title: Effects on muscle performance of NSAID treatment with Piroxicam versus placebo in geriatric patients with acute infection-induced inflammation. a double blind randomized controlled trial Financial impact of sarcopenia on hospitalization costs The influence of celecoxib on muscle fatigue resistance and mobility in elderly patients with inflammation. Randomized clinical trial of multimodal optimization of surgical care in patients undergoing major colonic resection Little effect of physical training on body composition and nutritional intake following colorectal surgery—a randomised placebo-controlled trial The underrecognized epidemic of low mobility during hospitalization of older adults. Multimodal optimization of surgical care shows beneficial outcome in gastrectomy surgery. Essential amino acid and carbohydrate supplementation ameliorates muscle protein loss in humans during 28 days bedrest. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions Nutritional support in patients with chronic obstructive pulmonary disease during hospitalization for an acute exacerbation; a randomized controlled feasibility trial. Nutritional, respiratory, and psychological effects of recombinant human growth hormone in patients undergoing abdominal aortic aneurysm repair. Bed rest promotes reductions in walking speed, functional parameters, and aerobic fitness in older, healthy adults. Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial. Randomized clinical trial of multimodal optimization and standard perioperative surgical care A pilot study of anabolic steroids in elderly patients with hip fractures. Does additional feeding support provided by health care assistants improve nutritional status and outcome in acutely ill older in-patients?--a randomised control trial. Positive effect of protein-supplemented hospital food on protein intake in patients at nutritional risk: a randomised controlled trial. Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery. Prevalence and outcomes of low mobility in hospitalized older patients. Two phase randomised controlled clinical trial of postoperative oral dietary supplements in surgical patients. A randomized controlled trial on early physiotherapy intervention versus usual care in acute car unit for elderly: Potential benefits in light of dietary intakes Postoperative Physical Training following Colorectal Surgery: A Randomised, Placebo-Controlled Study Randomized controlled trial of preoperative oral carbohydrate treatment in major abdominal surgery Enforced mobilization, early oral feeding, and balanced analgesia improve convalescence after colorectal surgery. Early nutritional support and physiotherapy improved long-term self-sufficiency in acutely ill older patients. An Enhanced-Recovery Protocol Improves Outcome After Colorectal Resection Already During the First Year: A Single-Center Experience in 168 Consecutive Patients Effect of Delirium and Other Major Complications on Outcomes After Elective Surgery in Older Adults. EAA supplementation to increase nitrogen intake improves muscle function during bed rest in the elderly.
abstract: Background Inflammation is the main cause of disease-associated muscle wasting . In a previous single blind study we have demonstrated improved recovery of muscle endurance following celecoxib treatment in hospitalized geriatric patients with acute infection . Here we further evaluate NSAID treatment with piroxicam in a double blind RCT and investigate the role of cytokines and heat shock proteins ( Hsp ) with respect to muscle performance . We hypothesized that NSAID treatment would preserve muscle performance better than antibiotic treatment alone , by reducing infection-associated inflammation and by increasing expression of cytoprotective Hsp . Methods Consecutive admissions to the geriatric ward were screened . 30 Caucasian patients , median age 84.5 years , with acute infection-induced inflammation and serum levels of CRP > 10 mg/L were included and r and omized to active treatment with 10 mg piroxicam daily or placebo . Assessment comprised general clinical and biochemical parameters , 25 cytokines in serum , intra- and extracellular Hsp27 and Hsp70 , Elderly Mobility Scale ( EMS ) scores , grip strength ( GS ) , fatigue resistance ( FR ) and lean body mass ( LBM ) . Patients were evaluated until discharge with a maximum of 3 weeks after treatment allocation . Results EMS scores , FR and grip work ( GW ) , a measure taking into account GS and FR , significantly improved with piroxicam , but not with placebo . Early decreases in IL-6 serum levels with piroxicam correlated with better muscle performance at week 2 . Basal expression of Hsp27 in monocytes without heat challenge ( WHC ) was positively correlated with FR at baseline and significantly increased by treatment with piroxicam compared to placebo . Profound modifications in the relationships between cytokines or Hsp and changes in muscle parameters were observed in the piroxicam group . Conclusions Piroxicam improves clinical ly relevant measures of muscle performance and mobility in geriatric patients hospitalized with acute infection-induced inflammation . Underlying mechanisms may include modifications in the cytokine network and increases in monocytic expression of cytoprotective Hsp27.Trial registration numberIS RCT N : IS RCT Background / Objectives : This study aims to increase knowledge regarding the association of sarcopenia with hospitalization costs among a wide-ranging sample of adult hospitalized patients .Subjects/ Methods : A prospect i ve study was conducted among hospitalized adult patients . Sarcopenia was identified according to the European Working Group on Sarcopenia in Older People , as low muscle mass , assessed by bioelectrical impedance analysis and low muscle function evaluated by h and grip strength .  