Dietary Characteristics of Elders with Frailty and with Mild Cognitive Impairment: Cross-Sectional Findings and Implications from the Nutrition and Health Survey in Taiwan 2014-2017.

It is unclear whether low dietary intake accompanied with multiple nutrient deficiencies or specific nutrient inadequacy is associated with geriatric syndrome. This study aimed to examine the nutrition inadequacy profiles associated with frailty and cognitive impairment (CI). With information from the Nutrition and Health Survey in Taiwan, 2014-2017, sex-specific nutrient intakes and intake per kg of body weight (BW) were estimated from 24-hour recall data for two age groups (65-74 years; ≥75 years) regarding the three frailty and three CI subgroups. Total energy intakes were significantly lower with the severity of both frailty and CI in analysis combining both gender and age groups, and in both the 65-to-74-year-old women or the over-75-year-old women. These trends were observed but not significant in either of the two age groups in men. Significantly lower levels of energy intake have been observed when age, sex, and sampling strata were adjusted. Intake levels of multiple nutrients also decreased with the severity of frailty and CI. A greater number of nutrient inadequacies for the frail and the CI was found in the 65-to-74-year-old group than the over-75-year-old age group. However, most of the associations between micronutrients and the two geriatric syndromes disappeared after energy adjustment. The remaining few did not show consistency across age-sex subgroups. In conclusion, frailty or CI was associated with low amounts of food consumption accompanied by multiple nutrient insufficiencies. Dietary intervention to ensure adequate total energy and multiple nutrient intakes should be trialed in the geriatric population to address both the causal and efficacy issues.

Changes of sarcopenia case finding by different Asian Working Group for Sarcopenia in community indwelling middle-aged and old people.

Sarcopenia is an emerging issue, but there is no universal consensus regarding its screening and diagnosis, especially regarding the influence of the Asian Working Group for Sarcopenia (AWGS) 2019 new definition on the prevalence of community-dwelling adults. To compare the prevalence of sarcopenia between the 2019 and 2014 definitions, a cross-sectional study including 606 normal nutritional status subjects (203 men/403 women; mean age 63.3 ± 10.0 years) was performed. Sarcopenic parameters, including calf circumference, grip strength, 6-m gait speed, and bioelectrical-impedance-analysis-derived skeletal mass index (SMI), were evaluated. According to the 2019 AWGS definition, the prevalence of possible sarcopenia and sarcopenia among community-dwelling adults was 7.4 and 2.8%, respectively. There were highly consistent findings regarding sarcopenia between the 2019 and 2014 AWGS definitions according to Cohen's kappa coefficient (0.668). However, the prevalence of possible sarcopenia according to 2014 and 2019 AWGS in males increased 7.9%; in contrast, sarcopenia decreased from 7.4 to 3.7% in females (p < 0.001). In conclusion, the AWGS 2019 definition is more convenient for sarcopenia case screening and remains considerably consistent in sarcopenia identification in community-dwelling adults in Taiwan. The discordance of possible sarcopenia and sarcopenia by sex is a concern.

Adequate protein intake in older adults in the context of frailty: cross-sectional results of the Nutrition and Health Survey in Taiwan 2014-2017.

BACKGROUND: Emerging evidence suggests that a dietary protein intake higher than the current recommended dietary allowance of 0.8 g/kg body weight (BW)/d may be needed to maintain optimal muscle mass, strength, and function in older adults. However, defining optimal protein intake in this age group remains a challenge. OBJECTIVE: In this study we sought to describe the dietary protein intake in frail, prefrail, and robust older Taiwanese adults. METHODS: Data for 1920 older adults were collected from the Nutrition and Health Survey in Taiwan from 2014 to 2017. Dietary intake was assessed using the 24-h recall method. Frailty was determined using the modified Fried's criteria. Body composition was assessed using DXA. Sex-specific dietary protein intakes, measured as values/kg of BW, fat-free mass (FFM), and lean mass (LM), were estimated for the 3 age groups (65-69, 70-79, and ≥80y) and the 3 frailty levels. RESULTS: In both males (P for trend = 0.034) and females (P for trend = 0.015), there were significant downward trends for protein intake/kg of BW with the severity of frailty. The age-adjusted protein intake/kg of BW was still significant in males (P for trend = 0.009), but no longer in females. This phenomenon was also seen for protein intake at lunch and dinner but not at breakfast. Age-adjusted trends for protein intake/kg FFM or LM were not significant in either sex. The median protein intake in robust older males and females was 1.21 and 1.19 g/kg BW/d, respectively, and the mean intakes were even higher. CONCLUSION: Median protein intake in robust Taiwanese older adults was approximately 1.2 g/kg BW/d, with higher mean values. The protein adequate intake in Taiwanese older adults was higher than the current recommended daily allowance (RDA) level but within the RDA range derived from the state-of art indicator amino acid oxidation technique.

