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Zusammenfassung Ziel der Studie Subjektive Gründe, Barrieren sowie Unterstützungsbedarfe älterer Menschen mit Adipositas hinsichtlich einer Gewichtsreduktion sind bisher wenig bekannt und wurden daher in einer qualitativen Studie untersucht. Methodik Leitfadengestützte, problemzentrierte Interviews wurden mit 13 Teilnehmenden (selbständig,≥65 Jahre, BMI≥30 kg/m²) geführt und mittels strukturierender und zusammenfassender Inhaltsanalyse nach Mayring ausgewertet. Ergebnisse Fast alle Teilnehmenden nannten sowohl Gründe für (n=5 Kategorien) als auch gegen eine Gewichtsreduktion (n=6 Kategorien). Soziale Einflüsse und Gesundheitsprobleme wurden beiden Bereichen zugeordnet. Weitere Gründe für eine Gewichtsreduktion waren Ästhetik, innerer Druck und Partizipation, weitere Gründe dagegen eine geringere Lebensqualität während der Gewichtsreduktion, Zufriedenheit mit dem aktuellen Gewicht, das Alter sowie Frustration/Resignation aufgrund „gescheiterter“ Gewichtsreduktionen. Als Barrieren wurden physiologische, intrinsische, umweltbezogene und hedonische Aspekte genannt. Hinsichtlich der Gestaltung von Gewichtsreduktionsprogrammen präferierten die Teilnehmenden Gruppenangebote, einfache Maßnahmen und Angebote, die eine Tagesstrukturierung unterstützen. Neben den inhaltliche Komponenten Ernährung, Bewegung und Verhalten wurden Beratung durch Fachkräfte und medizinische Betreuung als wichtig angesehen. Schlussfolgerung Die Berücksichtigung der identifizierten komplexen Gründe, Barrieren und Unterstützungsbedarfe, als Schlüsselkomponenten für Motivation und Adhärenz, könnte zum Erfolg von Lebensstilinterventionen bei älteren Menschen mit Adipositas beitragen und die Wahl patientenzentrierter Zielgrößen unterstützen.

Adipositas im Alter wird, genauso wie bei Jüngeren, durch einen erhöhten Body-Mass-Index, Bauchumfang oder Körperfettanteil definiert. Aufgrund steigender Prävalenzzahlen und zahlreicher negativer Konsequenzen auf die körperliche und psychische Gesundheit erlangen Adipositas und speziell auch sarkopene Adipositas – eine Kombination aus erhöhtem Fettanteil und niedriger Muskelmasse sowie Muskelfunktion – bei älteren Menschen zunehmend an Bedeutung. Therapieoptionen bei Adipositas sind Lebensstilinterventionen, medikamentöse Begleitbehandlungen und chirurgische Eingriffe mit entsprechender Nachsorge, wobei letztere Optionen bei älteren Menschen bisher eine untergeordnete Rolle spielen. Bei Therapieentscheidungen sollten der Erhalt von Selbstständigkeit und Lebensqualität im Vordergrund stehen. Da Gewichtsreduktionen eine Abnahme von Muskelund Knochenmasse induzieren, sind der gesundheitliche Nutzen und die möglichen funktionellen Risiken sorgfältig gegeneinander abzuwägen. Lebensstilinterventionen, die Ernährungs-, Bewegungsund Verhaltenskomponenten kombinieren und einen langsamen Gewichtsverlust fokussieren, haben sich bei jüngeren Senior*innen mit Adipositas als effektiv und sicher erwiesen. Die Übertragbarkeit auf hochbetagte Menschen mit funktionellen Einschränkungen ist noch zu klären.

Obesity is a chronic disease, in which treatment outcomes are highly dependent on patient and family adherence to behavioural recommendations. The role of healthy eating, physical activity, medication adherence as well as adherence to pre- and post-bariatric surgery protocols are of utmost importance for long-term treatment outcomes. Even the best interventions are not likely to reach their maximum benefit without significant levels of adherence on the part of the individual and family. Traditionally, the annual meeting of the European Childhood Obesity Group (ECOG) includes an expert workshop addressing one specific topic within the field of childhood obesity. During the 30th annual meeting, hosted by the University of Pécs, Hungary, as a virtual meeting, “adherence to treatment recommendations in obesity as a chronic disease” was addressed. The discussions that developed during the workshop are summarized in the following article.

