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Systematic review

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Prevalence of and interventions for sarcopenia in ageing adults: a systematic review. Report of the International Sarcopenia Initiative (EWGSOP and IWGS).

Journal Age and ageing
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis 35 Broad syntheses (1 reference)

This article includes 35 Primary studies 35 Primary studies (35 references)

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OBJECTIVE: to examine the clinical evidence reporting the prevalence of sarcopenia and the effect of nutrition and exercise interventions from studies using the consensus definition of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). METHODS: PubMed and Dialog databases were searched (January 2000-October 2013) using pre-defined search terms. Prevalence studies and intervention studies investigating muscle mass plus strength or function outcome measures using the EWGSOP definition of sarcopenia, in well-defined populations of adults aged ≥50 years were selected. RESULTS: prevalence of sarcopenia was, with regional and age-related variations, 1-29% in community-dwelling populations, 14-33% in long-term care populations and 10% in the only acute hospital-care population examined. Moderate quality evidence suggests that exercise interventions improve muscle strength and physical performance. The results of nutrition interventions are equivocal due to the low number of studies and heterogeneous study design. Essential amino acid (EAA) supplements, including ∼2.5 g of leucine, and β-hydroxy β-methylbutyric acid (HMB) supplements, show some effects in improving muscle mass and function parameters. Protein supplements have not shown consistent benefits on muscle mass and function. CONCLUSION: prevalence of sarcopenia is substantial in most geriatric settings. Well-designed, standardised studies evaluating exercise or nutrition interventions are needed before treatment guidelines can be developed. Physicians should screen for sarcopenia in both community and geriatric settings, with diagnosis based on muscle mass and function. Supervised resistance exercise is recommended for individuals with sarcopenia. EAA (with leucine) and HMB may improve muscle outcomes.

Systematic review

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Creatine Supplementation during Resistance Training in Older Adults--A Meta-analysis.

Authors Devries MC , Phillips SM
Journal Medicine and science in sports and exercise
Year 2014
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Introduction: Age-related sarcopenia and dynapenia have negative effects on strength and the ability to perform activities of daily living. Resistance training (RT) increases muscle mass and strength in older adults and is an established countermeasure for sarcopenia and dynapenia, and creatine may enhance this effect. We aimed to determine whether the addition of Cr to RT increased gains in muscle mass, strength, and function in older adults over RT alone by conducting a systematic review and meta-analysis. Methods: PubMed and Healthstar databases were searched. Randomized, placebo-controlled trials that involved older adults supplemented with Cr and included RT regimens (>6 wk) were included. Data were analyzed using fixed or random (if data were heterogeneous) effects meta-analysis using RevMan 5. Results: The meta-analysis comprised 357 older adults (average ± SD Cr: 63.6 ± 5.9 yr, Pl: 64.2 ± 5.4 yr) with 12.6 ± 4.9 wk of RT. Cr + RT increased total body mass (P = 0.004) and fat-free mass (P < 0.0001) with no effect on fat mass as compared with RT alone. Cr + RT increased chest press (P = 0.004) and leg press (P = 0.02) one-repetition maximum to a greater extent than RT alone, with no difference in the effect on knee extension or biceps curl one-repetition maximum, isokinetic or isometric knee extension peak torque. Cr + RT had a greater effect than RT alone on the 30-s chair stand test (P = 0.03). Conclusion: Retention of muscle mass and strength is integral to healthy aging. The results from this meta-analysis are encouraging in supporting a role for Cr supplementation during RT in healthful aging by enhancing muscle mass gain, strength, and functional performance over RT alone; however, the limited number of studies indicates further work is needed.

Systematic review

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Clinical effectiveness of protein and amino acid supplementation on building muscle mass in elderly people: a meta-analysis.

