI: 1.05, 1.09) for preparing hot meals, 1.06 (CI: 1.04, 1.08) for managing money, and 1.05 (CI: 1.02, 1.09) for using a telephone. Conclusions: Decreased HGS was associated with each IADL impairment, and slightly different associations were observed in individual IADL tasks for aging adults in the United States. Our findings suggest that decreased HGS, which is reflective of reduced function of the neuromuscular system, is associated with diminished performance in autonomous living tasks during aging. Losses in HGS may lead to the development of an IADL impairment. Therefore, health-care providers working with aging adults should utilize measures of HGS as a screening tool for identifying future deficits in neuromuscular functioning. Interventions designed to preserve IADLs in aging adults should also include measures of HGS for detecting early changes in IADL capacity, and intervening at the onset of HGS declines may help aging adults retain their ability to live autonomously.

CITATION:
R. McGrath ; K. M. Erlandson ; B.M. Vincent ; K.J. Hackney ; S.D. Herrmann ; B.C. Clark (2018): Decreased Handgrip Strength is Associated With Impairments in Each Autonomous Living Task for Aging Adults in the United States. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.47

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HIGHLIGHTS FROM THE 2019 INTERNATIONAL CONGRESS ON FRAILTY AND SARCOPENIA RESEARCH

M. Maltais, M. Aubertin-Leheudre, C. Dray, R.A. Fielding, Y. Rolland, M. Cesari, B. Vellas

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CITATION:
M. Maltais ; M. Aubertin-Leheudre ; C. Dray ; R.A. Fielding ; Y. Rolland ; M. Cesari ; B. Vellas (2019): Highlights from the 2019 International Congress on Frailty and Sarcopenia Research. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.13

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PROCEEDINGS OF THE CANADIAN FRAILTY NETWORK WORKSHOP: IDENTIFYING BIOMARKERS OF FRAILTY TO SUPPORT FRAILTY RISK ASSESSMENT, DIAGNOSIS AND PROGNOSIS. TORONTO, JANUARY 15, 2018

J. Muscedere, P.M. Kim, J. Afilalo, C. Balion, V.E. Baracos, D. Bowdish, M. Cesari, J. D. Erusalimsky, T. Fülöp, G. Heckman, S.E. Howlett, R.g. Khadaroo, J.L. Kirkland, L. Rodriguez Mañas, E. Marzetti, G. Paré, P. Raina, K. Rockwood, A. Sinclair, C. Skappak, C. Verschoor, S. Walter, for the Canadian Frailty Network

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The Canadian Frailty Network (CFN), a pan-Canadian not-for-profit organization funded by the Government of Canada through the Networks of Centres of Excellence Program, is dedicated to improving the care of older Canadians living with frailty. The CFN has partnered with the Canadian Longitudinal Study on Aging (CLSA) to measure potential frailty biomarkers in biological samples (whole blood, plasma, urine) collected in over 30,000 CLSA participants. CFN hosted a workshop in Toronto on January 15 2018, bringing together experts in the field of biomarkers, aging and frailty. The overall objectives of the workshop were to start building a consensus on potential frailty biomarker domains and identify specific frailty biomarkers to be measured in the CLSA biological samples. The workshop was structured with presentations in the morning to frame the discussions for the afternoon session, which was organized as a free-flowing discussion to benefit from the expertise of the participants. Participants and speakers were from Canada, Italy, Spain, United Kingdom and the United States. Herein we provide pertinent background information, a summary of all the presentations with key figures and tables, and the distillation of the discussions. In addition, moving forward, the principles CFN will use to approach frailty biomarker research and development are outlined. Findings from the workshop are helping CFN and CLSA plan and conduct the analysis of biomarkers in the CLSA samples and which will inform a follow-up data access competition.