Effects of enriched branched-chain amino acid supplementation on sarcopenia.

To evaluate the effects of short-term administration of enriched branched-chain amino acids (BCAAs) on subjects with pre-sarcopenia or sarcopenia, our quasi-experimental study enrolled 33 subjects (12 pre-sarcopenia/21 sarcopenia; 6 men/27 women; mean age 66.6 ± 10.3 years) to take one sachet (3.6 g) of enriched BCAA powder twice a day for five weeks followed by a discontinuation period of 12 weeks. We evaluated sarcopenic parameters, including grip strength, 6-meter gait speed, and bioelectrical-impedance-analysis-derived skeletal mass index (SMI), at baseline, 5 weeks, and 17 weeks. We found that both pre-sarcopenic and sarcopenic subjects showed improved SMI, gait speed, and grip strength at 5 weeks. However, all three parameters progressively declined at 17 weeks, especially SMI and grip strength in subjects aged < 65 years and gait speed and grip strength in subjects aged ≥ 65 years. It thus appears that supplementation with enriched BCAAs for 5 weeks correlates with short-term positive effects on sarcopenic parameters but attenuation of those effects following discontinuation for 12 weeks.

Interaction of central obesity and sarcopenia on nutritional status in the community-dwelling older people.

OBJECTIVES: To investigate the interrelationships between central obesity, sarcopenia and nutritional status in the elderly. METHODS: We enrolled 501 elderly (women: 47.5 %) with complete datasets. Biochemical and anthropometric data were measured after an overnight fast. Basic characteristics, psychosocial and behavioral factors, nutritional status, and history of chronic disease came from structured questionnaires. Central obesity was defined as waist circumference ≥ 90 cm for men, ≥ 80 cm for women. Sarcopenia was defined by the Asian consensus. Nutritional status was assessed using Mini Nutritional Assessment scores: abnormal nutritional status ≤ 23.5. Multiple logistic regression analysis was done to determine the independent factors of an abnormal nutritional status. RESULTS: Ninety (18.0 %) participants had an abnormal nutritional status, 300 (59.9 %) had central obesity, 52 (10.4 %) sarcopenia and 3 (0.6 %) sarcopenic obesity. Central obesity (OR = 0.455, 95 % CI: 0.244-0.847) and total lymphocyte count (OR = 0.526, 95 % CI: 0.315-0.880) were negatively and sarcopenia (OR = 3.170, 95 % CI: 1.485-6.767), current smoking (OR = 4.071, 95 % CI: 1.357-12.211), and total number of chronic diseases (OR = 1.484, 95 % CI: 1.234-1.785) were positively associated with abnormal nutritional status. An analysis of the combine effects of central obesity and sarcopenia on nutritional status showed that significantly fewer participants with central obesity but not sarcopenia had abnormal nutrition than participants with sarcopenia with or without central obesity (12.8 % vs 38.5 or 65.4 %, p < 0.001). CONCLUSIONS: Central obesity and sarcopenia were interactively associated with the nutritional status of older people living in a rural community.

Inverse Relationship between Metabolic Syndrome and 25-Hydroxyvitamin D Concentration in Elderly People without Vitamin D deficiency.

Vitamin D status is inversely associated with the prevalence of metabolic syndrome (MetS). Whether this is true in the elderly without vitamin D deficiency is rarely investigated. Our data source is a cross-sectional survey of 1,966 community-dwelling elderly Taiwanese in 2012. An overnight fasting blood were obtained for biochemistry variables. Vitamin D deficiency was defined as serum 25-hydroxyvitamin D3 [25(OH)D] concentration <20 ng/mL. MetS is defined using modified ATP-III criteria. Of 523 participants without vitamin D deficiency (Men/Women = 269/254, age = 76.0 ± 6.2 years old [65-102 years old]), mean 25(OH)D was 44.0 ± 11.1 ng/mL, and the MetS prevalence of MS was 46.5%. Serum 25(OH)D was negatively associated with osteocalcin, the homeostatic model assessment insulin resistance (HOMA-IR) index, body mass index (BMI), and glycated hemoglobin A1c. Participants with more MetS features have lower serum 25(OH)D and osteocalcin. Binary logistic regression models showed that 25(OH)D, physical activity, and osteocalcin were negatively independent MetS factors, but that the HOMA-IR index, BMI, and being female were positively independent factors. The risk of MetS was progressively lower along with the increased 25(OH)D concentration, even above 60 ng/mL. In conclusion, a low 25(OH)D concentration is an independent risk factor for MetS in elderly people without vitamin D deficiency.

Increased dietary zinc and vitamin B-2 is associated with increased alanine aminotransferase in Taiwanese adolescents.

