Body Composition In Older Adults Research Articles

Association between cognitive function and body composition in older adults: data from NHANES (1999-2002).

To investigate the association between cognitive function and body composition in older adults. We collected data on 2080 older adults (>60 years of age) from the National Health and Nutrition Examination Survey (NHANES) for the years 1999-2000 and 2001-2002. Candidate variables included: demographic data (sex, age, race, education level, marital status, poverty-to-income ratio), alcohol consumption, cardiovascular disease, diabetes, osteoporosis, total bone mineral density, and total fat mass. A logistic regression model was established to analyze the association between cognitive function and body composition in older adults. In addition, stratified logics regression analysis was performed by sex and age. Bone mineral density significantly affects cognitive function in older adults (p<0.01). When examining the data according to sex, this correlation is present for women (p < 0.01). For men, though, it is not significant (p = 0.081). Stratified by age, total bone mineral density was significantly correlated with cognitive function in 60-70 and 70-80 years old people, but not in older adults older than 80 years(for 60-70 years old, p = 0.019; for 70-80 years old, p = 0.022). There was no significant correlation between total bone mineral density and cognitive function (p = 0.575). The decrease of total bone mineral density was significantly correlated with cognitive decline in the older adults, especially among women and older people in the 60 to 80 age group. There was no connection between total fat mass, total percent fat, total lean mass, appendicular lean mass, appendicular lean mass /BMI and cognitive function in the older adults.

Exploring the Complexities of Sarcopenic Obesity and Nutritional Approaches for Promoting Healthy Aging: a Literature Review

ABSTRACT The ongoing global demographic transition towards an aging population indicates that the proportion of individuals aged 60 and above is expected to reach 21% by the year 2050, with more than 5% of this group being 80 or older. As a result of this shift in demographics towards an increasingly elderly population, there has been a noticeable increase in the occurrence of a medical condition known as sarcopenic obesity. This academic paper thoroughly examines the existing body of literature by consolidating information from various reputable sources. The primary focus of this review is to investigate the implementation of therapies related to obesity, sarcopenia, and nutrition. The data for this assessment was systematically collected by conducting an extensive search of electronic databases, encompassing research publications and review papers. It is crucial to acknowledge that traditional measures like body weight and body mass index are not advisable for assessing body composition in older adults because they cannot distinguish between adipose tissue and muscle mass. Sarcopenia is closely linked to inadequate dietary intake, while obesity results from excessive energy consumption, creating an imbalance between daily energy intake and expenditure. When formulating a nutritional strategy to address sarcopenic obesity, it is essential to consider dual goals. The primary goal is to ensure a proper intake of nutrients that promotes the growth of skeletal muscle mass or reduces the risk of muscle loss. At the same time, it is crucial to achieve balance by advocating for sufficient nutrition and energy intake to prevent the accumulation of excess fat tissue. Keywords: Sarcopenic Obesity, Elderly Population, Nutritional Therapeutic

Clinical Significance of Nutritional Status, Inflammation, and Body Composition in Elderly Hemodialysis Patients-A Case-Control Study.

Nutritional and inflammatory disorders are factors that increase the risk of adverse clinical outcomes and mortality in elderly hemodialysis (HD) patients. This study aimed to examine nutritional and inflammation status as well as body composition in older adults on HD compared to matched controls. A case-control study was conducted on 168 older participants (84 HD patients (cases) and 84 controls) age- and sex-matched. Demographic, clinical, anthropometric, and laboratory parameters were collected from medical records. The primary outcome was nutritional status assessment using a combination of nutritional and inflammatory markers along with the geriatric nutritional risk index (GNRI). Sarcopenic obesity (SO) was studied by the combined application of anthropometric measures. Body composition and hydration status were assessed by bioelectrical impedance analysis (BIA). Univariate and multivariate regression analyses were performed to identify nutritional and inflammatory independent risk indicators in elderly HD patients and controls. A significantly high prevalence of nutritional risk measured by the GNRI was found in HD patients (32.1%) compared to controls (6.0%) (p < 0.001). Elderly HD patients were overweight and had lower percent arm muscle circumference, phase angle (PA), serum albumin (s-albumin), as well as higher percent extracellular body water (ECW%) and serum C-reactive protein (s-CRP) than controls (all at least, p < 0.01). SO was higher in HD patients (15.50%) than in controls (14.30%). By multi-regression analyses, age < 75 years (OR: 0.119; 95%CI: 0.036 to 0.388), ECW% (OR: 1.162; 95%CI: 1.061 to 1.273), PA (OR: 0.099; 95%CI: 0.036 to 0.271), as well as BMI, s-albumin ≥ 3.8 g/dL, and lower s-CRP were independently related between cases and controls (all at least, p < 0.05). Elderly HD patients had increased nutritional risk, SO, inflammation, overhydration, and metabolic derangements compared to controls. This study highlights the importance of identifying nutritional risk along with inflammation profile and associated body composition disorders in the nutritional care of elderly HD patients. Further studies are needed to prevent nutritional disorders in elderly HD patients.

