Effects of Randomized Multivitamin Supplementation on Carotenoids and α-Tocopherol in the COcoa Supplement and Multivitamin Outcomes Study.

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

Abnormalities of choroidal blood flow in the eye are associated with occurrence of age-related macular degeneration (AMD). Cocoa flavanols show beneficial effects on vascular risk factors in small and short-term trials and may help reduce AMD risk. To examine whether daily supplementation with cocoa extract, a source of flavanols, prevents the development or progression of AMD. This was a prespecified ancillary study of the COSMOS (COcoa Supplement and Multivitamins Outcomes Study) trial, a double-blind, placebo-controlled, 2 × 2 factorial randomized clinical trial of a cocoa extract supplement and a multivitamin supplement in the prevention of cardiovascular disease and cancer among 21 442 US adults, including 12 666 women aged 65 years and older and 8776 men aged 60 years and older. The intervention phase was performed from June 2015 through December 2020; data analysis was completed in August 2024. Cocoa extract supplement (500 mg/day cocoa flavanols, including 80 mg (-)-epicatechin) or placebo. The primary end point was a composite of incident cases of AMD plus cases of progression to advanced AMD (geographic atrophy, neovascular membrane, retinal pigment epithelium detachment, or disciform scar) among participants with AMD at baseline, based on self-report confirmed by medical record review. Mean (SD) participant age was 72.1 (6.6) years, and 12 666 participants (59.1%) were female. During a median (IQR) period of 3.6 (3.2-4.2) years of treatment and follow-up, 344 participants (1.6%) experienced a confirmed AMD event (316 incident AMD, 28 progression to advanced AMD). For the primary composite end point, there were 159 cases (1.5%) in the cocoa extract group and 185 cases (1.7%) in the placebo group (hazard ratio [HR], 0.87; 95% CI, 0.71-1.08; P = .21). Separate Cox models fitted because of evidence of nonproportional hazards (P = .048) indicated a 23% decreased risk in the cocoa extract group during the first 2 years of treatment (HR, 0.77; 95% CI, 0.59-1.01), with no added benefit for treatment beyond 2 years (HR, 1.06; 95% CI, 0.76-1.50). Similar time-dependent findings were observed for the secondary trial outcomes of incident visually significant AMD and advanced AMD. In this ancillary study of the COSMOS randomized clinical trial, cocoa extract supplementation for a median period of 3.6 years among older women and men had no effect overall on occurrence of AMD. However, a possible modest treatment effect early in the trial could not be ruled out, which warrants further investigation to clarify whether cocoa extract may help reduce AMD risk. ClinicalTrials.gov Identifier: NCT03205202.

Objective:Investigate the relationship between serum α-tocopherol concentration and long-term risk of prostate cancer, and evaluate the interaction with vitamin E–related genetic variants and their polygenic risk score (PRS).Methods:We conducted a biochemical analysis of 29 102 male Finnish smokers in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Serum α-tocopherol was measured at baseline using high-performance liquid chromatography, and 2 724 prostate cancer cases were identified during 28 years of follow-up. Cox proportional hazards models examined whether serum α-tocopherol concentrations were associated with prostate cancer risk. Among 8 383 participants, three SNPs related to vitamin E status (rs964184, rs2108622, and rs11057830) were examined to determine whether they modified the relationship between serum α-tocopherol concentrations and prostate cancer risk, both individually and as a PRS using logistic regression models.Results:No association was observed between serum α-tocopherol and prostate cancer risk (fifth quintile (Q5) versus Q1 hazard ratio (HR)=0.87, 95% confidence interval (95% CI) 0.75, 1.02; p-trend=0.57). Though no interactions were seen by population characteristics, high α-tocopherol concentration was associated with reduced prostate cancer risk among the trial α-tocopherol supplementation group (Q5 quintile versus Q1 HR=0.79, 95% CI 0.64, 0.99). Finally, no associated interaction between the three SNPs or their PRS and prostate cancer risk was observed.Conclusion:Although there was a weak inverse association between α-tocopherol concentration and prostate cancer risk over nearly three decades, our findings suggest that men receiving the trial α-tocopherol supplementation who had higher baseline serum α-tocopherol concentration experienced reduced prostate cancer risk. Vitamin E–related genotypes did not modify the serum α-tocopherol-prostate cancer risk association.

