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ABSTRACT Background: National guidelines for managing diabetes set standards for care. We sought to determine whether a 1-year intensive multitherapy program resulted in greater goal attainment than usual care among [...]

Abstract UNINTENTIONAL WEIGHT LOSS, or the involuntary decline in total body weight over time, is common among elderly people who live at home. Weight loss in elderly people can have [...]

Background: Ascorbate and glutathione play central roles in the defense against free radicals and oxidants that are implicated in chronic diseases. Objective: The objective was to determine the ability of vitamin C supplements to modulate the concentration of glutathione in human lymphocytes. Design: The effect of vitamin C supplements was determined in a sequential study with time points before supplementation, after 13 wk of vitamin C supplements (500 or 1000 mg/d), and after 13 wk of matching placebo. The supplementation group was selected on the basis of low plasma ascorbate (< 33 mmol/L) and consisted of 48 healthy men and women, smokers and nonsmokers, aged 25-64 y. Ascorbate and glutathione were measured in purified lymphocytes. Results: At baseline, the mean ([+ or -] SD) concentration of plasma ascorbate was 19.5 [+ or -] 7.2 [micro]mol/L, 22.5 [micro]mol/L below the median of normal distribution. The ascorbate concentration in plasma was linearly associated with that in lymphocytes (r = 0.53, P < 0.001). On supplementation with vitamin C, lymphocyte ascorbate increased by 51% (from 16.7 [+ or -] 4.9 to 25.3 [+ or -] 6.9 nmol/mg protein; P < 0.001) and was accompanied by an increase of lymphocyte glutathione by 18% (from 22.5 [+ or -] 4.5 to 26.6 [+ or -] 6.5 nmol/mg protein; P < 0.001). After placebo, the ascorbate and glutathione concentrations fell to near baseline concentrations (17.1 [+ or -] 5.4 and 23.5 [+ or -] 6.4 nmol/mg protein, respectively). No significant interaction was observed for sex and smoking status. Finally, the changes in lymphocyte ascorbate after supplementation were strongly associated with changes in lymphocyte glutathione (r = 0.71, P < 0.001). The association suggests that every 1-mol change in ascorbate is accompanied by a change of [approximately equal to] 0.5 mol in glutathione. Conclusion: Vitamin C supplements increase glutathione in human lymphocytes.

A significant portion of the elderly who do not live in institutions have been observed to be at risk for deficiencies of certain nutrients. Immune functions appear to be affected by deficiencies of specific nutrients such as proteins, or by lack of sufficient calories. Defective immune function in the elderly has been implicated in some of the diseases and infections to which the elderly are susceptible. However, the association between immune function, dietary status, and resistance to disease in the aged has not been well studied. The immune status of 82 free-living elderly persons was evaluated in relation to their nutritional status. For most of the subjects, nutrient intake was above two-thirds the recommended levels, with many having more than adequate intake due to the use of supplements. However, many had inadequate zinc intake, with 19 percent having low blood zinc levels. In addition, study subjects had a somewhat low calorie intake. Two measures of immune function were used, and these were associated with resistance to cancer and regulation of immune response. The first, determination of the cytolytic (cell-destroying) activity of NK (natural killer) cells, a type of white blood cell, was highly variable and not associated with blood levels or intake of any particular nutrient. The second test measured activity of interleukin-2 (IL-2), a protein made by a type of white blood cell, and this was undetectable in 69 percent of subjects. Among those with IL-2 activity, levels were one-third that of young adults. Although not related to blood levels of nutrients, IL-2 activity decreased as intake of vitamin E and D increased in men, and as vitamin E intake increased in women. IL-2 activity was likely to be higher among men than women with the same vitamin D and E intake. Further research is needed to delineate the relationship between nutrition and immune function in the elderly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Data from the Massachusetts Framingham Heart Study is used to investigate risk factors for sarcopenia, or age-related skeletal muscle mass loss, in elderly patients living in community settings. Findings show that sarcopenia is related to a decrease in anabolic stimuli in men, such as growth hormone, but is related to a rise in catabolic stimuli in women, such as interleukin 6.