BACKGROUND AND OBJECTIVES: Alanine aminotransferase (ALT) is generally used for evaluating liver function, and its concentrations are closely associated with sex and nutritional status. This study investigates the relationships between dietary components and serum ALT activity in Taiwanese adolescents. METHODS AND STUDY DESIGN: Data were collected from 1,941 adolescents aged 13-18 years who participated in the fourth National Nutrition and Health Survey in Taiwan (2010-2011, adolescents). RESULTS: The mean age was 15.3±0.1 y (15.3±0.1 y for boys and 15.2±0.1 y for girls). Mean serum ALT was 14.8±13.3 U/L (17.7±16.3 U/L for boys and 12.1±8.7 U/L for girls; p<0.001). Multivariate analysis revealed that, among girls, a single-unit increase in dietary zinc was associated with 1.12- and 1.11-fold increases in risk for increased serum ALT tertile 2 (T2) and T3, respectively, compared with T1; and a single-unit increase in vitamin B-2 intake increased risk by 1.71- and 1.54-fold, respectively. Further analysis revealed that the risk increase for boys and girls who consumed the highest amounts of dietary zinc and vitamin B-2 (T3) was 1.97- and 2.62-fold, respectively; they were also more likely to have higher serum ALT (>11 U/L for boys and >9 U/L for girls) than those of the reference (presented as zinc T1 and vitamin B-1 T1). CONCLUSIONS: Increased dietary zinc and vitamin B-2 intake is associated with higher serum ALT in adolescents.

Prevalence and associated factors of sarcopenia and severe sarcopenia in older Taiwanese living in rural community: the Tianliao Old People study 04.

AIM: The aim of the present study was to show the prevalence and associated factors of sarcopenia and severe sarcopenia in rural community-dwelling older Taiwanese. METHODS: Using the whole community sampling method, a total of 285 men and 264 women aged over 65 years were randomly sampled (response rate = 50%) from Tianliao District, southern Taiwan, in 2012. Participants were interviewed by trained investigators to complete a validated structural questionnaire. Body composition was measured by bioelectrical impedance analysis, and skeletal muscle mass was estimated by Janssen's equation. The Mini-Nutritional Assessment (MNA) score, Short Portable Mental Status Questionnaire, grip strength, gait speed and short physical performance battery (SPPB) were obtained by the standard procedures. Sarcopenia and severe sarcopenia were defined according to the 2010 consensus of the Report of the European Working Group on Sarcopenia in Older People. RESULTS: Of the 549 study participants, 39 (7.1%) were classified as having sarcopenia and 31 (5.6%) participants were classified as having severe sarcopenia. Using multiple logistic regression models, the age, sex, working status, waist circumference, body mass index, hypertensive history, MNA and SPPB score were independently associated with different stages of sarcopenia. CONCLUSIONS: Approximately one-fifth of community-dwelling older adults were facing the threat of sarcopenia in southern Taiwan. The older age, female sex, lower body mass index, higher waist circumference, a history of hypertension, lower MNA or SPPB score and not working regularly were associated factors for either sarcopenia or severe sarcopenia.

Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria.

Functional gastrointestinal disorders (FGID) are a group of disorders of the digestive system in which the chronic or recurrent symptoms cannot be explained by the presence of structural or tissue abnormality. This survey used a modified Rome III questionnaire on the health and nutrition status of a general population in Taiwan during 2005-2008. A total of 4,275 responders completed the questionnaire. The sample was evenly distributed for men (n=2,137) and women (n=2,138). The prevalence of FGID was 26.2%. Unspecified functional bowel disorder was the most prevalent (8.9%). The second was functional dyspepsia (5.3%), and the third were irritable bowel syndrome (4.4%) and functional constipation (4.4%). Women had a greater prevalence than males (33.2% compared to 22.4%, p<0.05) with regards to total FGID. Most categories of FGID were significantly prominent in women, except functional diarrhea. The FGID groups took fewer servings of vegetables and fruits than the non-FGID group each day (vegetables 2.51 vs 2.70, p<0.001; fruits 0.82 vs 0.91, p<0.001). Smoking, alcohol consumption, and betel nut chewing had no significant impaction on prevalence of FGID. The mean BSRS (brief-symptom rating scale) for screening depression and suicide ideation was higher in the FGID group (2.86 vs 1.63, p<0.001). In conclusion, FGID diagnosed with Rome III criteria are not uncommon in Taiwan's general population. Subjects who met the Rome III criteria for FGID in Taiwan were younger, had less vegetables and fruits intake, higher BSRS scores and were of greater female predominance.

Trends in nutrient and dietary intake among adults and the elderly: from NAHSIT 1993-1996 to 2005-2008.

