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Examining Weight Bias among Practicing Canadian Family Physicians.
Alberga, AS, Nutter, S, MacInnis, C, Ellard, JH, Russell-Mayhew, S
Obesity facts. 2019;12(6):632-638
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Weight bias represents negative attitudes and beliefs about individuals because of their weight. The aim of this study was to examine: a. weight bias in a national sample of family physicians in Canada, b. the relationships between weight bias, attitudes about treating patients with obesity, and how people with obesity are perceived as a burden to the public healthcare system. A probability sample of 400 currently practicing family physicians completed the survey by phone or online. Results show that most respondents were white (63.3%) men (61.3%) aged 45 years or older. The average total score of explicit weight bias was 2.95 (1.17) evaluated on a 7-point Likert scale. Furthermore, although weight bias was not present in the majority of the sample, it was present among some physicians. Authors conclude that future work is needed to investigate weight bias reduction techniques targeted at physicians.
Abstract
OBJECTIVES The aim of this study was to examine the attitudes of practicing Canadian family physicians about individuals with obesity, their healthcare treatment, and perceptions of obesity treatment in the public healthcare system. METHOD A national sample of Canadian practicing family physicians (n = 400) completed the survey. Participants completed measures of explicit weight bias, attitudes towards treating patients with obesity, and perceptions that people with obesity increase demand on the public healthcare system. RESULTS Responses consistent with weight bias were not observed overall but were demonstrated in a sizeable minority of respondents. Many physicians also reported feeling frustrated with patients with obesity and agreed that people with obesity increase demand on the public healthcare system. Male physicians had more negative attitudes than females. More negative attitudes towards treating patients with obesity were associated with greater perceptions of them as a public health demand. CONCLUSION Results suggest that negative attitudes towards patients with obesity exist among some family physicians in Canada. It remains to be determined if physicians develop weight bias partly because they blame individuals for their obesity and its increased demand on the Canadian public healthcare system. More research is needed to better understand causes and consequences of weight bias among health professionals and make efforts towards its reduction in healthcare.
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Nicotinamide Riboside Augments the Aged Human Skeletal Muscle NAD+ Metabolome and Induces Transcriptomic and Anti-inflammatory Signatures.
Elhassan, YS, Kluckova, K, Fletcher, RS, Schmidt, MS, Garten, A, Doig, CL, Cartwright, DM, Oakey, L, Burley, CV, Jenkinson, N, et al
Cell reports. 2019;28(7):1717-1728.e6
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As the body ages, there is a decline in muscle mass and function, which can be combatted with diet, exercise, and supplementation. Nicotinamide riboside (NR) or vitamin B3 has been shown in animal studies to promote healthy muscle, however its effects in human muscle are unknown. This randomised control trial of overweight older men aimed to determine if NR can be used by muscle and whether it has any effect on muscle function. The results showed that NR supplementation (1 g/day) for 3 weeks can be used by the muscle but had no effect on muscle function as shown by the hand grip test. Supplementation also decreased energy production in muscle and had anti-inflammatory effects. It was concluded that NR is available to muscle and that it may have anti-inflammatory properties, which may be of benefit to older individuals.
Abstract
Nicotinamide adenine dinucleotide (NAD+) is modulated by conditions of metabolic stress and has been reported to decline with aging in preclinical models, but human data are sparse. Nicotinamide riboside (NR) supplementation ameliorates metabolic dysfunction in rodents. We aimed to establish whether oral NR supplementation in aged participants can increase the skeletal muscle NAD+ metabolome and if it can alter muscle mitochondrial bioenergetics. We supplemented 12 aged men with 1 g NR per day for 21 days in a placebo-controlled, randomized, double-blind, crossover trial. Targeted metabolomics showed that NR elevated the muscle NAD+ metabolome, evident by increased nicotinic acid adenine dinucleotide and nicotinamide clearance products. Muscle RNA sequencing revealed NR-mediated downregulation of energy metabolism and mitochondria pathways, without altering mitochondrial bioenergetics. NR also depressed levels of circulating inflammatory cytokines. Our data establish that oral NR is available to aged human muscle and identify anti-inflammatory effects of NR.
