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Key summary points: Aim: To examined the potential association between intrinsic capacity (IC) and oral functional decline in older adult population. Findings: This study highlights the potential relationship between the number of IC domain deficits and oral functional decline, with the most significant domain being locomotion. Furthermore, it suggests a possible link between sensory and oral function. Message: Future longitudinal studies are required to elucidate the dynamic nature of the relationships examined in the present study. Purpose: This study aimed to investigate how intrinsic capacity (IC) deficit is associated with oral functional decline. Methods: This cross-sectional study enrolled older adults at a research hospital frailty clinic between July 2021 and May 2023. IC evaluation included the locomotion, cognition, vitality, psychology, and sensory domains. Criteria for deficits were established within each domain, and the number of IC deficit domains was calculated for each patient. Oral function assessment included oral hygiene, oral dryness, occlusal force, tongue–lip motor function, tongue pressure, masticatory function, and swallowing function. Patients who met three or more criteria were classified into the oral hypofunction (OHF) group. Univariate and multivariate logistic regression analyses were performed to investigate the relationship between IC deficit and OHF. Results: Of 222 included patients (mean age 78.3 ± 6.3 years; 39.6% men), 105 (47.3%) met the criteria for OHF. This OHF group showed a significantly higher prevalence of locomotion, cognition, psychology, and sensory domain deficits than the normal oral function group. Multivariate analysis adjusted for age and sex revealed a significant association between IC deficits and OHF (odds ratio [OR], 1.33; 95% confidence interval [CI] 1.04–1.70). A significant association was also observed between the locomotion domain and OHF (OR, 2.06; 95% CI 1.13–3.76). Conclusion: This study highlights the potential relationship between the number of IC domain deficits and oral functional decline, with the most significant domain being locomotion. Furthermore, it suggests a possible link between sensory and oral function. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: This study aimed to investigate whether HFRS affects the postoperative incidence of HAD in older patients who underwent pancreatectomy. Findings: The prevalence of intermediate and high-risk frailty was 2.7% and the incidence of HAD was significantly higher in the intermediate- and high-risk groups compared to that in the low-risk group. Logistic regression analysis demonstrated that intermediate and high risks of frailty increased the likelihood of HAD (odds ratio, 3.55; 95% confidence interval: 1.12–11.2). Message: The risk of frailty evaluated using the HFRS increased the likelihood of developing HAD in older patients undergoing pancreatectomy. Purpose: Frailty and hospitalization-associated disabilities (HAD) are geriatric conditions that should be managed in older patients undergoing pancreatectomy. The Hospital Frailty Risk Score (HFRS) can evaluate frailty based on medical records and could predict postoperative activities of daily living (ADL) decline. This study aimed to investigate whether HFRS affects the postoperative incidence of HAD in older patients who underwent pancreatectomy. Methods: This retrospective, observational study used data from a nationwide hospital-based database. We included consecutive patients aged ≥ 65 years who were diagnosed with pancreatic cancer (International Statistical Classification of Diseases, 10th revision code C25) and underwent curative pancreatectomy between April 2014 and August 2020. We evaluated preoperative frailty using HFRS. The primary outcome was HAD following pancreatectomy. Logistic regression analysis was performed for analyzing the impact of frailty on HAD following pancreatectomy. Results: We included 671 patients for the analysis (mean age 74.3 ± 5.6, male 54.8%). The prevalence of intermediate and high risk of frailty with HFRS ≥ 5 was 2.7%. The incidence of HAD was significantly higher in the intermediate- and high-risk groups compared to that in the low-risk group (33.3% vs. 8.4%, p < 0.001). Logistic regression analysis demonstrated that intermediate and high risks of frailty increased the likelihood of HAD (odds ratio, 3.55; 95% confidence interval: 1.12–11.2). Conclusions: The risk of frailty evaluated using the HFRS increased the likelihood of developing HAD in older patients undergoing pancreatectomy. Future research on effective perioperative interventions for preventing postoperative HAD and enhancing postoperative ADL recovery is warranted. [ABSTRACT FROM AUTHOR]

