Quality of life and sarcopenic patients.

Sarcopenia is defined as a progressive and generalised loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, has identified a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on patient's quality of life. The first quality of life questionnaire specific to sarcopenia, the SarQoL®, was developed in 2015. Psychometric validation of the SarQoL® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change, as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice and in the context of both observational or interventional evaluations.

[Which quality of life for the sarcopenic patient?] / Quelle qualité de vie pour le patient sarcopénique ?

Sarcopenia is defined as a progressive and generalized loss of muscle strength, muscle mass and physical performance with advancing age. Among the multiple consequences of sarcopenia, the reduction in the quality of life associated with it can undeniably be considered as a major consequence. Quality of life is measured via generic or specific questionnaires. Current research, mainly using so-called "generic" questionnaires, identifies a reduced quality of life in patients with primary age-related sarcopenia, mainly in areas related to functional status and physical performance. A specific quality of life questionnaire could, in combination with a generic questionnaire, provide more precise data on the impact that sarcopenia has on the quality of life of patients. It was in 2015 that the first quality of life questionnaire specific to sarcopenia, the SarQoL®, was developed. Psychometric validation of the SarQoL® has been carried out in several international patient populations indicating excellent internal consistency, reliability and convergent validity and sensitivity to change as well as an absence of floor and ceiling effects. In combination with a generic questionnaire, this specific questionnaire is therefore suitable for measuring the quality of life of populations suffering from sarcopenia, both in research and in clinical practice, both in the context of observational or interventional evaluations.

[Protein supplementation to prevent loss in muscle mass and strength in frail older patients: a review]. / Quels bénéfices attendre de la supplémentation en protéines pour limiter la perte de masse et de fonction musculaire chez le sujet âgé fragile ?

Minimum levels of protein intake are essential for the preservation of muscle mass and function, which is a major preventive issue of successful aging. Epidemiological studies suggest strong associations between protein intake and the different elements of sarcopenia, namely maintenance of lean mass and muscle strength. Most often, protein intakes among older patients are below requirements, independently from situations of under nutrition. This opens the path for nutritional interventions to prevent the consequences of sarcopenia in older patients. Isolated amino-acids such as leucine have shown positive effects in the short term only. The positive effects of protein supplementations on muscle strength and function are currently not established in the absence of concomitant exercise training. The highest level of evidence supports interventions combining exercise and nutrition.

Effects of a multi-component nutritional telemonitoring intervention on nutritional status, diet quality, physical functioning and quality of life of community-dwelling older adults.

This study aimed to evaluate the effects of an intervention including nutritional telemonitoring, nutrition education, and follow-up by a nurse on nutritional status, diet quality, appetite, physical functioning and quality of life of Dutch community-dwelling elderly. We used a parallel arm pre-test post-test design with 214 older adults (average age 80 years) who were allocated to the intervention group (n 97) or control group (n 107), based on the municipality. The intervention group received a 6-month intervention including telemonitoring measurements, nutrition education and follow-up by a nurse. Effect measurements took place at baseline, after 4·5 months, and at the end of the study. The intervention improved nutritional status of participants at risk of undernutrition (ß (T1)=2·55; 95 % CI 1·41, 3·68; ß (T2)=1·77; 95 % CI 0·60, 2·94) and scores for compliance with Dutch guidelines for the intake of vegetables (ß=1·27; 95 % CI 0·49, 2·05), fruit (ß=1·24; 95 % CI 0·60, 1·88), dietary fibre (ß=1·13; 95 % CI 0·70, 1·57), protein (ß=1·20; 95 % CI 0·15, 2·24) and physical activity (ß=2·13; 95 % CI 0·98, 3·29). The intervention did not have an effect on body weight, appetite, physical functioning and quality of life. In conclusion, this intervention leads to improved nutritional status in older adults at risk of undernutrition, and to improved diet quality and physical activity levels of community-dwelling elderly. Future studies with a longer duration should focus on older adults at higher risk of undernutrition than this study population to investigate whether the impact of the intervention on nutritional and functional outcomes can be improved.