Association of Physical Activity and Exercise with Physical Performance and Muscle Mass in Older Adults: Results from the Longevity Check-Up (Lookup) 7+ Project.

Regular engagement in physical activity (PA) or physical exercise (PE) is effective at improving physical performance and body composition in older adults. Less is known about the benefits that may be obtained through combining PA with PE and whether the effects of activity habits differ between men and women. This study cross-sectionally investigated the association of PA and/or PE with physical performance and anthropometric measures in a large and relatively unselected sample of older adults enrolled in the Longevity Check-up (Lookup) 7+ project. Participants were individuals 65 years and older living in the community who were recruited in unconventional settings across Italy. Adherence to PA or PE was operationalized as involvement in light walking or various types of exercise, respectively, at least twice weekly for a minimum of 30 min per session throughout the last 12 months. Physical performance measures included handgrip strength and five-time sit-to-stand (5STS) tests. Lower-limb muscle power and appendicular skeletal muscle mass (ASM) were estimated through validated equations. We analyzed data of 4119 participants, of whom 2222 (53.4%) were women. The mean age was 72.8 ± 5.8 years in men and 72.1 ± 5.4 years in women. Regular engagement in PA + PE was reported by 139 (7.3%) men and 100 (4.5%) women. Results indicated that regular walking activity and/or PE were significantly associated with better physical performance and greater ASM with sex-specific patterns. Associations were also influenced by the type of activity, physical performance assessment tool, and anthropometric parameters. Men engaged in PA + PE performed better on the 5STS test and had greater handgrip strength, ASM, and relative and specific muscle power than those practicing either PA or PE. In women, the combination of PA and PE was associated with greater handgrip strength. The findings of this study indicate that older adults regularly practicing PA + PE had better physical performance than those who only engaged in either modality. In men, the combination of PA and PE was also associated with greater ASM.

Relationship between inflammatory markers, compliance to the MIND diet and body composition in older adults without cognitive decline

AbstractBackgroundChronic low‐grade inflammation is one of the main drivers of cognitive decline. The MIND Diet is a dietary pattern that includes foods rich in antioxidants that exert a neuroprotective effect by decreasing oxidative stress (OS) and inflammation. The aim was to evaluate the association between inflammation markers and the intake of foods characteristic of the MIND diet with body composition in older adults.Method Cross‐sectional analysis of 73 older adults (70.6±4.6 years, 63% women) without cognitive decline who are participating in the LatAm Fingers study in Mexico. Basal blood samples were taken to determine C‐reactive protein (CRP) and Lipopolysaccharide (LPS). Subjects were divided into two groups according to CRP levels (≤1.0 mg/L without inflammation; &gt;1.0 mg/L with inflammation). Body composition was measured by multi‐frequency bioelectrical impedance (Inbody 720). Participants were asked to autocomplete a validated food frequency questionnaire (POINTER) to evaluate the dietary intake of the MIND diet foods (leafy green vegetables, other vegetables, olive oil, fish, poultry, nuts, whole grains, legumes, and berries). Low adherence was defined as a total score of &lt;8 out of 15 points. Result74% of women presented elevated CRP levels (&gt;1.0mg/L). Interestingly, subjects from the group without inflammation had lower values of body mass index (BMI) (27.2 ± 2.4 vs. 30.0 ± 3.6 Kg/m²; p = 0.002), total fat percentage (35.5 ± 5.6 vs. 42.9 ± 6.9%; p = 0.0001) and visceral fat area (108.3 ± 20.7 vs. 123.6 ± 24.0 cm²; p = 0.012) and higher levels of total muscle mass (23.9 ± 5.0 vs. 21.6 ± 4.3Kg; p = 0.049). All participants had metabolic endotoxemia (LPS levels 450 ± 211 ng/mL). Compliance with the MIND diet was deficient (score &lt;8 points) in most participants (58.3%).Conclusion High levels of CRP are associated with a negative impact on body composition in older Mexican adults. Additionally, this population is at high risk of cognitive decline as it presents elevated markers of systemic inflammation with a low intake of neuroprotective foods.

