The Impact of Multimorbidity on Resting Metabolic Rate in Community-Dwelling Women over a Ten-Year Period: A Cross-Sectional and Longitudinal Study.

OBJECTIVES: Ageing has been associated with increasing multimorbidity. This study investigated whether the number of diseases is a predictor of resting metabolic rate (RMR) and its long-term changes in community-dwelling elderly women. SUBJECTS AND DESIGN: Cross-sectional and longitudinal data, obtained over ten years with repeated follow-ups, from 180 women aged 60 - 86 years and with a BMI of 18 - 43 kg/m2 at baseline were analyzed. MEASUREMENTS: RMR was measured using indirect calorimetry and body composition by bioelectrical impedance analysis. Diagnosed diseases were assessed by a questionnaire comprising 23 disease categories. Subjects with 0 - 2 diseases were classified as relatively healthy and with > 2 diseases as multimorbid. RESULTS: At baseline, relatively healthy (N = 75) and multimorbid (N = 105) women did not differ in RMR. During the ten-year follow-up, the median (range) number of diseases increased from 2 (0 - 2) to 4 (0 - 8) in relatively healthy and from 5 (3 - 11) to 7 (3 - 15) in multimorbid women. In the longitudinal analyses, only women who were multimorbid at baseline showed a significant increase in RMR of 31 kJ/d per additional disease (P = 0.015), adjusted for fat-free mass, fat mass, waist circumference and age. CONCLUSION: Increasing multimorbidity in community-dwelling women is associated with an increase in RMR independently of body composition and age.

No Associations of 25-Hydroxycholecalciferol and Parathyroid Hormone Concentrations with Calcaneal Bone Characteristics in Community-Dwelling Elderly Subjects: A Cross-Sectional Study.

OBJECTIVE: This study examined the associations of 25-hydroxycholecalciferol [25(OH)D3] and intact parathyroid hormone (iPTH) concentrations with bone status parameters in elderly subjects. DESIGN/SETTING: Cross-sectional data based on the follow-up 2008 of the longitudinal study on nutrition and health status of senior citizens in Giessen, Germany. PARTICIPANTS: One hundred eighty-eight independently living subjects aged 66-96 years. MEASUREMENTS: Serum concentrations of 25(OH)D3, iPTH, N-terminal propeptide of type 1 collagen (P1NP) and activity of alkaline phosphatase (ALP) were assessed. Broadband ultrasound attenuation, speed of sound and stiffness index were determined by calcaneal quantitative ultrasound (QUS). Multiple linear regression analyses were performed to analyse associations of 25(OH)D3 and iPTH with bone status parameters. RESULTS: Median (range) 25(OH)D3 and iPTH concentrations were 62.8 (29.9-106.7) nmol/L and 4.6 (1.3-21.0) pmol/L, respectively. Neither 25(OH)D3 nor iPTH was associated with calcaneal bone characteristics measured by QUS, whereas negative associations between 25(OH)D3 and bone formation markers (P1NP and ALP) were found. In a sub analysis, 25(OH)D3 was negatively associated with ALP only in subjects with iPTH concentrations > 4.59 pmol/L. CONCLUSION: The present study provides no evidence for independent associations of 25(OH)D3 and iPTH with calcaneal bone characteristics in community-dwelling elderly subjects with 25(OH)D3 concentrations between 30 and 107 nmol/L. However, 25(OH)D3 interacts with bone formation markers, particularly in subjects with high iPTH concentrations.

Changes in resting metabolic rate in an elderly German population: cross-sectional and longitudinal data.

