Differences in the Prevalence of Sarcopenia in Community-Dwelling, Nursing Home and Hospitalized Individuals. A Systematic Review and Meta-Analysis.

BACKGROUND: Sarcopenia is an age-related disease which leads to a decline in muscle mass and function and is one of the most important health issues in elderly people with a high rate and variety of adverse outcomes. OBJECTIVE: The current systematic review and meta-analysis study was carried out to estimate the overall prevalence of sarcopenia in both males and females in different regions around the world and to show the major differences in its occurrence among different populations. DESIGN: A systematic review and meta-analysis of studies published in PubMed (Medline) and Scopus. PARTICIPANTS: Community dwelling, nursing home and hospitalized older adults aged over 60 years. MEASUREMENTS: Sarcopenia was defined by the major validated diagnostic criteria, such as the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia (AWGS) and the International Working Group on Sarcopenia (IWGS). The model used was the random effect model for estimating the prevalence of sarcopenia. The sex-specific prevalence of sarcopenia as well as 95% CI (Confidence interval) were calculated using MetaXL (version 5.3). Heterogeneity assessment was carried out by subgroup analysis. RESULTS: We included 41 studies with a total of 34955 participants. The prevalence of sarcopenia in community-dwelling individuals in the included studies were 11% (95% CI: 8-13%) in men and 9% (95% CI: 7-11%) in women. The prevalence of sarcopenia in nursing-home individuals in the included studies were 51% (95% CI: 37-66%) in men and 31% (95% CI: 22-42%) in women and in hospitalized individuals were 23% (95%, CI: 15-30%) in men and 24% (95% CI: 14-35%) in women. CONCLUSIONS: Despite the differences encountered between the studies, regarding diagnostic tools used to measure of muscle mass, different regions around the world and different populations and clinical settings, this systematic review revealed that a significant proportion of old people has sarcopenia (major in nursing homes), even in populations healthy in general. However, sarcopenia is caused by the aging progress, early diagnosis and individualized care, including physical activity and nutrition, can prevent some adverse outcomes in all populations.

Is beverage intake related to overweight and obesity in school children?

BACKGROUND AND AIM: Recently, considerable attention has been given to beverage intake as a source of calories which may be linked to pediatric obesity. The purpose of our study was to evaluate the beverage intake in school children and adolescents aged 7 to 15 years old. METHODS: Six hundred and seven (607) out of 655 children participated in the study. One hundred percent fruit juice were classified those beverages that contain 100% fruit juice, without sweetener. Sweetened sugar beverages (SSBs) were included (fruit drinks sweetened fruit juice, fruit-flavored drink or drink that contained fruit juice in part, sweeten soft drinks, coffee, and tea). RESULTS: Around 84% of subjects consumed water while 81% of children who were included in the analysis consumed milk, 49.5% consumed 100% fruit juice, and 79.4 % SSBs. Whole milk was consumed by 40.9% of school children. Skim milk and 1% milk were consumed by 3.6% and 4.7% of the children, respectively. Children and adolescents consuming SSBs were 2.57 (95% CI: 1.06, 3.38) times more likely to become obese compared to normal peers. CONCLUSION: Sugar beverage drinks but not 100% fruit juices and milk are associated with obesity. Further studies investigating the relationship among beverage consumption, total energy intake, and development of overweight are needed.

Effects of diet and exercise in 337 overweight/obese adults.

BACKGROUND AND AIMS: The purpose of the study was to determine for the first time the effects of a weight loss diet with or without exercise on body fat levels and other anthropometrical characteristics in overweight and obese Cypriot adults. METHODS: Three hundred and thirty seven overweight and obese subjects were assigned randomly to either a diet only (DO) or diet and exercise group (DE) for an 18-week period. Both groups received an energy reduced diet of 1500 ± 200 Kcal. Furthermore, the DE group received specific dietary and activity guidelines involving a moderate intensity activity level included any of the following 3 criteria of ACSM guidelines and behavior modification consultation. All data analyses were performed by using the SPSS(v. 16.5) and the level of statistical significance was set at p < 0.05. RESULTS: No significant differences were observed in both DO and DE groups during baseline period. During the intervention period weight, BMI and WC decreased significantly in DO group (p<0.001). In addition, body fat levels were found to be significantly reduced (p<0.001) in the DE group compared with the DO group. In multiple regression analysis Body fat levels were independently associated with weight (Beta: 0.569, 95%CI: 0.157-1.296, P<0.001) BMI (Beta: 0.295, 95%CI:0.088-1.214, P<0.01) and WC (Beta:0.206, 95%CI:0.095-0.954, P<0.001) after adjustment of age and gender. CONCLUSIONS: Despite the reduced effects of diet alone on body weight, BMI and WC, combining a reduced diet with exercise improves also BF levels which may have important benefits on several diseases later in life.