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess in hospitalised older people with (risk of) malnutrition the effects of different nutrition interventions (e.g. supportive interventions, nutritional counselling, food modifications, oral nutritional supplements, comprehensive individualised nutritional interventions or combined approaches) compared to control groups (usual care, placebo or health education materials) on patient-relevant outcomes, and to rank the effects of the different treatments by using a network meta-analysis with individual participant data.

Child and adolescent overweight and obesity have increased globally and are associated with significant short- and long-term health consequences.To assess the effects of surgery for treating obesity in childhood and adolescence.For this update, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Latin American and Caribbean Health Science Information database (LILACS), World Health Organization International Clinical Trials Registry Platform (ICTRP)and ClinicalTrials.gov on 20 August 2021 (date of the last search for all databases). We did not apply language restrictions. We checked references of identified studies and systematic reviews.We selected randomised controlled trials (RCTs) of surgical interventions for treating obesity in children and adolescents (age18 years) with a minimum of six months of follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or which included participants with a secondary or syndromic cause of obesity, or who were pregnant.We used standard methodological procedures expected by Cochrane. Two review authors independently extracted data and assessed the risk of bias using the Cochrane Risk of Bias 2.0 tool. Where necessary, we contacted authors for additional information.With this update, we did not find any new RCTs. Therefore, this updated review still includes a single RCT (a total of 50 participants, 25 in both the intervention and comparator groups). The intervention focused on laparoscopic adjustable gastric banding surgery, which was compared to a control group receiving a multi-component lifestyle programme. The participating population consisted of Australian adolescents (a higher proportion of girls than boys) aged 14 to 18 years, with a mean age of 16.5 and 16.6 years in the gastric banding and lifestyle groups, respectively. The trial was conducted in a private hospital, receiving funding from the gastric banding manufacturer. For most of the outcomes, we identified a high risk of bias, mainly due to bias due to missing outcome data. Laparoscopic gastric banding surgery may reduce BMI by a mean difference (MD) of -11.40 kg/mLaparoscopic gastric banding led to greater body weight loss compared to a multi-component lifestyle program in one small study with 50 participants. These results have very limited application, primarily due to more recent recommendations derived from observation studies to avoid the use of banding in youth due to long-term reoperation rates. This systematic review update still highlights the lack of RCTs in this field. The authors are concerned that there may be ethical barriers to RTCs in this field, despite the lack of other effective therapies for severe obesity in children and adolescents and the significant morbidity and premature mortality caused by childhood obesity. Nevertheless, future studies, whether pre-registered and planned non-randomised or pragmatic randomised trials, should assess the impact of the surgical procedure and post-operative care to minimise adverse events, including the need for post-operative adjustments and revisional surgery. Long-term follow-up is also critical to comprehensively assess the impact of surgery as participants enter adulthood.

Background Comprehensive geriatric assessment (CGA) has been in use for the last three decades. However, some doubts remain regarding its clinical use. Therefore, we aimed to capture the breadth of outcomes reported and assess the strength of evidence of the use of comprehensive geriatric assessment (CGA) for health outcomes in older persons. Methods Umbrella review of systematic reviews of the use of CGA in older adults searching in Pubmed, Embase, Scopus, Cochrane library and CINHAL until 05 November 2021. All possible health outcomes were eligible. Two independent reviewers extracted key data. The grading of evidence was carried out using the GRADE for intervention studies, whilst data regarding systematic reviews were reported as narrative findings. Results Among 1,683 papers, 31 systematic reviews (19 with meta-analysis) were considered, including 279,744 subjects. Overall, 13/53 outcomes were statistically significant (P Conclusions CGA seems to be beneficial in the hospital medical setting for multiple health outcomes, with a high certainty of evidence. The evidence of benefits is less strong for the use of CGA in other settings.

The obesity epidemic has reached old age in most industrialized countries, but trials elucidating the benefits and risks of weight reduction in older adults above 70 years of age with obesity remain scarce. While some findings demonstrate a reduced risk of mortality and other negative health outcomes in older individuals with overweight and mild obesity (i.e. body mass index (BMI) 27 kg/m2), especially when combined with exercise. However, in this age group weight reduction is usually associated with a reduction of muscle mass and bone mineral density. Since uncertainty persists as to which level overweight or obesity might be tolerable (or even beneficial) for older persons, current recommendations are to consider weight reducing diets only for older persons that are obese (BMI ≥ 30 kg/m2) and have weight-related health problems. Precise treatment modalities (e.g. appropriate level of caloric restriction and indicated dietary composition, such as specific dietary patterns or optimal protein content) as well as the most effective and safest way of adding exercise are still under research. Moreover, the long-term effects of weight-reducing interventions in older individuals remain to be clarified, and dietary concepts that work for older adults who are unable or unwilling to exercise are required. In conclusion, further research is needed to elucidate which interventions are effective in reducing obesity-related health risks in older adults without causing relevant harm in this vulnerable population.

