@article{HerpichHassKochliketal.2021,
  author    = {Herpich, Catrin and Haß, Ulrike and Kochlik, Bastian Max and Franz, Kristina and Laeger, Thomas and Klaus, Susanne and Bosy-Westphal, Anja and Norman, Kristina},
  title     = {Postprandial dynamics and response of fibroblast growth factor 21 in older adults},
  series = {Clinical Nutrition},
  volume    = {40},
  journal   = {Clinical Nutrition},
  number    = {6},
  publisher = {Elsevier},
  address   = {Amsterdam},
  issn      = {0261-5614},
  doi       = {10.1016/j.clnu.2021.04.037},
  pages     = {3765 -- 3771},
  year      = {2021},
  abstract  = {Background \& aims: Fibroblast growth factor 21 (FGF21) plays a pivotal role in glucose and lipid metabolism and has been proposed as a longevity hormone. However, elevated plasma FGF21 concentrations are paradoxically associated with mortality in higher age and little is known about the postprandial regulation of FGF21 in older adults. In this parallel group study, we investigated postprandial FGF21 dynamics and response in older (65-85 years) compared to younger (18-35 years) adults following test meals with varying macronutrient composition. Methods: Participants (n = 60 older; n = 60 younger) were randomized to one of four test meals: dextrose, high carbohydrate (HC), high fat (HF) or high protein (HP). Blood was drawn before and 15, 30, 60, 120, 240 min after meal ingestion. Postprandial dynamics were evaluated using repeated measures ANCOVA. FGF21 response was assessed by incremental area under the curve. Results: Fasting FGF21 concentrations were significantly higher in older adults. FGF21 dynamics were affected by test meal (p < 0.001) and age (p = 0.013), when adjusted for BMI and fasting FGF21. Postprandial FGF21 concentrations steadily declined over 240 min in both age groups after HF and HP, but not after dextrose or HC ingestion. At 240 min, FGF21 concentrations were significantly higher in older than in younger adults following dextrose (133 pg/mL, 95\%CI: 103, 172 versus 91.2 pg/mL, 95\%CI: 70.4, 118; p = 0.044), HC (109 pg/mL, 95\%CI: 85.1, 141 versus 70.3 pg/mL, 95\%CI: 55.2, 89.6; p = 0.014) and HP ingestion (45.4 pg/mL, 95\%CI: 34.4, 59.9 versus 27.9 pg/mL 95\%CI: 20.9, 37.1; p = 0.018). FGF21 dynamics and response to HF were similar for both age groups. Conclusions: The age-specific differences in postprandial FGF21 dynamics and response in healthy adults, potentially explain higher FGF21 concentrations in older age. Furthermore, there appears to be a significant impact of acute and recent protein intake on FGF21 secretion.},
  language  = {en}
}
@article{FranzOttenMuellerWerdanetal.2019,
  author    = {Franz, Kristina and Otten, Lindsey and M{\"u}ller-Werdan, Ursula and D{\"o}hner, Wolfram and Norman, Kristina},
  title     = {Severe Weight Loss and Its Association with Fatigue in Old Patients at Discharge from a Geriatric Hospital},
  series = {Nutrients},
  volume    = {11},
  journal   = {Nutrients},
  number    = {10},
  publisher = {MDPI},
  address   = {Basel},
  issn      = {2072-6643},
  doi       = {10.3390/nu11102415},
  pages     = {10},
  year      = {2019},
  abstract  = {Although malnutrition is frequent in the old, little is known about its association with fatigue. We evaluated the relation of self-reported severe weight loss with fatigue and the predictors for fatigue in old patients at hospital discharge. Severe weight loss was defined according to involuntary weight loss >= 5\% in the last three months. We determined fatigue with the validated Brief Fatigue Inventory questionnaire. The regression analyses were adjusted for age, sex, number of comorbidities, medications/day, and BMI. Of 424 patients aged between 61 and 98 y, 34.1\% had severe weight loss. Fatigue was higher in patients with severe weight loss (3.7 +/- 2.3 vs. 3.2 +/- 2.3 points, p = 0.021). In a multinomial regression model, weight loss was independently associated with higher risk for moderate fatigue (OR:1.172, CI:1.026-1.338, p = 0.019) and with increased risk for severe fatigue (OR:1.209, CI:1.047-1.395, p = 0.010) together with the number of medications/day (OR:1.220, CI:1.023-1.455, p = 0.027). In a binary regression model, severe weight loss predicted moderate-to-severe fatigue in the study population (OR:1.651, CI:1.052-2.590, p = 0.029). In summary, patients with self-reported severe weight loss at hospital discharge exhibited higher fatigue levels and severe weight loss was an independent predictor of moderate and severe fatigue, placing these patients at risk for impaired outcome in the post-hospital period.},
  language  = {en}
}
@article{FranzOstOttenetal.2018,
  author    = {Franz, Kristina and Ost, Mario and Otten, Lindsey and Herpich, Catrin and Coleman, Verena and Endres, Anne-Sophie and Klaus, Susanne and M{\"u}ller-Werdan, Ursula and Norman, Kristina},
  title     = {Higher serum levels of fibroblast growth factor 21 in old patients with cachexia},
  series = {Nutrition : the international journal of applied and basic nutritional sciences},
  volume    = {63-64},
  journal   = {Nutrition : the international journal of applied and basic nutritional sciences},
  publisher = {Elsevier},
  address   = {New York},
  issn      = {0899-9007},
  doi       = {10.1016/j.nut.2018.11.004},
  pages     = {81 -- 86},
  year      = {2018},
  abstract  = {Objective: Fibroblast growth factor (FGF)21 is promptly induced by short fasting in animal models to regulate glucose and fat metabolism. Data on FGF21 in humans are inconsistent and FGF21 has not yet been investigated in old patients with cachexia, a complex syndrome characterized by inflammation and weight loss. The aim of this study was to explore the association of FGF21 with cachexia in old patients compared with their healthy counterparts. Methods: Serum FGF21 and its inactivating enzyme fibroblast activation protein (FAP)-cc were measured with enzyme-linked immunoassays. Cachexia was defined as >= 5\% weight loss in the previous 3 mo and concurrent anorexia (Council on Nutrition appetite questionnaire). Results: We included 103 patients with and without cachexia (76.9 +/- 5.2 y of age) and 56 healthy controls (72.9 +/- 5.9 y of age). Cachexia was present in 16.5\% of patients. These patients had significantly higher total FGF21 levels than controls (952.1 +/- 821.3 versus 525.2 +/- 560.3 pg/mL; P= 0.012) and the lowest FGF21 levels (293.3 +/- 150.9 pg/mL) were found in the control group (global P < 0.001). Although FAP-alpha did not differ between the three groups (global P = 0.082), bioactive FGF21 was significantly higher in patients with cachexia (global P = 0.002). Risk factor-adjusted regression analyses revealed a significant association between cachexia and total ((beta = 649.745 pg/mL; P < 0.001) and bioactive FGF21 (beta = 393.200 pg/mL; P <0.001), independent of sex, age, and body mass index. Conclusions: Patients with cachexia exhibited the highest FGF21 levels. Clarification is needed to determine whether this is an adaptive response to nutrient deprivation in disease-related cachexia or whether the increased FGF21 values contribute to the catabolic state. (C) 2018 Elsevier Inc. All rights reserved.},
  language  = {en}
}