Background: Endogenous reactive oxygen species appear to contribute to aging and cancer and dietary antioxidants, present in fruit and vegetables, counteract these effects. Objective: The objective was to examine the association between intracellular glutathione, ascorbate (vitamin C), and [Alpha]-tocopherol (vitamin E) in human lymphocytes. Design: The study group consisted of 240 healthy nonsmoking volunteers with an approximately equal number of male and female subjects subdivided into 3 age groups: 18-39, 40-59, and [is greater than or equal to] 60 y). Glutathione, glutathione disulfide, ascorbate, and [Alpha]-tocopherol were measured in lymphocytes by HPLC. Results: The average concentration of antioxidants in lymphocytes was 27 [+ or -] 8 nmol/mg protein for glutathione, 21 [+ or -] 8 nmol/mg protein for ascorbate, and 0.4 [+ or -] 0.2 nmol/mg protein for [Alpha]-tocopherol. There was a strong positive correlation between glutathione and ascorbate (r = 0.62, P [is less than] 0.001). No correlation was observed for glutathione and ascorbate with [Alpha]-tocopherol. The concentration of glutathione in lymphocytes was inversely correlated with age (r = - 0.19, P [is less than] 0.01), as was that of ascorbate (r = - 0.22, P [is less than] 0.01), with 10-20% lower values in elderly than in young and elderly subjects. The concentrations of glutathione in lymphocytes were as much as 25% higher and those of ascorbate were as much as 38% higher during the summer than during the winter. The seasonal variation of ascorbate in lymphocytes was described by a linear function for age and a periodic sine function for season. Conclusion: Glutathione and ascorbate are directly correlated in human lymphocytes. Am J Clin Nutr 2000;71:1194-200. KEY WORDS Vitamin C, vitamin E, glutathione, lymphocytes, ascorbic acid, antioxidants, micronutrients, aging, elderly, cancer, reactive oxygen species, season

Identification of eating patterns in older people can contribute to prevention of nutritional inadequacy and promotion of optimal aging strategies. Many 'functional foods' (FF), common foods with health benefits beyond their nutritive value, have antioxidant properties with potential to mediate the degenerative changes of aging. A pilot study was conducted among 51 healthy, home-dwelling elderly people aged 70 to 86 (51% male) to develop a method for evaluating relationships between lifelong diet and health. A population-based semi-quantitative food frequency questionnaire (FFQ) with portion size photos was modified for older people and used to assess usual diet. A non-quantitative questionnaire (FF-FFQ) was also developed to examine intake patterns of 33 FF currently, and at ages 65, 45, 25 and 10. Visual aides and memory cues were employed to help respondents remember past intakes, and their reporting confidence was queried. The instrument was self-administered (among 32%), or administered by a dietitian-interviewer in face-to-face (42%) or telephone (26%) interviews. The semi-quantitative FFQ was validated by 4 dietary recalls adjusted for intraindividual and seasonal variability. Reliability of the FF-FFQ was assessed in a sub-sample (n-20). Average usual energy intakes were 1898 [+ or -] 495 kcal (men) and 1681 [+ or -] 458 kcal (women). Participants reported their current, regular (several times/month) number of FFs eaten as 18 [+ or -] 4 (men) and 20 [+ or -] 4 (women). These averages decreased almost linearly with time: at age 10, numbers reported were 12 [+ or -] 7 (men) and 15 [+ or -] 4 (women). Men differed from women in their memory of food consumption, food choices (particularly protein foods) and FF intakes. Food-related memory appears to be linked to dietary knowledge, food preparation experience and availability of foods in the past. The FF-FFQ provides novel data on lifetime FF consumption which can help clarify relationships between diet and health, and the role of diet in aging.

Objective: To evaluate the impact of nutritional intervention on nutritional status, muscle strength, functional status and quality of life in Meals-On-Wheels elderly clients at risk of malnutrition (17 [greater than or equal to] MNA[TM] [less than or equal to] 23.5). Methods: 99 elderly adults (79 [+ or -] 6 years) were randomized to an experimental (E) group (n=50) provided with a nutrient dense protein-energy liquid supplement (NuBasics[R]) and professional nutrition counseling to improve daily intake from other foods, or to a control (C) group (n=49). Both groups were home visited on a monthly basis. Outcome variables were measured at the start (week 0) and end (week 24) of the study by a dietitian blinded to treatment assignment and compared on an 'intention to treat' basis using ANOVA for repeated measures. Results: Total mean daily energy (+150 kcal; p27% (M) or >38% (F) body fat, classified 15 E and 18 C as obese. No improvement in nutritional or anthropometric indices was observed in obese E subjects as compared to obese C except for protein intake (p=.001). A tendency to decreased functional performance (knee extension: p=.09, walking speed: p=.06) and reduced perceived vitality (p=.05) and general health (p=.06) was observed in obese E subjects compared to obese C. In contrast, in nonobese E subjects, intervention brought about a significant improvement in perceived general health (p=.04). Conclusion: Individuals at risk of malnutrition encompass heterogeneous sub-groups of the free-living frail elderly. This may tone down or mask efficacy of nutritional interventions. The latter should specify target population and appropriatly adapt strategies. Supported by University-Industry grant from Medical Research Council of Canada and Nestec, Ltd.