BACKGROUND/OBJECTIVES: This study investigates age-dependent changes in resting metabolic rate (RMR) considering changes in body composition and fat distribution within the longitudinal study on nutrition and health status in an aging population in Giessen (GISELA), Germany, using three different approaches. SUBJECTS/METHODS: In approach 1 cross-sectional data from 358 female and 155 male participants of the GISELA study were evaluated (mean age of 67.4 +/- 5.9 and 66.9 +/- 5.2 y, respectively). In approach 2 longitudinal data of 107 female and 55 male subjects who participated over a follow up period of 10 years were analysed. In approach 3 all data obtained at a total of 3033 visits from 363 women and 153 men between 1994 and 2006 were evaluated. The mean duration of follow-up was eight years. RMR was assessed by indirect calorimetry. RESULTS: Approach 1: RMR correlates significantly negatively with age in women and men. Considering fat free mass, fat mass, and WHR, age proved to be a significant predictor of RMR in both sexes in multiple regression analysis; RMR falls by 11.2 kJ/d and 34.1 kJ/d per year in females and males, respectively. Approach 2: In males but not in females RMR decreases significantly in the course of the follow up. After ten years measured RMR is significantly lower than expected RMR predicted on the basis of body composition and fat distribution in females and males. Deviations correspond to a decline in RMR by 11.4 and 27.5 kJ/d per year independently of changes in body composition and fat distribution. Approach 3: Results of the mixed linear model show that RMR decreases in the course of aging in both women and men; after considering changes in body composition and fat distribution respective decreases were 8.7 and 30.7 kJ/d per year. CONCLUSIONS: These results indicate that the decline in RMR with advancing age cannot be totally due to changes in body composition.

Longitudinal changes in energy expenditure in an elderly German population: a 12-year follow-up.

BACKGROUND/OBJECTIVES: This study investigates age-dependent changes in different components of energy expenditure (EE) within the longitudinal study on nutrition and health status in an aging population in Giessen, Germany (GISELA). SUBJECTS/METHODS: Between 1994 and 2006, data obtained at a total of 3033 visits from 363 women and 153 men with a mean initial age of 67.4+/-5.9 and 66.9+/-5.2 years, respectively, were evaluated. The mean duration of follow-up was 8 years. Resting metabolic rate (RMR) was assessed by indirect calorimetry and physical activity patterns were assessed by questionnaire. EE of physical activity and total EE (TEE) were calculated using multipliers for RMR. Energy intake was determined through a validated 3-day estimated dietary record. Linear mixed models were used to analyze the influence of age on EE adjusted for covariates. RESULTS: Resting metabolic rate decreased in women and men by 158 and 326 kJ/d per decade, respectively; after considering changes in body composition and fat distribution, respective decreases were 81 and 286 kJ/d per decade. EE of physical activity decreased similarly in both sexes (472 kJ/d per decade). TEE dropped in women and men by 540 and 823 kJ/d per decade, respectively. No statistically significant changes in energy intake and body weight were observed in the course of follow-up. CONCLUSIONS: The age-dependent decrease in TEE is mainly due to a decrease in physical activity. The stable energy intake and body weight of the GISELA subjects may be indicators for a relatively good health status.

Intake of vitamin and mineral supplements in an elderly german population.

AIM: To assess the prevalence of vitamin and mineral supplement use in a free-living elderly population and the contribution of these supplements to usual dietary intake. METHODS: Analyses are based on data obtained from 388 subjects (>or=60 years) participating in the longitudinal study on nutrition and health status in an ageing population in Giessen (GISELA), Germany, in 2002. Nutrient intake from food was assessed by means of a 3-day estimated dietary record. Supplement use was recorded over a period of 3 days using a self-administered questionnaire. RESULTS: Nearly half of the study population consumed at least 1 supplement within these 3 days. The use of supplements was more prevalent among women than among men (51.5 vs. 33.9%). On average women consumed 2.03+/-1.30 products and men 1.65+/-1.07 products. Magnesium, vitamin C and vitamin E were supplemented most often by men, while women supplemented magnesium, vitamin E and calcium most often. Most of the supplemented nutrients did not distinctly increase the average intake of the respective nutrients from the diet in this population. However, supplement use markedly decreased the proportions of elderly subjects with an intake below the current reference values for certain nutrients, particularly for vitamin E. CONCLUSION: Results indicate that the intake of supplements is a common behavior in the population under investigation and therefore has to be considered when nutrient intake is evaluated.

Lower resting metabolic rate in the elderly may not be entirely due to changes in body composition.

