Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients.

OBJECTIVE: We investigated the potential of a high-protein, arginine- and micronutrient-enriched oral nutritional supplement (ONS) to improve healing of pressure ulcers in non-malnourished patients who would usually not be considered for extra nutritional support. METHODS: Forty-three non-malnourished subjects with stage III or IV pressure ulcers were included in a multicountry, randomized, controlled, double-blind, parallel group trial. They were offered 200 mL of the specific ONS or a non-caloric control product three times per day, in addition to their regular diet and standard wound care, for a maximum of 8 wk. Results were compared with repeated-measures mixed models (RMMM), analysis of variance, or Fisher's exact tests for categorical parameters. RESULTS: Supplementation with the specific ONS accelerated pressure ulcer healing, indicated by a significantly different decrease in ulcer size compared with the control, over the period of 8 wk (P

Benefits of an oral nutritional supplement on pressure ulcer healing in long-term care residents.

OBJECTIVE: To investigate the effects of an oral nutritional supplement (ONS) plus standard care on the healing of pressure ulcers in long-term nursing home residents in addition to standard care. The ONS (Cubitan, Nutricia Advanced Medical Nutrition) was high in energy and protein, and enriched with arginine, vitamin C and zinc. METHOD: A total of 245 patients with grade II-IV pressure ulcers were enrolled into this open study at 61 long-term-care facilities, which reflect the nursing-home population of Luxembourg and Belgium. Residents received the ONS daily for nine weeks, along with their normal diet or enteral feed and standard pressure care. Pressure ulcer area (mm2) and condition were assessed after three and nine weeks. Data were analysed using ANOVA and expressed as mean +/- SD. RESULTS: The patients' age was 82.2 +/- 10.1 years. Sixty-seven patients (27%) had been previously treated with the ONS. The majority of pressure ulcers were located at the sacrum (54%) and heel (32%). The average intake of the 200 ml ONS was 2.3 +/- 0.56 servings daily, which corresponds to 46 g protein, 6.9 g arginine, 575 mg vitamin C, 87 mg vitamin E and 21 mg zinc. After nine weeks' nutritional support, the average pressure ulcer area reduced significantly from 1580 +/- 3743 mm2 to 743 +/- 1809 mm2, which is a reduction of 53% (p<0.0001). Complete wound closure occurred after three and nine weeks in 7% and 20% of the pressure ulcers respectively. The amount of exudation (assessed subjectively) also decreased after specialised nutritional support (p<0.0001). CONCLUSION: A high-protein ONS enriched with arginine, vitamin C, vitamin E and zinc, when used with standard pressure ulcer care, significantly reduced the mean pressure ulcer area of long-term nursing home residents.

Exercise-induced oxidative stress in older adults as measured by antipyrine oxidation.

Aging is associated with increased susceptibility to free radical-mediated tissue damage. Measuring exercise-induced oxidative stress, however, is a major problem in free radical research. We used an exogenous marker (antipyrine) to measure oxidative stress in older adults during submaximal exercise. Antipyrine pharmacokinetics is independent of blood flow to the liver. Furthermore, antipyrine reacts quickly with hydroxyl radicals (10(10)-10(11) L x mol(-1) x s(-1)) to form para- and ortho-hydroxyantipyrine (o-APOH). o-APOH is not formed in man through the mono-oxygenase pathway of cytochrome P450. Thirty-four subjects (62 +/- 1 years) orally ingested 10 mg antipyrine/kg body mass. One hour after ingestion subjects cycled 45 minutes at 50% maximal power output. Exercise significantly increased the ratio of para-hydroxyantipyrine (p-APOH) to native antipyrine in plasma (.0014 +/-.0001 v.0021 +/-.0002; P <.0001). Also, the ratio of o-APOH was significantly increased after exercise (.0014 +/-.0001 v.0019 +/-.0002; P <.0001). Exercise significantly increased plasma levels of plasma malondialdehyde MDA) (.55 +/-.07 v.92 +/-.21 micromol/L; P <.01). In conclusion, in older adults, oxidative stress occurs during cycling at submaximal intensity as measured with free radical reaction products of antipyrine.

Antioxidant supplementation and exercise-induced oxidative stress in the 60-year-old as measured by antipyrine hydroxylates.