This study investigated the effects of differences in oral function and depressive tendencies on nutritional status in older adults requiring support or low-level care. In 106 older adult participants residing in nursing/care homes or participating in community-level preventive care activities, the Mini Nutritional Assessment-Short Form (MNA®-SF) for nutritional status and oral diadochokinesis (ODK), tongue pressure, and repetitive saliva swallowing test (RSST) for oral function, 15-item Geriatric Depression Scale (GDS), Diet-Related Quality of Life Scale-Short Form (DRQOL-SF), and Functional Independence Measure (FIM) were administered. Basic information, including cognitive function, was evaluated. Hierarchical MNA (dependent variable)-based multiple regression analysis was performed, followed by path analysis using factors with significant associations with MNA scores. RSST, ODK, tongue pressure, FIM, and DRQOL were positively correlated with MNA scores and GDS was negatively correlated. Hierarchical multiple regression demonstrated associations with tongue pressure, GDS, FIM, DRQOL scores, and gender. Path analysis confirmed significant paths from tongue pressure to MNA, tongue pressure to FIM, and FIM to MNA (P < .001). Significant paths were confirmed from GDS to MNA (P < .01), from DRQOL to MNA (P < .05), and from gender to MNA (P < .01). Tongue pressure, GDS, FIM, DRQOL scores, and gender were identified as factors that directly affect MNA. Tongue pressure showed the greatest effect and indirectly affected MNA via FIM. These findings emphasize the importance of early detection of low nutritional risk for preventing depression and oral function deterioration, and of evaluation of dietary satisfaction and improvement of quality of life in diets.

Weight and appetite regulation have been associated with the expression and secretion of ATPase inhibitory factor 1 (IF1) and growth differentiation factor-15 (GDF-15), 2 potential biomarkers for age-related mitochondrial dysfunction. The aim was to explore the associations between these biomarkers and nutritional variables in the Multidomain Alzheimer Preventive Trial study. IF1 and GDF-15 plasma levels were quantified at 1-year follow-up. The nutritional status was measured using the Mini Nutritional Assessment (MNA) score variation between baseline and 1- and 2-year visits; appetite loss was extracted from the MNA. Bodyweight was measured every 6 months until the third year and then yearly until the fifth year of follow-up, and weight loss was established if the loss was greater than 5% or 10% within the past 6 or 12 months, respectively. Bidirectional associations of IF1 and GDF-15 levels with malnutrition, appetite, and weight loss were examined. The interactions between individual IF1 and GDF-15 with sex were explored. Four hundred and forty-eight participants had MNA data and 1 045 had weight loss data. All the associations between IF1 levels and the MNA score, appetite loss, and weight loss were nonsignificant. Higher GDF-15 levels were cross-sectionally associated with appetite loss at the first year of follow-up, and the GDF-15 highest quartile was associated with nearly 80% higher risks of weight loss over 4 years. Interactions between IF1 and GDF-15 levels, and between these 2 markers and sex were not significantly associated with the outcomes. GDF-15 plasma levels were related to key malnutrition criteria.

Comparison of serum lipid compositions, lipid peroxide, α-tocopherol and lipoproteins in captive marine mammals (bottlenose dolphins, spotted seals and West Indian manatees) and terrestrial mammals

To examine the long-term effect of cocoa flavanols on inflammaging biomarkers in the COcoa Supplement and Multivitamin Outcomes Study (COSMOS). COSMOS is a large, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial testing the effects of a cocoa extract supplement (containing 500mg cocoa flavanols/day, including 80mg (-)-epicatechin) among women aged ≥65 years and men aged ≥60 years. This ancillary study measured five widely used serum inflammaging biomarkers, including three pro-inflammatory markers (high-sensitivity C-reactive protein [hsCRP], interleukin-6, tumour necrosis factor-α), one anti-inflammatory cytokine (interleukin-10) and one pleotropic cytokine (interferon-γ [IFN-γ]) in a random sample of 598 participants with biospecimens collected at baseline, Year 1, and Year 2. The mean age was 70.0 ± 5.6years, and 49.8% were female. Cocoa extract supplementation significantly decreased hsCRP levels compared with placebo, with a between-group difference in yearly percentage change relative to baseline levels of -8.4% (95% CI, -14.1% to -2.3%; nominal P = .008; Holm-adjusted P value = .039). Moreover, cocoa extract increased IFN-γ with a 6.8% (95% CI, 1.5% to 12.2%, nominal P = .011; Holm-adjusted P value = .043) difference in yearly percentage change versus placebo. The effects of cocoa extract on other inflammatory markers were not significant (all adjusted P values >.05). Cocoa extract supplementation significantly decreased hsCRP, supporting a role in modulating the chronic inflammaging process as a potential mechanism underlying its cardio-protective effects, including a 27% reduction in cardiovascular disease death in the COSMOS trial. The biological effect of increased IFN-γ by cocoa extract warrants further exploration.