The impact of an oral nutritional supplement on body weight gain in older adults with malnutrition: an open-label randomized controlled trial

BackgroundThe global aging population is expanding rapidly and many individuals have a particularly higher risk of malnutrition. Malnutrition can lead to impaired body function, morbidity, and mortality. Meeting nutritional requirements is a key strategy to minimize multiple debilitating adverse outcomes associated with malnutrition in the elderly.Oral nutritional supplements (ONS) have been widely used as a dietary intervention for malnutrition in older adults. These supplements provide additional nutrients and calories to support nutritional requirements and have been shown to improve nutritional status, physical function, and quality of life in malnourished older adults.MethodsThis is an open-label, randomized controlled, parallel-group study including 50 institutionalized older adults (aged > 60 years) with malnutrition or at risk of malnutrition, living in a selected elderly care institution in Colombo, Sri Lanka. The aim is to assess improvement in healthy body weight gain and body composition in older adults with malnutrition at risk of malnutrition by using an ONS. Older adults will be screened for malnutrition using the Mini Nutrition Assessment (MNA) tool and eligible participants randomized using the simple random sampling technique to intervention and control groups (1:1 allocation ratio). The intervention group will consume 200 mL of ONS before bed continuously for 12 weeks. The primary outcome is the percentage who achieved at least 5% weight gain in the intervention group compared to the control group. Nutritional status (anthropometric, biochemical, clinical, and dietary), body composition (dual-energy X-ray absorptiometry), frailty, functional capacity (hand grip strength, knee extension, and Barthel index) cognitive status (Montreal Cognitive Assessment), and physical activity will be assessed as secondary outcomes at baseline and at the end of the 12-week intervention. Some measurements (anthropometry, dietary, and functional assessments) will also be performed at the end of the 4th week. Data will be analyzed using SPSS V-23.DiscussionThis study will determine whether the use of an ONS is effective in promoting healthy weight gain in older adults with malnutrition or at risk of malnutrition. In addition, investigating the impact of an ONS on multiple outcomes via clinical, nutritional, functional, and cognitive function will provide a more comprehensive understanding of the potential benefits of these supplements.Trial registrationSri Lanka Clinical Trail Registry SLCTR/2022/021. Oct. 6, 2022.

Impact of an oral nutritional supplement on improving body composition in older adults with malnutrition : A randomized controlled trial

The consequences of malnutrition in the elderly often manifest as weight loss and altered body composition. The aim of this study was to assess the efficacy of an oral nutritional supplement (ONS) on body composition in malnourished older adults.

Physical Activity, Sedentary Time, And Body Composition In Older Adults With Coronary Heart Disease In Puerto Rico

Physical Activity, Sedentary Time, And Body Composition In Older Adults With Coronary Heart Disease In Puerto Rico

Exploring Handgrip Strength as a Cross-cultural Correlate of Body Composition and Upper Body Strength in Older Adults from Costa Rica and Kansas.