Association between cachexia, chemotherapy and outcomes in older cancer patients: A systematic review.

BACKGROUND & AIMS: The aims of this systematic review were (i) to determine the prevalence of malnutrition and cachexia in older cancer patients in a chemotherapy setting, and (ii) to report the chemotherapy-related causes of malnutrition and (iii) the consequences of malnutrition on the outcomes of these patients. METHODS: We searched MEDLINE for articles published in English or French between 2005 and 2016 and which reported retrospective or prospective, observational or interventional studies of the prevalence of malnutrition and its consequences in patients 65 years or older with solid tumors and chemotherapy-related causes of malnutrition. RESULTS AND CONCLUSION: Malnutrition is prevalent up to 83% in older patients with cancer scheduled to receive chemotherapy. One third or more of patients were malnourished before receiving chemotherapy. A weight loss of 10% or more during the past three or six months was reported in 8%-40% of cancer patients, while a body mass index <21 kg/m2 was found in 10.7%-23%. Malnutrition was more prevalent in digestive (28%-75%) than in non-digestive cancers (8%-46.9%), and also in metastatic cancers (64%-76.5%). During the course of chemotherapy, weight loss was observed in 40%-91.6% of patients, depending on cancer location. The most frequently reported chemotherapy-related digestive symptoms likely to impair nutritional status were dry mouth, nausea, stomach pain, diarrhea and constipation. Low Mini-Nutritional-Assessment score was an independent predictor of early discontinuation of chemotherapy and increased the risk of mortality.

Regular-Fat Dairy and Human Health: A Synopsis of Symposia Presented in Europe and North America (2014-2015).

In recent history, some dietary recommendations have treated dairy fat as an unnecessary source of calories and saturated fat in the human diet. These assumptions, however, have recently been brought into question by current research on regular fat dairy products and human health. In an effort to disseminate, explore and discuss the state of the science on the relationship between regular fat dairy products and health, symposia were programmed by dairy industry organizations in Europe and North America at The Eurofed Lipids Congress (2014) in France, The Dairy Nutrition Annual Symposium (2014) in Canada, The American Society for Nutrition Annual Meeting held in conjunction with Experimental Biology (2015) in the United States, and The Federation of European Nutrition Societies (2015) in Germany. This synopsis of these symposia describes the complexity of dairy fat and the effects regular-fat dairy foods have on human health. The emerging scientific evidence indicates that the consumption of regular fat dairy foods is not associated with an increased risk of cardiovascular disease and inversely associated with weight gain and the risk of obesity. Dairy foods, including regular-fat milk, cheese and yogurt, can be important components of an overall healthy dietary pattern. Systematic examination of the effects of dietary patterns that include regular-fat milk, cheese and yogurt on human health is warranted.

Mediterranean diet and cognitive function: a French study.

BACKGROUND: Evidence on the association between Mediterranean diet (MedDiet) adherence and cognition is presently inconsistent. OBJECTIVES: The aims of this study were to investigate the association between midlife MedDiet adherence and cognitive performance assessed 13 y later among participants in the SU.VI.MAX (Supplementation with Vitamins and Mineral Antioxidants) study and to test the hypothesis of effect modification by occupation and education as cognitive reserve markers. DESIGN: A Mediterranean Diet Score (MDS) and a Mediterranean-Style Dietary Pattern Score (MSDPS) were estimated by using repeated 24-h dietary records (1994-1996) from 3083 middle-aged subjects. Cognitive performance was assessed in 2007-2009 by using 6 neuropsychological tests, and a composite score was built. Subgroup analyses were performed according to occupational and educational status. Mean differences and 95% CIs were estimated through covariance analyses. RESULTS: After potential confounders were accounted for, no association between MDS or MSDPS and cognitive scores was detected except for a lower phonemic fluency score with decreasing MSDPS (P = 0.048) and a lower backward digit span score with decreasing MDS (P = 0.03). In turn, a low MDS was related to a lower composite cognitive score in the small subsample of manual workers (n = 178, P-interaction = 0.04) who could be hypothesized to have low cognitive reserve. MedDiet adherence did not interact with educational level in relation to cognitive function. CONCLUSION: This study did not find support for a beneficial effect of MedDiet adherence on cognitive function, irrespective of educational level, which is the strongest indicator of cognitive reserve.