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The Effect of Vitamin B12 and Folic Acid Supplementation on Serum Homocysteine, Anemia Status and Quality of Life of Patients with Multiple Sclerosis.
Nozari, E, Ghavamzadeh, S, Razazian, N
Clinical nutrition research. 2019;8(1):36-45
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Multiple sclerosis (MS) is a relatively common chronic neurological disorder in which damage to the protective covering of neurons occurs in different areas of the central nervous system. Relapsing remitting multiple sclerosis (RRMS) is the relapsing episodes of MS and periods of stability in between relapses. The aim of this study was to determine the effect of vitamin B12 and folic acid supplementation on serum homocysteine (amino acid), anaemia status and quality of life of RRMS patients The study is a double-blind clinical trial which recruited 50 participants. The participants were randomly assigned to one of the 2 groups of RRMS: the vitamin group or the placebo group. Results indicate that increasing the consumption of folic acid and vitamin B12 improved physical and mental dimensions of quality of life in the vitamin group. However, in the placebo group, improvements were only limited to the psychological dimension of quality of life and no significant change in the physical dimension was observed. Authors conclude that homocysteine levels, anaemia status, and eventually quality of life of patients with MS can be significantly improved by administration of 1mg of vitamin B12 monthly and adding rich-food sources of folic acid on their diet.
Abstract
Plasma homocysteine level and megaloblastic anemia status are two factors that can affect the quality of life of patients with multiple sclerosis (MS). We conducted this study to determine the effect of vitamin B12 and folic acid supplementation on serum homocysteine, megaloblastic anemia status and quality of life of patients with MS. A total of 50 patients with relapsing remitting multiple sclerosis (RRMS) included in this study which divided into 2 groups. The vitamin group received 5 mg folic acid tablet daily and 3 doses of vitamin B12 (1,000 mcg) injection and the other group received placebo and normal saline injection (same doses). The quality of life was measured by using Multiple Sclerosis Quality of Life-54 questionnaire (MSQOL-54). Fully automated fluorescence polarization immunoassay was used to measure serum homocysteine, vitamin B12 and folate. Complete blood count blood test was conducted to determine the anemia status. The mean homocysteine level reduced by 2.49 ± 0.39 µmol/L (p = 0.001), hemoglobin increased from 11.24 ± 1.54 to 13.12 ± 1.05 g/dL (p = 0.001), and mean corpuscular volume decreased from 95.50 ± 6.65 to 89.64 ± 4.24 in the vitamin group (p = 0.001). There was a significant improvement in the mental field of life quality in the placebo group (37.46 ± 19.01 to 50.98 ± 21.64; p = 0.001), whereas both physical and mental fields of quality of life were improved significantly in the vitamin group (40.38 ± 15.07 to 59.21 ± 12.32 and 29.58 ± 15.99 to 51.68 ± 18.22, respectively; p = 0.001). Serum homocysteine level decrease and anemia status improvement with vitamin B12 and folic acid supplementation reveal the potential role of these two vitamins in improving the life quality of MS patients. TRIAL REGISTRATION Iranian Registry of Clinical Trials Identifier: IRCT2015100313678N7.
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Association of the Functional Medicine Model of Care With Patient-Reported Health-Related Quality-of-Life Outcomes.
Beidelschies, M, Alejandro-Rodriguez, M, Ji, X, Lapin, B, Hanaway, P, Rothberg, MB
JAMA network open. 2019;2(10):e1914017
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The functional medicine model of care provides an operating system that works to reverse illness, promote health, and optimize function by addressing underlying causes, symptoms, and functional imbalances in interconnected biological networks. The aim of this study was to investigate the association between the functional medicine model of care and health-related quality of life (HRQoL) by comparing functional medicine with care received in a family medicine setting. The study is a single-centre retrospective cohort study which recruited 7252 new patients. The study evaluated the association of HRQoL in patients receiving functional medicine care vs patients receiving primary care. Results indicate that clients seen at the Centre for Functional Medicine were more likely to experience a clinically meaningful change in their (patient-reported outcome measurement information system and global physical health) scores at 6 months, which was less likely to decrease over time. Authors conclude that the functional medicine model of care may have beneficial and sustainable associations with improved HRQoL in patients as measured by patient-reported outcome measurement information system, global physical health and global mental health scores.