Risk factors of obesity in a cohort of 1001 Cypriot adults: An epidemiological study.

BACKGROUND AND AIMS: To measure the prevalence of overweight and obesity in adults in the Republic of Cyprus, and to evaluate and relate possible obesity risk factors of the adult Cypriot population. METHODS: This is an epidemiological cross-sectional study on a stratified random sample of 1001 (48.5% males-51.5% females) subjects, aged 18-80 years old. Anthropometric, biochemical, and dietary/lifestyle characteristics included in the study. RESULTS: The prevalence of overweight (Ow) and obesity (Ob) was 46.9% and 28.8% for males and 26% and 27% for females, respectively. Overweight and obese subjects were found to have statistically significant higher levels of Body Mass Index (p<0.001), Waist circumference (p<0.001), Total serum cholesterol (p<0.001), Low density lipoprotein (p<0.005), Glucose (p<0.007) and Triglycerides (p<0.001) compared to normal peers. In addition, Ow and Ob participants consumed significantly lower levels of fruits and vegetables (p<0.001), exercised less time/d (p<0.001) and smoke more cigarettes/d (p<0.001), compared to normal subjects, respectively. In multiple regression analysis of factors associated with overweight and obesity, Waist Circumference (beta: 1.132, p<0.001), Glucose (beta: 0.892, p<0.045), alcohol consumption (beta: 0.563, p<0.001), and exercise levels (beta: -0.444, p<0.001), were the most significant ones. CONCLUSION: The prevalence of overweight and obesity is very high in Cypriot adults. The current study also revealed a significant positive relation of Ow and Ob with waist circumference, high blood glucose levels and increased consumption of alcohol and a negative one with decreased levels of exercise.

First body fat percentiles for 607 children from Thessaloniki-Northern Greece.

BACKGROUND AND AIM: The purpose of this study was to establish for the first time reference curves for body fat levels in a Greek pediatric population aged 7-15y. METHODS: Six hundred and seven (607) children randomly selected from 8 primary and secondary schools from Northern Greece. Percentage body fat was measured by bioelectrical impedance analysis and percentile curves were constructed using the LMS method. All children were measured twice in the morning and the mean number of the two measurements was considered as the percentage of body fat. RESULTS: The mean number of the percentage body fat for the age group (7-9) was 18.2 ± 5.1 and 18.4 ± 6.1 for boys and girls, respectively. In the second age group (10-12) the girls had higher mean fat levels than boys (22.6 ± 5.8 vs. 20.4 ± 6.2). This increase was continued also in the third age group (13-15) with the girls having higher mean body fat levels (24.2 ± 5.5 vs. 17 ± 5.9). The 85th and 95th percentiles represented the cut-off point for overweight and obesity and it was (26.3, 33.0 and 28.9%) and (34.0, 38.2 and 38.1) for boys for the three age groups (7-9, 10-12 and 13-15), respectively. On the other hand, the girls had higher 85th and 95th percentiles for the same age group (7-9, 10-12, 13-15y) and it was (34.5, 32.9 and 33.6%) and (39.0, 370 and 38.3%), respectively. CONCLUSION: Body fat level, which is the component of overweight that leads to pathology, is a better representative over body mass index. These first percentile curves will be at great assistance helping the medical community to identify obesity in these children at early stages and to prevent development at pathological diseases early in their lives.

Effects of oral folate supplementation on serum total homocysteine and cholesterol levels in hyperhomocysteinemic children.

BACKGROUND: Hyperhomocysteinemia may be a risk factor for cardiovascular disease even among children. Increased levels of total serum homocysteine (tHcy) may initiate atherosclerosis by modulating increased cholesterol synthesis in the liver. Folate supplementation has been found to reduce homocysteine levels. However, no data have been reported about the relationship between folate supplementation and cholesterol levels in children. METHODS: Twenty of 26 hyperhomocysteinemic (>95th percentile for age) children underwent a therapeutic intervention of 5 mg of oral folate supplementation twice per week for 2 months. RESULTS: After the 2-month intervention with folate supplement, tHcy levels were statistically significantly decreased (P < .001), folate levels were significantly increased (P < .001), while total cholesterol levels were significantly improved from 183.8 (115-296 mg/dL) to 160.8 (109-265 mg/dL) (P < .05). CONCLUSIONS: Folate supplementation may reduce tHcy, serum folate, and total serum cholesterol levels in hyperhomocysteinemic children.

