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Objective:To investigate the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Methods:This paper retrospectively collected and analyzed the data of human composition and laboratory index in elderly patients with diabetes(n=106)and non-diabetic(n=153)patients in the Nutrition Department of Beijing Hospital, compared the differences between two groups, and explored the correlation between phase angle and muscle mass reduction in elderly diabetic patients.Phase angle was detected by bioelectrical impedance which was calculated as reactance/resistance× 180/π.Results:Phase angle was lower in elderly diabetic patients(5.17±0.65)°than in non-diabetic elderly patients(5.37±0.76)°( t=-2.075. P<0.05); age and fasting blood glucose were higher in elderly diabetic patients than in non-diabetic elderly patients(all P<0.05).There was no significant difference between the two groups in body mass index, fat, body fat percentage, visceral fat area, skeletal muscle index, body cell mass, total protein, albumin, and hemoglobin(all P>0.05).Correlation analysis results showed that in elderly diabetic patients, the phase angle was negatively correlated with body mass index( r=0.288, P<0.01), age( r=-0.680, P<0.01), was positively correlated with skeletal muscle( r=0.477, P<0.01), skeletal muscle index( r=0.505, P<0.01)and hemoglobin( r=0.382, P<0.01); and in the elderly non-diabetic group, phase angle was negatively correlated with age( r=-0.666, P<0.01)and positively correlated with body mass index( r=0.296, P<0.01), skeletal muscle( r=0.504, P<0.01), fat free mass( r=0.161, P<0.05), skeletal muscle index( r=0.441, P<0.01), body cell volume( r=0.496, P<0.01), and hemoglobin( r=0.420, P<0.01).The bioelectrical impedance apectroscopy detected skeletal muscle mass index<7.0 kg/m 2 for male and<5.7 kg/m 2 for female were used as the diagnosis standard for reduced muscle mass.The detection rate of muscle mass reduction was higher in elderly diabetic patients(17 cases, 16.04%)than in elderly non-diabetic patients(12 cases, 7.84%, χ2=4.229, P<0.05).The results of multiple regression analysis showed that the decrease of muscle mass in elderly diabetic patients was related to low phase angle( OR=0.413, 95% CI: 0.280-0.973, P<0.05)and aging( OR=2.174, 95% CI: 1.574-3.003, P<0.01). Conclusions:The phase angle is lower in diabetic elderly patients than in non-diabetic elderly patients, and the incidence of muscle mass reduction is higher in diabetic elderly patients than in non-diabetic elderly people.Decreased phase angle and increased age are related to the decrease of muscle mass in elderly diabetic patients.
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Objective:To use the Global Leadership Initiative on Malnutrition(GLIM)criteria to assess the incidence of malnutrition in hospitalized elderly stroke patients, and to investigate the correlation between the criteria and clinical outcomes.Methods:A cross-sectional study was conducted from March 2012 to August 2021 to evaluate malnutrition in 658 elderly stroke inpatients aged 65-92 years, the GLIM criteria were used, and the correlation between the criteria and clinical outcomes was explored.Results:Of the 658 patients, men showed higher values in height, weight, Bady mass index, upper arm circumference, calf circumference and creatinine(all P<0.05), but lower total cholesterol( P<0.05). The incidence of malnutrition diagnosed with the GLIM criteria was 9.12%(60 cases). Based on the GLIM criteria, those with malnutrition had lower weight, Bady mass index, upper arm circumference, calf circumference, albumin and total cholesterol(all P<0.05), while age, duration of hospitalization, infectious complications and mortality was higher than those without malnutrition( P<0.05). Using the mini nutritional assessment-short form(MNA-SF), 14.74%(97 cases)of the patients had malnutrition.Results from the GLIM criteria and the MNA-SF were moderately consistent(sensitivity: 59.4%, specificity: 100.0%, positive predictive value: 100.0%, negative predictive value: 93.1%, Kappa=0.712). Malnutrition diagnosed with the GLIM criteria was associated with a longer duration of hospitalization( OR=1.022, 95% CI: 1.005-1.039, P<0.01), increased infectious complications( OR=16.614, 95% CI: 8.130-33.952, P<0.01), and increased risk of death( OR=2.810, 95% CI: 1.393-3.548, P<0.05). Conclusions:The incidence of malnutrition in hospitalized elderly stroke patients based on the GLIM criteria is lower than that based on the MNA-SF, and malnutrition is associated with adverse clinical outcomes.