Abstract
Importance: The incidence of chronic disease is increasing along with health care-related costs. The functional medicine model of care provides a unique operating system to reverse illness, promote health, and optimize function. The association between this model of care and patient's health-related quality of life (HRQoL) is unknown. Objective: To assess the association between functional medicine and patient-reported HRQoL using Patient-Reported Outcome Measurement Information System (PROMIS) global health measures. Design, Setting, and Participants: A retrospective cohort study was performed to compare 7252 patients aged 18 years or older treated in a functional medicine setting with propensity score (PS)-matched patients in a primary care setting. Sensitivity analyses assessed improvement limited to patients seen at both 6 and 12 months. The study included patients who visited the Cleveland Clinic Center for Functional Medicine or a Cleveland Clinic family health center between April 1, 2015, and March 1, 2017. Main Outcomes and Measures: The primary outcome was change in PROMIS Global Physical Health (GPH) at 6 months. Secondary outcomes included PROMIS Global Mental Health (GMH) at 6 months and PROMIS GPH and GMH at 12 months. The PROMIS GPH and GMH scores were transformed to a T-score from 0 to 100 with a mean of 50. Higher scores indicate a better health-related quality of life. Results: Of the 7252 patients (functional medicine center: 1595; family health center: 5657), 4780 (65.9%) were women; mean (SD) age was 54.1 (16.0) years. At 6 months, functional medicine patients exhibited significantly larger improvements in PROMIS GPH T-score points than were seen in patients treated at a family health center (mean [SD] change, functional medicine center: 1.59 [6.29] vs family health center: 0.33 [6.09], P = .004 in 398 PS-matched pairs). At 12 months, functional medicine patients showed improvement similar to that observed at 6 months; however, comparisons with patients seen at the family health center were not significant. Patients in the functional medicine center with data at both 6 and 12 months demonstrated improvements in PROMIS GPH (mean [SD], 2.61 [6.53]) that were significantly larger compared with patients seen at a family health center (mean [SD], 0.25 [6.54]) (P = .02 in 91 PS-matched pairs). Conclusions and Relevance: In this study, the functional medicine model of care demonstrated beneficial and sustainable associations with patient-reported HRQoL. Prospective studies are warranted to confirm these findings.
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The Effectiveness of Intermittent Fasting to Reduce Body Mass Index and Glucose Metabolism: A Systematic Review and Meta-Analysis.
Cho, Y, Hong, N, Kim, KW, Cho, SJ, Lee, M, Lee, YH, Lee, YH, Kang, ES, Cha, BS, Lee, BW
Journal of clinical medicine. 2019;8(10)
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Calorie restriction (CR) is known to reduce body weight and to improve various cardiovascular risk factors. Due to the many difficulties in sustaining daily CR, intermittent fasting (IF) has been proposed as an alternative strategy for achieving and maintaining weight reduction. The aim of this study was to investigate the effectiveness of IF on weight loss and glucose metabolism by analysing the effect size of previous studies among the general population without diabetes mellitus. A total of 12 studies were included in this study. The total number of participants was 545 (261 in the intervention group and 284 in the control group). Study analysis indicates an improvement in glycaemic control and insulin resistance through IF diet as compared with a non-fasting control group. Lean mass was relatively conserved in the IF diet group however, no significant weight reduction was identified. Authors conclude that IF diet may improve fat distribution in the general population without chronic metabolic disease.