The aim of this study was to investigate trends in nutrients and sources of dietary intake for Taiwanese people from the Nutrition and Health Survey in Taiwan (NAHSIT) 1993-1996 to 2005-2008. Twenty-four hour dietary recall data were obtained from the 2005-2008 NAHSIT. The results showed that intake of cereals and grains, and dietary fiber has decreased, whereas intake of carbohydrate rich convenience foods has increased. As a result, 10-20 g of dietary fat is now obtained from carbohydrate rich foods. A greater proportion of Taiwanese are choosing low-fat meat products, however, excessive intake of meat by men and women aged 19 to 64 years is resulting in excessive intakes of protein, cholesterol and saturated fat. Men and women aged 19 to 30 years had insufficient intakes of fruit and vegetables. Consumption of fruit, dairy/products, and nuts was low in all age groups. We recommend strengthening public nutrition education and changing diet related environment to improve dietary quality and food group distributions. Issues of concern include excessive intakes of energy and the soybean/fish/meat/eggs food group in all subjects, high amount of processed foods and refined-carbohydrate rich foods in men aged 19 to 64 years and women aged 19-30 years, as well as intakes below the DRI for a variety of nutrients in elderly persons.

Dietary nutrient intake and major food sources: the Nutrition and Health Survey of Taiwan Elementary School Children 2001-2002.

The aim of the study was to investigate nutrient intake and their dietary sources in Taiwanese children ages 6-12 years by analyzing the 24-hour recall data of 2386 participants from a nationally representative sample. Results showed that children in Taiwan were slightly lower in mean proportion of energy intake from carbohydrates (53.5% of energy intake) and higher in those from fats (30.8%) and protein (15.8%) as based on the recommendations of Department of Health in Taiwan. The mean intake of vitamins and of minerals by children was equivalent to or exceeded Daily Reference Intake of Taiwan (DRI) or other recommended standards with the exception of a seriously insufficient calcium intake and extremely high sodium intake. A substantial proportion of children in different age/gender/location strata had lower mean vitamin and mineral intake by DRI and other recommended standards. These nutrient profiles were mainly related to dietary patterns with relatively low intake of fruits, vegetables, cereals/grains, and dairy products, but high intake of the protein-rich foods, salt/sauces, and fats/oils. According to the suboptimal dietary nutrient profiles of Taiwanese children, particularly in the underprivileged areas, recommendations are made in this article for policy makers and health practitioners to consider in order to improve dietary quality of elementary school children.

Intake levels and major food sources of energy and nutrients in the Taiwanese elderly.

The purpose of this article is to examine dietary intake levels and major food sources of energy and nutrients for the Taiwanese elderly in order to relate nutrient intakes to food choices and to provide suggestions for dietary improvement. The data were derived from the 24-hour recalls from 1,911 subjects (955 males and 956 females) aged 65 and above, who participated in the Elderly NAHSIT carried out from 1999 to 2000. The differences in food consumption patterns between the elderly and younger adults (aged 19 to 64) were also evaluated by comparison with data obtained from NAHSIT 1993-1996. The results revealed that cereals/roots, meat, other protein-rich foods and fats/oils contributed most to daily energy intake. The energy contributions from fats/oils, poultry, meat, other protein-rich foods, refreshments/snacks, alcoholic beverages, and miscellaneous food groups were lower in elderly diets compared with those of younger adults. Meat and cereals/roots were the major food sources of protein. The main carbohydrate-contributing food group was cereals/roots, while primary lipid sources were meat and fats/oils for the elderly. The food groups with a high contribution to vitamin intake were the following: vegetables for vitamin A; meat and cereals/roots for vitamin B1; dairy products, vegetables, cereals/roots and meat for vitamin B2; cereals/roots, seafood and meat for niacin; meat, vegetables and cereals/roots for vitamin B6; plant oils for vitamin E; and vegetables and fruit for vitamin C. The highest ranked food sources for minerals are listed as follows: dairy products, vegetables and seafood for calcium; dairy products and cereals/roots for phosphorous; vegetables and meat for iron; and vegetables, cereals/ roots, other protein-rich foods and seafood for magnesium. The elderly were found to consume more salt, dairy products and vegetables, but less poultry and meat than their younger counterparts. In summary, differences in consumption patterns between the elderly and younger adults was reflected in differences in common food sources of energy and specific nutrients. The dietary patterns of the elderly are in general "healthier" than that of younger adults except for higher salt intake among the elderly. Nonetheless, our elderly population needs to increase their intake of calcium, magnesium, vitamins E and B6, and dietary fiber, and decrease their consumption of salt. Promoting the ingestion of whole-grain and nut products may be a useful strategy to improve the nutritional status of the Taiwanese elderly, aiming at increasing the percentage of energy obtained from carbohydrates and the daily intake of vitamins E and B6, magnesium, and dietary fiber. Suitable strategies are also needed to improve the calcium status of Taiwanese elderly, particularly as a high proportion of them are either lactose intolerant or dislike dairy products.