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Quantitative muscular ultrasound (QMUS): pilot data on interrater reliability of three techniques of grayscale analysis. Journal of Frailty & Aging. 2014;3(1):75-76

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SYMPOSIA
FRAILTY IN MEXICAN POPULATION FROM HOSPITAL TO COMMUNITY.
M. Pérez-Zepeda, S. Sánchez-Garcia, C. Garcia-Peña, R. Castrejon-Pérez (Mexico City,
Mexico)
Research in aging on developing countries is a priority in order to generate new
knowledge that could support in a cost-efficient way attention of this growing group of
age. In particular, frailty and its components has gained attention in the last years due to
the potential interventions that could impact in both the individual and health system
levels. The aim of this symposium is to show how research is shaping different angles of
the current knowledge of older adults in a developing country with an accelerated aging
process. The first speaker (chair) would present an overview of how the topic has been
approached in Mexico and the contrast of the results on research with other countries. With
a critical view there would be also an exposition of the real impact of research in the
current health of older adults in Mexico and the opportunities and new lines of research
that are currently in development. The rest of the speakers would present results of new
research developed in the frailty topic. The first speaker will present how a physical
performance test such as handgrip strength is sensible to change in an emergency room
setting. A valuable tool that merits further research to transform it into usual practice
among clinicians. The second speaker will present results about how cognition and
affection is associated with frailty and disability in a group of community-dwelling
Mexican older adults. Finally, results of how oral health is in close relationship to frailty
and its potential implications will be discussed.
Presentation #1: Older Patient admitted in the Emergency Department: Transitions of
Hand grip strength, C. García-Peña (Mexico City, Mexico)
This first presentation would present results of modifications in handgrip strength (HS)
from admission to discharge of an ER of older adults. 65-year or older subjects admitted to
the ER in two General Hospitals, were included. Variables included sociodemographic,
health services, pressure ulcers risk, depression, cognition, quality of life, functionality,
comorbidty, medication, nutrition, HS, physical activity, gait speed. 372 participants were
included and HS was measured at admission and discharge in 223 patients. 53.4% (n=119)
were female, mean age was 76 years (SD=7.73). Mean HS at baseline was 10.5 (SD=9.20)
and at discharge 7.0 (SD=10.12). Funding: This project is supported by grants from the
Mexican Institute of Social Security.
Presentation #2: Depression, Cognitive Impairment, Frailty And Their Effect On
Disability In Older Adults, S. Sánchez-García (Mexico City, Mexico)
This presentation would show results of 1,933 community-dwelling older adults from
Mexico City. With information on socio-demographics, disability, MCI, depression,
comorbidity and frailty. The association in subjects who presented depressive symptoms
and mild cognitive impairment (MCI) with frailty was OR=17.0. Those only with
depression had OR=12.8 and only MCI had OR=2.4. Subjects with depressive symptoms
and MCI with frailty have an association of OR=9.3 and OR=12.6 for ADL and IADL
limitations, respectively. Depressive symptoms and frailty had OR=12.9 and OR=10.0;
MCI and frailty of OR= 4.5 and OR=6.3. Frailty had and of OR=3.9 and 6.5 for ADL and
IADL limitations. Funding: The present study was supported by grants from
SSA/IMSS/ISSSTECONACYT (México) Salud-2007-01-69842 and the Fund for the
Promotion of Health Research, Mexican Institute of Social Security,
FIS/IMSS/PROT/G09/772.
Presentation #3: Oral health and frailty, R.C. Castrejón-Pérez (Mexico City, Mexico)
Finally, as a result of cross-sectional studies and using the frailty phenotype, there were
observations that community-dwelling women using dentures and reporting difficulty
chewing/swallowing, and self-rated bad oral health, and those who did not use dental
services and those who need dental prostheses have higher probability to be frail. In a
cohort study we found that each tooth in mouth reduces the risk of developing frailty
(three-year follow-up). The information available allows proposing some possible
pathways to explain these associations, including between chronic conditions and oral
health problems, and its potential to predict frailty. Funding: This study was funded by the
National Council for Science and Technology of Mexico (CONACyT) (SALUD-2006-
C01- 45075).