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Authors Xu ZR , Tan ZJ , Zhang Q , Gui QF , Yang YM
Journal PloS one
Year 2014
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis 9 Broad syntheses (1 reference)

This article includes 9 Primary studies 9 Primary studies (9 references)

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OBJECTIVE: A major reason for the loss of mobility in elderly people is the gradual loss of lean body mass known as sarcopenia. Sarcopenia is associated with a lower quality of life and higher healthcare costs. The benefit of strategies that include nutritional intervention, timing of intervention, and physical exercise to improve muscle loss unclear as finding from studies investigating this issue have been inconsistent. We have performed a systematic review and meta-analysis to assess the ability of protein or amino acid supplementation to augment lean body mass or strength of leg muscles in elderly patients. METHODS: Nine studies met the inclusion criteria of being a prospective comparative study or randomized controlled trial (RCT) that compared the efficacy of an amino acid or protein supplement intervention with that of a placebo in elderly people (≥ 65 years) for the improvement of lean body mass (LBM), leg muscle strength or reduction associated with sarcopenia. RESULTS: The overall difference in mean change from baseline to the end of study in LBM between the treatment and placebo groups was 0.34 kg which was not significant (P = 0.386). The overall differences in mean change from baseline in double leg press and leg extension were 2.14 kg (P = 0.748) and 2.28 kg (P = 0.265), respectively, between the treatment group and the placebo group. CONCLUSIONS: These results indicate that amino acid/protein supplements did not increase lean body mass gain and muscle strength significantly more than placebo in a diverse elderly population.

Systematic review

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Are informal carers and community care workers effective in managing malnutrition in the older adult community? A systematic review of current evidence.

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Journal The journal of nutrition, health & aging
Year 2013
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This article is included in 1 Broad synthesis 4 Broad syntheses (1 reference)

This article includes 4 Primary studies 4 Primary studies (4 references)

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BACKGROUND: Enhancing the effectiveness of the community and aged care workforce to prevent malnutrition and functional decline is important in reducing hospital and aged care facility demand. OBJECTIVE: To investigate the impact of nutrition-related interventions delivered to or by informal carers and non-clinical community care workers on malnutrition-related health outcomes of community-dwelling older adults (≥65years). METHODS: Intervention studies were searched for using six electronic databases for English-language publications from January 1980 to 30 May 2012. Results: Nine studies were eligible for inclusion. The strength and quality of the evidence was moderate (six studies with level II intervention evidence, five with positive quality). Types of interventions used were highly varied. The majority of interventions were delivered to informal carers (6 studies), with three of these studies also involving older adult care recipients. Five interventions were targeted at identifying, preventing and/or treating malnutrition specifically (two positive quality, three neutral quality, n=2368). As a result of these interventions, nutritional status improved or stabilized (two positive quality, two neutral quality, n=2333). No study reported an improvement in functional status but two successfully prevented further decline in their participants (two neutral quality, n=1097). CONCLUSION: Interventions targeted at identifying, preventing and/or treating malnutrition were able to improve or prevent decline in nutritional and functional status, without increasing informal carer burden. The findings of this review support the involvement of non-clinical community care workers and informal carers as part of the nutritional care team for community-dwelling older adults.

Systematic review

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Oral nutritional support of older (65 years+) medical and surgical patients after discharge from hospital: systematic review and meta-analysis of randomized controlled trials.

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Authors Beck AM , Holst M , Rasmussen HH
Journal Clinical rehabilitation
Year 2013
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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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OBJECTIVE: To estimate the effectiveness of oral nutritional support compared to placebo or usual care in improving clinical outcome in older (65 years+) medical and surgical patients after discharge from hospital. Outcome goals were: re-admissions, survival, nutritional and functional status, quality of life and morbidity. DATA SOURCES: Three recent Cochrane reviews and an update of their literature search using MEDLINE, EMBASE, Web of Science. Search terms included randomized controlled trials; humans; age 65+ years; subset: dietary supplements. REVIEW METHODS: One reviewer assessed trials for inclusion, extracted data and assessed trial quality. RESULTS: Six trials were included (N = 716 randomly assigned participants). All trials used oral nutritional supplements. A positive effect on nutritional intake (energy) and/or nutritional status (weight) (in compliant participants) were observed in all trials. Two pooled analysis was based on a fixed-effects model. No significant effect were found on mortality (four randomized controlled trials with 532 participants, odds ratio 0.80 (95% confidence (CI) interval 0.46 to 1.39)) or re-admissions (four randomized controlled trials with 478 participants, odds ratio 1.07 (95% CI 0.71 to 1.61)). CONCLUSION: Although the evidence is limited, we suggest that oral nutritional support may be considered for older malnourished medical and surgical patients after discharge from hospital.