Objective: To assess the associations between oral health status and short-term functional outcomes in hospitalized patients aged over 65 years with acute ischemic stroke. Materials and methods: This retrospective observational analysis included older adult patients (age, ≥ 65 years) admitted for acute ischemic stroke. The oral health status at admission was evaluated using the Oral Health Assessment Tool (OHAT). Patients were categorized into the normal oral health (OHAT score, 0–2) or poor oral health (OHAT score, ≥ 3) group. Stroke severity, Functional Oral Intake Scale (FOIS), and medical history were compared. Multivariate analysis was used to determine the association between the OHAT score and modified Rankin Scale (mRS) score at discharge, FOIS score at discharge, and length of hospital stay. Results: The study comprised 129 patients (mean age: 78.8 ± 7.7 years). The poor oral health group (n = 22) had a higher stroke severity and lower FOIS scores than the normal oral health group (n = 107). The poor oral health group exhibited significantly higher rates of moderate to severe disability at discharge (odds ratio = 9.18, 95% confidence interval [CI]: 1.74–48.30, P = 0.009), lower FOIS scores at discharge (β = -0.96, 95% CI: -1.71 to -0.20, P = 0.014), and longer hospital stays (β = 10.70, 95% CI: 0.80–20.61, P = 0.034) than the other group. Conclusion: In older patients with acute ischemic stroke, poor oral health status at admission was associated with worse short-term functional outcomes, including increased disability, dysphagia, and longer hospital stay. Clinical relevance: Assessing and addressing the oral health status of this population can potentially improve short-term functional outcomes and enhance comprehensive stroke care. [ABSTRACT FROM AUTHOR]

Background: Epigenetic studies have reported relationships between dietary nutrient intake and methylation levels. However, genetic variants that may affect DNA methylation (DNAm) pattern, called methylation quantitative loci (mQTL), are usually overlooked in these analyses. We investigated whether mQTL change the relationship between dietary nutrient intake and leukocyte DNAm levels with an example of estimated fatty acid intake and ATP-binding cassette transporter A1 (ABCA1). Methods: A cross-sectional study on 231 participants (108 men, mean age: 62.7 y) without clinical history of cancer and no prescriptions for dyslipidemia. We measured leukocyte DNAm levels of 8 CpG sites within ABCA1 gene by pyrosequencing method and used mean methylation levels for statistical analysis. TaqMan assay was used for genotyping a genetic variant of ABCA1 (rs1800976). Dietary fatty acid intake was estimated with a validated food frequency questionnaire and adjusted for total energy intake by using residual methods. Results: Mean ABCA1 DNAm levels were 5% lower with the number of minor alleles in rs1800976 (CC, 40.6%; CG, 35.9%; GG, 30.6%). Higher dietary n-3 PUFA intake was associated with lower ABCA1 DNAm levels (1st (ref) vs. 4th, β [95% CI]: –2.52 [–4.77, –0.28]). After controlling for rs180076, the association between dietary n-3 PUFA intake and ABCA1 DNAm levels was attenuated, but still showed an independent association (1st (ref) vs. 4th, β [95% CI]: –2.00 [–3.84, –0.18]). The interaction of mQTL and dietary n-3 PUFA intake on DNAm levels was not significant. Conclusions: This result suggested that dietary n-3 PUFA intake would be an independent predictor of DNAm levels in ABCA1 gene after adjusting for individual genetic background. Considering mQTL need to broaden into other genes and nutrients for deeper understanding of DNA methylation, which can contribute to personalized nutritional intervention. [ABSTRACT FROM AUTHOR]

This small-sample pilot study sought to uncover the role of palliative care education for general nurses providing care to patients with intractable cancer. While nurses serve as total care coordinators in patient recuperation, most general nurses in Japan dealing with such patients must independently update their knowledge. A questionnaire was developed comprising 28 items from the five supportive care need categories according to the Integrating Oncology and Palliative Care (IOP) model and 22 items from the Nurses' Difficulties in Cancer Care (NDCC) scale. General nurses who had worked in cancer care for over 5 years were recruited using snowball sampling. Based on the results, we planned a lecture and free study session on IOP using information and communication technology (ICT). Four lectures were delivered to 108 nurses from Hokkaido to Okinawa and remote islands. Overall, 90% of the participants were female nurses. They were categorized into two groups based on the number of times they attended the lectures (Group 1 [G1, attended once or twice]: 45; Group 2 [G2, attended three or four times]: 63). Comparing G1 and G2 showed that the practical ability of the participants in G2 increased for the items "Patient/Family Communication" and "Knowledge and Skills." Continued education using ICT may improve the practical skills of general nurses caring for patients with intractable cancer. [ABSTRACT FROM AUTHOR]