REDUCING THE IMPACT OF FRAILTY IN THE HEALTH AND SOCIAL
SERVICES: SOME EXPERIENCES FROM THE EUROPEAN INNOVATION
PARTNERSHIP ON ACTIVE AND HEALTHY AGEING. J. Pinto Antunes1,
A. Hendry2, H.W. Jager3, B. Bolibar4(1. Bruxells, Belgium; 2. NHS, Scotland; 3. Hanze,
The Netherlands, 4. Barcelona, Spain)
One of the biggest challenges in European society is how to adjust to an ageing society
whilst achieving sustainability. European health and care systems are in urgent need of
restructuring to match the future needs of ageing societies: for example, with a greater
focus on chronic diseases, offering longer term healthcare services, and more palliative
care. Ageing has a significant impact, but should not be perceived solely as a burden.
Looking at ageing as an opportunity requires a positive approach to it. This is why healthy
and active ageing is a key component of the Commission's Europe 2020 Strategy. The
European Innovation Partnership on Active and Health Ageing (EIP) offers a unique multi-
stakeholder platform to develop critical mass for action in areas key to active and healthy
ageing, to deliver high quality and sustainable care to older people and help EU industry to
remain competitive. Over 500 commitments are contributing to the Partnership. After two
years the work process and outcomes of the EIP are helping to identify and develop new
approaches for supporting the necessary changes in this direction. The symposium will
present the approach and preliminary results on 3 topics related to prevention of frailty
undertaken by the Partnership members. No conflict of interests.
FRAILTY RESEARCH: EVIDENCE FROM JAPAN. H. Arai1, M. Kuzuya2, S. Satake1
(1. Kyoto, Japan; 2. Nagoya, Japan)
Rapidly growing aging populations are a global public health concern. In 2013, 25% of
adults in Japan are older than 65 years, the highest percentage in the world. Along with
population aging, the rapid increase in the number of frail older adults is a major health
care challenge. In recent years, the term ‘frailty’ has been repeatedly discussed in the
research literature, and several different definitions have been proposed. A number of
concepts have been raised that dealt with maintaining health or preventing frailty.
However, there is insufficient evidence to accept a single definition of frailty, and no single
definition is currently considered to be a gold standard. Thus, valid and low-cost frailty
assessment tools are needed for both research and clinical purposes. Therefore, in the year
of 2006, the Japanese government implemented a frailty index named the Kihon Checklist
that identifies vulnerable older adults who are at high risk of becoming dependent. This
checklist consists of seven domains: lifestyle, physical strength, nutrition, eating,
socialization, memory and mood. In the last 7 years we have been accumulating substantial
amounts of evidence from this checklist. The main purpose of this symposium is to call
international audience and share them with the research data from Japan. Prof. Masafumi
Kuzuya will focus on the role of nutrition in frailty (Nutritional Assessment for Frailty).
Prof. Hidenori Arai will report the results of the Kihon Checklist (Frailty Checklist in
Japan; Does it work?). Prof. Shosuke Satake will report their approach to physical frailty
(Implication of Frailty Screening in Japan). This symposium will summarize the main
findings of major study groups in Japan, and may promote the discussion of further
research in other countries.
