Journal of Nutrition Health & Aging最新文献

Background: Higher ultra-processed foods (UPF), attributed to more than half of daily intake in the US, have been associated with impaired health outcomes. Documented evidence highlights disparities in UPF consumption due to food insecurity, which is a public health challenge among older adults in the US.

Objectives: The study examined the link between food insecurity and UPF consumption. The potential of participants' sex, age, and race and Supplemental Nutrition Assistance Program (SNAP) participation in modifying the association were explored.

Method: The analytical sample comprised 6295 US adults, aged 52 - 101 years, enrolled in the longitudinal Health and Retirement Study (HRS), a nationally representative study of aging. Food insecurity was evaluated in the 2013 HRS Health Care and Nutrition Study using the six-item Short Form Food Security Survey Module. Dietary intake was assessed using a food frequency questionnaire, and UPFs, quantified using the NOVA food classification system, were expressed as a percentage of total energy intake. The association between food insecurity and UPFs was examined using linear regression models, adjusted for sociodemographic characteristics.

Results: The prevalence of food insecurity was 15%. Mean UPFs% (95% confidence intervals) were 49.1 (47.8, 50.3), 48.5 (46.6, 50.4), and 52.3 (50.4, 54.3) among adults with food security, low food security, and very low food security, respectively (P-trend = 0.0156). Race modifies the association between food insecurity and UPFs (P-interaction = 0.0033). A positive linear trend was detected among Whites (P-trend = 0.0036), but an inverse linear trend was found among African Americans (P-trend = 0.0007). There was no evidence for heterogeneity by age, sex, or SNAP participation.

Conclusion: Food insecurity was positively correlated with UPF consumption among adults in the US. Race modifies the association with a positive linear trend among Whites and an inverse linear trend among African Americans. Further efforts are needed to promote healthy aging via improving diet quality among food-insecure older adults.

Objectives: Nutritional status, as one of the core characteristics of frailty, the impact of its changes on clinical outcomes in older patients following transcatheter aortic valve replacement (TAVR) remains unclear.

Design: A retrospective cohort study.

Setting: This study included a total of 781 patients who underwent TAVR at West China Hospital between 2012 and 2022.

Method: The average age of the patients was 72.6 years, with a mean follow-up period of 2.2 years. All patients were followed for at least one year, and their nutritional status was assessed using the Controlling Nutritional Status (CONUT) score both before TAVR and six months post-TAVR. Based on post-TAVR changes in nutritional status, patients with normal nutritional status pre-TAVR were categorized into Non-malnutrition and New malnutrition groups, while patients with malnutrition pre-TAVR were categorized into Malnutrition regression and Malnutrition persistence groups.

Result: The New malnutrition group experienced higher cumulative incidences of all-cause mortality (20.5% vs. 2.4%, P = 0.002), MACE (25.5% vs. 23.7%, P = 0.001), and readmissions for heart failure (13.1% vs. 7.3%, P = 0.027) compared to the Non-malnutrition group. Conversely, the Malnutrition regression group showed a lower cumulative incidence of all-cause mortality (3.1% vs. 18.0%, P = 0.016) compared to the Malnutrition persistence group, although no statistically significant differences were observed in MACE (14.7% vs. 28.5%, P = 0.087) and readmissions for heart failure (7.0% vs. 8.3%, P = 0.551).

Conclusion: Our study indicates that deterioration in nutritional status after TAVR is associated with poorer clinical outcomes, whereas improvement is associated with better outcomes.

Sarcopenia is a prevalent neuromuscular condition among older adults, marked by significant reductions in muscle mass and strength, which result in notable impairments in physical performance. Modifications in lifestyle habits have been frequently highlighted as essential approaches to mitigate the progression of sarcopenia, with a particular focus on protein consumption. Over the past few decades, a wealth of knowledge has emerged, driven by both observational and experimental studies exploring various factors related to protein intake, such as amount, timing, and sources. This review provides a pauca verba overview of these findings, presenting a concise yet informative summary of key insights.

Objective: Dietary inflammatory potential, measured by the dietary inflammatory index (DII) has been linked to cognitive impairment. However, evidence was mostly driven by cross-sectional studies. This meta-analysis of prospective cohort studies aims to evaluate the relationship between DII and the risk of cognitive impairment, including mild cognitive impairment (MCI) and dementia.

Methods: We conducted a systematic search of PubMed, Web of Science, and Embase for studies published up to July 25, 2024. Prospective cohort studies with adults aged 18 years or older, without dementia at baseline, and reporting the incidence of cognitive impairment by DII category were included. Data were analyzed using a random-effects model to calculate pooled risk ratios (RRs) with 95% confidence intervals (CIs).