Oral supplementation of folic acid for two months reduces total serum homocysteine levels in hyperhomocysteinemic Greek children.

BACKGROUND & AIM: Hyperhomocysteimemia is a cardiovascular risk factor even among children. Supplementation of oral folic acid may reduce homocysteine levels to normal. However, data is limited at this point for healthy children and adolescents. METHODS: Five hundre and twenty four children participated in the study; Twenty six of them were found to be hyperho mocysteinemic(>95(th) percentile for age). Twenty of them received 5 mg of folic acid twice per week for two consecutive months while the other six received a diet rich in dietary folate. RESULTS: Serum homocysteine levels were statistically significantly decreased from 13.1 (10-24.2 micromol/L ) to 7.7 (4.9- 15.2 micromol/L), p<0.001. Serum folate levels were significantly rose from 4.3 (3-20 ng/mL) to 16.8 (7-20 ng/mL), p<0.001. On the contrary, no important changes were observed in the above parameters in children to whom a diet rich in folic acid was recommended. Homocysteine levels were found to be positively associated with age (r=0.314, p<0.001), BMI (r=0.192, p<0.001), WC (r = 0.215, p<0.001), simple sugars (r= 0.182, p<0.001 ) and negatively associated with folic acid (r = -0.331, p<0.001), vitamin B12 (r = -0.214, p<0.001) and dietary folic acid (r= -0.228, p=0.003). CONCLUSIONS: Oral folic acid 5 mg twice per week may efficiently reduce serum homocysteine levels and increase serum folic acid levels in healthy children with increased homocysteine levels (>95(th) percentile for age). Hyperhomocysteinemia in childhood may be a predictive factor of cardiovascular disease. In addition, these results may offer more help to health practioners in order to establish more prospective studies to elucidate the relationship between homocysteine, folic acid and heart disease in children.

Homocysteine lowering with folic acid supplements in children: effects on blood pressure.

Hyperhomocysteinemia is emerging as an independent predictor of cardiovascular disease and hypertension among children. The aim of the study was to examine the effects of oral folic acid on homocysteine and blood pressure. Folic acid supplementation has been found to reduce homocysteine levels and in some cases blood pressure. Five hundred and twenty children participated in the study, and 26 of them were found to be hyperhomocysteinemic; 20 of these children randomly received 5 mg oral folic acid supplement while the other six children were the controls. Serum homocysteine (P < 0.001) levels as well as systolic (P < 0.001) and diastolic (P = 0.045) blood pressure were statistically significantly decreased in the intervention group compared with the controls, while folic acid levels were statistically significantly increased (P < 0.001). Total serum homocysteine levels were correlated with age, serum folate, body mass index, and blood pressure. It appears that folic acid may be a safe and effective supplement to reduce homocysteine and possibly blood pressure, which consequently may prevent cardiovascular disease in children in early life.

Central precocious puberty due to hypothalamic hamartoma in a 7-month-old infant girl.

Hypothalamic hamartomas (HH) are rare congenital lesions of the tuber cinereum presenting with the classic triad of gelastic epilepsy, central precocious puberty (CPP) and developmental delay. In light of the important and diverse consequences of precocious puberty for affected children and their families, a correct diagnosis without delay is imperative. We present here a rare case of a 7-month-old infant girl with CPP and HH who was successfully treated with depot gonadotropin-releasing hormone (GnRH) analogue is presented.

Prevalence of hypertension and association of dietary mineral intake with blood pressure in healthy schoolchildren from northern Greece aged 7-15 years.

BACKGROUND AND AIMS: Pediatric hypertension is urgently increasing in Greece. The purpose of this study is to record the prevalence of hypertension in schoolchildren and to relate dietary minerals to blood pressure (BP). METHODS AND RESULTS: 308 males and 298 females, aged 7-15 years, from 10 schools in Northern Greece participated in the study. BP and dietary minerals were measured in all children. Twenty-seven and 12.3% of boys and 21.2 and 15.1% of girls were diagnosed with prehypertension systolic BP and systolic hypertension, respectively. For diastolic BP, 19 and 13.3% of boys and 21.5 and 15.1% of girls were diagnosed with prehypertension diastolic BP and diastolic hypertension, respectively. Systolic BP was significantly positively associated with age (beta: 0.283, 95% CI: 1.440-2.484, p < 0.001), BMI (beta: 0.267, 95% CI: 0.830-1.489, p < 0.001) and potassium (beta: 0.139, 95% CI: 0.001-0.005, p < 0.001) and negatively related to Ca (beta: -0.160, 95% CI: -0.012 to 0.002, p = 0.007). Diastolic BP was positively related only to BMI (beta: 0.194, 95% CI: 0.380-0.968, p < 0.001). CONCLUSION: The current study tried to estimate the prevalence of hypertension among children in Northern Greece. Early prevention through nutrition education programs on BP that include diet and exercise modifications is urgently needed in order to avoid certain chronic risk factors in early life.