TROUBLE AT THE JUNCTION: FACTORS CAUSING INSTABILITY OF THE
AGING NEUROMUSCULAR JUNCTION. R.T. Hepple (McGill University, Canada)
The role of synaptic molecules in motor neuron and muscle diseases, G. Valdez
(Virginia Tech Carilion Research Institute, USA); Alterations in myocyte signaling
networks regulating post-synaptic components of the neuromuscular junction with aging,
R. Hepple (McGill University, Canada); Decoding of the functional state of the
neuromuscular junction by glial cells in normal and pathological aging, R. Robitaille
(McGill University, Canada)
The neuromuscular junction (NMJ) is a remarkable structure that transmits the
electrochemical signals of alpha motor neurons to the muscle fibers they innervate to
permit contraction of muscle fibers. With aging this communication can become
compromised owing to instability in the NMJ structures and is characterized in part by
dispersal of the post- !synaptic acetylcholine receptor cluster from its typical pretzel- like
configuration into fragmented islands. Ultimately, this fragmentation of the acetylcholine
receptor cluster may sufficiently impair targeting of the terminal axon of the alpha
motoneuron to precipitate a spontaneous denervation event. Fortunately, for most of adult
life denervation is shortly followed by axonal sprouting of adjacent motor axons, guided in
part by perisynaptic Schwann (glial) cells, and innervation is re- established. The net result
of these events is that aging of muscle is characterized by repeating cycles of denervation
and reinnervation, resulting in profound motor unit remodeling in very advanced age, a
The Journal of Frailty & Aging©
Volume 3, Number 1, 2014
ICFSR 2014
International Conference on Frailty and Sarcopenia Research
March 12-14, 2014
Barcelona, Spain
The Journal of Frailty & Aging©
Volume 3, Number 1, 2014
75
the same age suggesting the presence of hypometabolism due to muscle mass reduction. In
this regard, the DMD could be a model for sarcopenia which is a syndrome characterized
by a gradual, generalized loss of muscle mass and strength. In sarcopenia, as well as in
DMD, there are two different adiposities phenotypes and they are both characterized by
sub-inflammation state. Longitudinal data are needed for better understanding possible
links.
P199- APPETITE-REGULATING HORMONES AND PHYSICAL FUNCTION IN
COMMUNITY LIVING OLDER PERSONS. R. Diekmann1, B. Hofner2,
V. Schusdziarra3, M.J Kaiser2, K. Vidal4, C.C. Sieber2, J.M. Bauer1(1. Oldenburg,
Germany; 2. Nürnberg, Germany; 3. München, Germany; 4. Lausanne, Switzerland)
Background: Age-associated alterations of the secretion of appetite-regulating
hormones have been linked to the so-called `anorexia of aging´. Beyond being relevant in
the pathogenesis of malnutrition it was of interest whether or not these hormones were
associated with physical performance in older age. Aim : To analyse the association of
appetite-stimulating hormones with physical function in community-living older persons.
Methods: Frailty assessment according to Fried, the Short Physical Performance Battery
(SPPB), gait speed (4,5m) and the timed up and go test (TUG) were performed in
community-dwelling elderly above age 75. Malnutrition (MN) was identified by Mini
Nutritional Assessment (MNA). Baseline fasting and 90 min. postprandial blood samples
(after a standardized breakfast) were drawn and ghrelin (GhreF; GhrePP), activated ghrelin
(aGhreF; aGhrePP) and leptin (only LepF) were analyzed. Spearman’s partial correlation,
adjusted for the confounders BMI, age, and sex, was used to describe the association
between hormones and function, p-values 0.05 (*) are considered to be significant,
0.001 (**) highly significant. Results: 182 subjects, 65% (n=118) female, age 81.8 (±4.2)
years and BMI 27.7 (±3.5) kg/m2 (mean ±SD) were included. 50% (n=91) were robust,
42% (n=76) pre-frail and 8% (n=15) frail. No subject suffered from MN according to
MNA. Regarding functionality, subjects showed the following results (median and IQR):
SPPB 11 (9-12) points, gait speed 4 (4-5) sec, TUG 9 (7-11) sec. GhreF was significantly
associated with SPPB (-0.158*), aGhreF with frailty (-0.181*) and TUG (-0.168*) and
LepF with frailty (0.178*), SPPB (-0.236**) and gait speed (0.150*). AGhrPP was
associated with all functional measurements (frailty -0.299**, SPPB 0.190*, TUG -
0.229** and gaitspeed -0.197*). Conclusion: Ghrelin, activated ghrelin (fasting and
postprandial) and leptin were associated with physical function in community-dwelling
older people, which was independent of malnutrition according to MNA. The biological
relevance of this correlation needs to be explored in further studies. Funding: This study
was supported by a Nestlé research grant.
