Effects of an Oral Nutritional Supplementation Plus Physical Exercise Intervention on the Physical Function, Nutritional Status, and Quality of Life in Frail Institutionalized Older Adults: The ACTIVNES Study.

OBJECTIVES: The objective of this study was to assess the effects of a hyperproteic, hypercaloric oral nutritional supplement with prebiotic fiber, vitamin D, and calcium, plus a standardized physical intervention, in the functional status, strength, nutritional status, and quality of life of frail institutionalized older adults. DESIGN: Multicentric prospective observational study under usual clinical practice conditions. SETTING: Four nursing homes from Burgos (2), Albacete, and Madrid, Spain. PARTICIPANTS: Participants included 91 institutionalized older adults (age ≥70), able to walk 50 m, and meeting at least 3 of the Fried frailty phenotype criteria. INTERVENTION: Daily intake of two 200-mL bottles of an oral nutritional supplement, each bottle containing 300 kcal, 20 g protein, 3 g fiber, 500 IU vitamin D, and 480 mg calcium, plus a standardized physical exercise training consisting of flexibility, balance, and strengthening exercises for arms and legs, 5 days per week. MEASUREMENTS: Short Physical Performance Battery (SPPB), Short-Form-Late-Life Function and Disability Instrument (SF-LLFDI) function subscale, handgrip strength, EuroQoL-5 Dimensions visual analogic scale (EQ5DVAS), weight, body mass index (BMI), and Short-Form Mini Nutritional Assessment (MNA-SF) at baseline and 6 and 12 weeks. RESULTS: Forty-eight participants (52.7%) improved at least 1 point in the SPPB at week 6, and 44 (48.4%) did so at week 12; 39 participants (42.9%) improved at least 2 points in the SF-LLFDI at week 6, and 46 (50.5%) at week 12. Participants improved their quality of life measured with the EQ5DVAS by 6% (95% confidence interval [CI] 3%-10%) at week 6, and by 5% (95% CI 0%-10%) at week 12. They also improved their nutritional status (weight gain, BMI increase, and higher MNA-SF scores at 6- and 12-week follow-up). This improvement was higher in participants with more frailty criteria, lower functional level, lower vitamin D levels, and poorer nutritional status. CONCLUSION: A 12-week intervention with oral nutritional supplementation plus physical exercise improves function, nutritional status, and quality of life in frail institutionalized older adults.

[Prevalence of asymptomatic peripheral artery disease detected by the ankle-brachial index in patients with cardiovascular disease. MERITO II study]. / Prevalencia de enfermedad arterial periférica asintomática, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II.

BACKGROUND AND OBJECTIVE: Patients with polyvascular disease have an increased rate of cardiovascular events and death. Their identification would define a subgroup of the population at very high risk, who would be candidates to intensified preventive measures. The objective of the present study was to evaluate the prevalence of subclinical peripheral artery disease in subjects with a previous diagnosis of vascular disease in other territories. PATIENTS AND METHOD: Subjects with a coronary or a cerebrovascular event between 3 months and 5 years, and who were attended at internal medicine outpatient clinics from Spain were included in the study. All patients had a clinical history, a physical examination, a blood and urine analysis, and a measurement of the ankle-brachial index (ABI). RESULTS: A total of 1203 patients (64% males; mean age: 74.3 years), were included in the study. A previous coronary event was reported in 55.4% of the participants, cerebrovascular disease in 38%, and a clinical history of disease in both territories in 6.7%. The prevalence of a low ABI (< 0,9) was 33.8%, 32.4% and 53.9% for each group, respectively. In a multivariate analysis, factors associated with a low ABI were age, smoking habit, diabetes, a reduced glomerular filtration rate, systolic blood pressure and the presence of clinical disease in both territories upon inclusion. The sensitivity of both, the Edinburgh questionnaire and pulse palpation for detecting and ABI below 0.9, were low. CONCLUSIONS: Prevalence of a low ABI is elevated in asymptomatic patients with coronary or cerebrovascular disease, particularly if there are clinical manifestations in both territories.

Prevalencia de enfermedad arterial periférica asintomática, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II / Prevalence of asymptomatic peripheral artery disease detected by the ankle-brachial index in patients with cardiovascular disease. MERITO II study

FUNDAMENTO Y OBJETIVO: Los pacientes con enfermedad arterial en varios territorios presentan unaelevada tasa de complicaciones vasculares y de mortalidad. Su identificación permitiría definir a unsubgrupo de la población de muy alto riesgo, candidatos a recibir medidas preventivas más enérgicas.El objetivo del presente estudio ha sido estimar la prevalencia de enfermedad arterial periféricasubclínica en personas con antecedentes de enfermedad vascular en otros territorios arteriales.PACIENTES Y MÉTODO: Se incluyó en el estudio a pacientes con historia de enfermedad coronaria y/ocerebrovascular entre los 3 meses y los 5 años previos, atendidos en consultas de medicina internarepartidas por toda la geografía nacional. Se les realizaron anamnesis, exploración física, analíticasanguínea y urinaria, y se les determinó el índice tobillo-brazo (ITB).RESULTADOS: Se estudió a 1.203 pacientes (64% varones), con una edad media de 74,3 años. El55,4% tenía antecedentes de enfermedad coronaria, un 38% de enfermedad cerebrovascular y un6,7% de afectación en ambos territorios. La prevalencia de ITB bajo (< 0,9) fue del 33,8, el 32,4y el 53,9% para cada grupo, respectivamente. En el análisis multivariante los factores que se asociaroncon un ITB bajo fueron la edad, el tabaquismo, la diabetes, una tasa reducida de filtradoglomerular, la presión arterial sistólica y el haber presentado afectación de ambos territorios vasculares.La sensibilidad del cuestionario de Edimburgo y de la palpación de pulsos para detectar lapresencia de un ITB inferior a 0,9 fue baja.CONCLUSIONES: La prevalencia de un ITB bajo es elevada en pacientes asintomáticos con enfermedadcoronaria o cerebrovascular, especialmente si presentan afectación conjunta de ambos territorios

BACKGROUND AND OBJECTIVE: Patients with polyvascular disease have an increased rate of cardiovascularevents and death. Their identification would define a subgroup of the population at very highrisk, who would be candidates to intensified preventive measures. The objective of the presentstudy was to evaluate the prevalence of subclinical peripheral artery disease in subjects with a previousdiagnosis of vascular disease in other territories.PATIENTS AND METHOD: Subjects with a coronary or a cerebrovascular event between 3 months and 5years, and who were attended at internal medicine outpatient clinics from Spain were included inthe study. All patients had a clinical history, a physical examination, a blood and urine analysis,and a measurement of the ankle-brachial index (ABI).RESULTS: A total of 1203 patients (64% males; mean age: 74.3 years), were included in the study. Aprevious coronary event was reported in 55.4% of the participants, cerebrovascular disease in 38%,and a clinical history of disease in both territories in 6.7%. The prevalence of a low ABI (< 0,9) was33.8%, 32.4% and 53.9% for each group, respectively. In a multivariate analysis, factors associatedwith a low ABI were age, smoking habit, diabetes, a reduced glomerular filtration rate, systolic bloodpressure and the presence of clinical disease in both territories upon inclusion. The sensitivity of both,the Edinburgh questionnaire and pulse palpation for detecting and ABI below 0.9, were low.CONCLUSIONS: Prevalence of a low ABI is elevated in asymptomatic patients with coronary or cerebrovasculardisease, particularly if there are clinical manifestations in both territories