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An altered amino acid metabolism has been described in frail older adults which may contribute to muscle loss and functional decline associated with frailty. In the present investigation, we compared circulating amino acid profiles of older adults with physical frailty and sarcopenia (PF&S, n = 94), frail/pre-frail older adults with type 2 diabetes mellitus (F-T2DM, n = 66), and robust non-diabetic controls (n = 40). Partial least squares discriminant analysis (PLS-DA) models were built to define the amino acid signatures associated with the different frailty phenotypes. PLS-DA allowed correct classification of participants with 78.2 ± 1.9% accuracy. Older adults with F-T2DM showed an amino acid profile characterized by higher levels of 3-methylhistidine, alanine, arginine, ethanolamine, and glutamic acid. PF&S and control participants were discriminated based on serum concentrations of aminoadipic acid, aspartate, citrulline, cystine, taurine, and tryptophan. These findings suggest that different types of frailty may be characterized by distinct metabolic perturbations. Amino acid profiling may therefore serve as a valuable tool for frailty biomarker discovery.

267 p., Tesi honek ausazko entsegu kliniko bat barne hartzen du. Helburu nagusia ariketa fisikoan oinarritutako osagai anitzeko ariketa fisikoko bi esku-hartze desberdinen (talde zein bakarkako saioen epeak iraupen desberdinekoak ziren) eraginkortasuna aztertzea da ospitalizazio bat pairatu duten hirugarren adineko pertsonetan. Lehenik horrelako esku hartze bat onartzeko edo ezeztatzeko arrazoiak aurkitzen saiatu ginen. Emaitzek agerian utzi zuten adin handia, nutrizio-egoera txarra eta etxerako irisgarritasun txikiagoa zirela parte-hartzea baztertzeko faktore prediktiboak. Ospitale-altari aplikatutako osagai anitzeko ariketa fisikoko bi esku-hartzeek 12 asteren ondoren funtzio fisiko eta nutrizio-egoeran onura nabarmenak ekarri, eta jarduera fisikoa handitu zuten, eta hurrengo 12 asteetan ondorio positiboei eutsi zieten. Ez zen talde-denbora elkarrekintzarik hauteman. Bestalde, sarkopenian eta hauskortasunean ere 3 hilabeteko esku-hartzearen ondoren ez zen talde-denbora elkarrekintzarik ikusi. Bi taldeek ordea hauskortasun indizea murriztu zuten. Sarkopenia egiaztatua zuten pazienteen ehunekoak bi taldeetan ere hobera egin zuen, baina ez zen eragin esanguratsurik izan. Azkenik ospitaleratu ondoko adineko pertsonetan miostatinaren eta follistatinaren eta hauskortasuna eta/edo sarkopenia arteko lotura alderatzea proposatu genuen. Emaitzek erakutsi zuten ibilera abiadura eta altxa, ibili, bira eta eseri probak hauskortasuna identifikatzeko biomarkatzaileak baino gaitasun handiagoa zutela. Miostatina izan zen berriz sarkopenia identifikatzeko gai zen biomarkatzaile bakarra. Arestian aipatutakoa kontutan hartuta, ondorioztatu dezakegu bi esku-hartzeak eraginkorrak direla hirugarren adineko pazienteentzako. (ez bete tarte hau baino gehiago)

BACKGROUND: To study the effects of exercise on falls, fractures, hospitalizations, and death in people with dementia. METHOD: We conducted an individual-level patient data meta-analysis of 7 randomized controlled trials (RCTs). We looked for studies from the reference list of previous systematic reviews and undertook an electronic search for articles published between 2013 and 2019 in Ageline, CENTRAL, PsycINFO, PubMed, and SportsDiscus. Main (binary) outcome measures were the risk of mortality, hospitalization, faller, multiple faller, injurious faller, and fractures. Secondary (count) outcomes were the incident rates of hospitalizations, falls, and injurious falls. RESULTS: From the 1314 participants, 771 were allocated to the exercise group and 543 to the control group. The number of cases regarding the main outcome measures in exercisers and controls were, respectively: 45 (5.8%) and 31 (5.7%) deaths; 102 (14.4%) and 65 (13.4%) participants hospitalized; 221 (34.4%) and 175 (41.3%) had at least 1 fall; 128 (20.2%) and 92 (21.7%) had multiple falls; 78 (24.8%) and 92 (29.3%) had injurious falls; and 19 (2.9%) and 15 (3.5%) had suffered a fracture. Two-step meta-analysis found no effects of exercise on any outcome. One-step meta-analysis found exercise reduced the risk of falls (odds ratio 0.75; 95% CI: 0.57-0.99). Exploratory analysis showed exercise decreased the rate of incident falls in participants with the lowest functional ability (incident rate ratio 0.48; 95% CI: 0.30-0.79). CONCLUSIONS: Although the 2-step meta-analysis suggests exercise does not have an effect on the outcomes, 1-step meta-analysis suggested that exercise may reduce fall risk. Data from further high-quality RCTs are still needed.

Background: Recommendations for individualised glycaemic management in older people with type 2 diabetes (T2D) have recently been provided in clinical practice guidelines (CPGs) issued by major scientific societies. The aim of this systematic review is to compare the content of these recommendations concerning health assessment, targets for glycaemic control, lifestyle management and glucose-lowering therapy across CPGs. Methods: The CPGs on T2D management in people aged ≥65 years published in English after 2015 by major scientific societies were systematically reviewed in accordance with the PRISMA statement. The quality of the CPGs included was assessed using the AGREE-II tool. The recommendations for individualised glycaemic management were extracted, and their level of evidence (LOE) and strength of recommendation recorded. Results: Three CPGs of high methodological quality were included, namely those from the American Diabetes Association 2020, the Endocrine Society 2019 and the Diabetes Canada Expert Committee 2018. They made 27 recommendations addressing individualised glycaemic management, a minority of which (40%) had a high LOE. Comparison of the 27 recommendations identified some discrepancies between CPGs, e.g. the individualised values of HbA1c targets. The 13 strong recommendations addressed 10 clinical messages, five of which are recommended in all three CPGs, i.e. assess health status, screen for cognitive impairment, avoid hypoglycaemia, prioritise drugs with low hypoglycaemic effects and simplify complex drug regimens. Conclusions: Although there is a consensus on avoiding hypoglycaemia in older patients with T2D, significant discrepancies regarding individualised HbA1c targets exist between CPGs. Keywords: clinical practice guidelines; individualisation of glycaemic management; older patients; older people; systematic review; targets for glycaemic control; type 2 diabetes.