P200- VASCULAR MILD COGNITIVE IMPAIRMENT AND FRAILTY IN
MEXICAN ELDERLY IN A MEMORY CLINIC. S.G. Aguilar Navarro,
A. Mimenza Alvarado, S. Juárez Arellano, C. Bernal López, A. Samudio,
A. Reyes Martínez, J.A. Ávila Funes (México City, Mexico)
Background: Studies have shown an association between physical frailty and cognitive
function. In addition, they have suggested that in some elderly, physical frailty associated
with development of dementia. However, little is known about the relationship between
mild cognitive impairment (MCI) and frailty. The aim of our study was to determine the
factors associated with the vascular MCI and physical frailty. Methods: Cross- sectional
study, 140 outpatients were evaluated by a geriatrician and a neurologist for diagnosis of
MCI and Frailty. Each patient sociodemographic characteristics and risk factors were
obtained. Patients with MCI underwent neuropsychological evaluation to establish vascular
cognitive profile. Frailty criteria developed by the Cardiovascular Health Study, we
considered to be characterized by limitations in 3 or more of the following 5 domains:
mobility, strength, endurance, physical activity, and nutrition. All patients who met criteria
underwent cranial MRI. Results: There were 97 (69.3 %) females, 106 (75.7 %)
participants had less than 12 years of education. 42 (30 %) was pre-frail, 22 (15.7 %)
frailty, 14 (10%) combined: Va MCI and frailty criteria. Increasing associated with
cognitive impairment (MCI and frailty (p = .020). MCI was significantly associated with a
lower education level (p = .036). The presence of vascular risk factors (n = 140) ranged
from 66.4 % (hypertension) to 14.3 % (diabetes). Subjective memory complaints Were
Significantly Associated with cognitive impairment (p = .001), except for the use of the
telephone (p = .225) and the television (p = .08) , impairment in all domains of
instrumental activities of daily living were significantly associated with a frailty and Va-
MCI criteria. Conclusion: The study showed that was associated with cognitive impairment
increase increasing age and low education levels. The Presence of vascular risk factors
places this population at risk for future cognitive decline and frailty.
P201- COMPARISON OF CLASS-STYLE SUPERVISED INTERVENTION
VERSUS HOME-BASED UNSUPERVISED INTERVENTION IN PREVENTING
SARCOPENIA. Y. Watanabe, Y. Yamada, T. Yoshida, K. Yokoyama, M. Miyake,
E. Yamagata, M. Kimura (Kyoto, Japan)
Background: Preventing sarcopenia has been considered important to maintain the
quality of life of older individuals. In this study, we compared the effects of class-style
supervised intervention (CS) versus home-based unsupervised intervention (HB) on
improving muscle mass and physical function in older adults. Methods: A total of 288
older adults (65–87 years) living independently participated in this cluster-randomized
trial. They were assigned to one of two groups (CS and HB) and instructed on a resistance
exercise program in two lectures. Also, all participants were provided with exercise
materials (ankle weight, Thera-Band, triaxial-accelerometer/pedometer and exercise log),
and then encouraged to perform resistance exercise and increase the average daily activity
level. In CS intervention, the participants conducted the resistance exercise program at
weekly class-style sessions. On other days, they performed the program independently. In
HB intervention, the participants were only given instruction and practice about exercise.
All participants were also encouraged to increase 2,000 steps per day. Results: Lower limb
muscle mass (both front thigh muscle thickness and lower limb intracellular volume) and
knee extension strength were significantly increased in both groups. A significant increase
in the upper limb intracellular volume was observed only in the CS group. There were
significant improvements in physical function (maximal gait velocity and chair-stand time)
in both groups. Additionally, the mean number of daily steps significantly increased in
both groups. None of these variables showed a significant difference between groups.
Conclusions: These results indicated that low intensity resistance training with an increase
in daily walking steps can induce muscle hypertrophy, strength gain, and improvement of
physical function. Particularly, it is important that there was no significant difference in the
training effects on the lower limb muscle and physical function between CS and HB
interventions. Thus, HB intervention is considered a cost-effective method to prevent
sarcopenia.
P202- PREVALENCE OF SARCOPENIA AMONG HOSPITALIZED PATIENTS.