A healthy dietary pattern at midlife is associated with subsequent cognitive performance.

Few studies have investigated the long-term impact of overall dietary patterns (DP) on cognition. We evaluated the association between empirically derived DP in midlife and cognitive performance 13 y later. Dietary data were based on 24-h dietary records obtained from a subsample of the Supplémentation en Vitamines et Minéraux Antioxydant Study. Cognitive performance was assessed via a battery of neuropsychological tests that included verbal fluency, the RI-48 cued recall test, the trail-making test, and forward and backward digit span. Three composite variables, for global cognitive function, verbal memory, and executive functioning, were built. The multivariate analyses were adjusted for baseline characteristics (age, gender, intervention group, education, alcohol and energy intake, number of dietary records, physical activity, BMI, tobacco use, self-reported memory troubles, diabetes, hypertension, and, for women, menopausal status and hormone therapy use), follow-up time, history of cardiovascular disease, and depressive symptoms. Adjusted means ± SEM of composite variables across quartiles (Q4 vs. Q1) of DP were estimated using ANCOVA. A healthy and a traditional DP were identified. In the multivariate model, the healthy pattern was associated with better global cognitive function (50.1 ± 0.7 vs. 48.9 ± 0.7; P-trend = 0.001) and verbal memory (49.7 ± 0.4 vs. 48.7 ± 0.4; P-trend = 0.01). These relationships were stronger in participants scoring below the gender-specific median values for energy intake (<2490 kcal for men and <1810 for women) than in those scoring at or above those values. Adherence to a healthy DP in middle life may help preserve global cognitive function, especially verbal memory, when total energy intake is regulated.

Cross-sectional but not longitudinal association between n-3 fatty acid intake and depressive symptoms: results from the SU.VI.MAX 2 study.

Findings regarding the association between n-3 polyunsaturated fatty acid (PUFA) status and depression are conflicting. Thus, the authors studied associations between PUFA intake and depressive symptoms. In 1996, depressive symptoms were assessed in a subsample of participants from the Supplementation with Antioxidant Vitamins and Minerals (SU.VI.MAX) Study using the Center for Epidemiologic Studies Depression Scale (CES-D). In 2007-2009, information on CES-D score, history of depression, and use of antidepressant medication was obtained. Intakes of n-3 PUFAs were estimated from repeated 24-hour dietary records collected during 1994-1996. Subjects with depressive symptoms (cases) were identified using CES-D scores greater than 15 and/or antidepressant use. Logistic regression analyses were used. Cross-sectional (n = 2,744) and longitudinal (n = 1,235) associations between quartiles of PUFA intake and depressive symptoms were estimated. In cross-sectional analyses, quartile of n-3 PUFA intake was associated with lower odds of depressive symptoms (fourth quartile vs. first: odds ratio = 0.74, 95% confidence interval: 0.58, 0.95; P for trend = 0.001). No association between PUFA intake and incidence of depressive symptoms over 13 years was detected. This study provides new insights into the PUFA-depression link. While no association between n-3 PUFA intake and incidence of depressive symptoms was detected, an association was observed in cross-sectional analyses, which may reflect unhealthy dietary patterns among subjects with depressive symptoms.

Alcohol consumption in midlife and cognitive performance assessed 13 years later in the SU.VI.MAX 2 cohort.