Association of blood pressure, obesity and serum homocysteine levels in healthy children.

AIM: Obesity, hypertension and total serum homocysteine levels are well-known risk factors for cardiovascular disease in adults. However, there is limited data on the relation of these risk factors in children. METHODS: Five hundred twenty-four healthy school children aged 6-15 years participated in the study. BMI were used to categorize our subjects in normal overweight and obese groups based on Internationally Obesity Task Force criteria. RESULTS: The prevalence of overweight and obesity was 21.1% and 8.4% for boys and 17.6% and 7.3% for girls, respectively. Diastolic blood pressure (DBP), systolic blood pressure (SBP) and waist circumference (WC) were significantly higher in overweight and obese group compared to normal ones, whereas for homocysteine levels no difference was observed. Based on the results derived from the multiple regression analysis, BMI was positively related to energy intake (beta=0.247, p<0.001) and WC (beta=0.014, p<0.001). Both SBP and DBP were positively related to age ([beta=0.251, p<0.001] and [beta=0.301, p<0.001, respectively]), and BMI ([beta=0.096, p<0.001] and [beta=0.022, p<0.001], respectively). CONCLUSION: The current study revealed an association of blood pressure and WC with overweight and obesity in children, and even though these children may not have increased homocysteine levels, they still have enough reasons to reduce weight in order to avoid cardiovascular disease in their life later on.

Reference range of total serum homocysteine level and dietary indexes in healthy Greek schoolchildren aged 6-15 years.

Elevated total serum homocysteine (tHcy) may be a possible risk factor for CVD. A 5 micromol/l increase in tHcy is associated with an approximately 70 % increase in relative risk of CVD in adults. Data for children and adolescents are, however, limited. The purpose of the present study was to provide a reference range for tHcy and investigate any relationship between tHcy and nutritional indexes in a Greek paediatric population. tHcy, folate, vitamin B12 levels and dietary indexes were measured in 520 healthy schoolchildren (274 boys, 246 girls) aged 6-15 years. As in adults, the tHcy distribution skewed to the right, with a geometric mean for both genders of 7.4 (range 3.4-29 micromol/l). Concentrations were lower in young children and increased with age. No statistically significant difference in tHcy level was observed between gender. The 95th percentiles for the three age groups were as follows: 6-9 years, 9.98 micromol/l; 10-12 years, 10.62 micromol/l; 13-15 years, 14.4 micromol/l. Using Pearson's coefficient analysis, tHcy level was correlated with age, serum folate, BMI and systolic blood pressure. Dietary analysis showed that folate, vitamin B12 and fibre intake were inversely related with tHcy; conversely, sugar and fat were positively associated with tHcy. However, in multiple linear regression analysis, only age (odds ratio 0.246, P < 0.05) and folate (odds ratio -0.346, P < 0.05) were significantly and independently associated with tHcy. This study provides age-specific reference data regarding tHcy concentration in a Greek paediatric population. tHcy levels increased as a function of age. Serum folate levels were significantly and independently associated with tHcy levels.

The ketogenic diet in children with epilepsy.

Children with epilepsy, especially those facing intractable seizures, experience a great impact on the quality of their lives. Effective treatment is essential, and although new anti-epileptic drugs have shown an improved profile of action, still a substantial number of children look for more efficacious ways of treatment that are far away from potential toxicity and ineffectiveness. The ketogenic diet is a dietary therapy for epileptic children based on manipulation of metabolism principles and brain energetics. This regimen aims to produce a controlled ketonaemia through excessive dietary fat intake, little carbohydrates and adequate (for growth) protein. The present paper is a review of previous and current papers regarding the proposed mechanisms of the ketogenic diet's action, and the efficacy of the regimen on epileptic children. Unfortunately, a few small studies in sample size and duration tried to evaluate the potential risks of this regimen and their results were rather inconclusive. Further research needs to be done in order for the exact mechanism of the ketogenic diet to be clarified which will help to improve the diet's application, especially for vulnerable epileptic children as far as their growth is concerned.