A.S. Sousa, R.S. Guerra, I. Fonseca, F. Pichel, T.F. Amaral (Porto, Portugal)
Background: Sarcopenia has been indicated as a reliable marker of poor prognosis,
with worse clinical outcomes. There are few data on the prevalence of sarcopenia among
hospitalized patients and information for use in clinical practice is still lacking. The aim of
this study was to evaluate the prevalence of sarcopenia in hospitalized patients. Methods:
A cross-sectional study was conducted in a university hospital. Sarcopenia was defined,
according to the European Working Group on Sarcopenia in Older People criteria, as the
presence of both low muscle mass and low muscle function. Bioelectric Impedance
Analysis was used to access muscle mass and muscle function was evaluated through hand
grip strength. Results: 608 adult inpatients (45.7% women) compose the study sample. For
participants <65 years, prevalence of sarcopenia was 23.9% for men and 15.2% for
women. Between 65-79 years, prevalence of sarcopenia was 39.6% for men and 28.1% for
women. The greatest prevalence of sarcopenia was found for 80 years (54.5% men and
47.1% women). Conclusions: Prevalence of sarcopenia is very high, is more frequent in
men than in women and increases with age, affecting half of patients aged 80 years. Our
results also suggest that the prevalence of sarcopenia among adult men and women (<65
years) is relatively high. This finding corroborates that sarcopenia can occur in hospitalized
adult patients and more research is needed concerning this age group.
P203- FRAILTY: COMMON END POINT, DIFFERENT PATHWAYS. J.M. Jacobs,
Y. Rottenberg, S. Jochanan (Jerusalem, Israel)
Background: Fried’s definition of frailty requires 3/5 of the commonly observed
clinical states of weight-loss, weakness, self-reported exhaustion, slowness, and low level
of physical-activity, with pre-frailty defined as 2/5 conditions. Numerous combinations
exist, and the aim of this study was to characterize the common clusters of symptoms,
within the definitions of pre-frailty and frailty. Methods: The study was based upon cross-
sectional data from subjects aged 85 years old, enrolled in the Jerusalem Longitudinal
Study, which follows a representative sample of community-dwelling people born 1920-
1921. Subjects underwent comprehensive geriatric assessment at home. K means, an
iterative distance-based clustering method, was applied to construct the five most common
clusters of frailty symptoms using Fried’s parameters. Results: Among the study
population (n=840), prevalence of frailty, pre-frailty and non-frailty was 56% (n=470),
19.5% (n=164), and 24.5% (n=206) respectively. Five common clusters of symptoms were
identified, each group according to a predominance of: 1) “exhaustion” (n=303, 36.1%), 2)
“minimal/absence of symptoms” (n=269, 32%), 3) “weakness” (n=91, 10.8%), 4)
“maximal number of symptoms” (n=90), and 5) “weight loss” (n=87). The majority of pre-
frail subjects were from the “exhausted” (65%) and “minimal limitation” group (13%),
with few from the weight loss (9.8%) or weakness groups (9.4%). The “exhausted” group
was characterized by absence of other symptoms except for low-physical activity in about
one fifth of the study population. Subjects defined as frail were observed in the "maximal
symptom" (46%), “weakness” (29%), and “weight loss” groups (25%), and absent from the
“exhaustion” cluster. Subjects within the "weight loss" and the "weakness" clusters were
divided equally between pre-frail and frail subjects. Conclusion: We suggest that the
spectrum of frailty and pre-frailty is composed of five dominant clusters of symptoms.
Better characterizing of these clusters may improve the understanding of frailty’s
pathogenesis. Funding: This work was supported by funds from the Ministry of Senior
Citizens of the State of Israel, and Eshel- the Association for the Planning and
Development of Services for the Aged in Israel.