The effects of 12 weeks of antioxidant supplementation on exercise-induced oxidative stress were investigated in older adults (60 (SE 1) years; BMI 26 (SE 1) kg/m(2)). Subjects were randomly divided in two groups: supplementation (n 11) with 100 mg dl-alpha-tocopheryl acetate, 200 mg ascorbic acid, and 2 mg beta-carotene, and placebo (n 9). Before and after the 12 week supplementation period, subjects cycled for 45 min at submaximal intensity (50 % maximal workload capacity). Antipyrine was used as marker for oxidative stress. Antipyrine reacts quickly with hydroxyl radicals to form para- and ortho-hydroxyantipyrine. The latter metabolite is not formed in man through the mono-oxygenase pathway of cytochrome P450. Daily supplementation significantly increased plasma concentrations of alpha-tocopherol and beta-carotene in the supplemented group (Delta 14.4 (SE 3.2) and 0.4 (se 0.1) micromol/l; P<0.001 and P<0.01). No significant differences, within and between groups, were observed in the exercise-induced increase in the ratios para- and ortho-hydroxyantipyrine to antipyrine. In addition, supplementation did not affect the exercise-induced increase in thiobarbituric acid reactive substances in plasma. In conclusion, in 60-year-old subjects antioxidant supplementation had no effect on the exercise-induced increase in oxidative stress as measured by free radical products of antipyrine.

Physical activity and parameters of aging: a physiological perspective.

Increasing age is associated with a decline in fat-free mass. The question is whether age-related changes in body composition can be delayed by an active life style. This analysis includes data where physical activity was assessed with doubly labeled water and body composition with hydrodensitometry or isotope dilution. Subjects were 136 women and 180 men over 20 years, who were tested in Maastricht University between 1983 and 1998. Increasing age was associated with lower activity levels and lower fat-free mass. After controlling for age there was no longer any association between physical activity and fat-free mass. A few exercise intervention studies showed that elderly subjects compensate for exercise training by a decline in spontaneous physical activity, in contrast to younger subjects. Although no effect of habitual activity level on changes in body composition are observed, training has a positive effect on muscle function. Elderly subjects with relatively high levels of physical activity are not different from those with low activity levels, as far as fat-free mass and fat mass are concerned. However, training might delay the age-induced impairment of personal mobility associated with a reduction in physical activity.

Exercise training and oxidative stress in the elderly as measured by antipyrine hydroxylation products.

Effects of 12 wk exercise training on oxidative stress were examined in elderly humans. We measured oxidative stress during a 45 min cycling test by using antipyrine hydroxylation products. Antipyrine breakdown is independent of blood flow to the liver, which is important during exercise. Furthermore, antipyrine reacts quickly with hydroxyl radicals to form para- and ortho-hydroxyantipyrine. Ortho-hydroxyantipyrine is not formed in man through the mono-oxygenase pathway of cytochrome P450. Twenty subjects (9 women; 60 +/- 3 y) participated in the training program. Thirteen subjects (5 women; 64 +/- 7 y) served as inactive controls. Subjects trained, twice a week for 1 h, at a fitness center. After 12 wk, maximal oxygen uptake (p < .005) and workload capacity (p < .001) were only significantly elevated in the training group. After 12 wk, both groups observed no change in the ratios of antipyrine hydroxylates, para- and ortho-hydroxyantipyrine, to native antipyrine. Furthermore, no differences were observed within or between groups in the exercise-induced increase in the plasma level of thiobarbituric acid reactive species. In conclusion, 12-wk training had no effect on exercise-induced oxidative stress in elderly humans as measured by free radical reaction products of antipyrine. Despite the fact that training in elderly humans improves functional capacity, it appears not to compromise antioxidant defense mechanisms.

Physical inactivity as a determinant of the physical activity level in the elderly.

OBJECTIVE: To assess the relationship between the mean physical activity level (PAL) and the time spent on activities of three different intensity levels in an elderly population. Data was compared with previously obtained data from a group of younger adults. SUBJECTS: Fourteen elderly women and 14 elderly men (61+/-4 y; 27+/-5 kg/m(2); 33+/-7% body fat), and 14 young women and 16 young men (27+/-5 y, 24+/-2 kg/m(2)). MEASUREMENTS: PAL was determined as average daily metabolic rate (ADMR) combined with a measurement of basal metabolic rate (BMR): PAL=ADMR/BMR. ADMR was measured with the doubly labeled water method. BMR was measured with a ventilated hood system. Time spent on activity and activity intensity was measured by using a tri-axial accelerometer (7x2x0.8 cm, 30 g) over a 2 week interval. RESULTS: Mean PAL was 1.65+/-0.14. PAL was inversely related to the percentage of time spent on low-intensity activity (lying, sitting and standing), r= -0.43; P<0.05. Older subjects spent significantly more time at these activities than 20 to 35-y-old subjects (82+/-7% vs 65+/-7%; P<0.0001). A significant relation was not observed between PAL and the percentage of time spent on moderate (walking) or high (household activities, exercise and sports) intensity activity, or activity monitoring time (14.4+/-1.2 h/day). CONCLUSION: In the elderly, spending relatively more time on low-intensity activities affects the mean PAL negatively. To obtain a higher PAL does not necessarily imply high-intensity activities like sports.