Abstract
The effects of an intermittent fasting diet (IFD) in the general population are still controversial. In this study, we aimed to systematically evaluate the effectiveness of an IFD to reduce body mass index and glucose metabolism in the general population without diabetes mellitus. Cochrane, PubMed, and Embase databases were searched to identify randomized controlled trials and controlled clinical trials that compared an IFD with a regular diet or a continuous calorie restriction diet. The effectiveness of an IFD was estimated by the weighted mean difference (WMD) for several variables associated with glucometabolic parameters including body mass index (BMI) and fasting glucose. The pooled mean differences of outcomes were calculated using a random effects model. From 2814 studies identified through a literature search, we finally selected 12 articles (545 participants). Compared with a control diet, an IFD was associated with a significant decline in BMI (WMD, -0.75 kg/m2; 95% CI, -1.44 to -0.06), fasting glucose level (WMD, -4.16 mg/dL; 95% CI, -6.92 to -1.40), and homeostatic model assessment of insulin resistance (WMD, -0.54; 95% CI, -1.05 to -0.03). Fat mass (WMD, -0.98 kg; 95% CI, -2.32 to 0.36) tended to decrease in the IFD group with a significant increase in adiponectin (WMD, 1008.9 ng/mL; 95% CI, 140.5 to 1877.3) and a decrease in leptin (WMD, -0.51 ng/mL; 95% CI, -0.77 to -0.24) levels. An IFD may provide a significant metabolic benefit by improving glycemic control, insulin resistance, and adipokine concentration with a reduction of BMI in adults.
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The Fluid Aspect of the Mediterranean Diet in the Prevention and Management of Cardiovascular Disease and Diabetes: The Role of Polyphenol Content in Moderate Consumption of Wine and Olive Oil.
Ditano-Vázquez, P, Torres-Peña, JD, Galeano-Valle, F, Pérez-Caballero, AI, Demelo-Rodríguez, P, Lopez-Miranda, J, Katsiki, N, Delgado-Lista, J, Alvarez-Sala-Walther, LA
Nutrients. 2019;11(11)
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The Mediterranean diet is considered one of the most studied diets in scientific literature and this review specifically looks at two fluid aspects of the MedDiet; olive oil and red wine. Olive oil is rich in phenolic compounds and red wine in polyphenols and the study looks at their therapeutic effect on cardiovascular disease prevention, particularly on lipids, blood pressure, plaque and glucose metabolism. Known mechanisms of the MedDiet include reduction of inflammatory and oxidative stress markers, and an improvement in lipid profile and insulin sensitivity. Polyphenols are important antioxidants abundant in plant foods including olives and red grapes used in wine (known to be x10 richer in polyphenols than white wine). The review reports that low to moderate consumption of red wine 30-50g daily lowers risk factors for CVD, improve HDL lipid profile, exerts a beneficial effect on blood pressure (BP), promotes vasodilation thus helping to reduce plaques and finally limited data shows it may beneficially affect insulin resistance. Polyphenols in olives were reported to reduce blood pressure, reduce LDL lipids and increase HDL lipids, support weight loss and help prevent obesity, metabolic syndrome and type II diabetes, reduce inflammation and oxidative stress, and possibility benefit gut microbiota. The review concludes that both fluids exert cardio-protection when consumed in moderation as part of a MedDiet.
Abstract
A growing interest has emerged in the beneficial effects of plant-based diets for the prevention of cardiovascular disease, diabetes and obesity. The Mediterranean diet, one of the most widely evaluated dietary patterns in scientific literature, includes in its nutrients two fluid foods: olive oil, as the main source of fats, and a low-to-moderate consumption of wine, mainly red, particularly during meals. Current mechanisms underlying the beneficial effects of the Mediterranean diet include a reduction in inflammatory and oxidative stress markers, improvement in lipid profile, insulin sensitivity and endothelial function, as well as antithrombotic properties. Most of these effects are attributable to bioactive ingredients including polyphenols, mono- and poly-unsaturated fatty acids. Polyphenols are a heterogeneous group of phytochemicals containing phenol rings. The principal classes of red wine polyphenols include flavonols (quercetin and myricetin), flavanols (catechin and epicatechin), anthocyanin and stilbenes (resveratrol). Olive oil has at least 30 phenolic compounds. Among them, the main are simple phenols (tyrosol and hydroxytyrosol), secoroids and lignans. The present narrative review focuses on phenols, part of red wine and virgin olive oil, discussing the evidence of their effects on lipids, blood pressure, atheromatous plaque and glucose metabolism.
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Adherence to the Mediterranean Diet and Its Association with Body Composition and Physical Fitness in Spanish University Students.