Sarcopenia and disability in older adults are often characterized by body composition measurements; however, the gold standard of body composition measurement, dual-energy X-ray absorptiometry (DEXA), is expensive to acquire and maintain, making its use in low and middle income countries (LMIC) it out-of-reach in developing nations. Because these LMIC will bear a disproportionate amount of chronic disease burden due to global aging trends, it is important that reliable, low-cost surrogates need to be developed. Handgrip strength (HGS) is a reliable measure of disability in older adults but has not been used widely in diverse populations. This study compared HGS to multiple measurements of body composition in older adults from the US (Kansas) and a middle-income country (Costa Rica) to test if HGS is a cross-culturally appropriate predictive measure that yields reliable estimates across developed and developing nations. Percent body fat (%BF), lean tissue mass index (LTMI), appendicular lean soft tissue index (ALSTI), body fat mass index (BFMI), bone mineral density (BMD), and HGS were measured in older Costa Ricans (n = 78) and Kansans (n = 100). HGS predicted lean arm mass with equal accuracy for both samples (p ≤ 0.05 for all groups), indicating that it is a reliable, low-cost and widely available estimate of upper body lean muscle mass. Older adults from Costa Rica showed different body composition overall and HGS than controls from Kansas. Handgrip operates equivalently in the US and Mesoamerica and is a valid estimate of lean arm muscle mass as derived by the more expensive DEXA.

Effects of resistance training on body weight and body composition in older adults: An inter-individual response difference meta-analysis of randomized controlled trials.

Whether true inter-individual response differences (IIRD) occur as a result of resistance training on body weight and body composition in older adults with overweight and obesity is not known. To address this gap, data from a previous meta-analysis representing 587 men and women (333 resistance training, 254 control) ≥ 60 years of age nested in 15 randomized controlled trials of resistance training ≥ 8 weeks were included. Resistance training and control group change outcome standard deviations treated as point estimates for body weight and body composition (percent body fat, fat mass, body mass index in kg.m2, and lean body mass) were used to calculate true IIRD from each study. True IIRD as well as traditional pairwise comparisons were pooled using the inverse-variance (IVhet) model. Both 95% confidence intervals (CI) and prediction intervals (PI) were calculated. While statistically significant improvements were found for body weight and all body composition outcomes (p < 0.05 for all), no statistically significant IIRD was observed for any of the outcomes (p > 0.05 for all) and all 95% PIs overlapped. Conclusions: While resistance training is associated with improvements in body weight and body composition in older adults, the lack of true IIRD suggests that factors other than training response variation (random variation, physiological responses associated with behavioral changes that are not the result of resistance training) are responsible for the observed variation in body weight and body composition.

Protein Supplementation in Addition to Strength Training Programs for Improving Body Composition in Older Adults: What Else Is Left to Know? A Brief Update Review of the Current Evidence.

Resistance training alongside proper protein intake is an important tool to mitigate the deleterious effects of the aging process on skeletal muscle tissue. However, it is not completely elucidated whether adding protein supplementation provides further improvements on body composition outcomes of older adults during resistance training programs. The present narrative review aimed to describe the most recent evidence regarding the effects of protein supplementation on both lean body mass and fat mass of older adults and to provide insight into how health professionals may use this information to properly design nutritional programs for this population. While individuals with previous training experience, not meeting daily protein requirement, or displaying frailty symptoms may experience some benefits, protein supplementation does not seem to provide further improvements in untrained and healthy subjects. Aspects such as the age of the individuals and the different characteristics of the supplementation protocols must be considered when making evidence-based decisions regarding this topic.

Substituting sedentary time with physical activity in youngest-old to oldest-old community-dwelling older adults: Associations with body composition.

