Clinical Nutrition & Metabolic Care

Editorial introductions No abstract available

Editorial: COVID-19 in older persons: the role of nutrition No abstract available

A year with the GLIM diagnosis of malnutrition – does it work for older persons? Purpose of review In early 2019, the Global Leadership Initiative on Malnutrition (GLIM) concept was published advocating a two-step procedure, that is, screening followed by confirmation of the malnutrition diagnosis requiring a combination of phenotypic and etiologic criteria. This review summarizes 14 publications that have applied the GLIM criteria in older populations. Recent findings Four studies miss data on muscle mass. The mandatory screening appears missing in some studies. Two studies report that criterion validity is fair to good when compared with Subjective Global Assessment as semigold standard. Most studies report strong predictive validity when mortality is used as outcome. Not unexpectedly malnutrition relates strongly to sarcopenia as low muscle mass is a GLIM criterion. Overall, the lack of guidance on how to assess muscle mass and disease burden/inflammation in the original GLIM publication provides uncertainties on how to interpret the results. Summary Fourteen exclusively retrospective studies in older adult cohorts are summarized. In several cases, the data sets are imperfect or incomplete. Still, criterion and predictive validity for GLIM appears well acceptable when applied for older adults. Continuing global implementation efforts are justified. The GLIM consortium needs to provide guidance on assessment of muscle mass and disease burden/inflammation. Moreover, further prospective validation studies are needed to add knowledge for the future GLIM format updates.

Protein intake and renal function in older patients Purpose of review Chronic kidney disease (CKD) is highly prevalent in elderly patients. There is growing recognition of the importance of attention to dietary protein intake (DPI) in this population given their predisposition to age-related changes in kidney function and coexisting comorbidities (i.e., hypertension). We reviewed the impact of DPI on kidney health and survival and the role of dietary protein management in older CKD patients. Recent findings While kidney function parameters including glomerular filtration rate (GFR) and renal plasma flow are slightly lower in elderly patients irrespective of CKD status, the kidneys' ability to compensate for increased DPI by augmentation of GFR is preserved until 80 years of age or less. However, long-term consumption of high DPI in individuals of older age and/or with CKD may contribute to kidney function deterioration over time. Prescription of a plant-dominant low-protein diet of 0.6–0.8 g/kg/day with more than 50% from plant sources or very low protein diets less than 0.45 g/kg/day supplemented with essential amino acids or their keto-analogues may be effective in preserving kidney function in older patients and their younger counterparts, while also monitoring for development of protein–energy wasting (PEW). Summary Using tailored precision nutrition approaches in prescribing plant-dominant low DPI that also maintains adequate energy and nitrogen balance may ameliorate kidney function decline while also preventing development of PEW in elderly patients with CKD.

Obesity, vitamin D deficiency and old age a serious combination with respect to coronavirus disease-2019 severity and outcome Purpose of review Old age, obesity and vitamin D deficiency are considered as independent risk factors for severe courses of COVID-19. The aim of the review is to discuss common features of these risk factors and the impact of vitamin D. Recent findings The recently discovered relationship between vitamin D and the infection pathway of the virus via the renin--angiotensin system (RAS) and the adipokines leptin and adiponectin play an important role. The frequency of studies showing a relationship between a low vitamin D status in comorbidities and severe COVID-19 courses makes an impact of vitamin D effects likely. Summary There is a direct relationship between vitamin D, body fat and age in COVID-19 courses. With age, the ability of the skin to synthesize vitamin D decreases, and leads to vitamin D-deficits. If the skin is insufficiently exposed to sunlight, severe deficits can develop. As vitamin D plays an important role not only in the immune system but also in the RAS, and thus at the point where the virus attacks, a good vitamin D supply is an important basis for reducing the risk of severe COVID-19 processes. Treatment with vitamin D supplements should be based on severity of the vitamin D deficiency.