Systematic review

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Effectiveness of Nutritional Supplementation on Muscle Mass in Treatment of Sarcopenia in Old Age: A Systematic Review.

Journal Journal of the American Medical Directors Association
Year 2013
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This article is included in 1 Broad synthesis 17 Broad syntheses (1 reference)

This article includes 17 Primary studies 17 Primary studies (17 references)

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Abstract: Background: Much interest has been focused on nutritional treatment of sarcopenia, loss of muscle mass and performance associated to aging; however, its benefits are unclear. Objective: To analyze the relevance of nutritional treatment of sarcopenia and assess the effects of supplementation on muscle mass and function within the aged population. Methods: We searched Medline and the Cochrane Library for controlled trials published between 1991 and 2012. We have assessed the quality, type of intervention, the cohort used, the way muscle mass was measured, and the outcomes of the various studies. Results: We have included 17 studies, with a total of 1287 patients, aged between 65 and 85 on average. An improvement in muscle mass was proven, whether measured with bioelectrical impedance analysis or dual energy x-ray absorptiometry, and an improvement in strength was also proven. Conclusion: Nutritional supplementation is effective in the treatment of sarcopenia in old age, and its positive effects increase when associated with physical exercise. The main limitation of this treatment is lack of long-term adherence. A healthy diet associated with a physically active lifestyle and possibly with aerobic exercise are the basis of healthy aging, which is the aim of all doctors treating aged people must seek.

Systematic review

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Multi-component weight-loss interventions for people with cardiovascular disease and/or type 2 diabetes mellitus: a systematic review.

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Journal European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology
Year 2013
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This article is included in 1 Broad synthesis 8 Broad syntheses (1 reference)

This article includes 8 Primary studies 8 Primary studies (8 references)

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OBJECTIVES: To determine whether weight loss interventions, which combine dietary, exercise and behaviour change strategies, result in reduced weight, body mass index (BMI) and waist circumference in people with coronary heart disease (CHD), hypertension (HTN) and/or type 2 diabetes mellitus (T2DM). DESIGN: A systematic review of studies published 1997 to 2010. DATA SOURCES: The electronic databases MEDLINE, PsycINFO, COCHRANE, CINAHL and EMBASE. REVIEW METHODS: Studies were included if samples were: ≥ 18 years old, overweight or obese (BMI 26-39.99 kg/m(2)), and diagnosed with CHD, T2DM and/or HTN. Only randomised controlled trials (RCTs) or systematic reviews of RCTs reporting group-based interventions that combined dietary, exercise and behavioural change strategies and outcomes for weight, BMI and/or waist circumference up to 12 months were included. Two researchers extracted data and appraised quality, with a third making final decisions. RESULTS: Eight RCTs were included (total n = 1428). Participants' mean age was 60.4 years and 61% were female. Interventions varied by contact time, content and delivery. Mean weight loss ranged from -2 kg to -4 kg (SD 4 kg) at 3-4 months, -1.3 kg to -8.2 kg (SD 4 kg) at 5-6 months and -0.87 (SD 0.57 kg) to -6.9 kg (SD 4 kg) at 12 months. Of the few studies that measured waist circumference the mean reduction was -3.1 cm at three and 12 months. CONCLUSIONS: Weight loss interventions that combine exercise, diet and behaviour change strategies result in minor weight loss at 3-12 months in people with CHD, T2DM or HTN. Further research is required to determine the most effective and efficient methods.

Systematic review

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Omega 3 fatty acids in the elderly.

Journal The British journal of nutrition
Year 2012
Links Pubmed DOI

This article is included in 1 Broad synthesis 36 Broad syntheses (1 reference)

This article includes 38 Primary studies 36 Primary studies (38 references)

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Population ageing affects the entire world population. Also at world level one can observe a sharp increase in the proportion of older people. The challenge posed by population ageing translates into ensuring that the extra years of life will be as good as possible, free from high-cost dependency. Omega-3 fatty acids are now generally recognized as potential key nutrients to prevent the pathological conditions associated to the aging process. Ageing physiological process, its association with quality of life and the impact of omega-3 fatty acids intake and/or status is the focus of the present review. This report deals with the effects of omega-3 fatty acids on normal aging of older adults ( ≥ 65 years) mainly on the effects such as nutritional status itself, cognition, bone health, muscle tonus, and general health status. The preliminary broad search of the literature on the effects of omega-3 fatty acids on normal aging yielded 685 citations. Forty two full text papers were checked for inclusion and thirty six studies were finally included in this review. It may be concluded that paradoxically even though the elderly population is the largest one, the number of studies and the methodology employed clearly lacks of sufficient evidence to establish definite conclusions on the effects of omega-3 fatty acids on aging metabolism without pathological conditions and on quality of life.

