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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.
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.
Western-style obesity-promoting diets are associated with increased inflammation, higher disease incidence and mortality.
In contrast, plant-based diets (PBDs), which incorporate large amounts of vegetables and fruit, legumes, whole grains and only a small amount of meat, are generally associated with better health and lower mortality.
This narrative review summarizes the evidence on health and life span in adults adhering to PBDs and discusses the potentially longevity-promoting mechanism of PBDs as well as limitations due to nutrient deficiencies.
Epidemiologic studies consistently report lower mortality rates in adults who adhering to PBDs when compared with people whose diet regularly includes meat.
PBDs are associated with many health benefits, such as improved metabolic and inflammatory profile.
In turn, the incidence of cardiovascular disease is lower in adults consuming PBDs, which contributes to their better health. The health-promoting effects of PBDs are still not entirely clear but most likely multifactorial and include modulation of the gut microbiome. The interest in possible longevity-promoting mechanisms of PBDs has increased in recent years, as many characteristics of PBDs such as protein restriction and restriction of certain amino acids are known to extend the life span.
While there is ample evidence from animal studies, large-scale human studies, which also provide insight into the specific mechanisms of the effect of PBDs on longevity, are missing.
However, due to the lower protein content of PBDs, there appears to be an age limit for the anticipated health effects, as adults over 65 require larger amounts of protein.