Cobo-Cuenca, AI, Garrido-Miguel, M, Soriano-Cano, A, Ferri-Morales, A, Martínez-Vizcaíno, V, Martín-Espinosa, NM
Nutrients. 2019;11(11)
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The Mediterranean diet (MD) represents a dietary pattern that incorporates healthy traditional eating habits which includes high consumption of vegetables, fruit, legumes, nuts, beans, whole grains, fish, and unsaturated fats, and low consumption of red meat and dairy products. The Mediterranean Diet Adherence Screener (MEDAS-14 items) is a valid instrument for the estimation of adherence to the MD. The objectives of this study were to: 1. Estimate the prevalence of the adherence to the MD 2. Assess the association of adherence to the MD with physical fitness and body composition 3. Know the ability of each MEDAS item in the same sample to predict MD adherence. This study is a cross-sectional observational study which was performed with 310 first-year Spanish university students, aged between 18 and 30 years. Results indicate low prevalence of good adherence to the MD; and the participants with good adherence had high protein and low-fat intake compared to those with medium to low adherence. Furthermore, higher levels of physical fitness were also noticed amongst participants with good adherence to the MD. Twelve of the 14 items of the MEDAS score were associated with a high adherence to the MD. Authors conclude that MD adherence benefits both cardiorespiratory and muscular fitness amongst young adults.
Abstract
The aims of this study were to assess the association of adherence to the Mediterranean diet (MD) with physical fitness and body composition in Spanish university students and to determine the ability to predict the MD adherence of each Mediterranean Diet Adherence Screener (MEDAS) item. A cross-sectional study was performed involving 310 first-year university students. Adherence to the MD was evaluated with MEDAS-14 items. Anthropometric variables, body composition, and physical fitness were assessed. Muscle strength was determined based on handgrip strength and the standing long jump test. Cardiorespiratory fitness (CRF) was measured using the Course-Navette test. Only 24% of the university students had good adherence to the MD. The ANCOVA models showed a significant difference between participants with high adherence to the MD and those with medium and low adherence in CRF (p = 0.017) and dynamometry (p = 0.005). Logistic binary regression showed that consuming >2 vegetables/day (OR = 20.1; CI: 10.1-30.1; p < 0.001), using olive oil (OR = 10.6; CI: 1.4-19.8; p = 0.021), consuming <3 commercial sweets/week (OR = 10.1; IC: 5.1-19.7; p < 0.001), and consuming ≥3 fruits/day (OR = 8.8; CI: 4.9-15.7; p < 0.001) were the items most associated with high adherence to the MD. In conclusion, a high level of adherence to the MD is associated with high-level muscular fitness and CRF in Spanish university students.
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A pilot, randomized, double-blind, placebo-controlled trial to assess the safety and efficacy of a novel Boswellia serrata extract in the management of osteoarthritis of the knee.
Majeed, M, Majeed, S, Narayanan, NK, Nagabhushanam, K
Phytotherapy research : PTR. 2019;33(5):1457-1468
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Osteoarthritis (OA) is an age-related, degenerative joint disorder which affects many people worldwide. It causes pain, most frequently in the large joints such as knee and hips and is characterised by pain, decreased mobility and negative effects on the quality of life. This randomised, double-blind placebo controlled trial of 48 adults between the age of 35 and 75, aimed to evaluate the safety and efficacy of Boswellia serrata extract on newly diagnosed or untreated patients with OA of the knee. 340mg of Boswellia serrata extract was administered daily in 2 doses to the treatment group for 120 days. Outcome measures were WOMAC scores on pain, stiffness and physical function; a 6 min walk test assessing distance; physician assessment of range of motion, strength, stability and tenderness; x-ray images of joint space and growths; and hs-CRP, a blood marker of inflammation. The researchers found that the treatment group significantly improved, with reduced pain and stiffness compared to placebo. X-ray assessment also showed significantly improved knee join space and reductions in abnormal bone spur growth in the treatment group. Additionally, the treatment group had significantly lower hs-CRP compared to placebo. No adverse effects were reported. Whilst this is a small trial, Nutrition Practitioners working with patients with OA could consider the use of Boswellia serrata extract in their supplement protocols.