Several studies have suggested that physical activity and sedentary behavior are strongly and independently associated with body composition and obesity. However, few studies have investigated whether substituting sedentary time with moderate-to-vigorous physical activity is associated with body composition in older adults, especially among those older than 75 years. This study examined the associations between replacing sedentary time with physical activity and obesity indices in a sample of 199 community-dwelling older Taiwanese adults (52.3% women; 80.6 ± 7.0 years). Physical activity and sedentary behavior were measured using the triaxial accelerometer (GT3X+, ActiGraph). Body composition indices were computed through a bioelectrical impedance analysis of body fat percentage and appendicular skeletal muscle mass index. Waist circumference and body mass index were measured by trained personnel. Isotemporal substitution analyses estimated these associations after adjusting for sociodemographic characteristics and nutritional status. The study showed that substituting 30 min of sedentary behavior per day with moderate-to-vigorous physical activity was associated with lower body fat percentage (B = -1.408, 95% CI = -2.55, -0.264), body mass index (B = -0.681, 95% CI = -1.300, -0.061), and waist circumference (B = -2.301, 95% CI = -4.062, -0.539) after adjusting for covariates. Substituting 30 min of light physical activity per day with moderate-to-vigorous physical activity was associated with lower waist circumference (B = -2.230, 95% CI = -4.173, -0.287) after adjusting for covariates. Stratified analyses indicated that associations were stronger in youngest-old older adults, and in older adults with a normal nutritional status (vs. underweight status). These findings confirm the importance of reducing sedentary behavior and increasing moderate-to-vigorous physical activity among older adults to improve their physical health, as well as highlighting the importance of taking into account nutritional status and age group.

PSUN187 Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes

Abstract Background Aging and type 2 diabetes (T2DM) are associated with an increased risk of developing sarcopenia which is associated with poor outcomes and may necessitate specific treatment. Diagnosis of sarcopenia often requires the referral of patients to dual-energy X-ray absorptiometry (DXA) in specialized settings. Another available method for assessing body composition is direct segmental multi-frequency bioelectrical impedance analysis (DSMF-BIA). In this study, we examine the accuracy of a DSMF-BIA (InBody 770) for assessing body composition in older adults with T2DM when compared to DXA. Methods 84 older adults (49 women, age 71 ± 5 years. Body mass index 30 ± 5.6 kg /m2) with T2DM who were recruited for the CEV-65 study and had both DSMF-BIA and DXA assessments at baseline were included in the analysis. The main analysis included Bland-Altman plots and Intra Class Correlation Coefficients (ICC). Sub-analyses were performed according to gender and following 10 weeks of intervention (diet, circuit resistance training, and Empagliflozin). Results The leg lean mass results according to DSMF-BIA and DXA were 14.76 ± 3.62 kg and 15.19 ± 3.52 kg respectively, however, did not differ between devices according to Bland-Altman analyses (p=0.353). Assessment of appendicular skeletal mass index did not differ between DSMF-BIA and DXA (7.43 vs. 7.47 kg/m2; p=0.84; ICC=0.965, p&amp;lt;0.0001; bias of -0.068, p =0.595). The accuracy of DSMF-BIA was limited when estimating fat mass indices reflected by significant biases according to Bland-Altman analyses. Summary In a sample of older adults with T2DM the degree of agreement between DSMF-BIA and DXA, was high, supporting the use of DSMF-BIA for the diagnosis of low muscle mass. Better accuracy was observed when comparing parameters of lean mass versus parameters of fat mass. Gender as well as three common treatment modalities for T2DM did not modify the accuracy of the DSMF-BIA when compared to DXA. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Validation of a multi-frequency bioelectrical impedance analysis device for the assessment of body composition in older adults with type 2 diabetes

BackgroundAging and type 2 diabetes (T2DM) are associated with an increased risk of sarcopenia. Diagnosis of sarcopenia is commonly done using dual-energy X-ray absorptiometry (DXA) in specialized settings. Another available method for assessing body composition is direct segmental multi-frequency bioelectrical impedance analysis (DSMF-BIA). Here, we examine the accuracy of a DSMF-BIA (InBody-770) for assessing body composition in older adults with T2DM when compared to DXA.MethodsEighty-four obese/overweight older adults (49 women, 71 ± 5 years) with T2DM who were recruited for the CEV-65 study and had both DSMF-BIA and DXA assessments at baseline were included. The analysis included Bland–Altman plots and intra class correlation coefficients. Sub-analyses were performed according to gender and following 10 weeks of interventions (diet, circuit training, and Empagliflozin).ResultsThe leg lean mass results according to DSMF-BIA and DXA were 14.76 ± 3.62 kg and 15.19 ± 3.52 kg, respectively, with no difference between devices according to Bland–Altman analyses (p = 0.353). Assessment of appendicular skeletal mass index did not differ between DSMF-BIA and DXA (7.43 vs. 7.47 kg/m2; p = 0.84; ICC = 0.965, p < 0.0001; mean difference −0.068, p = 0.595). Gender and treatment interventions did not modify the accuracy of the DSMF-BIA when compared to DXA.ConclusionsIn older adults with T2DM the degree of agreement between DSMF-BIA and DXA, was high, supporting the use of DSMF-BIA to measure muscle mass.