Background: Frailty is a significant predictor of prognosis in older patients with community-acquired pneumonia (CAP). No effective therapy has been reported in frail patients with CAP, with frailty determined using the Hospital Frailty Risk Score (HFRS). Aims: To investigate whether early physical rehabilitation intervention would effectively minimize adverse outcomes in frail older patients (determined using the HFRS) hospitalized for CAP. Methods: This retrospective cohort analysis involved patients with CAP aged ≥ 65 years enrolled in the Japanese Diagnostic Procedure Combination Database between 2014 and 2020 and assessed as being frail. We compared 30-day mortality and readmission rates for patients who did and who did not receive physical rehabilitation within three days of admission and evaluated the association between outcomes and receiving early physical rehabilitation using Cox regression models and inverse probability weighting (IPW) for sensitivity analysis. Results: The analysis involved 31,133 frail older patients hospitalized for CAP (mean age 84.3 ± 6.3 years; females, 49.1%), including 11,515 (37.0%) who received early physical rehabilitation. Cox regression analysis showed that early physical rehabilitation intervention was inversely associated with 30-day mortality and readmission rates. The IPW model also showed similar results. Discussion: Early physical rehabilitation was associated with reduced risks of 30-day mortality, overall in-hospital mortality, and 30-day readmission rates in frail older patients with CAP. Conclusions: Early physical rehabilitation in frail older patients hospitalized for CAP may improve outcomes. This finding highlights the importance of simultaneously introducing the HFRS and early physical rehabilitation intervention into clinical practice for frail older patients with CAP. [ABSTRACT FROM AUTHOR]

Carbonated beverages initiate the swallowing reflex earlier than water and have a shorter pharyngeal transit time. However, the effects of carbonation in thickened beverages of the same flavor on swallowing dynamics have not been reported. Therefore, we investigated the effects of thickened carbonated beverages on swallowing in patients with dysphagia by comparing the swallowing dynamics between thickened carbonated and thickened non-carbonated beverages. We enrolled 38 patients with dysphagia and divided them into two groups. Thickened carbonated and thickened non-carbonated beverages were used. Videoendoscopic swallowing evaluations were performed. Aspiration, penetration, pharyngeal residue, and initiation position of the swallowing reflex were evaluated. The reduction in the amount of residue in both the vallecula (p = 0.007) and pyriform sinus (p = 0.004) was greater after ingestion of thickened carbonated cola than thickened non-carbonated cola. The onset of the swallowing reflex was significantly earlier after ingestion of thickened carbonated cola than thickened non-carbonated cola (p = 0.007). There were no significant differences in the extent of penetration. Thickened carbonated beverages positively affected swallowing compared with thickened non-carbonated beverages. Thus, the use of thickened carbonated beverages may be helpful for patients with dysphagia. [ABSTRACT FROM AUTHOR]

Background/objectives: Texture-modified diets (TMDs) may affect nutritional status and sarcopenia in patients after stroke. This study aimed to investigate the association of food texture levels consumed by patients after stroke with the prevalence of malnutrition and sarcopenia.Subjects/methods: This was a two-center cross-sectional study. A total of 443 patients aged ≥65 years undergoing post-stroke rehabilitation and with oral intake in rehabilitation wards in Shizuoka prefecture and Okinawa prefecture, Japan, were included in the analysis. Food textures were categorized according to the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition and sarcopenia was assess by the European Working Group on Sarcopenia in Older People 2 criteria. The Cochran-Armitage trend test was used to examine the prevalence of malnutrition and sarcopenia by consumption of lower food texture levels.Results: Malnutrition and sarcopenia were diagnosed in 245 (55.3%) and 275 (62.1%) participants, respectively. Consumption of lower food texture levels was associated with a higher prevalence of malnutrition and severe malnutrition (P < 0.001 for both). In addition, consumption of lower food texture levels was associated with a higher prevalence of probable sarcopenia and sarcopenia (P < 0.001 for both). On multivariate analysis, significant associations were observed between IDDSI levels 5 (P < 0.001) and 4 (P = 0.009) and malnutrition, and between IDDSI levels 6 (P = 0.015), 5 (P = 0.033), and 4 (P = 0.015) and sarcopenia.Conclusions: In patients with stroke, consumption of lower food texture levels categorized by the IDDSI framework was associated with a higher prevalence of malnutrition and sarcopenia. [ABSTRACT FROM AUTHOR]