Abstract
A double-blind, placebo-controlled human trial was conducted to evaluate the safety and efficacy of a standardized oral supplementation of Boswellin®, a novel extract of Boswellia serrata extract (BSE) containing 3-acetyl-11-keto-β-boswellic acid (AKBBA) with β-boswellic acid (BBA). A total of 48 patients with osteoarthritis (OA) of the knee were randomized and allocated to the BSE and placebo groups for intervention. Patients were administered BSE or placebo for a period of 120 days. The trial results revealed that BSE treatment significantly improved the physical function of the patients by reducing pain and stiffness compared with placebo. Radiographic assessments showed improved knee joint gap and reduced osteophytes (spur) confirming the efficacy of BSE treatment. BSE also significantly reduced the serum levels of high-sensitive C-reactive protein, a potential inflammatory marker associated with OA of the knee. No serious adverse events were reported. This is the first study with BSE conducted for a period of 120 days, longer than any other previous clinical trial on patients with OA of the knee. The findings provide evidence that biologically active constituents of BSE, namely, AKBBA and BBA, act synergistically to exert anti-inflammatory/anti-arthritic activity showing improvement in physical and functional ability and reducing the pain and stiffness.
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Additional Effects of Nutritional Antioxidant Supplementation on Peripheral Muscle during Pulmonary Rehabilitation in COPD Patients: A Randomized Controlled Trial.
Gouzi, F, Maury, J, Héraud, N, Molinari, N, Bertet, H, Ayoub, B, Blaquière, M, Bughin, F, De Rigal, P, Poulain, M, et al
Oxidative medicine and cellular longevity. 2019;2019:5496346
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Chronic obstructive pulmonary disease (COPD) is systematically associated with comorbidities. Muscle atrophy and weakness are therefore targets of exercise training interventions in pulmonary rehabilitation (PR). The aim of the study was to test the effects of oral antioxidant supplementation with vitamins and trace elements (i.e. vitamins C and E, zinc and selenium) versus placebo on muscle endurance (primary outcome) and muscle strength, oxidative stress, inflammation, and PR outcomes (secondary outcomes). The study is a randomized double-blind controlled trial during PR. COPD patients (aged between 40 and 78 years) were randomly assigned to the PR antioxidant group or to the PR placebo group. Results indicate that nutritional antioxidant supplementation (vitamins C and E, zinc, and selenium) failed to further improve the patients’ quadriceps endurance. However, results also demonstrate that additional improvements of three secondary outcomes and a trend toward increased muscle type I fiber proportion with supplementation versus placebo during PR. Authors conclude that efficient antioxidant supplementation results in greater improvement in muscle function when compared to placebo in combination with exercise training.
Abstract
BACKGROUND Skeletal muscle dysfunction in patients with chronic obstructive pulmonary disease (COPD) is not fully reversed by exercise training. Antioxidants are critical for muscle homeostasis and adaptation to training. However, COPD patients experience antioxidant deficits that worsen after training and might impact their muscle response to training. Nutritional antioxidant supplementation in combination with pulmonary rehabilitation (PR) would further improve muscle function, oxidative stress, and PR outcomes in COPD patients. METHODS Sixty-four COPD patients admitted to inpatient PR were randomized to receive 28 days of oral antioxidant supplementation targeting the previously observed deficits (PR antioxidant group; α-tocopherol: 30 mg/day, ascorbate: 180 mg/day, zinc gluconate: 15 mg/day, selenomethionine: 50 μg/day) or placebo (PR placebo group). PR consisted of 24 sessions of moderate-intensity exercise training. Changes in muscle endurance (primary outcome), oxidative stress, and PR outcomes were assessed. RESULTS Eighty-one percent of the patients (FEV1 = 58.9 ± 20.0%pred) showed at least one nutritional antioxidant deficit. Training improved muscle endurance in the PR placebo group (+37.4 ± 45.1%, p < 0.001), without additional increase in the PR antioxidant group (-6.6 ± 11.3%; p = 0.56). Nevertheless, supplementation increased the α-tocopherol/γ-tocopherol ratio and selenium (+58 ± 20%, p < 0.001, and +16 ± 5%, p < 0.01, respectively), muscle strength (+11 ± 3%, p < 0.001), and serum total proteins (+7 ± 2%, p < 0.001), and it tended to increase the type I fiber proportion (+32 ± 17%, p = 0.07). The prevalence of muscle weakness decreased in the PR antioxidant group only, from 30.0 to 10.7% (p < 0.05). CONCLUSIONS While the primary outcome was not significantly improved, COPD patients demonstrate significant improvements of secondary outcomes (muscle strength and other training-refractory outcomes), suggesting a potential "add-on" effect of the nutritional antioxidant supplementation (vitamins C and E, zinc, and selenium) during PR. This trial is registered with NCT01942889.