BACKGROUND: Associations between alcohol consumption and cognitive function are discordant and data focusing on midlife exposure are scarce. OBJECTIVE: To estimate the association between midlife alcohol consumption and cognitive performance assessed 13 y later while accounting for comorbidities and diet. METHODS: 3,088 French middle-aged adults included in the SU.VI.MAX (1994) study with available neuropsychological evaluation 13 y later. Data on alcohol consumption were obtained from repeated 24h dietary records collected in 1994-1996. Cognitive performance was assessed in 2007-2009 via a battery of 6 neuropsychological tests. A composite score was built as the mean of the standardized individual test scores (mean=50, SD=10). ANCOVA were performed to estimate mean differences in cognitive performance and 95% confidence intervals (CI). RESULTS: In women, abstainers displayed lower cognitive scores than did low-to-moderate alcohol drinkers (1 to 2 drinks/day) (mean difference= -1.77; 95% CI: -3.29, -0.25). In men, heavy drinkers (>3 drinks/day) had higher cognitive scores than did low-to-moderate (1 to 3 drinks/day) (mean difference=1.05; 95% CI: 0.10, 1.99). However, a lower composite cognitive score was detected in male drinkers consuming ≥ 90 g/d (≈8 drinks/d). A higher proportion of alcohol intake from beer was also associated with lower cognitive scores. These associations remained significant after adjustment for diet, comorbidities and sociodemographic factors. CONCLUSION: In men, heavy but not extreme drinking was associated with higher global cognitive scores. Given the known harmful effects of alcohol even in low doses regarding risk of cancer, the study does not provide a basis for modifying current public health messages. TRIAL REGISTRATION: ClinicalTrials.gov NCT00272428.

[Frailty in older population: a brief position paper from the French society of geriatrics and gerontology]. / La fragilité de la personne âgée: un consensus bref de la Société française de gériatrie et gérontologie.

Frailty in the older population is a clinical syndrome which evaluate a risk level. The Frailty syndrome defines a reduction of the adaptation capacity to a stress. It can be modulated by physical, psychological and social factors. The screening of the frailty syndrome is relevant for older people without disability for basic activities of daily living. The clinical criteria of frailty must be predictive of the risk of functional decline and adverse outcomes, consensual at the international level, and easy to perform in primary care as well as in the clinical researches.

Fruit and vegetable intake and cognitive function in the SU.VI.MAX 2 prospective study.

BACKGROUND: Current hypotheses suggest that intake of fruit and vegetables (FVs) protects against age-related cognitive impairment. OBJECTIVE: We examined the 13-y association between FV intake and cognitive performance in a sample of French adults. DESIGN: A total of 2533 subjects aged 45-60 y at baseline, who were part of the Supplementation with Antioxidant Vitamins and Minerals 2 (SU.VI.MAX 2) cohort, were selected. FV intake was estimated at baseline in participants who had completed at least six 24-h dietary records. Cognitive performance was assessed 13 y after baseline and included an evaluation of verbal memory (RI-48 cued recall, semantic, and phonemic fluency tests) and executive function (trail-making and forward and backward digit span tests). Principal components analysis was performed to account for correlations in test scores. The relation between cognitive performance and quartiles of FV intake was assessed by multivariate linear regression analyses. RESULTS: Intakes of FVs (P-trend = 0.02), fruit alone (P-trend = 0.04), vitamin C-rich FVs (P-trend = 0.03), vitamin C (P-trend = 0.005), and vitamin E (P-trend = 0.04) were positively associated with verbal memory scores. In contrast, intakes of FVs (P-trend = 0.006), vegetables alone (P-trend = 0.03), and ß-carotene-rich FVs (P-trend = 0.02) were negatively associated with executive functioning scores. CONCLUSIONS: FVs might have a differential effect on cognition according to groups of FVs and type of cognitive function. Further research using sensitive and reliable measures of various types of cognitive function is needed to clarify the effect of individual FV groups and nutrients. This trial is registered at clinicaltrials.gov as NCT00272428.

French adults' cognitive performance after daily supplementation with antioxidant vitamins and minerals at nutritional doses: a post hoc analysis of the Supplementation in Vitamins and Mineral Antioxidants (SU.VI.MAX) trial.