P204- SONOGRAPHIC ESTIMATES OF MUSCLE QUALITY: RELIABILITY OF
3 DIFFERENT METHODS OF GRAYSCALE ANALYSIS. C. Ismail, H.J. Hernandez,
B. Adams, J. Zabal, H. Manning, M.O. Harris-Love (Washington, USA)
Background: Grayscale analysis of ultrasound images has been proposed as a method
to estimate muscle quality related to sarcopenia. However, distinguishing parenchymal
abnormalities by grayscale analysis is reported to be operator-dependent. The purpose of
this study was to examine the interrater reliability of grayscale analysis by defining regions
of interest (ROI) in 3 different ways: 1) full image (FI), 2) single muscle (SM), and 3) peak
echogenicity of 1 cm2 within a muscle (SQ). Methods: Four investigators completed a total
of 120 grayscale estimates from 10 longitudinal images randomly selected from a database
that included the trapezius, pectoralis major, deltoid, brachioradialis, rectus femoris, and
tibialis anterior muscles. Scans performed by a single examiner using a 13-6 MHz linear
array transducer with no alteration of the machine’s default settings were obtained from
healthy participants (25.1 ±1.5 yrs). Adobe Photoshop was used to obtain grayscale
histogram mean values for each ROI. Reliability of the 3 methods was assessed using
intraclass correlation coefficients (ICC 2, k) and standard error of the measurement (SEM).
Results: The grayscale mean values obtained by the 4 investigators ranged from 61.4-61.8
for FI, 46.2-47.4 for SM, and 66.4-97.7 for SQ. Investigators demonstrated excellent
interrater reliability with the FI and SM methods yielding an ICC 2, k of .99 (95% C.I. =
.96-.99, p<.001; SEM = 1.3-1.6), whereas the SQ method demonstrated poor reliability
(ICC 2, k =.53, 95% C.I. = .18-.83, p<.001; SEM = 17.1). Conclusions: Our findings
demonstrate that the FI and SM techniques were the most reliable of our 3 grayscale
assessment methods and displayed comparable results. Given that the SM method captures
only the muscle of interest, this approach to grayscale estimation may be considered the
preferred technique. Funding: This study was supported by funding from the Department
of Exercise Science, The George Washington University, and the U.S. Department of
Veterans Affairs Office of Academic Affairs (H.J.H.).
P205- PATTERNS OF CIRCULATING INFLAMMATORY CYTOKINES IN
COMMUNITY-LIVING OLDER PERSONS WITH HIGH AND LOW PHYSICAL
PERFORMANCE. R. Calvani1, F. Landi2, D.L. Vetrano2, A.M. Martone2, F. Marini2,
C. Leeuwenburgh3, R. Bernabei2, E. Marzetti2(1. Bari, Italy; 2. Rome, Italy; 3. Gainesville,
USA)
Background. Studies have shown inverse correlations between individual inflammatory
biomarkers and physical performance in older inviduals. However, given the complexity of
the inflammatory response, it is likely that the simultaneous analysis of an array of
cytokines may provide more insights into the relationship between inflammation and age-
related physical function decline. Methods. Community-dwelling older adults were
categorized into high-functioning (HF; n = 24) or low-functioning (LF; n = 13) groups
according to their short physical performance battery (SPPB) summary score. A panel of
14 serum cytokines was assessed by multiplex analysis. Partial Least Squares Discriminant
Analysis (PLS-DA) was used to identify clusters of cytokines associated with the level of
physical performance. Results. The optimal complexity of the PLS-DA model was found
to be four latent variables. The proportion of correct classification was 87.5% for HF
subjects (79.2% in cross-validation) and 92.3% for LF individuals (61.5% in cross-
validation). Discriminant cytokines in the model were interleukin 8, interleukin 12,
myeloperoxidase (all higher in the LF group), and P-Selectin (higher in the HF group).
Conclusions. A distinct pattern of circulating pro-inflammatory cytokines characterize
older subjects with high and low level of physical performance. The dissection of these
patterns may provide significant insights into the role played by inflammation in the
disability cascade.
P206- FUNCTIONAL DECLINE ONE YEAR AFTER A HIP FRACTURE IN
ELDERLY OVER 75 YEARS. S. Drevet, B.J. Chedal Bornu, C. Bioteau, S. Mazière,
J. Tonetti, G. Gavazzi (Grenoble, France)
Background: 1% of falls in over-75 year-olds causes proximal femoral fracture (PFF).
PFF is associated with high morbidity and functional decline (FD). The principal objective
was to determine the prevalence of FD one year after PFF. Secondary objectives were to
identify factors associated with FD. Methods: A prospective observational epidemiological
study included 117 patients aged over 75 years and admitted in orthopedic unit of Grenoble
University Hospital. Assessment of functional status were performed before admission, at
discharge and one year after the hip fracture. FD one year after PFF was defined by a
decrease between activities in daily living (ADL) before the fracture and one year after.