OBJECTIVE: To investigate whether or not the lower resting metabolic rate (RMR) in the elderly is entirely due to changes in body composition. DESIGN: Cross-sectional data of 132 female (age 69.9+/-5.5 y, body mass index (BMI) 26.5+/-4.0 kg/m(2)) and 84 male (age 68.9+/-5.1 y, BMI 26.1+/-2.8 kg/m(2)) participants of the longitudinal study on nutrition and health status in an aging population of Giessen, Germany, as well as that of 159 young women (age 24.8+/-3.0 y, BMI 21.1+/-2.5 kg/m(2)) and 67 young men (age 26.8+/-3.4 y, BMI 23.3+/-2.4 kg/m(2)) were analysed. RMR was measured by indirect calorimetry after an overnight fast and body composition was estimated by bioelectrical impedance analysis and predictive equations from the literature. Analysis of covariance was used to adjust RMR for body composition, body fat distribution and smoking habits. Additionally, RMR that is to be expected theoretically, was calculated on the basis of the subjects' body composition and the specific metabolic rate of the different organs and was compared to measured RMR. RESULTS: Compared to young subjects adjusted RMR was significantly lower in elderly women (5432+/-82 vs 5809+/-70 kJ/day, P<0.01) and men (6971+/-99 vs 7558+/-121 kJ/day, P<0.001). In both elderly women and men, measured RMR was markedly lower than calculated RMR (-625+/-404, -515+/-570 kJ/day). By contrast, measured and calculated RMR were nearly the same in young men (159+/-612 kJ/day); in young women the difference between measured and calculated RMR was only -300+/-457 kJ/day. In both sexes, these differences are significantly larger in the elderly when compared to young adults. CONCLUSION: These results support the point of view that the decline in RMR with advancing age cannot be totally due to changes in body composition.

Underreporting of energy intake in an elderly German population.

OBJECTIVES: Within the longitudinal study on nutrition and health status in an aging population in Giessen, Germany (GISELA), the underreporters of energy intake (EI) were identified and characterized. METHODS: EI was assessed in 238 female and 105 male participants of the GISELA study (age range = 60-89 y) by means of a 3-day estimated dietary record developed especially for this study. Resting metabolic rate (RMR) was measured by indirect calorimetry after an overnight fast. EI was expressed as a multiple of RMR and subjects with an EI:RMR ratio below 1.073 were classified as underreporters. RESULTS: Mean EI:RMR was 1.62 +/- 0.46 in females and 1.53 +/- 0.46 in males; 7.6% of the females and 16.2% of the males were identified as underreporters. They showed lower levels of education and significantly greater body weight, body mass index, and fat mass than the adequate reporters. Further, underreporters stated more often than adequate reporters that they want to lose weight. Except for beta-carotene in males, reported nutrient intakes were significantly lower in underreporters than in adequate reporters. Carbohydrate and fat intake in both sexes, protein intake in females calculated as a percentage of EI, and vitamin and mineral densities were not affected by underreporting. CONCLUSIONS: The results indicate that underreporting of EI is related to a low educational level and greater body weight, body mass index, and fat mass and affects all nutrients. These findings should be considered when the association between nutrition and health status is investigated in the elderly.

Effects of fat mass and body fat distribution on resting metabolic rate in the elderly.

The aim of the present study was to investigate the relationship between resting metabolic rate (RMR) and fat-free mass, fat mass, and body fat distribution in 164 women (age 60 to 85 years; body mass index [BMI], 18.5 to 35.6 kg/m(2)) and 98 men (age 60 to 85 years; BMI, 18.3 to 36.5 kg/m(2)). After an overnight fast, RMR was assessed by indirect calorimetry and body composition by bioelectrical impedance analysis. Waist-to-hip ratio (WHR) was used to determine fat distribution. Results from linear regression analysis showed that most of the variance in RMR could be attributed to fat-free mass in women (R(2) = 0.54) and men (R(2) = 0.44), respectively. Fat mass explained an additional 3% and 2% of the variability in RMR in women and men, respectively. In stepwise multiple regression analysis, considering body composition and fat distribution, only fat-free mass and WHR were significant predictors of RMR in both sexes. In addition to fat-free mass, in women 6% and in men 8% of the variability in RMR was attributable to WHR. Grouping subjects according to their WHR, RMR, and RMR adjusted for fat-free mass and fat mass showed a significant increase with increasing WHR in both sexes. Results indicate that RMR not only depends on fat-free mass but also is influenced by fat mass, especially by fat distribution. These findings support our hypothesis of an elevated RMR with increasing abdominal body fat as a direct consequence of its greater metabolic activity.