This systematic review aims to investigate the effects of intermittent energy restriction (IER) on anthropometric outcomes and intermediate disease markers. A systematic literature search was conducted in three electronic databases. Randomized controlled trials (RCTs) were included if the intervention lasted ≥12 weeks and IER was compared with either continuous energy restriction (CER) or a usual diet. Random-effects meta-analysis was performed for eight outcomes. Certainty of evidence was assessed using GRADE. Seventeen RCTs with 1328 participants were included. IER in comparison to a usual diet may reduce body weight (mean difference [MD]: −4.83 kg, 95%-CI: −5.46, −4.21; n = 6 RCTs), waist circumference (MD: −1.73 cm, 95%-CI: −3.69, 0.24; n = 2), fat mass (MD: −2.54 kg, 95%-CI: −3.78, −1.31; n = 6), triacylglycerols (MD: −0.20 mmol/L, 95%-CI: −0.38, −0.03; n = 5) and systolic blood pressure (MD: −6.11 mmHg, 95%-CI: −9.59, −2.64; n = 5). No effects were observed for LDL-cholesterol, fasting glucose, and glycosylated-hemoglobin. Both, IER and CER have similar effect on body weight (MD: −0.55 kg, 95%-CI: −1.01, −0.09; n = 13), and fat mass (MD: −0.66 kg, 95%-CI: −1.14, −0.19; n = 10), and all other outcomes. In conclusion, IER improves anthropometric outcomes and intermediate disease markers when compared to a usual diet. The effects of IER on weight loss are similar to weight loss achieved by CER.

Background/Objectives Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents. Subjects/Methods NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/m2) p Results Of 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56–4.98]), a quarter (2.15 [1.56–2.97]) or half of the meal eaten (1.72 [1.40–2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0–23.0) (1.86 [1.44–2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65–74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00–1.62]) (vs. mobile) predicted incident MN in the final model. Conclusion 10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.

Sarcopenic obesity is increasingly found in youth, but its health consequences remain unclear. Therefore, we studied the prevalence of sarcopenia and its association with cardiometabolic risk factors as well as muscular and cardiorespiratory fitness using data from the German Children’s Health InterventionaL Trial (CHILT III) programme. In addition to anthropometric data and blood pressure, muscle and fat mass were determined with bioelectrical impedance analysis. Sarcopenia was classified via muscle-to-fat ratio. A fasting blood sample was taken, muscular fitness was determined using the standing long jump, and cardiorespiratory fitness was determined using bicycle ergometry. Of the 119 obese participants included in the analysis (47.1% female, mean age 12.2 years), 83 (69.7%) had sarcopenia. Affected individuals had higher gamma-glutamyl transferase, higher glutamate pyruvate transaminase, higher high-sensitivity C-reactive protein, higher diastolic blood pressure, and lower muscular and cardiorespiratory fitness (each p < 0.05) compared to participants who were ‘only’ obese. No differences were found in other parameters. In our study, sarcopenic obesity was associated with various disorders in children and adolescents. However, the clinical value must be tested with larger samples and reference populations to develop a unique definition and appropriate methods in terms of identification but also related preventive or therapeutic approaches.

When treating older adults, a main factor to consider is physical frailty. Because specific assessments in clinical trials are frequently lacking, critical appraisal of treatment evidence with respect to functional status is challenging. Our aim was to identify and categorize assessments for functional status given in clinical trials in older adults to allow for a retrospective characterization and indirect comparison of treatment evidence from these cohorts. We conducted 4 separate systematic reviews of randomized and nonrandomized controlled clinical trials in older people with hypertension, diabetes, depression, and dementia. All assessments identified that reflected functional status were analyzed. Assessments were categorized across 4 different functional status levels. These levels span from functionally not impaired, slightly impaired, significantly impaired, to severely impaired/disabled. If available from the literature, cut-offs for these 4 functioning levels were extracted. If not, or if the existing cut-offs did not match the predefined functional levels, cut-off points were defined by an expert group composed of geriatricians, pharmacists, pharmacologists, neurologists, psychiatrists, and epidemiologists using a patient-centered approach. We identified 51 instruments that included measures of functional status. Although some of the assessments had clearly defined cut-offs across our predefined categories, many others did not. In most cases, no cut-offs existed for slightly impaired or severely impaired older adults. Missing cut-offs or values to adjust were determined by the expert group and are presented as described. The functional status assessments that were identified and operationalized across 4 functional levels could now be used for a retrospective characterization of functional status in randomized controlled trials and observational studies. Allocated categories only serve as approximations and should be validated head-to-head in future studies. Moreover, as general standard, upcoming studies involving older adults should include and explicitly report functional impairment as a baseline characteristic of all participants enrolled.