BACKGROUND: Antioxidant properties of some vitamins and trace elements may help to prevent cognitive decline. OBJECTIVE: The aim of the current study was to estimate the long-term effects of antioxidant nutrient supplementation on the cognitive performance of participants in the Supplementation in Vitamins and Mineral Antioxidants (SU.VI.MAX) study 6 y after the end of the trial. DESIGN: This study included 4447 French participants aged 45-60 y who were enrolled in the SU.VI.MAX study (1994-2002), which was a double-blind, placebo-controlled, randomized trial. From 1994 to 2002, participants received daily vitamin C (120 mg), ß-carotene (6 mg), vitamin E (30 mg), selenium (100 µg), and zinc (20 mg) in combination or as a placebo. In 2007-2009, the cognitive performance of participants was assessed with 4 neuropsychological tests (6 tasks). Principal components analysis (PCA) was performed to identify cognitive-function summary scores. Associations between antioxidant supplementation and cognitive functions, in the full sample and by subgroups, were estimated through ANOVA and expressed as mean differences and 95% CIs. Subgroup analyses were performed according to baseline characteristics. RESULTS: Subjects receiving active antioxidant supplementation had better episodic memory scores (mean difference: 0.61; 95% CI: 0.02, 1.20). PCA indicated 2 factors that were interpreted as showing verbal memory and executive functioning. Verbal memory was improved by antioxidant supplementation only in subjects who were nonsmokers or who had low serum vitamin C concentrations at baseline. CONCLUSION: This study supports the role of an adequate antioxidant nutrient status in the preservation of verbal memory under certain conditions. This trial was registered at clinicaltrials.gov as NCT00272428.

Adherence to nutritional recommendations and subsequent cognitive performance: findings from the prospective Supplementation with Antioxidant Vitamins and Minerals 2 (SU.VI.MAX 2) study.

BACKGROUND: Few studies have investigated the long-term effect of overall nutritional recommendations on cognition. OBJECTIVE: In a French cohort of middle-aged adults, we evaluated the association between the French National Nutrition and Health Program (Program National Nutrition Santé) Guideline Score (PNNS-GS) assessed at baseline and cognitive performance evaluated 13 y later. DESIGN: The PNNS-GS was estimated at baseline (1994-1996) (maximum score: 15 points) in 2135 subjects in the SU.VI.MAX (Supplementation with Antioxidant Vitamins and Minerals) study. We assessed cognitive performance of subjects in 2007-2009 via a battery of 4 neuropsychologic tests that included phonemic and semantic fluency, the RI-48 (rappel indicé-48 item) cued-recall test, the trail-making test, and forward and backward digit spans. A principal components analysis was performed to account for correlations in test scores. Multivariate linear regression models or analyses of covariance were also performed. RESULTS: In a multivariate model, we observed a positive association between the PNNS-GS and the cued-recall test and semantic and phonemic fluency tasks, whereas no association was observed with digit spans. The principal components analysis revealed 2 factors interpreted as reflecting verbal memory and executive functioning. Better adherence to nutritional recommendations was significantly associated with the verbal memory factor (ß = 0.41; 95% CI: 0.17, 0.64), whereas no association was shown with the executive functioning factor. Removing specific components from the PNNS-GS did not modify the findings. CONCLUSION: This study suggests that strong compliance with nutritional recommendations in midlife is associated in elderly individuals with better verbal memory, which is a cognitive domain that is particularly vulnerable to pathologic aging and Alzheimer disease. This trial was registered at clinicaltrials.gov as NCT00272428.

Inhibition of markers of bone resorption by consumption of vitamin D and calcium-fortified soft plain cheese by institutionalised elderly women.

