Oral nutritional supplement combined with an online resistance training programme to improve physical function and nutritional status in older adults receiving home care and at risk of sarcopenia: protocol for the randomised controlled POWER trial

Background The aim of the POWER trial is to investigate the effects of a whey protein oral nutritional supplement (ONS) combined with an online resistance training (RT) programme compared to RT alone on physical function, nutritional status and health-related outcomes in community-dwelling older adults receiving supportive home care who are at risk of sarcopenia. Methods This home-based, randomised controlled trial will include older adults aged ≥70 years, receiving supportive home care (professional and/or informal), who will be screened for sarcopenia via telephone. Forty-six participants will be randomised into either (i) ONS + RT or (ii) RT only trial arms. Participants in the ONS + RT group will be provided with a whey protein ONS enriched with leucine and vitamin D to consume twice a day for 12 weeks. All participants will be provided with an online RT programme twice a week via Zoom. The primary outcomes are physical function, measured using the Timed Up and Go test and nutritional status, measured using the Mini-Nutritional Assessment-Full Form. Secondary outcomes include body composition, dietary intake, gait speed, muscle strength, cognitive function, depression risk, activities of daily living, quality of life and feasibility of intervention implementation. All outcomes will be measured at baseline, after and 12 weeks post-intervention. Conclusion This study will provide data on the effectiveness of a whey protein ONS enriched with leucine and vitamin D combined with an online RT programme delivered via Zoom, compared to the RT programme alone, for older adults at risk of sarcopenia and receiving supportive home care. Trial registration NCT05688956; registered December 2022.

The aim of the POWER trial is to investigate the effectiveness of a whey protein oral nutritional supplement (ONS) combined with an online resistance training (RT) programme compared to RT alone on physical function, nutritional status and health-related outcomes in community-dwelling older adults receiving supportive home care who are at risk of sarcopenia. This home-based, randomised controlled trial will include older adults aged ≥70 years, receiving supportive home care (professional and/or informal), who will be screened for sarcopenia via telephone. Forty-six participants will be randomised into either (i) ONS + RT or (ii) RT only trial arms. Participants in the ONS + RT group will be provided with a whey protein ONS enriched with leucine and vitamin D to consume twice a day for 12 weeks. All participants will be provided with an online RT programme twice a week via Zoom. The primary outcomes are physical function, measured using the Timed Up and Go test and nutritional status, measured using the Mini-Nutritional Assessment-Full Form. Secondary outcomes include body composition, dietary intake, gait speed, muscle strength, cognitive function, depression risk, activities of daily living, quality of life and feasibility of intervention implementation. All outcomes will be measured at baseline (T1), post-intervention (T2) and 12 weeks post-intervention (T3). This study will provide data on the effectiveness of a whey protein ONS enriched with leucine and vitamin D combined with an online RT programme delivered via Zoom, compared to the RT programme alone, for older adults at risk of sarcopenia and receiving supportive home care. NCT05688956; registered December 2022.

Associations Between Dentition Status and Nutritional Status in Community-Dwelling Older Adults

Frailty and malnutrition have emerged as critical public health issues amidst global population aging. Malnutrition not only significantly contributes to frailty but also intensifies its clinical symptoms, severely affecting the quality of life and health outcomes in older adults. Research in this field has accelerated in recent years; however, a comprehensive analysis of key research trends and hotspots remains absent. This study employs bibliometric methods to systematically analyze core themes and emerging research directions related to nutritional status and frailty in older adults, identifying potential research frontiers and guiding future development. A comprehensive search was conducted in the Web of Science Core Collection (WoSCC) database on November 6, 2024, using keywords relevant to frailty and nutrition status in older adults. Bibliometric analyses and knowledge mapping were performed using CiteSpace, VOSviewer, and R software. Between 2005 and 2024, 2,357 publications on frailty and nutrition status in older adults were produced by 13,080 researchers from 3,987 institutions across 88 countries. The volume of publications has shown a consistent upward trajectory over the past two decades (R2 = 0.84), with projections indicating a continued increase, peaking at 315 publications by 2033. This sustained growth underscores the field's significance and ongoing research interest. Early research has centered on the "home-living elderly" demographic, while current investigations have shifted focus from molecular biology, genetics, and health nursing to more clinical and medical domains. Key areas of emphasis now include nutrition and dietetics, geriatrics, oncology, and pharmacology. Emerging research hotspots involve the early identification and management of malnutrition to reduce frailty-related health risks and improve health outcomes and quality of life for older adults. Notable trends include the keywords "prediction," "nutritional assessment MNA," "intervention," and "infection." This bibliometric analysis offers a comprehensive examination of the research evolution, hotspots, and emerging frontiers in frailty and nutrition status among older adults over the past two decades. The findings provide an objective overview of the academic landscape, offering valuable insights for future research, resource allocation, and policymaking.

