A Longitudinal Study on the Nutritional State of Elderly Women at a Nursing Home in Japan

Nakamura, Hironori; Fukushima, Hideki; Miwa, Yoshiyuki; Shiraki, Makoto; Gomi, Ikuko; Saito, Masaya; Mawatari, Kazunori; Kobayashi, Hisamine; Kato, Masahiko; Moriwaki, Hisataka

doi:10.2169/internalmedicine.45.1743

Cited by 23 publications

(20 citation statements)

References 30 publications

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“…On the other hand, in elderly people, digestion and absorption are delayed by aging, and energy intake is decreased by decreased physical activity. Most elderly people, especially those residing in nursing homes and hospitals, tend to suffer from protein-energy malnutrition (PEM) (3). PEM status is indicated by hypoalbuminemia.…”

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confidence: 99%

Medium-Chain Triacylglycerol Suppresses the Decrease of Plasma Albumin Level through the Insulin-Akt-mTOR Pathway in the Livers of Malnourished Rats

Sekine

Terada

Aoyama

2013

J Nutr Sci Vitaminol

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123Medium-chain triacylglycerol (MCT) has been utilized for improvements of nutritional and energy statuses in preterm infants (1) and in patients with a variety of malabsorptive disorders (2) since the 1960s, because MCT is rapidly digested and absorbed in the gastrointestinal tract. On the other hand, in elderly people, digestion and absorption are delayed by aging, and energy intake is decreased by decreased physical activity. Most elderly people, especially those residing in nursing homes and hospitals, tend to suffer from protein-energy malnutrition (PEM) (3). PEM status is indicated by hypoalbuminemia. Albumin is synthesized in the liver, and serum albumin is a major component of serum protein, which sustains osmotic pressure and transports many kinds of substances or hormones to organs. Serum albumin has been the most common index of nutritional status. Its concentration in serum is influenced by many factors independent of nutritional factors, such as infections, trauma (by an increase in the transcapillary escape rate of albumin), hydration status (by haemodilution), liver function (by a decrease in synthesis) and kidney disease (by albumin losses).In previous studies, dietary MCT improved serum albumin concentration in elderly people with PEM (4) and in malnourished rats (5, 6). Nitrogen balance was also improved by dietary MCT (5, 7). Kojima and Kasai hypothesized that improvement of protein balance with MCT intake occurred through suppression of gluconeogenesis, which mainly started from body protein degradation. However, gluconeogenic enzymes were not changed in malnourished rats fed MCT (6). Therefore, the mechanism for the albumin improvement effect of dietary MCT is not yet clear. The results of previous studies indicated that dietary MCT increases serum insulin concentration in the rats (6,8,9) and humans (7, 10). One of the main properties of MCT is its ketogenic character (8,11,12). Madison et al. reported that ketone bodies have a direct stimulatory effect on the pancreatic beta cells (13). Insulin and other growth factors activate mammalian target of rapamycin (mTOR) complex 1 (mTORC1) via the activation of phosphatidylinositol 3-kinase (PI3K) and its downstream effecter, Akt (also called protein kinase B) (14,15). Active mTOR enhances cell growth by promoting mRNA translation and increasing cell mass (16,17). Ijichi et al. reported that branched-chain amino acids promote albumin synthesis in rat hepatocytes through the mTOR signal transduction system (18). Because mTOR might relate to albumin synthesis, we hypothesized that one of the mechanisms for the albumin improvement effect of dietary MCT is related to the insulin-Akt-mTOR signal transduction system. To clarify the albumin improvement mechanism of MCT, in the present study we evalu- Summary Recent studies have shown that medium-chain triacylglycerol (MCT) improved serum albumin concentration in elderly people with protein-energy malnutrition (PEM) and in malnourished rats. However, the mechanism for this effect has not been clarified....

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confidence: 99%

Medium-Chain Triacylglycerol Suppresses the Decrease of Plasma Albumin Level through the Insulin-Akt-mTOR Pathway in the Livers of Malnourished Rats

Sekine

Terada

Aoyama

2013

J Nutr Sci Vitaminol

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“…Thus, sarcopenia has also become a social and economic problem in aging societies 6) . The decrease in skeletal muscle mass with age is thought to be about 1% per year; however, Japanese elderly women (mean age, 83 years) living in a long-term nursing care facility that we studied had an average decrease of 4% per year, and the decrease in skeletal muscle mass was greater in those patients with a lower level of activities of daily living (ADLs) 7) . Inactivity is a major factor resulting in sarcopenia.…”

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confidence: 85%

Age-related sarcopenia and amino acid nutrition

Kobayashi

2013

JPFSM

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A decrease in skeletal muscle mass and strength, a condition called sarcopenia, occurs with aging. Because sarcopenia is one of the main factors of frailty and the need for nursing care in elderly people, effective treatment measures for it should be established. The skeletal muscle protein synthetic response to food/nutrition is blunted in the elderly and is thought to be the cause of sarcopenia. Therefore, stimulating skeletal muscle protein synthesis is the most effective way to prevent and treat sarcopenia in the elderly. A series of studies demonstrated that the oral intake of essential amino acids is important for promoting skeletal muscle protein synthesis in the elderly, and that the use of an essential amino acid mixture with an increased leucine content of up to 40% (Amino L40) more efficiently stimulated skeletal muscle protein synthesis in the elderly. We confirmed that Japanese women (aged >75 years) with sarcopenia who were prescribed 3 g of Amino L40 twice daily and moderate intensity exercise for 3 months gained muscle mass and strength as well as increased walking speed. Thus, use of the nutritional supplement Amino L40 would be an effective strategy to combat sarcopenia.

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“…There are a number of studies that document that 10 to 50% of nursing home residents are malnourished (Donini LM & Al, 2000;Saletti A & Al, 2000;Omran ML & Morley JE, 2000;Nakamura H & Al, 2006;Pauly L & Al, 2007). Over 50% of nursing home residents have reported to suffer from protein caloric malnutrition (Nakamura H & Al, 2006;Ordòňez J & Al, 2010).…”

Section: Nutrition and Malnutritionmentioning

confidence: 99%

“…Over 50% of nursing home residents have reported to suffer from protein caloric malnutrition (Nakamura H & Al, 2006;Ordòňez J & Al, 2010). Vitamin, zinc and micronutrients deficiencies are also reported (Mandal SK & Ray AK, 1987;Girodon F & Al, 1997;Bates CJ & Al, 1999a;1999b;Gosney MA & Al, 2008).…”

Section: Nutrition and Malnutritionmentioning

confidence: 99%