CITATION:
J. Muscedere ; P.M. Kim ; J. Afilalo ; C. Balion ; V.E. Baracos ; D. Bowdish ; M. Cesari ; J. D. Erusalimsky ; T. Fülöp ; G. Heckman ; S.E. Howlett ; R.g. Khadaroo ; J.L. Kirkland ; L. Rodriguez Mañas ; E. Marzetti ; G. Paré ; P. Raina ; K. Rockwood ; A. Sinclair ; C. Skappak ; C. Verschoor ; S. Walter ; for the Canadian Frailty Network ; (2019): Proceedings of the Canadian Frailty Network Workshop: Identifying biomarkers of frailty to support frailty risk assessment, diagnosis and prognosis. Toronto, January 15, 2018. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.12

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DEVELOPMENT OF PHARMACOTHERAPIES FOR THE TREATMENT OF SARCOPENIA

D. Rooks, R. Roubenoff

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Sarcopenia, the associated loss of skeletal muscle mass and strength and impaired physical function seen with aging, is a growing, global public health challenge in need of accepted, proven treatments that address the needs of a broad range of older adults. While exercise, primarily resistance training, and increased dietary protein have been shown to delay and even reverse losses in muscle mass, strength and physical function seen with aging, proven treatments that are accessible globally, cost effective and sustainable by patients are needed. While no drug has yet demonstrated the substantial safety and clinical value needed to be the first pharmacological therapy registered for muscle wasting or sarcopenia, the field is active. Several approaches to treating the muscle loss and subsequent functional decline are being studied in a variety of patient populations across every continent. We provide a review of the leading programs and approaches and available findings from recent studies. In addition, we briefly discuss several related issues needed to facilitate the development of a safe and efficacious pharmacotherapeutic that could be used as part of a treatment plan for older men and women with sarcopenia.

CITATION:
D. Rooks ; R. Roubenoff (2019): Development of pharmacotherapies for the treatment of sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.11

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JFA N°02 - 2019

 

THE TRIGGERING RECEPTOR EXPRESSED ON MYELOID CELLS-2 (TREM-2) AS EXPRESSION OF THE RELATIONSHIP BETWEEN MICROGLIA AND ALZHEIMER’S DISEASE: A NOVEL MARKER FOR A PROMISING PATHWAY TO EXPLORE

C. Gussago, M. Casati, E. Ferri, B. Arosio

J Frailty Aging 2019;8(2):54-56

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Alzheimer’s disease (AD) is a common neurodegenerative disorder, strongly related with age. It has been reported that genetic variants of the Triggering Receptor Expressed on Myeloid Cells-2 (TREM2), a cell-surface receptor expressed in microglial cells, greatly increase the risk of AD, thus suggesting an involvement of the microglia in the AD pathogenesis. The aim of this report is to provide an overview of the TREM2 and of its possible implication in the pathogenesis of AD.

CITATION:
C. Gussago ; M. Casati ; E. Ferri ; B. Arosio (2018): The Triggering Receptor Expressed on Myeloid cells-2 (TREM-2) as expression of the relationship between microglia and Alzheimer’s disease: a novel marker for a promising pathway to explore. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2018.43

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LONGITUDINAL CHANGES IN MUSCLE MASS AND FUNCTION IN OLDER MEN AT INCREASED RISK FOR SARCOPENIA – THE FrOST-STUDY

W. Kemmler, S. von Stengel, D. Schoene

J Frailty Aging 2019;8(2):57-61

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Background: Declines in muscle mass and function are inevitable developments of the advanced aging process. Corresponding dimensions of longitudinal changes in at-risk populations are still scarce although clinically relevant. The present study monitored changes in morphologic and functional sarcopenia criteria related to sarcopenia in older men with low muscle mass over a period of 24 months. Objectives: The main objective of the present study was to determine whether changes in muscle mass and function were comparable across the body. Our hypothesis was that both (1) fat free mass (FFM) and (2) function decline at a significantly higher rate in the lower versus the upper extremities. Design: We conducted an observational study of 24 months. Setting: Community dwelling men living in the area of Northern Bavaria were initially included in the Franconian Sarcopenic Obesity (FranSO) study by the Institute of Medical Physics University of Erlangen-Nürnberg, Germany. Participants: One hundred and seventy-seven (177) men (77.5±4.5 years) within the lowest skeletal muscle mass index (SMI) quartile of the FranSO study were included in the present 24 month analysis. Measurements: Fat free mass (direct-segmental, multi-frequency Bio-Impedance-Analysis (DSM-BIA)), handgrip strength (hand-dynamometer) and 10-m habitual gait velocity (photo sensors) were assessed at baseline and 24-month follow-up. Results: Lower extremity fat free mass (LEFFM: -2.0±2.4%), handgrip strength (-12.8±11.0%) and gait velocity (-3.5±9.0%) declined significantly (p<.001) during the follow-up period, while upper extremity FFM was maintained unchanged (UEFFM: 0.1±3.1%). Changes in LEFFM were significantly higher (p<.001) compared with UEFFM, however contrary to our expectation the decline in handgrip strength representing upper extremity muscle function was 3.7-fold higher (p<.001) than the decline in gait velocity. Conclusion: Medical experts involved in diagnosis, monitoring and management of sarcopenia should consider that parameters constituting morphologic and functional sarcopenia criteria feature different rates of decline during the aging process.

