Teresa F Amaral

University of Porto | UP · Faculty of Nutrition and Food Sciences

Background: Sarcopenia is prevalent in heart failure (HF) patients, contributing to its poor prognosis. Statin use is postulated as a probable risk for developing sarcopenia, but little is known regarding this association in HF patients. This work aims at classifying and characterising sarcopenia and at describing the association of statin use wit...

Population aging is a reality resulting in polymedication and its harmful consequences. Therefore, determining polymedication state in Portugal and identifying its associated characteristics is vital. Methods: Among the cross-sectional study Nutrition UP 65, information on socio-demographic data, cognitive performance, lifestyle, health, and nutr...

Despite the well-known benefits of the Mediterranean Diet (MedDiet), data on the sodium intake is scarce. This study aimed to quantify the association between sodium excretion and the adherence to the MedDiet in the elderly. A representative sample of 1500 Portuguese adults (≥65 years) was assessed (1321 were eligible for the present analysis). A 2...

Aim: Sarcopenia and malnutrition are highly prevalent in older adults undergoing hemodialysis (HD) and are associated with negative outcomes. This study aimed to evaluate the role of sarcopenia and malnutrition combined on the nutritional markers, quality of life, and survival in a cohort of older adults on chronic HD. Methods: This was an observat...

Background & aims Nutritional screening is the starting point for high-quality nutrition care. In Portugal, the systematic nutritional risk assessment became mandatory for every inpatient in hospitals of the National Health System in 2019. The aims of this study were to describe the country nutritional risk prevalence of hospitalized patients, and...

Background : Dual x-ray absorptiometry (DXA) is widely adopted to estimate muscle mass for research, but for daily practice is only available in a limited number of facilities. Aim : To elucidate if it is anthropometry or bioelectrical impedance analysis (BIA) the method more concordant with DXA in estimating muscle mass for sarcopenia diagnosis a...

Background Assessing body weight in older adults may be challenging. Hence, the present study aimed to develop and cross‐validate updated and reproducible equations to estimate body weight in a large sample of older adults, namely among the older‐old. Methods In total, 1456 individuals aged ≥ 65 years, from the Nutrition UP 65 study, were included...

Aim To investigate the association between nutritional and functional status of Alzheimer's disease patients and caregivers' burden. Methods A cross-sectional study was conducted among 79 community-dwelling Alzheimer's disease patients living with their caregivers. Caregivers' burden was assessed using the Zarit Burden-Interview. Multinomial logis...

Background Sodium intake is expected to affect water needs, although compensation mechanisms may not work efficiently particularly in older adults. The aim of this cross‐sectional study was to quantify the association between sodium excretion and hydration status in a representative sample of Portuguese older adults. Methods A cluster sampling app...

The FRAIL Scale and the SARC-F are valid tools designed specifically for the screening of physical frailty and sarcopenia, respectively. The aim of the present study was to produce valid, linguistically, and culturally adapted versions for the Portuguese language, while maintaining conceptual equivalence to the original tools. To this end, the stan...

Handgrip strength (HGS) is an indicator of muscle condition and general health wellbeing. Usually, instruments measuring handgrip strength only identify its maximum value. This preliminary study is focused on identifying force vs. time parameters which could contribute to better describe individual strength. They were obtained during a Handgrip str...

The association between frailty and obesity may differ according to the heterogeneity of body mass index (BMI) and waist circumference (WC) phenotypes in older adults. We hypothesized that the use of simple indicators of general and abdominal obesity combined, may more accurately represent obesity and allow to further elucidate on how frailty statu...

Older adults are particularly susceptible to sedentary behaviours. Sitting time has been increasingly referred to as a potentially modifiable risk factor in the prevention of chronic diseases. Identifying factors associated with sitting time, particularly those that are modifiable, will allow for more effective public health strategies. This study...

Background Undernutrition is associated with increased hospital length of stay (LOS). Anthropometrics is required for undernutrition screening and diagnosis. However, the measurements which are more strongly associated with LOS are to be specified. This study aims to measure the independent association of weight, triceps skinfold thickness (TST), m...