Nutrition risk, physical activity and fibre intake are associated with body composition in OA: analysis of the Canadian Longitudinal Study on Aging

ObjectiveSarcopenic obesity is a key feature in osteoarthritis (OA). While ideal OA treatment involves physical activity and diet, how diet influences OA pathophysiology is unclear. We explored the associations between...

Altered features of body composition in older adults with type 2 diabetes and prediabetes compared with matched controls.

BackgroundAgeing is accompanied by muscle loss and fat gain, which may elevate the risk of type 2 diabetes (T2D). However, there is a paucity of data on the distribution of regional lean and fat tissue in older adults with T2D or prediabetes compared with healthy controls. The objective of this study was to compare regional body composition [by dual‐energy x‐ray absorptiometry (DXA)], muscle and subcutaneous adipose tissue (SAT) thicknesses (by ultrasound), and ultrasound‐based muscle texture features in older adults with T2D or prediabetes compared with normoglycaemic controls.MethodsEighteen adults > 60 years with T2D or prediabetes (T2D group) were individually matched to normoglycaemic participants [healthy matched (HM) group] for age (±5 years), sex, and body fat (±2.5%). In a single study visit, all participants received a whole‐body DXA scan and ultrasound assessment of the abdomen and anterior thigh. At these two landmarks, we used ultrasound to measure muscle and SAT thickness, as well as texture features of the rectus femoris and rectus abdominis. We also conducted an exploratory subanalysis on a subset of participants (n = 14/18 in the T2D group and n = 10/18 in the HM group) who underwent additional assessments including strength testing of the knee extensors (using a Biodex dynamometer), and a fasting blood sample for the measurement of circulating markers of glucose metabolism [glucose, insulin, c‐peptide, and the homoeostatic model assessment of insulin resistance (HOMA‐IR)].ResultsThe T2D group was 72 ± 8 years old (mean ± SD), predominantly male (n = 15/18; 83%), and overweight (BMI: 27.8 ± 4.2 kg/m2, 33.2 ± 5.3% body fat). DXA‐derived upper arm lean mass was 0.4 kg greater (P = 0.034), and leg fat mass was 1.4 kg lower (P = 0.048), in the T2D vs. HM group. Ultrasound‐based texture features were distinct between the groups [rectus abdominis blob size: 0.07 ± 0.06 vs. 0.30 ± 0.43 cm2, P = 0.045; rectus femoris local binary pattern (LBP) entropy: 4.65 ± 0.05 vs. 4.59 ± 0.08 A.U., P = 0.007]. When all participants who underwent additional assessments were pooled (n = 24), we observed that certain ultrasound‐based muscle texture features correlated significantly with muscle strength (rectus abdominis histogram skew vs. power during an isokinetic contraction at 60°/s: r = 0.601, P = 0.003) and insulin resistance (rectus femoris LBP entropy vs. HOMA‐IR: r = 0.419, P = 0.042).ConclusionsOur findings suggest a novel body composition phenotype specific to older adults with T2D or prediabetes. We are also the first to report that ultrasound‐based texture features correspond with functional outcomes. Future larger scale studies are needed to uncover the mechanisms underpinning these regional body composition differences.

ApoE4 Is Associated with Lower Body Mass, Particularly Fat Mass, in Older Women with Cognitive Impairment.