CITATION:
W. Kemmler ; S. von Stengel ; D. Schoene (2019): Longitudinal changes in muscle mass and function in older men at increased risk for sarcopenia – the FrOST-study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.9

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THE ASSOCIATION OF APOE Ε4 STATUS WITH LOWER LIMB FUNCTION AND HANDGRIP STRENGTH IN OLDER ADULTS

M. Maltais, P. de Souto Barreto, Y. Rolland, B. Vellas, for the MAPT/DSA Study Group

J Frailty Aging 2019;8(2):62-66

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Background/Objectives: Apolipoprotein (ApoE ε4) status has been associated with various cardiovascular diseases and Alzheimer’s Disease. Some studies have found a possible relationship between the presence of an ApoE ε4 allele and the decrease of motor function in healthy older adults. The objective of this study was to measure the cross-sectional and prospective associations of ApoE ε4 status with lower limb function and handgrip strength in older adults. Design: Longitudinal observational study using data from a randomized controlled trial.Setting: Community-dwelling older adults. Participants: 1300 older adults (≥70 years old) with ApoE ε4 status from the Multidomain Alzheimer’s Preventive Trial (MAPT) were followed for three years. Measurements: Lower-limb function was measured with the Short Physical Performance Battery (SPPB) and muscle strength was measured with a handgrip strength dynamometer. ApoE ε4 status was assessed with a blood draw. Mixed-effect linear regressions were used to examine cross-sectional as well as prospective associations between ApoE ε4 status and the outcomes. Results: No significant cross-sectional or prospective associations were found between ApoE ε4 status, lower-limb function and handgrip strength in our study. Conclusions: ApoE ε4 status was not associated with motor function in older adults.

CITATION:
M. Maltais ; P. de Souto Barreto ; Y. Rolland ; B. Vellas ; for the MAPT/DSA Study Group (2019): The association of ApoE ε4 status with lower limb function and handgrip strength in older adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.7

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DEFINING FRAILTY IN RESEARCH ABSTRACTS: A SYSTEMATIC REVIEW AND RECOMMENDATIONS FOR STANDARDIZATION

E. Yaksic, V. Lecky, S. Sharnprapai, T. Tungkhar, K. Cho, J.A. Driver, A.R. Orkaby

J Frailty Aging 2019;8(2):67-71

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Multiple definitions of frailty are used. We sought to quantify the frequency that frailty is insufficiently defined in published abstracts. We conducted a systematic review of MEDLINE/PubMed for English abstracts of original research investigating frailty as an exposure or outcome in humans from 2015-2017. A complete definition of frailty included: 1) a named measure of frailty, including “frailty” alone, 2) details on variables included (e.g. grip strength), 3) number of variables included (e.g. 33-item frailty index), and 4) details on cutoffs or levels of frailty unless a definition was used continuously. Our search yielded 1,110 titles; 490 abstracts met review criteria, 348 abstracts had any definition of frailty and were included. Majority reported a single measure of frailty (n=313, 90%). The most commonly used measures were variations of Fried’s phenotype (n=167, 48%) and Rockwood’s cumulative deficit model (n=101, 29%). Only 56 abstracts had complete definitions (16%). In 123 abstracts (35%), a means of measuring frailty was named, but no additional details were given. When details of the frailty measure were described, they generally referred to cutoffs or levels rather than variables used in the measure. A minority of abstracts of original manuscripts related to frailty research had adequate definitions of frailty. We encourage scientists to adopt a standardized approach to defining the term for all abstracts related to frailty research to facilitate systematic reviews, meta-analysis, and accurate reporting of frailty science.