RESUMO O Nutritional Risk Screening (NRS 2002) é um instrumento que foi desenvolvido pela Danish Society for Parenteral and Enteral Nutrition. Trata-se de um sistema válido que permite detetar a presença do risco de desnutrição ou de desnutrição em indivíduos hospitalizados e que é aplicado pelos profissionais de saúde. Procedeu-se ao desenvolvimen...

Objectives To investigate the coexistence of sarcopenia, frailty, undernutrition and obesity and to identify the factors associated with the cooccurrence of these conditions in an older population. Design Cross-sectional. Setting Portugal. Participants 1454 older adults with 65 years or older, from Nutrition UP 65 study. Primary and secondary o...

Nutriscore is the only nutritional screening tool developed specifically for oncological outpatients. Due to the absence of a Portuguese version, the aim of this study was to create a Portuguese validated translation. The ten steps of the International Society for Pharmacoeconomics and Outcomes Research guideline were followed: preparation, forward...

Dementia is a progressive neurological syndrome without cure whose prevalence is increasing due to population ageing. There is a lack of knowledge among healthcare professionals and caregivers regarding the best feeding approach in patients with advanced dementia. As there are no national recommendations on this subject, a consensus report from the...

This study investigated how different nutritional and functional status indicators are associated with mortality in patients with Alzheimer’s disease (AD). A prospective cohort study was conducted among 79 community-dwelling older adults with AD. Follow-up was 60 months. Undernutrition status was evaluated by Mini Nutritional Assessment (MNA), body...

Objectives In older adults, diet and physical activity are among the most important behaviours that influence health. The Mediterranean Dietary Pattern has been related to longevity and can benefit physical function in older adults. The present study aims to quantify the association of adherence to a Mediterranean Dietary Pattern with physical func...

Introduction: Nutrition knowledge among health professionals has a major impact on older adults’ healthcare. However, there is a lack of specialized education offer in this area. Within the Nutrition UP 65 Project, a health professional’s qualification nutrition course was created and implemented from April 2015 to April 2017. We aim to describe th...

Background: Dehydration appears to affect muscle strength and weakness, although its influence on exhaustion remains unclear. The present study aimed to quantify the association between hydration status and exhaustion among older adults. Methods: A cluster sampling approach was used, representing Portuguese older adults (≥65 years) according to...

Objectives: The aim of this study was to evaluate adherence to the Mediterranean dietary pattern (MDP) and its associated factors in older Portuguese adults. Methods: A cross-sectional observational study was designed. In the context of the Nutrition UP 65 study, a national cluster sample of 1407 Portuguese individuals ≥65 y of age was analyzed....

Objective: Older adults present higher risk of functional disability detected by handgrip strength and an increased risk of poor health conditions, such as dehydration and low values of the sodium-to-potassium (Na/K) ratio. This study aimed to quantify the association of hydration status and Na/K ratio with handgrip strength, based on the urinary e...

Aim The aim of this study was to describe sarcopenia frequency, to identify the factors associated with sarcopenia and undernutrition, and to evaluate their coexistence. Methods A total of 1500 Portuguese older adults aged ≥65 years from the Nutrition UP 65 study were evaluated using a cross‐sectional analysis. Sarcopenia was defined according to...

Objective To characterise the nutritional status and to identify malnutrition-associated variables of older adults living in Portuguese nursing homes. Design Cross-sectional study. Data on demographic and socio-economic characteristics, self-reported morbidity, eating-related problems, nutritional status, cognitive function, depression symptoms, l...

Background Vitamin D deficiency is common in older adults and has been linked with frailty and obesity, but it remains to be studied whether frail obese older adults are at higher risk of vitamin D deficiency. Therefore, the aim of this study is to explore the association between frailty, obesity indices and serum 25(OH)D concentrations. Methods 1...

Characteristics of the 1447 study participants by obesity and frailty status. (DOCX)

Correlation between body mass index, waist circumference, body roundness index and body shape index. (DOCX)

Comparison of the included and excluded individuals†. (DOCX)

The present study aims to clarify the association of vitamin D status with functionality, measured through gait speed and hand grip strength, in a sample of older adults, considering sex-specific characteristics and the potential confounding effect of lifestyle factors, disease, skin phenotype, season of blood collection and vitamin D supplementati...