A lower body mass is associated with the progression of Alzheimer’s disease (AD) and the risk of mortality in patients with AD; however, evidence of genetic determinants of decreased body mass in cognitively impaired older adults is limited. We therefore investigated the genetic effect of APOE-ε4 on body composition in older adults with mild cognitive impairment (MCI) and early-to-moderate-stage AD. A total of 1631 outpatients (aged 65–89 years) with MCI and early-to-moderate-stage AD were evaluated for the association between body composition and APOE-ε4 status. After adjusting for covariates, including cognitive function evaluated with the Mini-Mental State Examination, the presence of the APOE-ε4 was associated with lower weight (β = −1.116 ± 0.468 kg per presence, p = 0.017), fat mass (β = −1.196 ± 0.401 kg per presence, p = 0.003), and percentage of body fat (β = −1.700 ± 0.539% per presence, p = 0.002) in women but not in men. Additionally, the impact of APOE-ε4 on measures of body composition in women was more remarkable in MCI than in AD patients. The presence of the APOE-ε4 allele was associated with lower fat mass, particularly in women with MCI, independent of cognitive decline.

Changes in Body Composition in Older Adults after a Technology-Based Weight Loss Intervention.

We conducted a post-hoc analysis of a pre/post, single-arm, nonrandomized, multicomponent weight loss intervention in older adults. Fifty-three older adults aged ≥65 with a body mass index ≥ 30 kg/m2 were recruited to participate in a six-month, remote monitoring and video-conferencing delivered, prescriptive intervention consisting of individual and group-led registered dietitian nutrition and physical therapy sessions. We assessed weight, height, and body composition using a SECA 514 bioelectrical impedance analyzer. Mean age was 72.9±3.9 years (70% female) and all had ≥2 chronic conditions. Of those with complete data (n=30), we observed a 4.6±3.5kg loss in weight, 6.1±14.3kg (1.9%) loss in fat mass, and 0.78±1.69L loss in visceral fat (all p<0.05). Fat-free mass (−3.4kg±6.8, p=0.19), appendicular lean mass (−0.25±1.83, p=0.22), and grip strength (+3.46±7.89, p=0.56) did not significantly change. These variables were preserved after stratifying by 5% weight loss. Our intervention led to significant body and visceral fat loss while maintaining fat-free and appendicular lean muscle mass.Electronic Supplementary MaterialSupplementary material is available for this article at 10.14283/jfa.2022.15 and is accessible for authorized users.

Relationship between vigorous physical activity and body composition in older adults

Objective: the objective of the present study was to analyze the relationship between vigorous physical activity and body composition in older people who attend primary care centers. Material and methods: this study is characterized by being a descriptive, cross-sectional epidemiological study in 654 older adults (288 men and 366 women), most of them between 60 and 69 years of age (59 %), attending primary care centers in the city of Maringá, Brazil. The participants were evaluated using the International Physical Activity Questionnaire (IPAQ), anthropometric measurements, and a sociodemographic questionnaire to characterize the sample. Results: older adults who practice physical activities in primary care centers with vigorous intensity are associated with lower abdominal circumference, waist, hip, quadriceps, and calf measurements when compared to older people with low or moderate levels of physical activity. Conclusions: the practice of vigorous physical activity is related to low body perimeters (abdominal, hip, waist, calf) in older adults who attend primary care centers.

Practice Patterns and Predictors of Severe Toxicity Among Older Adults with Diffuse Large B Cell Lymphoma Treated with Frontline Chemoimmunotherapy