CITATION:
E. Yaksic ; V. Lecky ; S. Sharnprapai ; T. Tungkhar ; K. Cho ; J.A. Driver ; A.R. Orkaby (2019): Defining Frailty in Research Abstracts: A Systematic Review and Recommendations for Standardization. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.4

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PSOAS AND PARASPINOUS MUSCLE MEASUREMENTS ON COMPUTED TOMOGRAPHY PREDICT MORTALITY IN EUROPEAN AMERICANS WITH TYPE 2 DIABETES MELLITUS

B.M. Tucker, F.C. Hsu, T.C. Register, J. Xu, S.C. Smith, M. Murea, D.W. Bowden, B.I. Freedman, L. Lenchik

J Frailty Aging 2019;8(2):72-78

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Background: Appendicular skeletal muscle mass index and muscle attenuation (density) are negatively associated with mortality in European-derived populations. Objectives: The present analyses assessed association between axial skeletal muscle density and muscle index with mortality in European Americans with type 2 diabetes mellitus (T2D). Design: Single-center observational study. Setting: Diabetes Heart Study. Participants: 839 European Americans with T2D. Methods: Computed tomography-measured psoas and paraspinous muscle mass index (cross sectional area/height2) and radiographic density (Hounsfield Units) were assessed in all participants. A Cox proportional hazards model was computed. The fully-adjusted model included covariates age, sex, body mass index, smoking, alcohol use, diabetes duration, insulin use, hormone replacement therapy (women), prevalent cardiovascular disease (CVD), hypertension, and coronary artery calcified atherosclerotic plaque mass score. Deaths were recorded in the National Death Index data through December 31, 2015. Results: Participants included 428 women and 411 men with median (25th, 75th quartile) age 62.8 (56.1, 69.1) years and diabetes duration 8.0 (5.0, 14.0) years. After 11.9 (9.4, 13.3) years of follow-up, 314 (37.4%) of participants were deceased. In the fully-adjusted model, psoas muscle density (hazard ratio [HR] 0.81, p<0.001), psoas muscle index (HR 0.82, p=0.008), and paraspinous muscle density (HR 0.85, p=0.003) were inversely associated with mortality. Paraspinous muscle index was not significantly associated with mortality (HR 0.90, p=0.08). Results did not differ significantly between men and women. Conclusions: In addition to established risk factors for mortality and CVD, higher psoas muscle index, psoas muscle density, and paraspinous muscle density were significantly associated with lower all-cause mortality in European Americans with T2D.

CITATION:
B.M. Tucker ; F.C. Hsu ; T.C. Register ; J. Xu ; S.C. Smith ; M. Murea ; D.W. Bowden ; B.I. Freedman ; L. Lenchik (2019): Psoas and paraspinous muscle measurements on computed tomography predict mortality in European Americans with type 2 diabetes mellitus. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.5

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AN ULTRASOUND PREDICTION EQUATION TO ESTIMATE DXA-DERIVED BODY FATNESS FOR MIDDLE-AGED AND OLDER CAUCASIAN ADULTS

T. Abe, J.P. Loenneke, R.S. Thiebaud

J Frailty Aging 2019;8(2):79-84

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Background & Objectives: Currently, only one study has used dual-energy X-ray absorptiometry (DXA)-derived percent body fat (BF%) as the criterion measure to develop ultrasound prediction equations to estimate BF% in adults between the ages of 50 and 80 years. The aim of this study was to examine the relationship between BF% estimated from subcutaneous fat thickness using a previously published Japanese-based prediction equation and DXA-derived BF% in Caucasian middle-aged and older adults. A secondary aim was to develop a new prediction equation for Caucasian adults if the previously published equation did not predict BF% well in Caucasians. Design: Cross-sectional study. Participants & Measurements: One-hundred and two Caucasian adults aged 50-76 years (59 men and 43 women) had ultrasound fat thickness and DXA values measured. A new BF% prediction model was developed using ordinary least squares multiple linear regression. Results: There was a strong correlation between ultrasound predicted and DXA-derived BF% (r = 0.882, p<0.001). Bland-Altman analysis did not indicate a bias in the prediction of BF% for Caucasian adults (r = -0.092, p>0.05). However, the predicted BF% was significantly higher compared to DXA-derived BF% (approximately 4%). A newly developed nonlinear prediction model used to estimate BF% was significant [F(17,84) = 33.44, p<0.001] with an R2 of 0.871 and an adjusted R2 of 0.845. When examining the stability of the model, bootstrapping (n=1000) resulted in an optimism value of 0.1135 so that the corrected R2 was 0.758. After removing an outlier, the model was significant [F(17,83) = 34.82, p<0.001] and it’s R2 was 0.877 and adjusted R2 was 0.852. Conclusion: The developed equation was stable with a high degree of variance compared to results from previous studies. The results of this study also suggest that ethnicity should be considered when choosing which prediction equations should be used to estimate BF%.