Background Although antihyperglycemic pharmacotherapy in frail older adults with type 2 diabetes mellitus (T2DM) is challenging, recommendations from international guidelines are mainly based on indirect evidence from trials not including frail participants. Objective This systematic review investigated the effectiveness and safety of pharmacotherapy in frail older adults with T2DM. Material and methods Randomized (RCT) and non-randomized prospective clinical trials (non-RCT) were searched in three electronic databases (Medline, Embase, Central) up to October 2018. Trials in older adults with T2DM who were assessed as significantly or severely impaired by defined cut-off scores of assessment instruments on frailty, activities of daily living or physical functional impairment were included. Results Two reviewers independently screened 17,391 references for inclusion and assessed risk of bias with ROBINS‑I. Five non-RCTs and no RCT were identified. Treatment of T2DM without insulin compared to insulin could be associated with increased improvement in cardiac functions in patients with cardiac resynchronization therapy and with decreased falls in frail older women. While better glycemic control with low variability and low HbA1c (hemoglobin A1c) values ( Conclusion Well-designed, large-scale RCTs including this important group of patients are required to assess the effectiveness and safety of pharmacotherapy and HbA1c targets.

Malnutrition (MN) in nursing home (NH) residents is associated with poor outcome. In order to identify those with a high risk of incident MN, the knowledge of predictors is crucial. Therefore, we investigated predictors of incident MN in older NH-residents.NH-residents participating in the nutritionDay-project (nD) between 2007 and 2018, aged ≥65 years, with complete data on nutritional status at nD and after 6 months and without MN at nD. The association of 17 variables (general characteristics (n = 3), function (n = 4), nutrition (n = 1), diseases (n = 5) and medication (n = 4)) with incident MN (weight loss ≥ 10% between nD and follow-up (FU) or BMI (kg/mOf 11,923 non-malnourished residents, 10.5% developed MN at FU. No intake at lunch (OR 2.79 [1.56-4.98]), a quarter (2.15 [1.56-2.97]) or half of the meal eaten (1.72 [1.40-2.11]) (vs. three-quarter to complete intake), the lowest BMI-quartile (20.0-23.0) (1.86 [1.44-2.40]) (vs. highest (≥29.1)), being between the ages of 85 and 94 years (1.46 [1.05; 2.03]) (vs. the youngest age-group 65-74 years)), severe cognitive impairment (1.38 [1.04; 1.84]) (vs. none) and being immobile (1.28 [1.00-1.62]) (vs. mobile) predicted incident MN in the final model.10.5% of non-malnourished NH-residents develop MN within 6 months. Attention should be paid to high-risk groups, namely residents with poor meal intake, low BMI, severe cognitive impairment, immobility, and older age.

Introduction Obesity is highly prevalent in older adults aged 65 years or older. Different lifestyle interventions (diet, exercise, self-management) are available but benefits and harms have not been fully quantified comparing all available health promotion interventions. Special consideration must be given to functional outcomes and possible adverse effects (loss of muscle and bone mass, hypoglycaemia) of weight loss interventions in this age group. The objective of this study is to synthesise the evidence regarding the effects of different types and modalities of lifestyle interventions, or their combinations, on physical function and obesity-related outcomes such as body composition in older adults with obesity.Methods and analyses Six databases (Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Psychinfo and Web of Science) and two trial registries (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) will be searched for randomised controlled trials of lifestyle interventions in older adults with obesity. Screening (title/abstract and full-text) and data extraction of references as well as assessment of risk of bias and rating of the certainty of evidence (Grading of Recommendations, Assessment, Development and Evaluation for network meta-analyses) will be performed by two reviewers independently. Frequentist random-effects network meta-analyses will be conducted to determine the pooled effects from each intervention.Ethics and dissemination We will submit our findings to peer-reviewed journals and present at national and international conferences as well as in scientific medical societies. Patient-targeted dissemination will involve local and national advocate groups.PROSPERO registration number CRD42019147286.