Scores were compared on quantitative tests (Student t) with the significance threshold set
at p<0.05. Factors associated with functional decline were collected: ADL, IADL, CIRS G,
MNA, MMSE. Results: Mean age was 87,08 years and the mortality rate one year after
PFF was 35,6% (42/117). Among survival cohort whole data were available for 51
patients. Prevalence of FD was 41,2% with an average of 0,81 point (minimum 0,0;
maximum 5,5). The unique factor associated with FD was ADL at the time of discharge
from orthopedic unit (p=0,027). The average mini nutritional assessment was 21/30 but
was not associated with FD. Patient admitted in long care facilities increased from 17,6 at
25,5%. Conclusions: One year-mortality rate is high and the one-year FD after PFF is
associated with ADL at discharge from hospital and not ADL before the PFF. Yet, early
interdisciplinary intervention may help to improve outcomes and orthogeriatric models
should be relevant. Given the present economic stakes relating to geriatric trauma patient,
it is essential to find other preventable factors that lead to increase functional recovery.
Interventional+ studies+ are+ needed+to+determine+whether+early+mana
gement+may+improve+long+term+outcomes. +
P207- PREVALENCE OF SARCOPENIA IN ANDALUSIAN PATIENTS
IMMEDIATELY AFTER A HIP FRACTURE. M.J. Montoya, M. Giner,
M.A. Vázquez, R. Pérez-Cano (Seville, Spain)
Sarcopenia-related falls and fractures are becoming an emerging problem as a result of
rapid aging worldwide. We aimed to investigate the prevalence of sarcopenia by estimating
the muscle mass of the arms and legs of patients with hip fracture. M&M This cross-
sectional study examined 84 patients immediately after a hip fracture. We carried out
whole-body dual energy X-ray absorptiometry to analyze skeletal muscle mass (MM),
total fat (TF), skeletal muscle mass index (SMI), appendicular skeletal muscle mass index
(appendicular SMI), bone mineral density, neck BMD and hip BMD. Sarcopenia was
defined according to the criteria reported by Baumgartner: appendicular SMI below 7.26
kg / m2 in men and below 5.45 kg/m2 in women. Statistical analysis of the results was
conducted using the T-student test (SPSS 21.0) Results: The age, TF, SMI, appendicular
SMI and neck BMD was similar in both goups. The woman showed higher BMI (body
mass index),(28.5 ± 5.5 vs 25.6 ± 4.8 kg/m2), lower MM (37,3 ± 5,2 vs 44.1 ± 5,7 kg)
and worst hip BMD value (0,73 ± 0,11 vs 0,80 ± 0,14 gHA/cm2) than men, in all cases p<
0.05. The prevalence of sarcopenia in men was higher, 70.6 % (12/17), than in women
16.4% (11/67), OR = 4.3, (95% CI 2.31 to 8), p = 0.0001. Sarcopenia risk increased with
age in men (62.5% in <80 years old and 77.8% in > 80 years old), while it decreased in
women (21.7 % vs 13.6%). The frequency of falls was not related with SMI and
appendicular SMI. We observed a positive correlation between hip BMD and TF (r =
0.271; p = 0.019), MM (r = 0.412; p = 0.0001) and SMI ( r = 0.231; p = 0.048).
Conclusions: The prevalence of sarcopenia in hip fracture patients is higher in men than in
women, mainly above 80 years old. Both tissues, fat and muscle, influence in bone mass
values. The present study is supported by ISCIII (FIS2014)
P208- NUTRITIONAL STATUS AND PHYSICAL PERFORMANCE OF
UNIVERSITY OF THE THIRD AGE STUDENTS FROM MAŁOPOLSKA
REGION ( POLAND) PRELIMINARY RESULTS. B. Piórecka, D. Twardzik,
P. Jagielski (Kraków, Poland)
Background: The aim of the study is to analyze the relationship between nutritional
status and physical performance of elderly people in respect to the diagnosis of sarcopenia.