CITATION:
T. Abe ; J.P. Loenneke ; R.S. Thiebaud (2019): An ultrasound prediction equation to estimate DXA-derived body fatness for middle-aged and older Caucasian adults. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.8

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PREDICTIVE ABILITY OF SEVEN DOMAINS OF THE KIHON CHECKLIST FOR INCIDENT DEPENDENCY AND MORTALITY

S. Satake, H. Shimokata, K. Senda, I. Kondo, H. Arai, K. Toba

J Frailty Aging 2019;8(2):85-87

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The Kihon Checklist (KCL) is a structured questionnaire consisting of 7 domains to assess seniors’ function in daily living. The aim of this study was to examine which domains of the KCL can predict incident dependency and mortality. The municipality sent a KCL questionnaire to independent seniors in Higashi-ura Town and collected the answers of the 5542 seniors who provided complete answers. Their incident dependency and mortality were followed-up for 2.5 years. A Cox proportional hazard model indicated that meeting any of the criteria in instrumental activities of daily living, physical, nutrition, and mood domains significantly predicted the risk of dependency, whereas meeting any of the criteria in physical, nutrition and socialization domains significantly predicted the risk of mortality. Category assessment by the KCL could be useful to predict incident dependency and all-cause mortality.

CITATION:
S. Satake ; H. Shimokata ; K. Senda ; I. Kondo ; H. Arai ; K. Toba (2019): Predictive ability of seven domains of the Kihon Checklist for incident dependency and mortality. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.3

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AGE OF HIV ACQUISITION AFFECTS THE RISK OF MULTI-MORBIDITY AFTER 25 YEARS OF INFECTION EXPOSURE

G. Guaraldi, A. Malagoli, J. Milic, I. Pintassilgo, E. Rossi, N. Riva, I. Franconi, A. Santoro, P. Sorin, A. Streinu-Cercel, M. De Rosa, C. Mussini

J Frailty Aging 2019;8(2):88-92

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Introduction: Understanding the intersection of HIV, aging and health is crucial due to the increasing number of people aging with HIV. Objective: The objective of the study was to assess the prevalence of, and risk factors for individual comorbidities and multi-morbidity in people living with HIV with similar duration of HIV infection, notwithstanding a 25-year difference at the time of HIV acquisition. Methods: In a cross-sectional multicentre retrospective study, we compared three match-control age groups. The “Young” were selected from Romania and included HIV-positive patients prenatally infected and assessed at the age of 25-30 years. The “Old” and the “Geriatric” were selected from Italy. These respectively included subjects infected with HIV at the age of 25 years and assessed at the age of 50-55 years, and those infected at the age of 50 years and assessed at the age of 75-80 years. Each group was sex and age matched in a 1:5 ratio with controls selected from the CINECA ARNO database from Italy. We described non-infectious comorbidities (NICM), including cardiovascular disease, hypertension, dyslipidaemia, diabetes, chronic kidney disease, and multi-morbidity (MM≥ 3 NICM). Results: MM prevalence in the “Young” group compared to controls was 6.2% vs 0%, while in the “Geriatric” was “68.2% vs 3.6%. Using “Young” as a reference, in multivariate analyses, predictors for MM were as follows: HIV serostatus (OR=47.75, IQR 14.78-154.25, p<0.01) and “Geriatric” vs “Young” (OR=30.32, IQR 5.89-155.98, p<0.01). Conclusion: These data suggest that age at acquisition of HIV should be considered as a risk factor for NICM and MM.