Low serum concentrations of antioxidants may be associated with an increased risk of cancer. Based on the accumulated evidence, we hypothesized that retinoids would elevate serum alpha-tocopherol. This study was designed to determine whether 9-cis-retinoic acid (9-cis-RA), the most common chemopreventive agent, could alter serum alpha-tocopherol in former smokers. Because hyperlipidemia is a known side effect of retinoids, we also evaluated the association between serum alpha-tocopherol and lipids in the same population. Subjects who had stopped smoking at least 12 months before the study were randomly assigned to receive oral 9-cis-RA or placebo daily for 3 months. Clinical information and blood samples were obtained monthly; serum alpha-tocopherol concentrations were measured by high-performance liquid chromatography and lipid levels by enzymatic assays before treatment and every month during the treatment. Of the 149 subjects in the study, 113 completed 3 months of treatment and provided samples for evaluation of serum alpha-tocopherol. Serum alpha-tocopherol levels in the 9-cis-RA group (n = 52) were higher after treatment (r = 0.445, P < 0.01) than before. The incidences of grade > or =2 hypertriglyceridemia and hypercholesterolemia were higher in the 9-cis-RA group than in the placebo group (P = 0.0005 and P = 0.01, respectively), but there were no serious complications related to hyperlipidemia. Treatment of former smokers with 9-cis-RA significantly increased their serum alpha-tocopherol levels, and this could be a benefit. In addition, serum alpha-tocopherol could serve as a biomarker for 9-cis-RA treatment.

Introduction: Weak grip strength, slow walking speed, changes in body composition are very common in hospitalized older adults, their presence implies alterations in mobility, longer hospital stay, risk of falls and frailty. Objective: To evaluate the association between physical performance and nutritional status in older adults hospitalized in an EsSalud hospital in Juliaca-Peru, 2023. Methods: Quantitative approach research, descriptive cross-association, cross-sectional, observational and prospective design, the sample consisted of 50 older adults hospitalized in Base Hospital III of the Juliaca EsSalud Healthcare Network. With the due consent of the patients, data was collected, nutritional assessment was carried out by taking anthropometric measurements such as weight, height and calf circumference; manual grip strength was determined using a Jamar brand dynamometer, and functional capacity was evaluated using the timed get up and walk test. Statistical analysis was performed using measures of central tendency such as median and interquartile range, and the chi-square test was applied to evaluate the relationship between variables. Results: The association between BMI and physical performance was not statistically significant (p = 0.470). Older adults with decreased muscle mass showed a tendency toward association with weak strength. In addition, decreased muscle mass is more likely to be at high risk in the "Get Up and Walk" test, with a significant association (p = 0.000). Conclusion: A statistically significant association was found between muscle mass and physical performance. Older adults with decreased muscle mass presented poor physical performance.

The Geriatric Nutritional Risk Index as a prognostic factor in older adult patients with locally advanced head and neck cancer receiving definitive chemoradiotherapy with tri-weekly cisplatin

To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China. A cross-sectional analysis was conducted among community-dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self-reported number of natural teeth, participants were categorized into ≥20, 10-19, 1-9 natural teeth, and edentulous. Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate-to-severe malnutrition) among a subgroup of participants. Linear and multinomial logistic regression models were used to examine the corresponding associations. Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (βedentulous =-0.39, 95% confidence interval [CI], -0.48, -0.30; β1-9 teeth =-0.46, 95% CI, -0.55, -0.37; β10-19 teeth =-0.36, 95% CI, -0.46, -0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1-9 and 10-19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio=0.49, 95% CI, 0.27, 0.89). Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective interventions to improve the dietary quality and nutrition status among partially and fully edentulous individuals, including those with Stage IV periodontitis.