Acceleration of bone remodelling increases the risk of fragility fractures. The objective of the present study was to explore in elderly women whether a vitamin D and Ca-fortified dairy product providing about 17-25 % of the recommended intakes in vitamin D, Ca and proteins would reduce secondary hyperparathyroidism and bone remodelling in a way that may attenuate age-related bone loss in the long term. Thirty-seven institutionalised women, aged 84.8 (sd 8.1) years, with low serum 25-hydroxyvitamin D (5.5 (sd 1.7) ng/ml) were enrolled into a multicentre open trial to consume during 1 month two servings of soft plain cheese made of semi-skimmed milk providing daily 686 kJ (164 kcal), 2.5 microg vitamin D, 302 mg Ca and 14.2 g proteins. The primary endpoint was the change in serum carboxy terminal cross-linked telopeptide of type I collagen (CTX), selected as a marker of bone resorption. Thirty-five subjects remained compliant. Mean serum changes were: 25-hydroyvitamin D, +14.5 % (P = 0.0051); parathyroid hormone (PTH), - 12.3 % (P = 0.0011); CTX, - 7.5 % (P = 0.01); tartrate-resistant acid phosphatase isoform 5b (TRAP 5b), - 9.9 % (P < 0.0001); albumin, +6.2 % (P < 0.0001); insulin-like growth factor-I (IGF-I),+16.9 % (P < 0.0001); osteocalcin, +8.3 % (P = 0.0166); amino-terminal propeptide of type 1 procollagen (P1NP),+19.3 % (P = 0.0031). The present open trial suggests that fortified soft plain cheese consumed by elderly women with vitamin D insufficiency can reduce bone resorption markers by positively influencing Ca and protein economy, as expressed by decreased PTH and increased IGF-I, respectively. The rise in the bone formation marker P1NP could be explained by a protein-mediated increase in IGF-I. Thus, such a dietary intervention might uncouple, at least transiently, bone resorption from bone formation and thereby attenuate age-related bone loss.

Zinc supplementation does not alter plasma homocysteine, vitamin B12 and red blood cell folate concentrations in French elderly subjects.

BACKGROUND/AIMS: In ageing, low folates and vitamin B12 status are frequent and can explain the increase of plasma homocysteine level. Zinc is involved in the folates and vitamin B12 metabolism with opposite actions. The aim of this study was to investigate the effects of zinc supplementation on homocysteine and vitamin B12 plasma levels as well as red blood cell folate level in French ageing subjects participating in the ZENITH study. METHODS: Apparently healthy middle-aged (55-70 years) and free-living older (70-85 years) subjects were enrolled. They were randomly allocated to three groups: 0, 15 or 30 mg Zn per day for 6 months as zinc gluconate in addition to their usual dietary intake. RESULTS: At baseline, plasma homocysteine levels (15.2+/-3.5 micromol/L) in older people were higher than in the middle-aged subjects (12.7+/-2.7 micromol/L) and was negatively correlated with vitamin B12 values (p=0.0036, r=-0.215) and with RBC folate levels (p<0.0001, r=-0.30). These results are in agreement with previous data. However, we found no correlation between the biomarkers of zinc status and homocysteine, vitamin B12 or folate levels at baseline. Moreover, 6-month zinc supplementation did not modify homocysteine, vitamin B12 and RBC folate values in either of the groups. CONCLUSIONS: Zinc supplementation at moderate doses do not lead to deleterious effect on folate or vitamin B12 status in ageing healthy free-living people, but does not have any beneficial effects on homocysteine metabolism either.

No antioxidant beneficial effect of zinc supplementation on oxidative stress markers and antioxidant defenses in middle-aged and elderly subjects: the Zenith study.

OBJECTIVE: The aim of the study was to investigate whether zinc supplementation affects antioxidant status in European middle-aged and elderly people. DESIGN: Multicentre prospective intervention study, randomized, double-blind, placebo-control. SETTING: France (Clermont-Ferrand/Theix, and Grenoble), Italy (Rome), Northern Ireland (Coleraine). SUBJECTS: A total of 387 healthy middle-aged (55-70 yrs) and free-living older aged (70-85 yrs) subjects were randomly allocated to three groups: 0, 15 or 30 mg zinc gluconate/d in addition to usual dietary intake during 6 months. METHODS: Oxidative stress status was evaluated by measurement of protein oxidation (plasma thiol groups), lipid peroxidation (plasma thio-barbituric acid reactants, TBARS), whole blood glutathione levels, erythrocyte copper/zinc superoxide dismutase activity and plasma antioxidant status (ferric reducing antioxidant power assay), at baseline and after 3 and 6 months. RESULTS: Zinc supplementation did not alter oxidative stress markers and antioxidant defenses in elderly, after 3 or 6 months, except an increase in Cu/Zn superoxide dismutase activity. CONCLUSIONS: In apparently healthy free living elderly people, a single zinc supplementation had no effects on oxidative stress status.