Nutrients to mitigate osteosarcopenia: the role of protein, vitamin D and calcium Purpose of review Osteosarcopenia (the joint loss of bone density and muscle mass and function) is an emerging geriatric syndrome, which associates with poor health outcomes. Several nutrients including protein, vitamin D and calcium interact (directly or through absorption properties) to regulate muscle and bone metabolism. We provided an update on the efficacy of these nutrients on musculoskeletal outcomes in older adults with, or at risk of, osteosarcopenia. Recent findings Randomized trials show that correcting vitamin D and calcium deficiencies to meet the recommended dietary allowance (RDA) increases bone density and reduces fracture (but not falls) risk. Supplementing above the RDA with protein supports gains in lean mass and lumbar-spine bone density; however, there is inconclusive evidence for muscle strength, physical function or other bone density sites. A likely explanation for this relates to the significant heterogeneity between trials regarding protein dose, type and timing, as well as baseline protein intake. Further high-quality trials are needed in older osteosarcopenic adults to investigate the effects of protein (while correcting vitamin D and calcium deficiencies) on clinically meaningful outcomes such as activities of daily living, falls and fractures. Summary An adequate intake of protein (1.2–1.5 g/kg/day), vitamin D (800 IU/day) and calcium (1000–1200 mg/day), is well tolerated and effective at mitigating some aspects of osteosarcopenia such as lean mass, bone density and fracture risk.

Therapeutic strategies for sarcopenic obesity: a systematic review Purpose of review Tough plenty of literature investigated therapeutic options for body composition changes targeting elderly people, evidence concerning potential treatments of sarcopenic obesity as a unique condition is scarce. The aim of the present review was to summarize recent evidence regarding treatment of sarcopenic obesity in adult and older individuals. Recent findings Exercise-based interventions were effective in ameliorating lean mass or sarcopenia-related indices and reducing total adiposity. Importantly, in one study, modifications of body composition were obtained in the absence of significant changes in body mass index. The majority of studies relied on resistance training, and all provided with beneficial effects in body composition. Conversely, effects in terms of muscle strength and functional ability were heterogeneous. Electrical acupuncture and whole-body electromyostimulation associated with nutritional supplementation resulted to be novel effective strategies in inducing body composition changes. Nonetheless, findings from nutritional supplementations are not conclusive, leading to conflicting results on strength and functional outcomes. Summary Specific interventions could improve sarcopenic obesity, but overall significance is limited by scarcity of data and lack of uniformity in the definition of sarcopenic obesity itself. Further research should clarify optimal treatment options for sarcopenic obesity in age classes other than the geriatric population.

Protein and physical activity in older persons Purpose of review The aim of this study was to highlight recent evidence on protein requirement and physical activity recommendations in older adults and their interrelationship. Recent findings Higher protein intake in older adults is beneficial for better physical function, reduced fracture risk, healthy ageing and lower mortality. However, the association between protein quality and health remains inconsistent. Higher physical activity is associated with a lower risk of physical dependence, frailty, cognitive impairment and mortality. Prospectively increasing or even sustaining physical activity can be protective against adverse health outcomes compared with decreasing physical activity. There is a synergistic protective effect of protein intake and physical activity on health. Data on the bidirectional link between protein intake and physical activity are scarce. Whether increasing physical activity can help to increase energy intake (and thus protein intake) and vice versa require further research. Summary The key role of protein intake and physical activity in optimizing health in older adults is well established. The synergistic effects of these two modifiable lifestyle factors strengthen the need to consider dietary and physical activity recommendations together. Future research may examine the bidirectional link between diet and physical activity, which could potentially be one of the strategies to increase the uptake of recommendations for protein intake and physical activity in older adults.

β-hydroxy-β-methylbutyrate supplementation in older persons – an update Purpose of review The interest in the use of beta-hydroxy-beta-methylbutyrate (HMB) as an intervention to prevent and treat sarcopenia has increased over recent years. The purpose of this review is to explore recent evidence pertaining to the mechanism of action of HMB and how this may influence changes in lean mass and strength in older persons who are both hospitalized and living in the community. Recent findings No new studies have been published over the last 2 years investigating the effect of HMB in older persons who are hospitalized, aside from one posthoc analysis of a randomized controlled trial exploring the effect of a high protein oral nutrition supplement containing HMB on handgrip strength and nutritional status. Three studies recruiting community-dwelling older adults have been published, but results are influenced by suboptimal methodological quality. Summary Recent data suggest the need for high-quality studies investigating the effectiveness of HMB to improve outcomes related to sarcopenia in both hospitalized and community-dwelling older persons.

Editorial: Distinct roles for dietary protein and amino acids in health and disease No abstract available

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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