CITATION:
G. Guaraldi ; A. Malagoli ; J. Milic ; I. Pintassilgo ; E. Rossi ; N. Riva ; I. Franconi ; A. Santoro ; P. Sorin ; A. Streinu-Cercel ; M. De Rosa ; C. Mussini (2019): Age OF HIV acquisition affects the risk of multi-morbidity after 25 years of infection exposure. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.6

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ECONOMIC IMPACT OF HOSPITALIZATIONS IN US ADULTS WITH SARCOPENIA

S. Goates, K. Du, M.B. Arensberg, T. Gaillard, J. Guralnik, S.L. Pereira

J Frailty Aging 2019;8(2):93-99

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Background: Sarcopenia is characterized by progressive loss of muscle mass with corresponding decline in strength and/or physical function. The economic burden of sarcopenia-associated disability is considerable in the US. Objective: To estimate the cost of hospitalizations in US adults with sarcopenia categorized by age, sex, and race/ethnicity. Design, setting and participants: A retrospective, prevalence based, economic burden study, consisting of 4011 adults aged ≥40 years with and without sarcopenia. Methods: Data on prevalence of low lean mass, functional limitations, and hospitalizations were obtained from the National Health and Nutrition Examination Survey (1999-2004); cost of hospitalizations was obtained from the Healthcare Cost and Utilization Project - National Inpatient Sample (2014), and population estimates were obtained from the US Census (2014). Probability and cost of hospitalizations were estimated by multiple logistic regression and negative binomial regression models, respectively. Results: The total estimated cost of hospitalizations in individuals with sarcopenia was USD $40.4 billion with an average per person cost of USD $260. Within this category, average per person cost was highest for Hispanic women (USD $548) and lowest for Non-Hispanic Black women (USD $25); average per person cost was higher for older adults (≥65 years) (USD $375) than younger adults (40-64 years) (USD $204) with sarcopenia. The total cost of hospitalizations in individuals with sarcopenia (≥65 years) was USD $19.12 billion. Individuals with sarcopenia had greater odds of hospitalization (OR, 1.95; p<.001) compared to those without and had an annual marginal increase in cost of USD $2315.7 per person compared to individuals without sarcopenia. Conclusion: Sarcopenia places considerable economic burden on the US healthcare system. The ethnic disparity and economic burden associated with sarcopenia warrant further investigation.

CITATION:
S. Goates ; K. Du ; M.B. Arensberg ; T. Gaillard ; J. Guralnik ; S.L. Pereira (2019): Economic impact of hospitalizations in US adults with Sarcopenia. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.10

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LOSS OF POSTERIOR OCCLUDING TEETH AND ITS ASSOCIATION WITH PROTEIN-MICRONUTRIENTS INTAKE AND MUSCLE MASS AMONG THAI ELDERS: A PILOT STUDY

B. Treesattayakul, T. Winuprasith, B. Theeranuluk, D. Trachootham

J Frailty Aging 2019;8(2):100-103

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Contact between upper and lower posterior teeth is crucial for chewing. However, the influence of posterior occluding teeth loss on protein intake and muscle mass was unclear. This cross-sectional study compared consumption frequency of protein food, amount of protein and relevant micronutrient intakes and muscle mass indices among older adults with different Eichner indices (EI) of posterior occluding teeth loss. Ninety Thai healthy adults were divided into three groups (N=30 each) according EI with statistically comparable characters. Food frequency questionnaire, 4-days diet record, and bioelectrical impedance analysis were used for outcome measurement. Our findings suggested that loss of posterior occluding teeth on both sides was associated with less frequent consumption of meat, nut, egg, fish and dairy products, inadequate intakes of protein (< 0.8 g/kg body weight), iron and vitamin B12, and reduced muscle mass indices in older adults. Future large-scale cohort studies are warranted to confirm these findings.

CITATION:
B. Treesattayakul ; T. Winuprasith ; B. Theeranuluk ; D. Trachootham (2019): Loss of posterior occluding teeth and its association with protein-micronutrients intake and muscle mass among Thai elders: A pilot study. The Journal of Frailty and Aging (JFA). http://dx.doi.org/10.14283/jfa.2019.2

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