Food chromium content, dietary chromium intake and related biological variables in French free-living elderly.

Trivalent chromium (Cr3+) is an essential trace element involved in insulin function. Cr deficiencies result in decreased insulin sensitivity, glucose intolerance and an increased risk of diabetes. Cr status decreases with age suggesting that the elderly may be at high risk of Cr deficiency. This study aimed to provide information about the Cr content of foods in France and the Cr intake in French free-living elderly. We measured the food Cr content and daily Cr intake of freely chosen diets for 3 d in twelve French free-living elderly people and their Cr excretion and plasma hormonal related variables, leptin, insulin and cortisol. Considering the relationship between insulin resistance and oxidative stress, we also determined plasma thiobarbituric acid reactive substance, thiol groups and total and reduced glutathione. Although these subjects had well-balanced diets, their daily Cr intakes did not reach the French recommendations. The low Cr intakes were due to the low Cr density of the foods. We found a negative correlation between Cr intakes and insulin, BMI and leptin.

Plasma carotene and alpha-tocopherol in relation to 10-y all-cause and cause-specific mortality in European elderly: the Survey in Europe on Nutrition and the Elderly, a Concerted Action (SENECA).

BACKGROUND: Only a few observational studies have related plasma carotene and alpha-tocopherol to mortality in elderly subjects. OBJECTIVE: The objective was to study the association of plasma carotene (alpha-and beta-carotene) and alpha-tocopherol with all-cause and cause-specific mortality in elderly subjects who participated in a European prospective study. DESIGN: Plasma concentrations of carotene and alpha-tocopherol were measured in 1168 elderly men and women. After a follow-up period of 10 y, 388 persons had died. The association between plasma antioxidants and mortality was analyzed by using Cox proportional hazard models. To put our results in context, we performed a meta-analysis of 5 studies on plasma antioxidants and all-cause mortality in elderly populations. RESULTS: Plasma carotene concentrations were associated with a lower mortality risk [adjusted rate ratio (RR) for an increment of 0.39 micromol/L: 0.79; 95% CI: 0.70, 0.89]. This lower mortality risk was observed for both cancer (RR: 0.59; 95% CI: 0.44, 0.79) and cardiovascular disease (RR: 0.83; 95% CI: 0.70, 1.00). The lower risk of cardiovascular death was confined to those with a body mass index (in kg/m2) <25 (RR: 0.67; 95% CI: 0.49, 0.94). Plasma concentrations of alpha-tocopherol were not associated with all-cause or cause-specific mortality. The results for both plasma antioxidants and all-cause mortality were confirmed by the meta-analysis. CONCLUSIONS: This prospective study suggests that high plasma concentrations of carotene are associated both with lower mortality from all causes and with cancer in the elderly. For cardiovascular mortality, the inverse association was confined to elderly with body mass indexes <25.

Strategies for ensuring good hydration in the elderly.

Dehydration is a frequent etiology of morbidity and mortality in elderly people. It causes the hospitalization of many patients and its outcome may be fatal. Indeed, dehydration is often linked to infection, and if it is overlooked, mortality may be over 50%. Older individuals have been shown to have a higher risk of developing dehydration than younger adults. Modifications in water metabolism with aging and fluid imbalance in the frail elderly are the main factors to consider in the prevention of dehydration. Particularly, a decrease in the fat free mass, which is hydrated and contains 73% water, is observed in the elderly due to losses in muscular mass, total body water, and bone mass. Since water intake is mainly stimulated by thirst, and since the thirst sensation decreases with aging, risk factors for dehydration are those that lead to a loss of autonomy or a loss of cognitive function that limit the access to beverages. The prevention of dehydration must be multidisciplinary. Caregivers and health care professionals should be constantly aware of the risk factors and signs of dehydration in elderly patients. Strategies to maintain normal hydration should comprise practical approaches to induce the elderly to drink enough. This can be accomplished by frequent encouragement to drink, by offering a wide variety of beverages, by advising to drink often rather than large amounts, and by adaptation of the environment and medications as necessary.