Prolonged tomato juice consumption has no effect on cell-mediated immunity of well-nourished elderly men and women.

The immunomodulatory potential of carotenoids has been investigated thoroughly only for beta-carotene. Data on the immunomodulatory activity of other carotenoids such as lycopene are scarce. The objective of this study was to investigate the effects of prolonged tomato juice consumption on cell-mediated immunity of well-nourished healthy elderly persons. In an intervention study, 33 female and 20 male subjects (aged 63-86 y) consumed 330 mL/d tomato juice (47.1 mg/d lycopene) or mineral water for 8 wk. Immune status was assessed by measuring number and lytic activity of natural killer (NK) cells, secretion of cytokines [interleukin (IL)-2, IL-4, tumor necrosis factor-alpha (TNF-alpha)] by activated peripheral blood mononuclear cells (PBMC), lymphocyte proliferation, and delayed-type hypersensitivity (DTH) skin responses. Tomato juice consumption resulted in significantly increased plasma lycopene and beta-carotene concentrations over time. In both treatment groups, TNF-alpha and IL-4 secretion were increased at the end of the intervention period, whereas IL-2 secretion was decreased. Tomato juice consumption had no effect on lymphocyte proliferation, DTH or the number of NK cells. Lytic activity of NK cells was increased in both groups at the end of the intervention period. In conclusion, these results show that prolonged tomato juice consumption increased plasma lycopene concentrations without significantly affecting cell-mediated immunity in well-nourished elderly subjects.

Resting metabolic rate, body composition, and serum leptin concentrations in a free-living elderly population.

OBJECTIVE: The present study investigated the relationship between serum leptin concentrations and resting metabolic rate (RMR) in a large study group of elderly individuals with special consideration of body composition and body fat distribution as possible confounders. DESIGN AND METHODS: The subjects were 122 women (age: 69+/-6 years, body mass index (BMI): 26.3+/-3.6 kg/m(2)) and 82 men (age: 69+/-5 years, BMI: 26.0+/-2.6 kg/m(2)). RMR was measured by indirect calorimetry and body composition by the bioelectrical impedance method. Serum leptin levels were determined by radioimmunoassay. RESULTS: There was a strong correlation between fat mass (FM) and serum leptin levels in both sexes. An age-related decline in leptin levels adjusted for FM was observed only in the women. After adjustment of RMR for both fat-free mass (FFM) and FM, leptin levels were not associated with RMR. In stepwise multiple regression analysis, FFM was the main predictor of RMR, explaining 35.8% and 47.6% of the variance of RMR in men and women respectively. FM did not explain variance in RMR in men, but accounted for 2.6% of the variance in RMR in women. Waist-hip-ratio and age influenced RMR only in males, explaining 5.7% and 4.0% of the variance in RMR respectively. CONCLUSION: Leptin is not a significant predictor of RMR in the elderly, but body composition and distribution of body fat are significantly associated with RMR.

Validation of a self-administered 3-day estimated dietary record for use in the elderly.

AIM OF THIS STUDY: was to assess the validity of a 3-day estimated dietary record, especially developed for the longitudinal study on nutrition and health status in an aging population (aged > or = 60 years) in Giessen, Germany. METHODS: The dietary record comprises 146 food items. Portion sizes of the foods consumed were estimated by means of household measures and corresponding dimensions. The validity of the dietary record was evaluated by means of nitrogen excretion in the 24 h urine in 14 women and 9 men, and by comparing energy intake and basal metabolic rate determined by indirect calorimetry in 238 women and 105 men. RESULTS: Neither in women nor in men were any differences found between calculated nitrogen intake (13.4 +/- 2.2 g and 15.0 +/- 2.0 g, respectively) and nitrogen excretion (12.9 +/- 2.1 g and 15.7 +/- 3.0 g, respectively). The ratio between reported energy intake and basal metabolic rate was 1.62 +/- 0.46 in women and 1.53 +/- 0.46 in men. Regarding energy intake, 7.6% of the females and 16.2% of the males were classified as under-reporters. They show a significantly higher body weight and BMI than the adequate reporters. CONCLUSION: The results have proved the new 3-day estimated dietary record as suitable to determine energy and nutrient supply of the elderly.