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Objective:To evaluate nutritional status and to analyse risk factors of acute exacerbation of chronic obstructive pulmonary disease (COPD) in the elderly.Methods:Data of elderly hospitalized patients with COPD mainly from 5 grade A, class 3 hospitals (Beijing Hospital, Shanghai Huadong Hospital, Tianjin Nankai hospital, the Second Affiliated Hospital of Medical College of Zhejiang University, Guangzhou First People′s Hospital) from January 2012 to December 2020 were retrospectively analyzed. According to the global initiative for chronic obstructive lung disease criteria (GOLD), elderly COPD patients were divided into acute exacerbation group and stable group. The differences in age, gender, medical history, anthropometry, laboratory examination, nutritional support, results of nutritional risk screening 2002 (NRS2002) and global leadership initiative on malnutrition (GLIM) were compared between the two groups after admission, and the risk factors of acute exacerbation of COPD in the elderly were analyzed by multivariate Logistic regression.Results:A total of 339 elderly patients with COPD aged 65-100 years were included in this study, including 177 cases (52.21%) in acute exacerbation stage. The detection rate of malnutrition in acute exacerbation stage was higher than that in stable stage (51.98% vs 41.98%, P<0.05). The weight, body mass index and grip strength of patients in the acute exacerbation stage were significantly lower than those in the stable period [(55.47±8.42) vs (60.63±9.30) kg, (20.52±4.25) vs (22.39±4.57) kg/m 2, (12.32±4.21) vs (16.59±2.97) kg] (all P<0.05). Spearman correlation analysis showed that the acute exacerbation of elderly patients with COPD was positively correlated with malnutrition ( r=0.443, P<0.001), and negatively correlated with body weight, body mass index and calf circumference ( r=-0.200, -0.214, -0.135, all P<0.05). Multiple Logistic regression analysis showed that acute exacerbation in elderly patients with COPD was only related to malnutrition ( OR=7.799, 95% CI: 4.466-13.622, P<0.001). Conclusions:The incidence of malnutrition in acute exacerbation stage of elderly COPD patients is high. Malnutrition is independently related to acute exacerbation of COPD.
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Objective:To investigate the muscular quality and its related influencing factors in elderly with sarcopenic obesity.Methods:The internalized 696 elderly subjects meeting inclusion and exclusion criteria were divided into four groups including the sarcopenic obesity(n=55), sarcopenia(n=8), simple obesity(n=481)and normal control(n=152)groups.The intergroup difference was retrospectively analyzed in the parameters of body composition, dietary intake of total energy and three major nutrients and their proportions.Multiple linear regression analysis was used to analyze the influencing factors related to the occurrence of sarcopenic obesity in the elderly.Results:The sarcopenic obesity group versus normal control group showed a higher level or value in age, body mass index, waist-hip ratio, fat mass, percentage of body fat, visceral fat area, fasting blood glucose, estimated glomerular filtration rate( P<0.01 or 0.05), and showed a lower level or value in grip strength, skeletal muscle, skeletal muscle index, muscle quality(grip strength/limb skeletal muscle), intake of energy, carbohydrate, fat and protein, body