Background: Inadequate dietary intake and malnutrition are commonly found in older adults. They tend to have early satiety that limits intake from main meals. Some reports indicated that small frequent meals may promote higher intake. From that point of view, snacks may be useful. Therefore, this study aimed to determine the effects of frequent snacks on energy intakes and nutritional status in older adults at risk of malnutrition. Methods: A randomized controlled study was conducted among older adults at risk of malnutrition in a suburban community from November 2020 to March 2021 in Chiang Mai, Thailand. Two villages were randomly assigned to either a control group (n=17) or an intervention group (n=17), and they were matched pairs by age and gender. An intervention snack consisted of 2 desserts and a box of milk (total 548 kcal) was used. For the first 3 weeks, an intervention snack was provided every day although it was too heavy for some participants. Therefore, after that, the intervention snack was provided every other day for 4 weeks. A nutrition survey by the 24-hour recall method for 3 days, body weight, mid-arm circumference (MAC), triceps skinfold (TSF), and grip strength were assessed at weeks 3 and 7 as baseline. Results: Thirty-one participants completed the study (91%). The average age was 71.8±4.8 years, and body mass index (BMI) was 19.0±2.1 kg/m2 . In the intervention snack group, there was an increased daily energy intake by 316 kcal and 214 kcal at weeks 3 and 7, respectively, (P<0.001, effect size: 0.884), with a body weight of 0.8 kg (P<0.001, effect size: 0.314), BMI of 2% (P=0.009, effect size: 0.314), and MAC of 4% (P<0.001, effect size: 0.265) compared with baseline, but such energy intake was not observed in the control group. Conclusion: Providing frequent snacks was an effective way to improve energy intake and nutritional status in community-dwelling older adults at risk of malnutrition.

Objective: The current study determined the nutritional status and dietary intake of older adults living at home and nursing homes (NH) in Dongying district of the city of Dongying. Methods: Nutritional status and dietary intake of older adults living at home and NH were analyzed using 24h recalls questionnaires, and evaluated base on the recommended intake and DRIs from dietary guidelines for Chinese older adults. Comparisons between two groups were also measured. Results: The intake of grains and yams, vegetables, meat, eggs, and legumes in older adults living at home, and the intake of grains and yams and eggs in older adults living at NH meet the recommended intake for Chinese older adults. The intake of carbohydrate, vitamin B3, selenium, and potassium in older adults living at home, and the intake of carbohydrate in older adults living at NH meet the corresponding DRIs. Older adults living at home had higher intake of vegetables, meat, seafood, legumes, macronutrients, vitamin B, C, E, calcium, iron, zinc, potassium, and lower intake of sodium compared to older adults living at NH. Conclusions: Overall, older adults living at home had better food and nutrient intake compared to older adults living at NH. The intake of many food and nutrients in older adults with both living patterns did not meet recommended intake levels. Improvement in the nutritional status of older adults is needed to guarantee successful aging among Chinese populations.