Repeated measurement of habitual food intake increases under-reporting and induces selective under-reporting.

The aim of the current study was to measure differences in reporting behaviour between a first occasion of 7 d food recording and a second occasion of 7 d food recording 12 weeks later, in a group of elderly men (n 17) and women (n 17). Half the group followed an exercise intervention. The mean age was 61 (sd 5) years and mean BMI was 26.2 (sd 3.8) kg/m2. Reported energy intake was compared with energy expenditure as calculated from measured BMR and physical activity assessed with a tri-axial accelerometer for movement registration. Total under-reporting was divided into undereating and under-recording. Undereating was calculated from the change in body mass over the recording week and the under-recording was measured using the water balance technique. In the first period, the total under-reporting was 21 % and increased to 27% in the second period In the first period there was no indication for subjects eating less during the recording week, however, in the second period subjects lost body mass during the food recording indicating undereating. The amount of under-recording was calculated at 21% in the first period and 18% in the second period of recording (P 0.28). During the second period subjects selectively under-reported their fat intake and over-reported their protein intake. In conclusion, repeated assessment of food intake caused a higher quantitative and a qualitative under-reporting of food intake. The effect of interventions (dietary or otherwise) on habitual food intake might be confounded by changes in food-reporting behaviour.

Use of a triaxial accelerometer to validate reported food intakes.

BACKGROUND: An easy and cheap method for validating reported energy intake (EI) is needed. OBJECTIVE: Reported EI was compared with calculated energy expenditure (EE(calc)) and with energy expenditure measured by the doubly labeled water method (EE(DLW)). DESIGN: EE was calculated on the basis of basal metabolic rate (BMR) measured with the ventilated-hood technique and physical activity (PA) measured with a triaxial accelerometer (EE(VH+PA)) and on the basis of BMR estimated by using World Health Organization equations and PA (EE(WHO+PA)): EE(calc) = -1.259 + 1.55 x BMR + 0.076 x counts/min (r(2) = 0.90, P = 0.0001). Subjects [n = 12 men and 12 women aged 60 +/- 3 y; body mass index (in kg/m(2)): 26 +/- 4] reported their food intakes for 7 d and EE(DLW), EE(VH+PA), and EE(WHO+PA) were assessed over the same 7 d. RESULTS: Reported EI (9.0 +/- 2.1 MJ/d) was lower (P: < 0.0001) than were EE(DLW) (11.3 +/- 2.3 MJ/d), EE(VH+PA) (10.8 +/- 1.7 MJ/d), and EE(WHO+PA) (10.8 +/- 1.8 MJ/d). Underreporting was 19.4 +/- 14.0%, 16.7 +/- 13.6%, and 16.4 +/- 15.5% on the basis of EE(DLW), EE(VH+PA), and EE(WHO+PA), respectively. The difference of 2.7 +/- 8.0% between EE(DLW) and EE(VH+PA) was not related to the average of both percentages and was not significantly different from zero. The percentage of underreporting calculated with EE(WHO+PA) was not significantly different from that calculated with EE(DLW). CONCLUSIONS: The use of a combination of BMR (measured or estimated) and PA is a good method for validating reported EI. There was no significant difference between the percentage of underreporting calculated with EE(VH+PA), EE(WHO+PA), or EE(DLW).

Effect of exercise training on physical activity and substrate utilization in the elderly.