Introduction:Chemoimmunotherapy with R-CHOP is the standard of care for newly diagnosed diffuse large B cell lymphoma (DLBCL) leading to high cure rates although treatment-related toxicities are significant among older adults. Reduced dose R-CHOP has been proposed to balance efficacy and safety, but there is considerable ambiguity in “whom” and “by how much” with the best available data on those >80y [Peyrade et al 2011]. In this study, we sought to document the variability in chemotherapy dosing among unselected older adults with DLBCL treated with R-CHOP at a large, urban academic center in the Deep South. In addition, we sought to determine how baseline clinical features impacted tolerance of treatment.Methods:We conducted a single-institution retrospective review of all adults with newly diagnosed DLBCL initiating chemoimmunotherapy, predominantly R-CHOP, between 1/2015 and 2/2021 at the University of Alabama at Birmingham. For the current analysis, the cohort was limited to patients >70y. We extracted information on baseline clinico-demographic variables (age, sex, race, albumin, ECOG performance status [ECOG PS], Charlson comorbidity index [CCI], cancer type, stage, Revised International Prognostic Index score) and treatment intensity (type and dose of chemotherapy at 1 st cycle). Dose reduction was defined as any pre-planned reduction in cyclophosphamide, vincristine, or doxorubicin from standard CHOP dosing for cycle 1 of treatment. The primary outcome of interest was ≥grade 3 treatment-related toxicity (using CTCAE v5.0) occurring up to 30 days from the last dose of R-CHOP; secondary outcomes included dose modifications (dose delays >7d, dose reductions and treatment discontinuation) and health care utilization (unplanned emergency department visits and hospitalizations). Given high missingness for ECOG PS, we performed multiple imputation with chained equations producing 10 imputed datasets. Finally, we built a multivariate logistic regression model to identify baseline characteristics associated with severe toxicity; putative risk factors included age, sex, ECOG PS, CCI, albumin and treatment intensity. We pooled regression coefficients across imputed datasets using Rubin's rules. All hypothesis testing were two-sided, and the level of significance was chosen as 0.05.Results:Of 287 patients with DLBCL initiating R-CHOP during the study period, 101 (35%) patients were included in our cohort. The median age was 76y (IQR 73-79), with 55% males and 85% whites. Stage IV disease was present in 33% of patients, and 11% had double or triple-hit subtype. Of those with non-missing ECOG PS (55%), 38% had ECOG PS ≥2, and 29% had a CCI ≥2 [Table 1].Overall, 55% of patients received planned reduced dose treatment. Interestingly, 51% of patients <80y received reduced dose R-CHOP, whereas 32% of patients ≥80y still received full dose R-CHOP. Over half of patients (54%) experienced ≥grade 3 toxicity (42% hematologic toxicity, 27% non-hematologic toxicity). Dose delays (12%), reductions (12%), or discontinuations (17%) were frequent, and over a third (35%) of patients had unplanned hospitalizations during treatment. In a multivariate logistic regression model, reduced dose R-CHOP (Odds Ratio, OR 0.34; 95% CI 0.12-0.94; p value 0.038) was associated with decreased risk of ≥grade 3 toxicity, and CCI ≥2 (OR 5.35; 95% CI 1.58-18.25; p value 0.007) was associated with increased risk of ≥grade 3 toxicity. Age, albumin, and ECOG PS were not associated with risk of toxicity [Table 2]. Overall, only 11% of the observed inter-individual variability in toxicity could be explained by the above potential risk factors.Conclusions:Among older adults >70y with DLBCL, planned dose reductions based on anticipated tolerability were frequent, yet over half of patients experienced severe treatment-related toxicity. Treatment intensity and comorbidity burden were significantly associated with increased risk of toxicity, but age, albumin, and performance status were not. Overall, pre-treatment factors only explained about 11% of the observed variability in toxicity suggesting that a significant proportion of inter-individual variability in severe toxicity is unexplained by traditional evaluation. Future studies should examine the role of geriatric assessment and altered body composition in older adults to identify those at increased risk of severe toxicity from chemoimmunotherapy. [Display omitted] DisclosuresNarkhede: Genentech/Roche: Research Funding; Genmab: Other: Medical writing support, Research Funding; TG Therapeautics: Research Funding; Gilead: Research Funding. Mehta: Affirmed; Kite/Gilead; Roche-Genetech; Celgene/BMS; Oncotartis; Innate Pharmaceuticals; Seattle Genetics; Incyte; Takeda; Fortyseven Inc/Gilead; TG Therapeutics; Merck; Juno Pharmaceuticals/Bristol Myers Squibb: Research Funding; Seattle Genetics; Incyte; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Seattle Genetics; Incyte; TG Therapeutics: Consultancy. Giri: PackHealth: Research Funding; CareVive: Honoraria, Research Funding.