Systematic review

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Dietary counselling with or without oral nutritional supplements in the management of malnourished patients: a systematic review and meta-analysis of randomised controlled trials.

Authors Baldwin C , Weekes CE
Journal Journal of human nutrition and dietetics : the official journal of the British Dietetic Association
Year 2012
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Dietary counselling and oral nutritional supplements (ONS) are recommended for managing malnutrition. A recent systematic review demonstrated (in separate analyses) that dietary counselling and dietary counselling with ONS improved energy intake, weight and some indices of body composition, although there was considerable heterogeneity. The present analysis aimed to examine the effects on mortality and nutritional indices of dietary counselling given with or without ONS and to explore the heterogeneity in the meta-analyses aiming to characterise the groups most likely to benefit from these interventions. A systematic review and meta-analysis was performed using Cochrane methodology. Twenty-six studies were included in the analysis: 12 comparing dietary counselling with usual care and 14 comparing dietary counselling and ONS if required with usual care (2123 participants). Quality of studies varied. Dietary counselling given with or without ONS had no effect on mortality [relative risk (fixed) = 1.12; 95% confidence interval = 0.86-1.46] but was associated with significant but heterogeneous benefits to weight [mean difference (random) = 1.7 kg; 95% confidence interval = 0.86-2.55], energy intake and some aspects of body composition. Subgroup analyses taking into account clinical background, age, nutritional status, type and length of intervention failed to reveal any differences in mortality, weight change and energy intake between groups. There were insufficient data on functional outcomes to explore these findings. Dietary counselling given with or without ONS is effective at increasing nutritional intake and weight but adequately-powered studies in similar patient populations and standardised for factors that might account for variations in response are required.

Systematic review

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Nutritional education for community dwelling older people: A systematic review of randomised controlled trials.

Authors Young K , Bunn F , Trivedi D , Dickinson A
Journal International journal of nursing studies
Year 2011
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Abstract: OBJECTIVES: To evaluate the effectiveness of nutritional education or advice on physical function, emotional health, quality of life, nutritional indices, anthropometric indicators, mortality, service use and costs of care in people over 65years of age living at home. DESIGN: Systematic review of randomised controlled trials (RCTs). Data sources: PUBMED, CINAHL, PSYCINFO, the Cochrane Central Register of Controlled Trials and the National Research Register. METHODS: We included studies evaluating nutritional education or advice for people aged 65 and over living in their own homes that measured one or more of the following outcomes: physical function, emotional well being, service use, dietary change and other anthropometric indicators. Studies were assessed for risk of bias on six domains. Due to high heterogeneity, results were not pooled but are reported narratively. RESULTS: Twenty-three studies met our inclusion criteria. All but one of the interventions were delivered by health care professionals; ten were delivered by nurses. The review found evidence to suggest that nutritional education or advice can be used to positively influence diet and improve physical function. There was also evidence that some biochemical markers can be positively affected, although these are surrogate outcomes and are generally disease specific. Several studies indicated that complex interventions, with nutritional education as a component, also reduce depression. The evidence from this review on the impact on weight change was inconclusive. There was no evidence of an improvement in anxiety, quality of life, service use, costs of care or mortality. However, many studies were at moderate or high risk of bias, and for some outcomes the data were insufficient to make judgments about effectiveness. CONCLUSIONS: This review indicates that nutritional education or advice can positively affect physical function and diet, whilst complex interventions with nutritional education as a component, can reduce depression in people over 65years who live at home. However, more research is needed to determine whether outcomes are influenced by types of intervention, morbidity, and socioeconomic circumstance of participants. Relevance to clinical practice: Nutritional education, alone or as part of a complex intervention, can improve diet and physical function and may reduce depression in the over 65s living at home.