This study examined the effect of training on physical activity and substrate utilization in the elderly. Before the start, in week 6 and week 12 (T0, T6 and T12) data on physical fitness, physical activity and substrate utilization were collected in the exercise (11 males, 11 females; 63 +/- 8yrs) and control group (6 males, 5 females; 59 +/- 4yrs). Physical activity was registered with a tri-axial accelerometer and substrate utilization was calculated from resting respiratory exchange ratio (RER) by indirect calorimetry. At T6 physical activity on training days was significantly higher than on non-training days (33.4 +/- 10.3 vs. 26.5 +/- 7.8 counts x min(-1); p<0.001). At T12, after adjusting for training activity, physical activity on training days was significantly lower than on non-training days (23.7 +/- 8.4 vs. 28.2 +/- 9.3 counts x min(-1); p<0.01). RER decreased significantly (0.02 +/- 0.03; p <0.05), indicating a relatively larger fat oxidation. Changes in RER were negatively correlated with pre-training RER. In conclusion, in elderly an increase in structured training (exercise) is compensated for by a corresponding decrease in non-training physical activity. Training increased relative fat utilization in elderly with a high pre-training RER, whereas elderly with a low pre-training RER decreased their relative fat utilization.

Operation Everest III: energy and water balance.

We hypothesized that hypoxia decreases energy intake and increases total energy requirement and, additionally, that decreased barometric pressure increases total water requirement. Energy and water balance was studied over 31 days in a hypobaric chamber at 452-253 Torr (corresponding to 4,500-8,848 m altitude), after 7 days acclimatization at 4,350 m. Subjects were eight men, age 27+/-4 years (mean+/-SD), body mass index 22.9+/-1.5 kg/m2. Food and water intake was measured with weighed dietary records, energy expenditure and water loss with labelled water. Insensible water loss was calculated as total water loss minus urinary and faecal water loss. Energy intake at normoxia was 13.6+/-1.8 MJ/d. Energy intake decreased from 10.4+/-2.1 to 8.3+/-1.9 MJ/d (P<0.001) and energy expenditure from 13.3+/-1.6 to 12.1+/-1.8 MJ/d (P<0.001) over the first and second 15-day intervals of progressive hypoxia. Absolute insensible water loss did not change (1.67+/-0.26 and 1.66+/-0.37 l/d), however, adjusted for energy expenditure it increased with ambient pressure reduction (P<0.05). In conclusion, hypoxia induced a negative energy balance, mainly by a reduction of energy intake. Overall insensible water loss was unchanged because the increase in respiratory evaporative water loss was counterbalanced by a decrease in metabolic rate that probably limited the hypoxia-induced increase in ventilation.

Effect of exercise training on total daily physical activity in elderly humans.

This study examined the effect of 12 weeks of exercise training on daily physical activity in elderly humans. Training consisted of a weekly group session and an individual session with cardio- and weight-stack machines. A group of 15 subjects served as the exercise group [EXER mean age 59 (SD 4) years], and 7 subjects as the controls [CONT mean age 57 (SD 3) years]. Physical activity and physical fitness were measured before the start of training (T), at week 6 and week 12 (T0, T6, T12 respectively) in EXER, and at T0 and T12 in CONT. Physical activity over 14 days was measured using a tri-axial accelerometer and physical fitness was measured during an incremental exercise test. At T12, mean maximal power output had significantly increased in EXER compared to CONT 8 (SD 12) vs -5 (SD 9) W; P < 0.02] and mean submaximal heart rate (at 100 W) had reduced [-10 (SD 7) vs -2 (SD 6) beats x min(-1); P < 0.05]. No differences or changes in physical activity were observed between EXER and CONT. At T6, physical activity on training days was significantly higher than on non-training days (P < 0.001). When the accelerometer output of the training session was subtracted from the accelerometer output on training days, at T12 non-training physical activity was significantly lower than on non-training days (P < 0.004). Accelerometer output of the individual training session at T12 had significantly increased compared to T6 (P < 0.05), whereas, accelerometer output of the group training session had remained unchanged. In conclusion, in elderly subjects an exercise training programme of moderate intensity resulted in an improved physical fitness but had no effect on total daily physical activity. Training activity was compensated for by a decrease in non-training physical activity.

Attitudes of health-care workers towards AIDS at three Dutch hospitals.

A questionnaire survey was held among 938 doctors and 2304 nurses to assess their attitudes toward AIDS and the influence of their concern about the occupational risks involved. The response was 65 and 72%, respectively. The results suggest that in treating patients with actual or possible HIV infection, in non-invasive procedures many doctors and nurses often take too many precautions, whereas in invasive procedures doctors often take too few. A minority of the respondents were in favour of testing all patients. The majority felt that patients in the high-risk groups should be tested. The percentage in favour of anonymous testing was considerably higher among the doctors than among the nurses. Most of the doctors and nurses were concerned about contagion by patients. This concern had a negative influence on their attitudes toward AIDS. Factual information alone does not suffice to dispel excessive concern. In training and educating medical personnel, attention should be devoted to cognitive as well as emotional aspects.