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Fat Soluble Vitamins in Institutionalized Elderly and the Effect of Exercise, Nutrition and Cognitive Training on Their Status-The Vienna Active Aging Study (VAAS): A Randomized Controlled Trial.
Franzke, B, Schober-Halper, B, Hofmann, M, Oesen, S, Tosevska, A, Strasser, EM, Marculescu, R, Wessner, B, Wagner, KH
Nutrients. 2019;11(6)
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Increasing life-expectancy and consequently the incidence of age-related diseases is one main challenge for health systems. Elderly people are often at risk for inadequate nutrient supply due to physiological, metabolic, and age-associated factors affecting nutrient and fluid intake. The main aim of this study was to evaluate the plasma status of ten fat soluble micronutrients in a cohort of institutionalized elderly. A secondary aim was to investigate the effect of six months of either strength training, strength training and a protein-vitamin supplement, or a cognitive intervention on their plasma status. The study is a secondary analysis of the ‘Vienna Active Ageing Study’. One hundred and seventeen institutionalized elderly women and men (aged 65–98 years) were recruited. The participants were randomly assigned into three intervention groups—cognitive training, resistance training (RT), RT + supplement, and stratified for gender in a randomised, controlled, observer-blind design. Results show a diverse plasma status of fat soluble micronutrients in old institutionalised elderly; appropriate for retinol, improvable for alpha-tocopherol, and not satisfying for beta-carotene. Furthermore, the effect of six months training intervention with or without protein-vitamin supplementation improved physical function, but it was very moderate on the status of fat soluble micronutrients. Authors conclude that their findings encourage a stronger focus on the supply of nutrient dense plant food in this age group in order to obtain sufficient micronutrient levels or, if not otherwise possible such as for vitamin D, to use specific supplements.
Abstract
BACKGROUND Institutionalized elderly are at higher risk for micronutrient deficiency. In particular, fat soluble micronutrients, which additionally have antioxidative function, are of interest. The purpose of this secondary investigation of the Vienna Active Ageing Study was to assess and evaluate the plasma status of retinol, alpha- and gamma-tocopherol, alpha- and beta-carotene, lutein, zeaxanthin, beta-cryptoxanthin, and lycopene, as well as vitamin D (25(OH)D) in a cohort of institutionalized elderly. We further determined the effect of six months strength training with or without supplementing (antioxidant) vitamins and protein on the plasma status of these ten micronutrients. METHODS Three groups (n = 117, age = 83.1 ± 6.1 years)-resistance training (RT), RT combined with protein and vitamin supplementation (RTS), or cognitive training (CT)-performed two guided training sessions per week for six months. Micronutrients were measured with High Performance Liquid Chromatography (HPLC) at baseline and after 6 months of intervention. Physical fitness was assessed by the 6-min-walking, the 30-s chair rise, isokinetic dynamometry, and the handgrip strength tests. RESULTS At baseline, the plasma status of retinol was satisfactory, for alpha-tocopherol, beta-carotene, and 25(OH)D, the percentage of individuals with an insufficient status was 33%, 73% and 61%/81% (when using 50 nmol/L or 75 nmol/L as threshold levels for 25(OH)D), respectively. Plasma analyses were supported by intake data. Six months of elastic band resistance training with or without protein-vitamin supplementation had no biological impact on the status of fat soluble micronutrients. Even for vitamin D, which was part of the nutritional supplement (additional 20 µg/d), the plasma status did not increase significantly, however it contributed to a lower percentage of elderly below the threshold levels of 50/75 nmol/L (49%/74%). CONCLUSIONS The findings of the study lead to the strong recommendation for regular physical activity and increased consumption of plant-based foods in institutionalized elderly. When supported by blood analysis, supplementing micronutrients in a moderate range should also be considered.