Background: How nutrition status indicators relate to function in older adults is an issue that needs to be explored. This study aimed to quantify the associations of anthropometric parameters and nutrition status indicators with hand grip strength (HGS) and gait speed (GS) in older adults. Methods: A cross-sectional observational study was cond...

Introduction: The body skinfolds compressibility is an individual characteristic determined by tissues properties. Compressibility could affect the skinfold thicknesses inducing error in the assessment of subcutaneous adipose tissue and in the estimation of body composition. Objectives: This study aims to firstly describe the time behaviour of eigh...

Background: Although undernutrition and sarcopenia are common among older adults and both result in worse health outcomes, data concerning the burden of these conditions in Portuguese community-dwelling older adults are scarce. Objective: The aim of this study was to firstly describe the occurrence of sarcopenia and undernutrition among a nation...

Background: Vitamin D deficiency is common in older adults and has been linked with frailty and obesity, but it remains to be studied whether frail obese older adults are at higher risk of vitamin D deficiency. Therefore, the aim of this study is to explore the association between frailty, adiposity indices and serum 25(OH)D concentrations. Methods...

Nutrition UP 65 project is framed on the goal of reducing nutritional inequities among older adults in Portugal, improving the knowledge on their nutritional status and empowering health professionals on dealing with older adults’ nutritional status. To achieve those goals, a nationwide study was conducted within a sample of 1500 subjects aged ≥ 65...

The association between nutritional status and gait speed remains unclear. This study described gait speed in older adults and quantified the association between overweight, obesity, undernutrition risk and gait speed. Gait speed as potential indicator of nutritional outcomes was also explored. A cross-sectional analysis was conducted in a populati...

Background There is a lack of evidence regarding the association between the undernutrition risk at hospital admission with adverse clinical outcomes amongst pulmonology inpatients. The aim of this study was to quantify the association between undernutrition risk at hospital admission and time to discharge alive. Methods A retrospective cohort stu...

Background We aimed to describe urinary sodium and potassium excretion and their ratio in a representative sample of Portuguese elderly population, according to sociodemographic characteristics and weight status. Methods A cluster sampling approach was used, representing older Portuguese adults (≥65 years) according to age, sex, education level, a...

Background and objectives: Skinfold thickness assessment is a widely recognized technique for the estimation of body adiposity and fat free mass. This method assumes that skinfolds' compressibility is constant but there are some factors that could influence its compressibility. This study aims to evaluate whether the skinfolds' compressibility is...

Data on the association between hydration and body weight in the elderly are scarce. The objective of this work was to quantify the association between 24-h urine osmolality and weight status in the elderly. A cross-sectional study was conducted within the Nutrition UP 65 study. A quota sampling was implemented to achieve a nationally representativ...

Background The older population is a risk group for hypovitaminosis D. The Ultraviolet Index (UVI) can be an indicator of potential for cutaneous synthesis of vitamin D but physiological and other environmental factors also influence vitamin D synthesis and status. Knowledge about vitamin D status in Portuguese older adults is limited. This study a...

Background Hand grip strength (HGS) is used for the diagnosis of sarcopenia and frailty. Several factors have been shown to influence HGS values during measurement. Therefore, variations in the protocols used to assess HGS, as part of the diagnosis of sarcopenia and frailty, may lead to the identification of different individuals with low HGS, intr...

Aim: In Portugal, the burden of pre-frailty and frailty in community-dwelling older adults is still unknown. The purpose of this study is to estimate the frequency of frailty in a Portuguese sample with ≥ 65years and to evaluate its associated factors. We also intend to identify which criterion has more impact on the diagnosis of frailty. Methods...

Background Handgrip strength is used to identify sarcopenia and frailty phenotypes, being a potential predictor of mortality in older adults. However, uniformity is lacking in the reference values. This study aimed to describe handgrip strength values of older population aged ≥65 years in Portugal, considering the possible influence of anthropometr...

Data on the association between hydration status and overweight in the elderly is scarce. Therefore, the objectives of this study were to evaluate the hydration status in a representative sample of Portuguese older adults and to assess the association between inadequate hydration and overweight (including obesity). A cluster sampling approach was u...

A few studies suggested that salt consumption might be related with weight gain. We aimed to quantify salt consumption in a representative sample of Portuguese older adults and to evaluate the association between salt intake and overweight (including obesity). A cluster sampling approach was used, representing Portuguese older adults (≥65 years) ac...