ABSTRACTObjectivesTo review the literature on the relationship between oral health, dietary intake, and nutritional status in older adults in care homes, identifying research gaps.BackgroundMany older adults in care homes retain natural teeth but face oral health issues due to challenges in maintaining hygiene and limited dental care access. While the provided diet aims to prevent frailty, it may contain high levels of sugars and fermentable carbohydrates, which can contribute to oral health issues such as dental caries and periodontal disease.MethodsA scoping review was conducted following PRISMA‐ScR guidelines. MEDLINE, CINAHL, Web of Science, and EMBASE were searched to answer, “What is known about the relationship between dietary intake, nutritional status and oral health in older adults in care homes?.”ResultsForty‐nine studies (1989–2024) addressed this relationship, with most studies being cross‐sectional (n = 43), including two qualitative and one mixed‐method study; six were longitudinal, including one interventional. Findings highlighted the negative impact of oral health problems—xerostomia, dysphagia, and chewing issues—on dietary intake and nutritional status, while interventions like denture provision and professional tooth brushing had positive effects. Longitudinal studies emphasised the harm of sugar intake on oral health, with additional factors like dementia, resident dependency, and staffing issues adversely affecting both oral health and nutrition.ConclusionsThis review highlights the complex relationship between oral health, diet, and nutrition in care homes, emphasising gaps in research on the impact of dietary intake, particularly sugar consumption, on oral health, as well as limitations in study designs.

The Mini Nutritional Assessment (MNA) is a validated questionnaire that estimates nutritional status. Given that this questionnaire uses stature measurement, which are unreliable in older adults, Mindex and Demiquet are alternatives to BMI for assessing malnutrition risk. However, the correlation of Mindex and Demiquet values with MNA scores has not been investigated. This cross-sectional study examined the correlation of Mindex and Demiquet with nutritional status and blood parameters in older adults in Thailand. The correlation of Mindex and Demiquet with MNA scores and body mass index (BMI), as well as blood parameters, was evaluated. Sociodemographic characteristics, anthropometric measurements, and blood test results were collected from 347 participants aged 60 years and older (mean ± SD, 66.4 ± 5.3 years). Spearman's rank correlation coefficient and multiple logistic regression analyses were used in statistical analyses. MNA scores were significantly correlated with Mindex (P < 0.001) and Demiquet (P = 0.001), and BMI was related to Mindex and Demiquet (P < 0.001). Low-density lipoprotein cholesterol (LDL-C) predicted MNA scores (P = 0.048) in males but not females. Mindex and Demiquet values were positively correlated with MNA scores and BMI. In addition, LDL-C predicted MNA scores in male older adults.

Nutritional status and all-cause mortality in older adults with acute coronary syndrome

Background: The aging population is expanding at an unprecedented rate, leading to a significant increase in the prevalence of malnutrition among older adults. Oral Nutritional Supplements (ONS) have emerged as a widely accepted strategy to address the nutritional needs of this demographic. Objective: This study aimed to evaluate the impact of an ONS on the nutritional status of malnourished older adults. Methods: This was an open-label, randomized-controlled, parallel-group, single-centered study. Recruitment criteria were age ≥60 years, and mini nutrition assessment-short form (MNA-SF) score ≤11. A total of 50 participants were randomly assigned to the intervention (IG) and control (CG) groups (1:1 ratio). The IG received 200 mL of ONS as a bedtime drink for 12 weeks, while the CG received 200 mL of water. Nutrition status, biochemical analysis, and dietary assessment were performed at the beginning and end of the study. Results: Forty-two participants (IG: n=20, and CG: n=22) completed the study. After 12 weeks, the IG showed a significant improvement in the MNA-SF score (p&lt;0.001) compared to the CG (p=0.118). The IG experienced a substantial increment in the vitamin D level (p=0.002). No significant improvements were found in the serum albumin and haemoglobin levels in either group. The intervention led to significant increases in daily intake of energy (p&lt;0.001), carbohydrate (p=0.013), protein (p&lt;0.001), and fat (p&lt;0.001) in comparison to the control group. Conclusion: Supplementing with an ONS, along with a regular diet, significantly improved nutritional status, some biochemical parameters, and daily intake of energy and macronutrients in older adults with malnutrition.