Iron is an essential micronutrient for living organisms, but its solubility is extremely low under alkaline conditions. Plants often suffer from iron deficiency chlorosis in calcareous soils, which consist of approximately 30% of the world's cultivated area, severely limiting plant productivity. Iron deficiency anemia is also a widespread problem in humans, especially in Asian and African people who take up iron mainly from staple foods containing low iron concentrations. Transgenic manipulation of genes involved in plant iron uptake, translocation, and storage has made improvements in enhancing iron deficiency tolerance or iron accumulation in edible parts, but these two properties have been characterized separately. We previously produced transgenic rice lines, with concomitant improvement of iron deficiency tolerance and grain iron accumulation by knocking-down OsHRZ ubiquitin ligases, which negatively regulate iron deficiency response and iron accumulation in rice. In the present report, we aimed to further improve the iron deficiency tolerance and grain iron accumulation of OsHRZ knockdown rice by the simultaneous introduction of the engineered ferric-chelate reductase gene Refre1/372 under the control of the OsIRT1 promoter for further enhancement of iron uptake. We obtained several transgenic rice lines with repressed OsHRZ expression and induced Refre1/372 expression. These lines showed a variable degree of iron deficiency tolerance in calcareous soils, with increased iron accumulation in brown seeds under both iron-deficient and iron-sufficient soil cultures. Selected OsHRZ knockdown plus Refre1/372 lines showed similar or better growth compared with that of singly introduced OsHRZ knockdown or Refre1/372 lines in calcareous soils under both non-submerged and submerged conditions. After submerged calcareous soil cultivation, these OsHRZ knockdown plus Refre1/372 lines accumulated 2.5–4.3 times and 17–23 times more iron concentrations than that of non-transformants in brown rice and straw, respectively, which was comparable or superior to a single OsHRZ knockdown line. Our results indicate that the combined introduction of OsHRZ knockdown and OsIRT1 promoter-Refre1/372 is highly effective in further improving the iron deficiency tolerance without compromising the iron accumulation of the OsHRZ knockdown effects. [ABSTRACT FROM AUTHOR]

Background: Diet-induced inflammation may be associated with sarcopenia; however, few reports have examined this relationship. Aim: To examine the association between the dietary inflammatory index (DII) and sarcopenia in older adults who visited a frailty clinic in Japan. Methods: This cross-sectional study used outpatient data from the Frailty Registry Study. The DII is an index of diet-induced inflammation, and a dietary assessment was performed using a brief self-administered diet history questionnaire to calculate the DII score. We classified DII scores by quartiles (Q1–Q4), and sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 consensus. Logistic regression analyses for sarcopenia were performed. Age, sex, comorbidities, and physical activity were entered as confounding factors (Model 1) and Models 2, 3, and 4 with BMI, protein intake, and energy intake added to Model 1. Results: We included 304 patients in the analysis (mean age, 77.6 ± 6.3 years; female, 67.4%). The prevalence of sarcopenia was 14.5%. Logistic regression analyses showed that DII scores were significantly associated with sarcopenia in Model 1 and 2 (Model 1, reference: Q1, Q4: OR 3.10, P = 0.020; Model 2, Q4: OR 3.40, P = 0,022) but not in Model 3 and 4. Discussion: Diet-induced inflammation is associated with a higher likelihood of sarcopenia; however, this association disappeared after confounding for protein and energy intake. Conclusions: The results demonstrated that dietary protein and energy parameters were the main drivers for muscle health in medical patients. [ABSTRACT FROM AUTHOR]