Material and Methods : The study involved 101 subjects (88 women and 13 men), aged
over 60 years, physically fit, mostly with secondary and higher education. The mean age of
the total group was 66.56 ± 5.19 years. Nutritional status was assessed on the basis of body
composition analysis by BIA (Tanita BC- 418MA). The assessment of physical
performance was tested with SPPB. The dominant limb muscle strength was measured
using hand dynamometry (Smedley Hand Dynamometer). The study was approved by the
Bioethics Committee of the Jagiellonian University No.: KBET/234/B/2012 of 27 June
2012. Results : According to WHO criteria concerning the BMI, only 26.7 % of the
subjects were of normal weight, 48.5% were overweight, while the remaining ones were
obese. Based on BMI and HGST measurements as proposed by Fried et al., a significant
risk of sarcopenic obesity was found in 10 women (9.9%). Those women had a
significantly higher BMI, waist circumference and hip circumference, BF [%] and FM
[kg], while there were no differences in FFM [kg]. In all of those women central obesity
was diagnosed (WC > 88 cm). However, according to SPPB assessment, sarcopenia was
diagnosed in 4 persons (1 male and 3 female) aged 70 years or more. We are still working
out the results concerning identification of indicators of low muscle mass in relation to the
proposed cut-off points for the Polish population (Krzymi-ka-Siemaszko et al 2013).
Conclusions : The study group has good nutritional status and high physical performance
level. The present study is supported by the Polish Committee for Scientific Research No
K/ZDS/003684.
P209- IS GLUTAMINE A LIMITING FACTOR OF SARCOPENIA IN VERY OLD
INDIVIDUALS? D. Meynial-Denis (Clemont-Ferrand, France)
Background and purpose : Glutamine is the most abundant free amino acid in the body
and has its primary source in skeletal muscle, from where it is released into the
bloodstream and transported to a variety of tissues such the gut. The size of muscle
glutamine pool may be related to lean body mass and so, to the sarcopenia. Because of
glutamine is known to have a specific role in very old rats (up to 25 months of age), the
aim of this study is to demonstrate if glutamine is a limiting factor of sarcopenia with
advanced age. Chosen model is very old female Wistar rats (27 months). Methods : We
have orally supplemented female rats with glutamine (20% of diet protein) intermittently,
before animals became very old (long-term treatment with glutamine). Rats were studied
after the last glutamine cure. Results : Muscle mass decreased by ~ 20 % with advanced
age. No difference was observed in skeletal muscle mass with glutamine supplementation.
However, glutamine synthesis was enhanced in skeletal muscle from very old female rat as
previously reported. Glutamine played a role in mass of splanchnic tissues. Total intestine
mass was significantly higher in glutamine supplemented very old rats than in controls
(~15%). Discussion : Long-term treatment with glutamine had positive effects on very old
rats: 1) it prevented the loss of body weight, but, 2) it did not prevent from the inevitable
sarcopenia because of its inefficiency to modify the rates of muscle protein turnover and,
3) it maintained the gut mass. Long-term treatment with glutamine essentially played a role
in maintaining intestine integrity and intestinal immune function. Consequently, the
observed increase in glutamine requirements can be explained by the increased use of
glutamine by the gut. Conclusion : Glutamine is not a limiting factor of sarcopenia in very
old individuals even if a very high synthesis capacity is maintained in aging atrophied-
muscle. Funding: The present study is supported by grants from INRA.
P210- IS THE GOTO-KAKIZAKI (GK) RAT A SUITABLE MODEL OF
SARCOPENIC OBESITY? F. Mouveaux, S. Raynal, S. Ben Massoud, A. Audet,
M. Kergoat (Chilly-Mazarin, France)
Background: Sarcopenic obesity (SO) is an age-related reduction of muscle quality in
an obesity context. Most of concerned people also suffer from type 2 diabetes, which may
also contribute to the pathology. The Goto-Kakizaki (GK) rat is a spontaneous type 2
diabetes model widely used for laboratory studies, and we wondered whether it could
represent a suitable model of SO. Methods: We calibrated a potential animal model to
The Journal of Frailty & Aging©
Volume 3, Number 1, 2014
76
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