Objectives To evaluate vitamin D status and its associated factors in Portuguese older adults from the Nutrition UP 65 study. Design Cross-sectional observational study. Participants and methods Nationwide cluster sample of 1500 Portuguese subjects ≥65 years old. Participants were classified, according to US Institute of Medicine cut-offs, as pre...

Objective: To explore triceps skinfold (TSF) compressibility and its associated factors among hospitalized patients. Methods: A cross-sectional study was conducted among hospitalized adult patients. Evolution of tissue compressibility during two seconds was registered and 120 TSF values were obtained using a digital calliper. Compressibility was d...

Teresa Madeira, Catarina Peixoto, Nuno Neto Santos, Osvaldo Santos, Violeta Alarcão, Paulo Nicola, Beatriz Goulao, Nuno Mendonca, Astrid Bergland, Asta Bye, Teresa Amaral, Carla Lopes, João Gorjão Clara

This study aims to evaluate the impact of oral nutritional supplementation (ONS) and a psychomotor rehabilitation program on nutritional and functional status of community-dwelling patients with Alzheimer's disease (AD). A 21-day prospective randomized controlled trial was conducted and third intervention group performed a psychomotor rehabilitatio...

Pulmonology patients are predisposed to be undernourished and a wide variability in the estimates of frequency of undernutrition risk and undernutrition is found in the literature. The aim of this systematic review and meta-analysis was to investigate the prevalence of undernutrition risk and undernutrition on hospital admission in pulmonology depa...

Guerra, RS, Amaral, TF, Sousa, AS, Fonseca, I, Pichel, F, and Restivo, MT. Comparison of Jamar and Bodygrip dynamometers for handgrip strength measurement. J Strength Cond Res 31(7): 1931-1940, 2017-Studies that compared the agreement between Jamar and other models of dynamometers for handgrip strength (HGS) measurement have exhibited variability i...

During the aging process, several modifications occur in the human brain. Neuronal death is one of these changes, which may lead to a decline of cognitive function and could progress into neurodegenerative diseases. They appear as a consequence of oxidative stress, which is an imbalance between the production and the elimination of reactive oxygen...

Background: The population of Portugal is aging. The lack of data on older adults' nutritional status and the lack of nutrition knowledge amongst health professionals, caregivers, and older adults themselves, remains a challenge. Objective: The Nutrition UP 65 study aims to reduce nutritional inequalities in the older Portuguese adult population...

Background & aims: The European Society for Clinical Nutrition and Metabolism (ESPEN) released a consensus statement for undernutrition diagnosis: ESPEN diagnostic criteria for malnutrition (EDC). The EDC lacks validation and therefore, the present study aims to assess the concurrent and predictive validity of this tool in a cohort of inpatients....

Introduction: Older adults are particularly susceptible to changes in nutritional status, including the development of undernutrition and sarcopenia, which are associated with worse health status. Because elders can develop these conditions in a community environment, knowledge of the extent of this problem is of the utmost importance. Objectives:...

Aim: The impact of sarcopenia on hospitalisation has been under intense investigation; however, little is known about the association between sarcopenia and their costs among hospitalised patients. The aim of the present study was to quantify the association between sarcopenia and hospitalisation costs among older adults. Methods: A cross-sectio...

Background/objectives: This study aims to increase knowledge regarding the association of sarcopenia with hospitalization costs among a wide-ranging sample of adult hospitalized patients. Subjects/methods: A prospective study was conducted among hospitalized adult patients. Sarcopenia was identified according to the European Working Group on Sar...

Undernutrition as well as low levels of vitamin B12 and folic acid are common problems among older adults. However, recommended routine nutritional status assessment tools may result in inadequate vitamin serum levels to go unnoticed. Therefore, the aim of this study is to evaluate the inadequacy of serum levels of vitamin B12 and folic acid within...

Background: The present study aimed to evaluate the effect of posture on body girth assessment among hospitalized adults and older adults. We further explored the influence of body mass index (BMI) on this effect. Materials and methods: A cross-sectional study was conducted among hospitalized adult patients. Arm, waist, hip, and calf girths were...