weight-adjusted intake of energy and protein, as well as ideal body weight-adjusted intake of energy and protein( P<0.01). The detection rate of sarcopenic obesity was 7.90%(n=55), including 7.60% in males(n=48)and 11.48% in females(n=7 cases). The detection rate of sarcopenic obesity was increased along with increasing age with 0.07%(2/287)in 60-69 years old group, 4.94%(12/243)in 70-79 years old group, and 24.70%(41/166)in ≥80 years old group( χ2=87.76, P<0.01). Taking the median point of grip strength/limb skeletal muscle volume as the cutoff point, the decrease rate of muscle quality was 12.36%(86/696)in total elderly subjects, 2.63%(4/152)in the control group, 11.64%(86/635)in the obesity group, 37.5%(3/8)in the sarcopenia group and 41.82%(23/55)in the sarcopenic obesity group, with an increasing trend of the decrease of muscle quality, which had significant differences( χ2=62.25, P<0.01). Multiple logistic regression analysis showed that aging, excessive visceral fat area, insufficient protein intake and decreased basal metabolism were the independent risk factors for sarcopenic obesity in elderly people( P<0.01 or P<0.05). Conclusions:The incidence of decrease of muscle quality is higher in the elderly with sarcopenic obesity than other elderly groups.Sarcopenic obesity is correlated with aging, insufficient intake of protein, decreased basal metabolism and excessive visceral fat accumulation.Individual evaluation and support is necessary in elderly people with sarcopenic obesity.
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Objective:To analyze influencing factors for sarcopenia in people of advanced age, in order to provide insight and evidence for the prevention and treatment of sarcopenia in people belonging to this age group.Methods:Data from 167 people of advanced age seeking care at our department from December 2014 to July 2017 were retrospectively analyzed.According to the diagnostic criteria for sarcopenia of the Asian Working Group for Sarcopenia, subjects were divided into the sarcopenia group( n=46, 27.5%)and the non-sarcopenia group( n=121). Differences in body composition, energy intake, quantities and proportions of three major nutrients were analyzed between males and females.Related influencing factors for sarcopenia were analyzed by using multiple linear regression. Results:Compared with the non-sarcopenia group, the sarcopenia group had lower body mass index, waist-hip ratio, fat mass, total energy intake and protein( P<0.05)but higher age and fat intake( P<0.05). Values for grip strength, muscle mass, index of skeletal muscle, adjusted muscle mass by body mass index, total energy intake, carbohydrates, fat and protein were lower and the percentage of body fat was higher in females than in males( P<0.05). Multiple Logistic regression analysis showed that insufficient intake of protein( β=-0.290, OR=0.748, 95% CI: 0.569-0.984, P<0.05), reduction of body fat mass( β=-2.673, OR=0.069, 95% CI: 0.010-0.488, P<0.05)and excessive visceral fat accumulation( β=0.739, OR=2.094, 95% CI: 1.219-3.597, P<0.01)were correlated with sarcopenia in people of advanced age. Conclusions:The occurrence of sarcopenia is higher in people of advanced age and is related to insufficient intake of protein, reduction of body fat mass and excessive visceral fat accumulation.Individualized nutrition evaluation and support should be carried out as early as possible for people in this age group.