To know the knowledge of the EuGMS members regarding meta-research, especially systematic reviews and meta-analyses. Interest in systematic reviews and meta-analyses is high and there is a demand for education on these topics in relation to geriatric medicine. We need more resources in the EuGMS for education for meta-research tailored for geriatric medicine. There has been an exponential increase in meta-research, especially in the branch dealing with systematic reviews [SRs] and meta-analyses [MAs]. However, the knowledge regarding these topics in geriatric medicine is still poorly explored. We therefore undertook a survey of the current knowledge and needs in meta-research in geriatrics. A short survey (taking approximately 5 min to complete) was freely available on the European Geriatric Medicine Society (EuGMS) website and disseminated via social networks by the EuGMS and the authors of the survey. The questionnaire was available during the whole year of 2019. The questionnaire specifically addressed demographic information, previous research activities and the knowledge of the participants on meta-research in geriatric medicine. The survey was completed by 291 participants from 36 different countries of about 20,000 EuGMS members (mostly with an age between 55 and 64 years; 51.5% female; mainly from Italy and Germany). Most respondents (65.6%) reported reading more than 20 articles in the past year, but few (36.4%) read more than 10 SRs/MAs. Participants reported that SRs and/or MAs are important in clinical practice: 83.8% giving a score of > 6/10, and 23.0% reporting 10. The large majority of the participants asked for more education in meta-research. In particular, there is need for educational courses for meta-research in geriatric medicine, online or in person, organized by the EuGMS. Our survey shows that interest in SRs/MAs is high, and there is a demand for education on these topics in relation to geriatric medicine.

Vaccination is the main public health intervention to prevent influenza. We aimed to evaluate the efficacy and safety of influenza vaccination including systematic reviews and meta-analyses of observational studies and randomized controlled trials (RCTs). Peer-reviewed systematic reviews with meta-analyses of prospective studies that investigated the association of influenza vaccination with any health-related outcome, as well as RCTs that investigated the efficacy and safety of influenza vaccination, were included. Among 1240 references, 6 meta-analyses were included. In cohort studies of community-dwelling older people influenza vaccination was associated with a lower risk of hospitalization for heart disease and for influenza/pneumonia (strength of evidence: convincing). Evidence in lowering the risk of mortality in community-dwelling older people, of all deaths/severe respiratory diseases in high risk community-dwelling older people and of hospitalization for influenza/pneumonia in case-control studies, was highly suggestive. In RCTs, influenza vaccination, compared to placebo/no intervention, was associated to higher risk of local tenderness/sore arm and to a reduced risk of influenza like-illness. Both these associations showed moderate evidence using the GRADE (Grading of Recommendations Assessment, Development and Evaluation). In conclusion, influenza vaccination in older people seems safe and effective. Further, the evidence on safety and efficacy of vaccines in this population might benefit by an extension of the follow-up period both in RCTs and in longitudinal studies, beyond the usual 6-month period, in order to be able to evaluate the impact of vaccination on long term outcomes. © 2020 Elsevier B.V.

Objectives: To identify determinants of incident malnutrition in community-dwelling older adults. Design: Meta-analysis of 6 community-based longitudinal datasets with follow-up of 1 to 3 years. Setting: Datasets from MaNuEL (MalNutrition in the Elderly) partners were included: 3 studies from Germany and 1 each from Ireland, the Netherlands, and New Zealand. Participants: community-dwelling adults aged 65 and older (N=4,844). Measurement: The same definition of incident malnutrition was used for all cohorts (body mass index < 20.0 kg/m2 at follow-up or weight loss ≥10 % between baseline and follow-up). Twenty-one potential baseline determinants from 7 domains (demographic, nutritional, lifestyle, social, psychological, physical functioning, medical) and 2 follow-up variables (hospitalization, falls) were harmonized for all studies. Binary logistic regression analyses were performed to assess the association between each variable, adjusted for specific confounders, and incident malnutrition. Combined odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects meta-analyses. Results: Studies included between 209 and 1,841 participants without malnutrition at baseline; mean age ranged from 71.7 to 84.6. Incidence of malnutrition varied from 5.1% and 17.2%. Meta-analyses identified 6 variables as independent determinants of incident malnutrition; with increasing age, the risk of developing malnutrition increased continuously. Unmarried, separated, or divorced participants were more likely to develop malnutrition than married participants, whereas no association was found for widowed participants. Participants with difficulty walking (OR=1.41, 95% CI=1.06–1.89) or difficulty climbing stairs (OR=1.45, 95% CI=1.14–1.85) and those who were hospitalized before baseline (OR=1.49, 95% CI=1.25–1.76) and during follow-up (OR=2.02, 95% CI=1.41–2.88) had higher odds of incident malnutrition. Conclusion: In this harmonized meta-analysis based on prospective data of older, community-dwelling adults, age, marital status, limitations with walking and climbing stairs, and hospitalization were identified as determinants of incident malnutrition. J Am Geriatr Soc 66:2335–2343, 2018.