Results: Nine prospective cohort studies with 266,169 participants were included. A high DII at baseline was associated with an increased risk of cognitive impairment during follow-up (RR: 1.34, 95% CI: 1.15-1.55, p < 0.001) with moderate heterogeneity (I² = 56%). Subgroup analyses revealed consistent associations across types of cognitive impairment (MCI, overall dementia, Alzheimer's disease) and study characteristics (p for subgroup difference all >0.05). Sensitivity analyses confirmed the robustness of the results.

Conclusions: This meta-analysis suggests that a higher dietary inflammatory potential is independently associated with an increased risk of cognitive impairment. These findings underscore the potential impact of dietary inflammation on cognitive health and highlight the need for dietary strategies to mitigate cognitive decline risk.

Objectives: Housing is an important social determinant of health. However, limited studies have focused on the relationship between housing quality and sarcopenia, especially in low- and middle-income countries. This study aims to examine the association between housing quality and sarcopenia in older adults in China and India.

Methods: The study was based on the China Health and Retirement Longitudinal Study and Longitudinal Aging Study in India. Housing quality was evaluated by five indicators, including housing materials, water sources, sanitation facilities, main fuel for cooking, and availability of electricity. Housing quality is divided into three types: good (0-1 poor housing indicators), medium (2-3 poor housing indicators), and poor (4-5 poor housing indicators). Sarcopenia was evaluated according to the Asian Working Group for Sarcopenia (AWGS) 2019 Consensus. The logistic regression model was performed to examine the association between housing quality and sarcopenia.

Results: The medium (OR = 1.69, 95%CI = 1.49-1.90) and poor housing quality (OR = 2.19, 95%CI = 1.89-2.54) were associated with sarcopenia in CHARLS. Similar results were also observed in the LASI with significantly higher prevalence of sarcopenia in medium (OR = 1.22, 95%CI = 1.11-1.33), and poor housing quality (OR = 1.60, 95%CI = 1.43-1.79). Moreover, we observed a linear relationship between housing quality and the prevalence of sarcopenia both in CHARLS and LASI (all P for trend <0.001).

Conclusions: Poorer housing quality was associated with a higher prevalence of sarcopenia in older adults in China and India. Housing quality improvement plans such as access to tap water, promotion of clean energy may have a positive effect on reducing the prevalence of sarcopenia.

Objectives: This study aimed to compare various frailty screening and assessment tools with the Frailty Phenotype (FP), Frailty Index (FI), and Comprehensive Geriatric Assessment (CGA), which are considered the current gold standards, among the Asia-Pacific population in community settings.

Design: Systematic review and meta-analysis.

Setting and participants: This review included studies evaluating frailty identification tools based on the criteria of population, index and reference tests, and diagnosis of interest.

Methods: A diagnostic test accuracy review was conducted to assess frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines. Comprehensive electronic database searches and manual searches were conducted up to August 20, 2024. Study quality, including risks of bias and applicability, was assessed using the QUADAS-2 tool. Hierarchical analysis and Youden's index were employed to identify the optimal tool and cutoff points, and pooled frailty prevalence was calculated.

Results: Fourteen studies were included: 10 for the FRAIL scale, 3 for TUG, and 2 for the SOF index (screening tools), and 2 each for the CFS and KCL, and 1 for the REFS (assessment tools). All studies demonstrated a high risk of bias. The pooled sensitivity and specificity for screening tools were 0.63 and 0.89, respectively, whereas for assessment tools, they were 0.79 and 0.85. The pooled prevalence of frailty and pre-frailty was 19.7% and 31.7%, respectively. The pooled diagnostic odds ratios were highest for the FRAIL scale (15.72) and CFS (35.03) among the screening and assessment tools. The subgroup analysis revealed that the setting had no significant impact on screening tool performance (p = 0.58), but a borderline significant effect was observed for assessment tools (p = 0.06), although this result is limited by the small number of studies, with only one conducted in a community setting. The FRAIL scale, with a cutoff of 2, had a Youden's index of 0.60, signifying optimal screening performance.

Conclusion: Among the frailty instruments recommended by the Asia-Pacific Clinical Practice Guidelines, this meta-analysis identifies the FRAIL scale as the most robust tool for distinguishing frailty, with a cutoff of 2 significantly enhancing diagnostic accuracy. Furthermore, the estimated prevalence of frailty in the Asia-Pacific region is 19.7% across various community settings, underscoring the need for further research and the development of validated assessment tools tailored to this population.

There is a small, but growing, evidence base on obtaining the patient's perspective on frailty, which can help guide future research and clinical management strategies. This mini-review provides a brief summary of some qualitative studies on the patient's perspective on frailty with a focus on the study design and emerging findings to date. We reviewed seven studies in total, examining how they approached the research question and their main findings. We provide a suggestions and considerations for future research on this topic.