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      Low Protein Intake Is Associated with Frailty in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies

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          Abstract

          (1) Background: Several factors have been suggested to be associated with the physiopathology of frailty in older adults, and nutrition (especially protein intake) has been attributed fundamental importance in this context. The objective of this study was to conduct a systematic review and meta-analysis to investigate the relationship between protein intake and frailty status in older adults. (2) Methods: A search of scientific studies was conducted in the main databases (Medline, Scopus, Cochrane library), and in the reference lists of selected articles. The search terms included synonyms and Medical Subject Headings and involved the use of Boolean operators which allowed the combination of words and search terms. Observational studies—cross-sectional and longitudinal—that met the eligibility criteria were included in the review. Article selection and data extraction were performed by two independent reviewers. Meta-analyses with random effects were performed. Publication bias was measured using the Strengthening the Reporting of Observational Studies in Epidemiology instrument. (3) Results: In the final sample, 10 articles, seven cross-sectional and three longitudinal, were included in the present study. Overall, studies investigated a total of 50,284 older adults from three different continents between 2006 and 2018. Four cross-sectional studies were included in the meta-analyses. The results demonstrated that a high protein intake was negatively associated with frailty status in older adults (odds ratio: 0.67, confidence interval = 0.56 to 0.82, p = 0.0001). (4) Conclusions: Our findings suggest that a high consumption of dietary protein is inversely associated with frailty in older adults.

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          Nutritional determinants of frailty in older adults: A systematic review

          Background Frailty is a geriatric syndrome that affects multiple domains of human functioning. A variety of problems contributes to the development of this syndrome; poor nutritional status is an important determinant of this condition. The purpose of this systematic review was to examine recent evidence regarding the association between nutritional status and frailty syndrome in older adults. Methods PubMed, Web of Science, and Scopus electronic databases were searched using specific key words, for observational papers that were published during the period from 2005 to February 2017 and that studied the association or relationship between nutritional status and frailty in older adults. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was followed to assess the quality of the included articles. Results Of the 2042 studies found, nineteen met the inclusion criteria. Of these studies, five provided data on micronutrients and frailty, and reported that frailty syndrome is associated with low intakes of specific micronutrients. Five studies provided data on macronutrients and frailty, and among those studies, four revealed that a higher protein intake was associated with a lower risk of frailty. Three studies examined the relationship between diet quality and frailty, and showed that the quality of the diet is inversely associated with the risk of being frail. Two studies provided data on the antioxidant capacity of the diet and frailty, and reported that a high dietary antioxidant capacity is associated with a lower risk of developing frailty. Finally, seven studies evaluated the relationship between scores on both the Mini Nutritional Assessment (MNA) and the MNA-SF (Short Form) and frailty, and revealed an association between malnutrition and/or the risk of malnutrition and frailty. Conclusions This systematic review confirms the importance of both quantitative (energy intake) and qualitative (nutrient quality) factors of nutrition in the development of frailty syndrome in older adults. However, more longitudinal studies on this topic are required to further understand the potential role of nutrition in the prevention, postponement, or even reversion of frailty syndrome. Electronic supplementary material The online version of this article (doi:10.1186/s12877-017-0496-2) contains supplementary material, which is available to authorized users.
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            Frailty in Older Persons

            Frailty is a clinical state characterized by a decrease of an individual's homeostatic reserves and is responsible for enhanced vulnerability to endogenous and/or exogenous stressors. Such a condition of extreme vulnerability exposes individuals to an increased risk of negative health-related outcomes. Multiple operational definitions of frailty are available in the literature, but none can be indicated as a gold standard. Frailty should be considered a condition of major interest for public health and become the lever for reshaping the obsolete health care systems currently unable to adequately address the clinical needs of aging populations.
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              Does nutrition play a role in the prevention and management of sarcopenia?

              There is a growing body of evidence that links nutrition to muscle mass, strength and function in older adults, suggesting that it has an important role to play both in the prevention and management of sarcopenia. This review summarises the discussions of a working group [ESCEO working group meeting 8th September 2016] that met to review current evidence and to consider its implications for preventive and treatment strategies. The review points to the importance of 'healthier' dietary patterns that are adequate in quality in older age, to ensure sufficient intakes of protein, vitamin D, antioxidant nutrients and long-chain polyunsaturated fatty acids. In particular, there is substantial evidence to support the roles of dietary protein and physical activity as key anabolic stimuli for muscle protein synthesis. However, much of the evidence is observational and from high-income countries. Further high-quality trials, particularly from more diverse populations, are needed to enable an understanding of dose and duration effects of individual nutrients on function, to elucidate mechanistic links, and to define optimal profiles and patterns of nutrient intake for older adults.

                Author and article information

                Journal
                Nutrients
                Nutrients
                nutrients
                Nutrients
                MDPI
                2072-6643
                19 September 2018
                September 2018
                : 10
                : 9
                : 1334
                Affiliations
                [1 ]Applied Kinesiology Laboratory–LCA, School of Physical Education, University of Campinas, Av. Érico Veríssimo, 701, Cidade Universitária “Zeferino Vaz”, Barão Geraldo, Campinas-SP 13083-851, Brazil; prof.brodrigues@ 123456gmail.com (B.R.); uchida@ 123456g.unicamp.br (M.U.)
                [2 ]Department of Geriatrics, Neurosciences and Orthopedics, Teaching Hospital “Agostino Gemelli”, Catholic University of the Sacred Heart, 00168 Rome, Italy; emarzetti@ 123456live.com
                Author notes
                [* ]Correspondence: coelhojunior@ 123456hotmail.com.br ; Tel.: +55-1194-9398-302
                Author information
                https://orcid.org/0000-0001-7482-9514
                https://orcid.org/0000-0003-4246-4703
                https://orcid.org/0000-0001-9567-6983
                Article
                nutrients-10-01334
                10.3390/nu10091334
                6165078
                30235893
                2bff96df-5ae3-4a79-ac8f-8432e73e6946
                © 2018 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 23 July 2018
                : 14 September 2018
                Categories
                Review

                Nutrition & Dietetics
                frailty,protein intake,older adults
                Nutrition & Dietetics
                frailty, protein intake, older adults

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