Objective: Treatment of paediatric obesity focuses on changes of nutrition and eating behaviour and physical activity. The evaluation of the patient education programme by KgAS was utilised to analyse the association of changes of portion size, eating rate and dietary habits with BMI-SDS reductions. Methods: Patients (n = 297) were examined at the beginning and at the end of treatment and after 1-year follow-up at different out-patient centres. Their parents completed questionnaires including estimation of children's portion size, eating rate and frequency of food intake. Associations of 1- and 2-year changes in BMI-SDS and behaviour were calculated for patients with complete data in BMI-SDS, portion size, eating rate, frequency of green, yellow and red food intake (n = 131) by multiple linear regression models. Results: Significant changes were found in the desired direction for BMI-SDS, portion size, eating rate and the intake of unfavourable red food items both after 1 and 2 years as well as for the consumption of favourable green food items after 1 year. Significant positive associations with BMI-SDS reduction after 1 and 2 years were detected for portion size (Cohen's f2 0.13 and 0.09) and eating rate (Cohen's f2 0.20 and 0.10), respectively. Conclusion: Reduced portion sizes and eating rates are associated with BMI-SDS reduction after 1 and 2 years. These findings suggest to focus on appropriate portion sizes and reduced eating rates in patient education programmes.

open access article; International audience; [u]Background & Aims[/u] Malnutrition in older adults results in significant personal, social, and economic burden. To combat this complex, multifactorial issue, evidence-based knowledge is needed on the modifiable determinants of malnutrition. Systematic reviews of prospective studies are lacking in this area; therefore, the aim of this systematic review was to investigate the modifiable determinants of malnutrition in older adults. [u]Methods[/u] A systematic approach was taken to conduct this review. Eight databases were searched. Prospective cohort studies with participants of a mean age of 65 years or over were included. Studies were required to measure at least one determinant at baseline and malnutrition as outcome at follow-up. Study quality was assessed using a modified version of the Quality in Prognosis Studies (QUIPS) tool. Pooling of data in a meta-analysis was not possible therefore the findings of each study were synthesized narratively. A descriptive synthesis of studies was used to present results due the heterogeneity of population source and setting, definitions of determinants and outcomes. Consistency of findings was assessed using the schema: strong evidence, moderate evidence, low evidence, and conflicting evidence. [u]Results[/u] Twenty-three studies were included in the final review. Thirty potentially modifiable determinants across seven domains (oral, psychosocial, medication and care, health, physical function, lifestyle, eating) were included. The majority of studies had a high risk of bias and were of a low quality. There is moderate evidence that hospitalisation, eating dependency, poor self-perceived health, poor physical function and poor appetite are determinants of malnutrition. Moderate evidence suggests that chewing difficulties, mouth pain, gum issues co-morbidity, visual and hearing impairments, smoking status, alcohol consumption and physical activity levels, complaints about taste of food and specific nutrient intake are not determinants of malnutrition. There is low evidence that loss of interest in life, access to meals and wheels, and modified texture diets are determinants of malnutrition. Furthermore, there is low evidence that psychological distress, anxiety, loneliness, access to transport and wellbeing, hunger and thirst are not determinants of malnutrition. There appears to be conflicting evidence that dental status, swallowing, cognitive function, depression, residential status, medication intake and/or polypharmacy, constipation, periodontal disease are determinants of malnutrition. [u]Conclusion[/u] There are multiple potentially modifiable determinants of malnutrition however strong robust evidence is lacking for the majority of determinants. Better prospective cohort studies are required. With an increasingly aging population, targeting modifiable factors will be crucial to the effective treatment and prevention of malnutrition.