[Nutritional status of participants in the Giessen Senior Long-Term Study with respect to antioxidant vitamins and selenium]. / Versorgungszustand von Teilnehmern der Giessener Seniorenlangzeitstudie (GISELA) mit antioxidativ wirksamen Vitaminen und Selen.

Within the longitudinal study on nutrition and health status in an aging population of Giessen, Germany, baseline measurements with regard to antioxidant status were obtained in 85 free living elderly persons. The subjects were at least 60 years old, non-smoking, feeding themselves, and not supplementing any vitamins or minerals. Dietary intake of nutrients was assessed by means of a 3-day estimated food record, which was especially developed and validated for this study. Antioxidant status was evaluated by fasting plasma concentrations of vitamin C, E, beta-carotene, and selenium. The results show that in this study group self-determined nutrition provides enough nutrients to yield a good antioxidant status in the advanced age. Although no differences could be detected in dietary intake of vitamin C, E, and beta-carotene between males and females, significantly higher plasma concentrations of all substances investigated were found in females when compared to males.

A comparison of dietary reference values for energy of different countries.

Dietary reference values for food energy for population groups are set at the level of average energy requirement without a safety margin to avoid any risk of inadequate energy intake. Average energy requirements and hence reference values for energy can be determined from either energy intake data or energy expenditure. In this article, the present reference values for energy of 12 countries, the FAO/WHO/UNU and the Scientific Committee on Food (SCF/EC) are compared regarding the level of their standards and underlying concepts. Methods for estimating energy requirements of different population groups and data sources for reference values for energy are summarized. Furthermore, reference values for energy for males and females of all ages are presented in separate graphs. The comparison of national standards illustrates that the level of reference values for energy for individual countries is dependent on variables such as methodology, data sources, allowances for physical activity, reference body weight, and age range. Standards for adolescents and elderly persons reveal that differences in reference values are most apparent in population groups for which only limited data on energy requirements are available. Although it is not possible to evaluate the adequacy of reference values for energy by comparing data of different countries, many differences in the level of reference values can be explained on the basis of underlying concepts.

[Historical development of dietary recommendations]. / Historische Entwicklung von Empfehlungen zur Nährstoffzufuhr.

The discovery of the preventive action of lemon juice against scorbut led to a first recommendation on dietary intake in 1753. During the tight economic situation of the following century and in face of the economic crisis after the World War I, several concepts of dietary recommendations developed, all of which primarily served to relieve starvation and hunger and to maintain the ability to work of males. Increasing knowledge of human requirements for essential nutrients led to a clear distinction between dietary standards and health policy recommendations. With their first set of Recommended Dietary Allowances in 1941, especially the American Food and Nutrition Board directed concepts towards the improvement and maintenance of health of all people. National and international work on dietary recommendations took place to an increased extent in the 1970s. In face of currently expanding demands on dietary recommendations at present new directives for the revision of the American Recommended Dietary Allowances are discussed.

Utilization of alanyl-L-glutamine and glycyl-L-glutamine during long-term parenteral nutrition in the growing rat.

Utilization of intravenously administered alanyl-L-glutamine and glycyl-L-glutamine as a source of glutamine was tested in growing rats receiving total parenteral nutrition for 15 days. In experiment A the two peptides were compared to each other, in experiment B alanyl-L-glutamine was compared to an equimolar mixture of free alanine and glutamine, and in experiment C glycyl-L-glutamine was tested against an equimolar mixture of free glycine and glutamine.There was no difference of statistical significance in weight gain or nitrogen balance between the respective groups participating in the 3 experiments. Plasma levels of free glutamine were similar during infusion with alanyl-L-glutamine or glycyl-L-glutamine. The daily urinary excretion rate recorded for alanyl-L-glutamine was 3.7% and for glycyl-L-glutamine 4.3% of the infused amount. The results show that both peptides are utilized for protein synthesis and growth to approximately the same as the corresponding free amino acids.

[The use of different cysteine derivatives in longterm parenteral nutrition]. / Verwertbarkeit vershiedener Cysteinderivate bei langfristiger parenteraler Ernährung.