The association of sleep quality and sleep duration with nutritional status in older adults: Findings from the WCHAT study

Objective To analyze the relationship between functional capacity, nutritional status, and sociodemographic variables of older adults living in long-term care facilities. Method This is a cross-sectional study conducted with 82 institutionalized older adults. For data collection, we used the Barthel Index to assess the degree of independence in the performance of basic activities of daily living and the Mini Nutritional Assessment (MNA) to assess the nutritional status of older adults. Data were collected in five geriatric long-term care facilities located in southern Brazil. Ordinal regression analyses were performed to identify associations between contextual social factors, and nutritional status with the functional capacity of institutionalized older adults. Results Most participants showed complete independence in performing activities of daily living (39.0%) and poor nutritional status (59.8%). The multivariate ordinal regression analysis showed that older adults with higher scores in the nutritional assessment are associated with better indicators of functional capacity (OR=1.33; 95% CI=1.15 to 1.54; p&lt;0.001). We did not find an association between educational level, pressure injuries, body mass index, and functionality. Conclusion Nutritional status is a significant predictor for dependency in institutionalized older adults.

HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.2 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Association Between Sarcopenia and Nutritional Status in Older Adults: A Systematic Literature Review" found on pages 33-41, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until June 30, 2019. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Describe the geriatric syndrome of sarcopenia. 2. Identify the outcome of the sarcopenia studies. DISCLOSURE STATEMENT Neither the planners nor the authors have any conflicts of interest to disclose. Sarcopenia is an important geriatric syndrome with high prevalence rates and one of the most common causes of reductions in mobility, quality of life, and increasing dependency on care. The current study examined the relationship between sarcopenia and nutritional status in adults 60 and older. A systematic literature search was conducted, and data from 33 publications were included. The currently available literature indicates that sarcopenia is correlated with poor nutritional status (e.g., low body mass index, unfavorable nutritional risk screening results, decreased nutritional laboratory parameters, anorexia). Comparison of the studies' results were complicated by the lack of a generally accepted definition for sarcopenia, as well as the use of many different instruments to detect sarcopenia. The co-occurrence of malnutrition and sarcopenia is of great relevance. Future scientific work should focus on the formation of consistent definitions and instruments for the detection of sarcopenia to improve data comparisons. [Journal of Gerontological Nursing, 42(7), 33-41.].

Animal and vegetable protein intake and malnutrition in older adults: a multicohort study.

Objectives:Musculoskeletal pain, one of the most common issues faced by older adults,has multidimensional effects including an increased risk of malnutrition.Therefore, this study aimed to investigate the association between paininterference and nutritional status in older adults with chronicmusculoskeletal pain.Methods:In this cross-sectional study, data were collected from older adults (age:>60 years) using the brief pain inventory and mini nutritional assessmentquestionnaire. The correlation between pain interference, pain severity, andnutritional status was assessed using the chi-square test and Spearman’srank correlation. Multiple logistic regression analysis was used to analyzethe variables associated with abnormal nutrition status.Results:Overall 241 older adults were recruited in the study. The median (IQR) age ofthe participants was 70 (11) years, pain severity subscale was 4.2 (1.8),and pain interference subscale was 3.3 (3.1). Abnormal nutritional statuswas positively correlated with pain interference (Odds ratio [OR]: 1.26; 95%confidence interval [CI]: 1.08-1.48; P = .004), painseverity (OR: 1.25; 95% CI: 1.02-1.53; P = .034), age (OR1.06; 95% CI: 1.01-1.11, P = .011), and hypertension(OR = 2.17; 95% CI: 1.11-4.26; P = .024).Conclusions:This study reports a strong correlation between pain interference andnutritional status. Therefore, pain interference can be a useful painassessment tool to indicate risk of abnormal nutritional status in olderadults. In addition, related factors, including age, underweight, andhypertension, were associated with a higher risk of malnutrition.