Key summary pointsAimTo investigate associations of sarcopenia with adverse health-related outcomes, through an umbrella review method.FindingsSarcopenia appears to be significantly associated with several adverse outcomes in older people, with a strong evidence for increased risk of mortality, disability, and falls.MessageSarcopenia is associated with several adverse health-related outcomes in older people, indicating the need of assessing this condition in daily practice. AbstractBackgroundThe clinical relevance of sarcopenia has increasingly been recognized. However, whether it is associated with the development of other medical conditions is still unclear. Therefore, we aimed to capture the scale of outcomes that have been associated with the presence of sarcopenia and systematically assess the quality, strength, and credibility of these associations using an umbrella review methodology.MethodsA systematic review in several databases was carried out, until 20th February 2019. For each association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity (I-2), evidence for small-study effect, evidence for excess significance bias, and 95%-prediction intervals were estimated. We used these metrics to categorize the evidence of significant outcomes (p

The clinical relevance of sarcopenia has increasingly been recognized. However, whether it is associated with the development of other medical conditions is still unclear. Therefore, we aimed to capture the scale of outcomes that have been associated with the presence of sarcopenia and systematically assess the quality, strength, and credibility of these associations using an umbrella review methodology.A systematic review in several databases was carried out, until 20th February 2019. For each association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity (IFrom 358 abstracts, 6 meta-analyses with 14 associations were included. Sarcopenia was associated with higher risk of other comorbidities and mortality in 11 of 14 outcomes explored. However, only 3 outcomes (i.e., association between sarcopenia and increased risk of death in community-dwelling older people [odds ratio, OR = 3.60; 95% CI 2.96-4.37; n = 14,305], disability [OR = 3.04; 95% CI 1.80-5.12; n = 8569], and falls [OR = 1.60; 95% CI 1.31-1.97; n = 12,261]) presented a highly suggestive evidence (class II). Other association was classified as having only a weak evidence.Sarcopenia is associated with several adverse health-related outcomes in older people, and its associations with mortality, disability, and falls are supported by a highly suggestive evidence. The effect of interventions on sarcopenia to improve these outcomes needs to be investigated.

Zusammenfassung Hintergrund: Die Beobachtungsstudie zur Evaluation ambulanter und stationärer Versorgung zur Behandlung der Adipositas im Kindes- und Jugendalter in Deutschland (BZgA-Studie) zeigte in einer breiten Angebotspalette sehr heterogene Therapieadhärenz und Ergebnisse. Es soll gezeigt werden, welche Ergebnisse durch ein homogenes, leitliniengerechtes, ambulantes Programm der Konsensusgruppe Adipositasschulung für Kinder und Jugendliche e. V. (KgAS) in der multizentrischen Anwendung erzielt warden können. Methode: 8–16-jährige adipöse Patienten und ihre Familien wurden an 14 Standorten in Deutschland ein Jahr ambulant nach dem KgAS-Programm in einer Gruppenschulung behandelt. Neben einem Fragebogen zur Lebensqualität wurden zu Therapiebeginn (T0) und -ende (T1) sowie ein Jahr später (T2) BMI, Blutdruck und Adipositas-relevante Laborwerte von den Patienten erhoben. Die Analyse erfolgte sowohl für Fälle mit vollständigen Daten als auch mit Baseline observation carried foreward (BOCF)-Methode für Patienten mit fehlenden Daten. Ergebnisse: Der BMI der 297 Patienten lag zu T0 im Mittel bei 28,7 kg/m², bzw. +2,37 SDS, 13,2 % übergewichtig, 55,8 % adipös, 31,0 % extrem adipös. Das mittlere Alter betrug 11,7 Jahre, 52,1 % waren weiblich und einen Migrationshintergrund hatten 34,7 % der Patienten. Zu T1 konnten 97 % der Patienten untersucht werden, zu T2 59 %. Der BMI-SDS reduzierte sich bis T1 signifikant (für vollständige Daten von +2,32 auf +2,03 zu T1 und +2,07 zu T2 und BOCF +2,37 [T0], 2,14 [T1] und 2,22 [T2]). Die Hypertonieprävalenz verminderte sich kurz- und langfristig signifikant (für vollständige Daten N=103, p Schlussfolgerung: Die KgAS-Studie weist mit einem standardisierten Programm in der multizentrischen Durchführung für alle dargestellten Behandlungsziele signifikante Verbesserungen nach: Übergewichtsreduktion, Reduktion von kardiovaskulären Risikofaktoren sowie positive Veränderungen der Lebensqualität.