Background and purposeMalnutrition commonly predicts adverse outcomes among older adults in the intensive care unit (ICU). The Geriatric Nutritional Risk Index (GNRI) is a simple and practical tool for assessing nutritional status in older adults. This study aims to explore the association between GNRI and adverse post-extubation outcomes in critically ill older adults.MethodsA total of 1,153 older adults aged 65–82 years in the ICU were included in this retrospective cohort study. GNRI categories were stratified into four subgroups based on nutritional risk: major risk (GNRI < 82), moderate risk (GNRI 82–91), low risk (GNRI 92–98), and no risk (GNRI > 98). Adverse post-extubation outcomes included mortality or pneumonia within 30 days post-extubation, reintubation within 72 h, post-extubation dysphagia, and length of stay (LOS) in the ICU and hospital. Multivariable logistic regression analysis and restricted cubic spline (RCS) were used to explore the association between GNRI categories and dichotomous adverse outcomes. Additionally, multivariable linear regression was used to evaluate the association between GNRI and LOS in the ICU and hospital.ResultsOlder adults with dichotomous adverse outcomes had lower GNRI values compared with those without (P-value<0.001), and increasing LOS in ICU and hospital was associated with decreasing GNRI value (P for trend<0.001). Patients at major nutritional risk had the highest risk of mortality [OR = 2.76, 95%CI: 1.40 ∼ 5.46] or pneumonia [OR = 3.07, 95%CI: 1.42 ∼ 6.68] within 30 days post-extubation, reintubation within 72 h [OR = 2.41, 95%CI: 1.06 ∼ 5.49] and post-extubation dysphagia [OR = 2.94, 95%CI: 1.19 ∼ 7.31](P for trend<0.001). The RCS study also validated the linear relationship between GNRI and mortality/pneumonia within 30 days post-extubation and post-extubation dysphagia. Conversely, there were non-linear associations between GNRI and ICU and hospital LOS, as well as reintubation within 72 h. Furthermore, GNRI showed a significant negative correlation with LOS in both the ICU and hospital. Kaplan-Meier curve analysis demonstrated that survival within 30 days post-extubation was significantly reduced in major nutritional risk group compared to the no risk group (P-value = 0.018).ConclusionsOur findings demonstrated that major nutritional risk defined by GNRI was associated with a higher risk of adverse post-extubation outcomes in critically ill older adults.

Analysis of the characteristics and components for the frailty syndrome in older adults from central Chile. The PIEI-ES study

Background and Aims Serum creatinine (sCr) often inaccurately estimates eGFR due to non-GFR determinants such as malnutrition. The 2024 KDIGO Guidelines recommend greater use of Cystatin C (CysC) for confirmatory eGFR testing and CKD staging. This study aimed to audit the utilization of CysC in confirmatory eGFR testing among older patients and examine the relationship between eGFR measurements and nutritional status, as assessed by the controlling nutritional status (CONUT) score. Method This retrospective cross-sectional study included hospitalized patients aged 65 years or older who underwent routine renal function testing. The frequency of prior Cystatin C (CysC) testing was recorded, and CysC measurements were taken to calculate combined CysC–serum creatinine (sCr) eGFR in all patients. Nutritional status was evaluated using the CONUT score, derived from serum albumin, total cholesterol, and lymphocyte count (Table 1). Differences in CKD staging between sCr-based eGFR and combined CysC–sCr eGFR were analysed using the chi-square test to determine any association with nutritional status. Results The study included 100 patients (median age: 81 years) with significant co-morbidities, including congestive cardiac failure (28%), diabetes mellitus (26%), and respiratory disease (23%). Biochemical nutritional deficits were prevalent, with 75% of patients showing intermediate or high CONUT scores. None of the patients had prior CysC testing for confirmatory eGFR assessment. Application of the combined CysC–sCr equation reclassified 55% of patients to a lower CKD stage, while only 2% were reclassified to a higher CKD stage. This re-classification of CKD stage is displayed in Graph 1. The relationship between CONUT score and differences in CKD staging was not statistically significant (P = 0.78). Conclusion This study highlights the underutilization of Cystatin C in the assessment of renal function in older adults, despite its ability to significantly alter CKD staging. The CONUT score was not a reliable predictor for identifying patients requiring confirmatory eGFR testing, underscoring the need for comprehensive nutritional assessments. Integrating CysC into renal function evaluation may improve diagnostic accuracy in this population.

Circulating oxidized low-density lipoproteins are associated with overweight, obesity, and low serum carotenoids in older community-dwelling women