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Objective To investigate whether vascular endothelial cells in choroidal neovascularization whether hypoxia condition can up-regulate SNAI1 and activate matrix metalloproteinase (MMP)2 and MMP9 therefore to participate in choroidal neovascularization(CNV).Methods Sixteen SPF male C57 mice aged 6-8 weeks were divided into control group and model group.CNV models were induced by retinal laser photocoagulation,and flatmount and frozen sections of retinal pigment epithelium (RPE)-choroid-sclera compound were prepared at 7 days after modeling.The CNV in flat-mount was examined by Isolectin B4 staining,and the location of SNAI1,MMP2 and MMP9 in frozen sections was determined by immunofluorescence technology.The expression of SNAI1,MMP2 and MMP9 at mRNA level in CNV was detected by real-time fluorescence quantitative PCR (real-time PCR).The use and care of experimental animals complied with Statement for the Use of Animals in Ophthalmic and Visual Research.The RF/6A cells were divided into normoxia group and hypoxia group and cultured for 24 hours in 5％ CO2condition and mix condition of 94％ N2,5％ CO2 and 1％ O2,respectively.The expression of SNAI1,MMP2 and MMP9 in the cells at mRNA and protein levels was detected by real-time PCR and Western blot assay,respectively.Small interfering RNA of SNAI1 (siSNAI1) was transfected into the cells,and then the expression of MMP2 in the cells at mRNA and protein levels was detected by real-time PCR and Western blot assay,respectively,and the migrating number of the cells was assayed by Transwell chamber assay.Results CD31 and SNAI1 positive-response cells were seen in RPE-choroid-sclera flat-mounts under the laser scanning confocal microscope.The relative expression levels of SNAI1mRNA and MMP2 mRNA in RPE-choroid-sclera tissues were higher in the model group than those in the control group (SNAI1 mRNA:1.291 ±0.060 vs.0.759±0.074,P =0.001;MMP2 mRNA:1.610±0.424 vs.0.772 ±0.080,P =0.044).The expression of MMP9 mRNA was not significantly elevated between model group and control group (P＞0.05).The relative expression level of MMP2 mRNA was higher in comparison with MMP9 mRNA in the model group (P＜0.01).The relative expressions of hypoxic induced factor 1α (HIF-1α),SNAI1 and MMP2 at mRNA level and protein level in RF/6A cells were significantly higher in the hypoxia group than those in the normoxia group (all at P＜0.05) and no considerable difference was seen in MMP9 mRNA expression between the two groups (P＞0.05).The relative expressions of MMP2 mRNA in the cells were 0.217±0.036 and 0.818±0.105,and those of MMP2 protein in the cells were 0.236±0.009 and 1.043±0.120 in the hypoxia+siSNAI1 group and only hypoxia group,respectively,with significant differences between them (P =0.002,0.003).The migrating number of the cells was (254.60 ±71.31)/field in the hypoxia+siSNAI1 group,which was significantly less than (534.10±96.21) /field in the control group (P =0.029).Conclusions The hypoxic environment at CNV can activate MMP2 by up-regulating the expression of SNAI1,which promotes the migration of vascular endothelial cells and therefore participates in CNV formation,and the intervention of SNAI1 activation under the hypoxic condition can inhibit this process.
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Objective To identify the applicability of Traditional nutritional evaluation method,short-form mini-nutritional assessment (MNA-SF) and nutrition risk screening 2002 (NRS 2002) on screening malnutrition in elderly in-patients.Methods 100 elderly in-patients with malnutrition were screened by the above screening instruments.The evaluation effects of the 3 methods were compared by sensitivity,specificity and ROC curve.Results The detection rates of elderly in-patients with malnutrition by BMI,MNA-SF and NRS 2002 was 7％,58％ and 39％ respectively.Taking the human body measurement instrument as standard,the sensitivities of BMI,MNA-SF and NRS 2002 was 0.475,0.918 and 0.410respectively,the specificities was 0.615,0.103 and 0.641 respectively.3 tools series test sensitivity and specificities was 0.557 and 0.913 respectively,parallel test sensitivity and specificities was 0.929 and 0.435 respectively.Conclusions There is significant difference among the sensitivities of the 3 methods,NRS 2002 has the highest accuracy and is applicable to the screening of nutrition risks in elderly patients.Combined 3 kinds of tool can better improve the effect.
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Objective To evaluate the nutrition status of the elderly patients with type 2 diabetes. Methods The nutrition status of 100 elderly patients〔male 52, female 48, aged 60-83 yrs, with average of (69.2?0.7)yrs〕 with type 2 diabetes was investigated by analyzing nutrient content in daily diet, body measurement and laboratory examinations. Results Compared with the ideal body weight, total calorie intake was suitable for the elderly patients〔male: (1592?216) kCal, female: (1320?172) kCal〕, fat intake 〔male:(67?12) g, female:(65?13)g〕 was higher than the standard for diabetics(P