Importance Controversies about the choice of antibiotic agent and treatment modality exist in the management of erythema migrans in early cutaneous Lyme borreliosis (LB). Objective To conduct a network meta-analysis (NMA) of all randomized clinical trials on various antibiotic agents and treatment modalities in early cutaneous LB. Data Sources Electronic searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were conducted from inception until July 2017. The reference lists of the included studies were hand searched, authors were contacted, and ongoing trials were searched at ClinicalTrials.gov. Study Selection One reviewer screened the titles and abstracts of the 9975 reports identified by the electronic searches. Full-text copies of 161 potentially relevant articles were obtained, and 2 reviewers independently assessed those articles for inclusion. Adults with a physician-confirmed early localized skin infection who were treated with antibiotics of any dose or duration were included. Data Extraction and Synthesis Two reviewers independently extracted data on study, patient, and intervention characteristics. Network meta-analyses on treatment effects and adverse outcomes were calculated with a frequentist approach using the R package netmeta. The Grading of Recommendations Assessment, Development and Evaluation guidance for NMA was used to assess the certainty of evidence. Main Outcomes and Measures Treatment effects for response to treatment (resolution of symptoms) and treatment-related adverse events. Results Overall, 19 studies (2532 patients) were included. The mean patient age ranged between 37 and 56 years, and the percentage of female patients ranged from 36% to 60%. The antibiotics investigated were doxycycline, cefuroxime axetil, ceftriaxone, amoxicillin, azithromycin, penicillin V, and minocycline. Pooled effect sizes from NMAs did not suggest any significant differences in treatment response by antibiotic agent (eg, amoxicillin vs doxycycline odds ratio, 1.26; 95% CI, 0.41-3.87), dose, or duration (eg, doxycycline, 200 mg/d for 3 weeks, vs doxycycline, 200 mg/d for 2 weeks, odds ratio, 1.28; 95% CI, 0.49-3.34). Treatment failures were rare at both 2 months (4%; 95% CI, 2%-5%) and 12 months (2%, 95% CI, 1%-3%) after treatment initiation. There were also no differences in the effect sizes among antibiotic agents and treatment modalities for treatment-related adverse outcomes, which were generally mild to moderate. Certainty of evidence was categorized as low and very low mostly because of imprecision, indirectness, and study limitations (high risk of bias) of the included studies. Conclusions and Relevance This NMA suggests that neither the antibiotic agent nor treatment modality contributed to comparative effectiveness or drug-related adverse outcomes. This finding is relevant for physicians treating patients with LB and for patient decision making.

Background Erythema migrans represents an early cutaneous and most common manifestation of Lyme borreliosis. Recommendations regarding pharmacological agents, dose and duration of treatment are subject of intense debate. This review aims to explore differences in efficacy and safety between pharmacological treatments and control treatment. Methods To identify relevant studies, we will conduct a systematic literature search. We will include randomised controlled trials (RCTs) and non-RCTs. Eligible comparative studies need to (1) consider patients with a diagnosis of erythema migrans resulting from Lyme borreliosis and (2) compare different pharmacological agents against each other, against any other non-pharmacological treatment, placebo or no treatment. Two review authors will independently assess included studies for risk of bias according to the methods of the Cochrane Handbook for Systematic Reviews of Interventions and related to specific study designs. We will address patient-relevant outcomes including clinical remission of cutaneous symptoms, any treatment-related adverse events, quality of life and progressive symptoms such as neuroborreliosis or Lyme carditis and flu-like symptoms. Provided that the identified trials are comparable in terms of clinical issues, combined estimates will be provided. Estimations of treatment effects will be calculated based on a random effects model. Heterogeneity will be evaluated based on I2 and chi-square test. In case of significant heterogeneity, a pooled estimate will not be provided, but heterogeneity will be investigated on the basis of methodological and clinical study aspects. We plan subgroup analysis to reveal potential differences in the effect estimates between patient populations and treatment specifications. We will consider risk of bias using sensitivity analyses to decide whether to rely on the pooled estimates. The quality of a body of evidence for individual outcomes will be assessed using the GRADE approach. Discussion Benefits and harms of pharmacological treatment in erythema migrans have not yet been adequately assessed. This systematic review will evaluate and summarise available evidence addressing benefits and harms of different pharmacological treatments. In addition, this summary of clinical evidence will inform decision-making between clinicians and patients and will play an important part in patient care. Systematic review registration PROSPERO: CRD42016037932 Electronic supplementary material The online version of this article (doi:10.1186/s13643-016-0251-3) contains supplementary material, which is available to authorized users.