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ABSTRACT: Sarcopenia, a reduction in muscle mass and muscle function, is considered one of the hallmarks of the aging process. Current views consider sarcopenia as the consequence of multiple medical, behavioural and environmental factors that characterize aged individuals. Likewise bone fragility is known to depend on several pathogenetic mechanisms leading to bone mass loss and reduction of bone strength. Muscle weakness, fear of falls, falls and subsequent fractures are associated to concurrent sarcopenia and osteoporosis and lead to restricted mobility, loss of autonomy and reduced life expectancy. The skeletal and the muscular organ systems are tightly intertwined: the strongest mechanical forces applied to bones are, indeed, those created by muscle contractions that condition bone density, strength, and microarchitecture. Not surprising, therefore, the decrease in muscle strength leads to lower bone strength. The degenerative processes leading to osteoporosis and sarcopenia show many common pathogenic pathways, like the sensitivity to reduced anabolic hormone secretion, increased inflammatory cytokine activity and reduced physical activity. Thus they may also respond to the same kind of treatments. Basic is life-style interventions related to exercise and nutrition. Sufficient vitamin D levels are of importance for both bone and muscle, primarily provided by sun exposure at younger age, and by supplementation at older age. Resistance training several times per week is crucial, and to be effective adequate access to energy and proteins is necessary.
European journal of physical and rehabilitation medicine 02/2013; 49(1):111-7. · 1.40 Impact Factor
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M Muscaritoli,
S D Anker,
J Argilés,
Z Aversa,
J M Bauer,
G Biolo,
Y Boirie,
I Bosaeus, T Cederholm,
P Costelli,
K C Fearon,
A Laviano,
M Maggio,
F Rossi Fanelli,
S M Schneider,
A Schols,
C C Sieber
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M Muscaritoli,
S D Anker,
J Argilés,
Z Aversa,
J M Bauer,
G Biolo,
Y Boirie,
I Bosaeus, T Cederholm,
P Costelli,
K C Fearon,
A Laviano,
M Maggio,
F Rossi Fanelli,
S M Schneider,
A Schols,
C C Sieber
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ABSTRACT: Chronic diseases as well as aging are frequently associated with deterioration of nutritional status, loss muscle mass and function (i.e. sarcopenia), impaired quality of life and increased risk for morbidity and mortality. Although simple and effective tools for the accurate screening, diagnosis and treatment of malnutrition have been developed during the recent years, its prevalence still remains disappointingly high and its impact on morbidity, mortality and quality of life clinically significant. Based on these premises, the Special Interest Group (SIG) on cachexia-anorexia in chronic wasting diseases was created within ESPEN with the aim of developing and spreading the knowledge on the basic and clinical aspects of cachexia and anorexia as well as of increasing the awareness of cachexia among health professionals and care givers. The definition, the assessment and the staging of cachexia, were identified as a priority by the SIG. This consensus paper reports the definition of cachexia, pre-cachexia and sarcopenia as well as the criteria for the differentiation between cachexia and other conditions associated with sarcopenia, which have been developed in cooperation with the ESPEN SIG on nutrition in geriatrics.
Clinical nutrition (Edinburgh, Scotland) 04/2010; 29(2):154-9. · 3.27 Impact Factor
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A.J. Cruz-Jentoft,
J.P. Baeyens,
J.M. Bauer,
Y. Boirie, T. Cederholm,
F. Landi,
F.C. Martin,
J.-P. Michel,
Y. Rolland,
S.M. Schneider,
E. Topinková,
M. Vandewoude,
M. Zamboni
Age and Ageing 01/2010; 39(4):412-423. · 3.09 Impact Factor
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ABSTRACT: Older subjects are at increased risk of partial or complete loss of independence due to acute and/or chronic disease and often of concomitant protein caloric malnutrition. Nutritional care and support should be an indispensable part of their management. Enteral nutrition is always the first choice for nutrition support. However, when patients cannot meet their nutritional requirements adequately via the enteral route, parenteral nutrition (PN) is indicated. PN is a safe and effective therapeutic procedure and age per se is not a reason to exclude patients from this treatment. The use of PN should always be balanced against a realistic chance of improvement in the general condition of the patient. Lower glucose tolerance, electrolyte and micronutrient deficiencies and lower fluid tolerance should be assumed in older patients treated by PN. Parenteral nutrition can be administered either via peripheral or central veins. Subcutaneous administration is also a possible solution for basic hydration of moderately dehydrated subjects. In the terminal, demented or dying patient the use of PN or hydration should only be given in accordance with other palliative treatments.
Clinical nutrition (Edinburgh, Scotland) 06/2009; 28(4):461-6. · 3.27 Impact Factor
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D Volkert,
Y N Berner,
E Berry, T Cederholm,
P Coti Bertrand,
A Milne,
J Palmblad,
St Schneider,
L Sobotka,
Z Stanga,
R Lenzen-Grossimlinghaus,
U Krys,
M Pirlich,
B Herbst,
T Schütz,
W Schröer,
W Weinrebe,
J Ockenga,
H Lochs
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ABSTRACT: Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.
Clinical Nutrition 05/2006; 25(2):330-60. · 3.73 Impact Factor
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M.J. Kaiser,
J.M. Bauer,
C. Ramsch,
W. Uter,
Y. Guigoz, T. Cederholm,
D.R. Thomas,
P.S. Anthony,
K.E. Charlton,
M. Maggio,
A.C. Tsai,
B. Vellas,
C.C. Sieber
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ABSTRACT: OBJECTIVES: To provide pooled data on the prevalence of malnutrition in elderly people as evaluated using the Mini Nutritional Assessment (MNA). DESIGN: Retrospective pooled analysis of previously published datasets. SETTING: Hospital, rehabilitation, nursing home, community. PARTICIPANTS: Four thousand five hundred seven people (75.2% female) with a mean age of 82.3. MEASUREMENTS: The prevalence of malnutrition in the combined database and in the four settings was examined. RESULTS: Twenty-four data sets with information on full MNA classification from researchers from 12 countries were submitted. In the combined database, the prevalence of malnutrition was 22.8%, with considerable differences between the settings (rehabilitation, 50.5%; hospital, 38.7%; nursing home, 13.8%; community, 5.8%). In the combined database, the "at risk" group had a prevalence of 46.2%. Consequently, approximately two-thirds of study participants were at nutritional risk or malnourished. CONCLUSION: The MNA has gained worldwide acceptance and shows a high prevalence of malnutrition in different settings, except for the community. Because of its specific geriatric focus, the MNA should be recommended as the basis for nutritional evaluation in older people
J.Am.Geriatr.Soc. 58(9).