Purpose: A high score determined by SARC-F, a simple screening questionnaire for sarcopenia, has been reportedly associated with worse medical outcomes. However, information regarding whether high SARC-F scores are associated with a poor prognosis in patients with advanced cancer remains limited. We clarified whether a SARC-F score ≥ 4 predicts poor prognosis in patients with cancer receiving palliative care.Methods: We conducted a retrospective cohort study of patients with cancer who received palliative care at a university hospital between May 2019 and April 2020. Patient characteristics including age, sex, height, weight, cancer type, serum albumin level, C-reactive protein level, presence of edema, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), SARC-F score, history of anticancer therapy, and clinical outcomes were collected from electronic medical records.Results: Of 304 patients, 188 had a SARC-F score < 4, and 116 patients had a SARC-F score ≥ 4. The overall survival of patients with a SARC-F score ≥ 4 was 40 days (95% CI 29-47), which was significantly worse than 121 days (95% CI 95-156) for patients with a SARC-F score < 4 (p < 0.001). SARC-F score ≥ 4 (hazard ratio: HR 1.56), edema (HR 1.94), head and neck cancer (HR 0.51), C-reactive protein (HR 1.05), ECOG-PS ≥ 3 (HR 1.47), and radiotherapy (HR 0.52) were associated with overall survival. The ability to climb stairs was a SARC-F sub-item significantly associated with mortality (HR 1.59).Conclusion: The SARC-F questionnaire is a useful predictor of prognosis for patients with cancer receiving palliative care because a SARC-F ≥ 4 score predicts worse overall survival. [ABSTRACT FROM AUTHOR]

Background: Osteosarcopenia is a newly described, aging-associated condition. Social frailty is an important condition whose prevalence may have risen by physical distancing during the coronavirus disease 2019 pandemic. However, the relationship between these two remains unclear. Aims: To examine the association between osteosarcopenia and social frailty. Methods: This cross-sectional study was conducted using data from outpatients visiting general geriatric hospital frailty clinics. Bone mineral density (BMD) and muscle mass were measured using dual X-ray absorptiometry. Osteoporosis was defined as a BMD of < 70% of the young adult mean, according to the Japan Osteoporosis Society. Sarcopenia was diagnosed as per the Asian Working Group for Sarcopenia 2019 recommendation. Osteosarcopenia was defined as the co-existence of osteoporosis and sarcopenia. We defined social frailty using a questionnaire comprising four items: general resources, social resources, social behavior, and basic social needs. Ordinal logistic regression analysis was performed with social frailty status and osteosarcopenia as the dependent and independent variables, respectively. Results: We included 495 patients (mean age = 76.5 ± 7.2 years) in the analysis; of these, 58.2% were robust and 17.2%, 13.5%, and 11.1% had osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively. Social frailty prevalence increased stepwise from 8.0% in robust patients to 11.8%, 17.9%, and 29.1% among those with osteoporosis alone, sarcopenia alone, and osteosarcopenia, respectively (P < 0.001). Logistic regression analysis revealed that only osteosarcopenia was significantly associated with social frailty (pooled odds ratio: 2.117; 95% confidence interval: 1.104–4.213). Discussion: Comprehensive assessment of osteosarcopenia and social frailty is needed for disability prevention in older adults. [ABSTRACT FROM AUTHOR]

(c) Bar graph comparing the amount of pharyngeal residue for thickened carbonated cola and thickened non-carbonated cola. (a) Comparison of penetration/aspiration with thickened carbonated cola and thickened non-carbonated cola. (b) Boxplot comparing the amount of pharyngeal residue between thickened carbonated cola and thickened non-carbonated cola (*p < 0.05). [Extracted from the article]

The article reports that sarcopenia is induced by many factors; it is a significant determinant of health and has become a challenging topic in geriatric nutrition in recent years . The diagnosis of sarcopenia is based on muscle strength, mass, and function. In relation to undernutrition, which is an etiology of sarcopenia, recent advances in microbiota analysis methods have occurred. Microbiota are the first barrier to the digestion and absorption of nutrients.