Utilization of cysteine derivatives for parenteral nutrition was established by means of nitrogen balance of growing rats. N,N-bis-acetylcystine and bisacetyl-glycyl-cystine were not utilized as substrates. N-acetylcysteine, glutathione disulfide, and L-thiazolidine-(4)-carboxylic acid gave evidence as suitable cysteine sources for parenteral nutrition.

[The significance of cysteine and its derivatives in parenteral nutrition]. / Zur Bedeutung des Cysteins und seiner Derivate für die parenterale Ernährung.

Data on l-cysteine (CYS) concentrations obtained by automated amino acid analysis are in fact cystine measurements. The necessity of a uniform use of nomenclature is discussed. The importance of a CYS supply during parenteral nutrition (PN) is pointed out by several studies. The presently available CYS derivatives and their potential use as CYS source in PN are discussed.

Utilization of glutathione disulfide as cysteine source during long-term parenteral nutrition in the growing rat.

Utilization of intravenously administered glutathione disulfide was investigated during long-term parenteral nutrition in growing rats. In a series of cross-over studies, three solutions were tested against one another by recording weight gain, nitrogen balance, and plasma amino acid patterns. Solution 1 contained the required amount of methionine for rats, solution 2 had only one third of the required methionine, but was made isonitrogenous with glycine, whereas in solution 3, two thirds of the methionine was replaced by glutathione disulfide. Weight gain was about twice as high during infusion with either the required amount of methionine or the glutathione disulfide when compared with solution 2. Nitrogen retention was significantly higher during infusion with sufficient methionine or a corresponding amount of glutathione disulfide, when compared with the solution low in methionine. Plasma levels of cystine decreased significantly under the low methionine supply, but no difference was observed for the groups receiving sufficient methionine or the corresponding amount of glutathione disulfide. It is concluded that glutathione disulfide permits adequate cysteine supply in parenteral nutrition and may replace part of the methionine in the presence of an impaired conversion of methionine to cysteine.

[Evaluation of N-acetyl-L-tryptophan in long-term intravenous administration in growing rats]. / Die Verwertung von N-Acetyl-L-Tryptophan bei langfristiger intravenöser Verabreichung in wachsenden Ratten.

Utilization of N-acetyl-L-tryptophan as a source of L-tryptophan is tested in growing rats receiving total parenteral nutrition for twelve days. The three solutions tested are isonitrogenous and isocaloric. Solution 1 contains an adequate amount of L-tryptophan, while in solution 2 two thirds of the L-tryptophan are substituted by a corresponding amount of glycine. In solution 3, the entire L-tryptophan is replaced by N-acetyl-L-tryptophan. Weight gain and nitrogen balance are similar under the infusion with either the adequate amount of L-tryptophan or the N-acetyl-L-tryptophan. The solution 2 in which two thirds of the L-tryptophan are replaced by glycine yields significantly lower results for weight gain and nitrogen retention. The results indicate that tryptophan from N-acetyl-L-tryptophan, when given intravenously, is utilized by the rat for protein synthesis and growth as well as free tryptophan.

[Cysteine in parenteral nutrition: comparative study of N-acetyl-cysteine and N,N-diacetylcystine in the rat model]. / Cystein in der parenteralen Ernährung: Vergleichende Studien über N-Acetylcystein und N,N-Diacetylcystin am Modell der Ratte.

In this study the question of whether N-N-diacetylcystine (DAC), which is more stable than N-acetylcysteine (AcCYS), may provide a useful cysteine source for parenteral nutrition was investigated. In in vitro studies the release of cysteine from DAC was measured. The Michaelis, constant and maximum velocity were compared with the corresponding results for AcCYS. In in vivo studies 3 groups of growing rats were maintained entirely by parenteral nutrition low in methionine for 15 days. Group I (n = 4) received a solution containing AcCYS, and group II (n = 6) was supplied with a corresponding amount of DAC. In the solution given to group III (n = 6) the CYS derivative was replaced by an isonitrogeneous amount of glycine. Utilization of the respective CYS derivatives was judged from weight gain, nitrogen balance, plasma amino acid pattern, and urinary excretion of free amino acids. The results from both the in vitro and in vivo studies indicate that DAC is not a suitable substitute for AcCYS in parenteral nutrition.