Hospitalization cost was calculated for each patient based on discharge diagnosis-related group codes and determined on the basis of a relative weight value . Costs were defined as the percentage of deviation from the cost of a patient with a relative weight equal to one . Multivariable linear regression models were performed to identify the factors independently associated with hospitalization costs . Results : A total of 656 hospitalized patients aged ⩾18 years ( 24.2 % sarcopenic ) composed the study sample . Sarcopenia increased hospitalization costs by [ euro ] 1240 ( 95 % confidence interval ( CI ) : [ euro ] 596–1887 ) for patients aged < 65 years and [ euro ] 721 ( 95 % CI : [ euro ] 13–1429 ) for patients aged ⩾65 years . Sarcopenic overweight was related to an increase in hospitalization costs of [ euro ] 884 ( 95 % CI : [ euro ] 295–1476 ) . Conclusions : Sarcopenia is independently related to hospitalization costs . This condition is estimated to increase hospitalization costs by 58.5 % for patients aged < 65 years and 34 % for patients aged ⩾65 years BACKGROUND Acute inflammation has a negative effect on the muscular system in elderly patients , compromising the outcome of the underlying disease . OBJECTIVE The aim of this study was to evaluate the effect of cyclooxygenase-2 ( COX-2 ) inhibition on muscle performance and mobility in hospitalized elderly patients with acute inflammation of infectious origin . METHODS In this single-blind , controlled trial , consecutively hospitalized elderly patients ( age > or = 70 years ) with inflammation ( C-reactive protein [ CRP ] levels > or = 10 mg/L ) due to acute infection were r and omly assigned to receive 2 weeks of treatment with the COX-2-selective inhibitor celecoxib , acetaminophen , or no supplementary medication ( control ) . The following variables were assessed at baseline and at 1 and 2 weeks ' follow-up : muscle fatigue resistance ( primary outcome measure ) ; grip strength and mobility ( secondary outcome measures ) ; and levels of the acute-phase markers CRP , interleukin (IL)-1beta , IL-6 , IL-10 , tumor necrosis factor-alpha ( TNF-alpha ) , and transforming growth factor-beta ( TGF-beta ) as explanatory variables . RESULTS Forty-three consecutively hospitalized elderly patients ( 31 women , 12 men ; mean [ SD ] age , 84 [ 6 ] years ) were enrolled . Fourteen patients received celecoxib , 14 received acetaminophen , and 15 received no supplementary medication . The change in fatigue resistance was significantly different between groups ( P = 0.021 , Kruskal-Wallis chi-square test ) , with significantly greater improvement in patients receiving celecoxib compared with the acetaminophen and control groups ( 63 % increase from baseline ; P < 0.05 ) . There were no significant between-group differences in changes in grip strength , mobility , IL-1beta , IL-6 , TNF-alpha , or TGF-beta . The changes in levels of IL-10 differed significantly between groups ( P = 0.020 , Kruskal-Wallis chi-square test ) , with greater improvement in the celecoxib group compared with the acetaminophen group ( P = 0.032 ) . CONCLUSION The results of this study suggest that COX-2-selective inhibition has a beneficial effect on muscle fatigue resistance in hospitalized elderly patients with acute inflammation of infectious origin . However , until further trials are conducted , the use of COX-2-selective inhibitors for this indication is not recommended The aim of this trial was to compare  multimodal optimization  with  conventional perioperative management  in a consecutive series of patients undergoing a wide range of colorectal procedures Objective : Postoperatively patients have a reduction in nutritional intake and body weight . We studied the effect of postoperative physical training on nutritional intake and body composition . Methods : Patients ⩾60 y admitted for elective colorectal surgery were  r and omised to train muscular strength ( group A ) or to nonstrengthening exercises ( group B ) for 3 months  . Fat mass ( FM ) and lean body mass ( LBM ) were assessed with bioimpedance preoperatively , 7 , 30 , and 90 days postoperatively . Nutritional intake was registered in a sub population . Results : Of 119 included patients , 60 were r and omised to group A and 59 to B. The changes in LBM at postoperative day 7 were a mean ( s.d . ) of 0.4 ( 2.1 ) kg in group A compared to −0.7 ( 2.0 ) kg in B. The difference between groups of 1.2 ( 0.5 ) kg at day 7 was statistically significant ( P=0.03 ) . At no other time was observed difference between groups in weight , LBM , or FM . The energy and protein intake rose during postoperative day 1–7 and rose further after discharge . At no time were differences between groups . Conclusion : Physical training had little effect on body composition following abdominal surgery . The nutritional intake in well-nourished patients did not increase by training OBJECTIVES To examine the proportion of time spent in three levels of mobility ( lying , sitting , and st and ing or walking ) by a cohort of hospitalized older veterans as measured by vali date d wireless accelerometers . DESIGN A prospect i ve , observational cohort study . SETTING One hundred fifty-bed Department of Veterans Affairs hospital . PARTICIPANTS Forty-five hospitalized medical patients , aged 65 and older who were not delirious , did not have dementia , and were able to walk in the 2 weeks before admission were eligible . MEASUREMENTS Wireless accelerometers were attached to the thigh and ankle of patients for the first 7 days after admission or until hospital discharge , whichever came first . The mean proportion of time spent lying , sitting , and st and ing or walking  was determined for each hour after hospital admission using a previously vali date d algorithm . RESULTS Forty-five male patients ( mean age 74.2 ) with a mean length of stay of 5.1 days generated 2,592 one-hour periods of data . A baseline functional assessment indicated that 35 ( 77.8 % ) study patients were willing and able to walk a short distance independently . No patient remained in bed the entire measured hospital stay , but on average , 83 % of the measured hospital stay was spent lying in bed . The average amount of time that any one individual spent st and ing or walking ranged from a low of 0.2 % to a high of 21 % , with a median of 3 % , or 43 minutes per day . CONCLUSION This is the first study to continuously monitor mobility levels early during a hospital stay . On average , older hospitalized patients spent most of their time lying in bed , despite an ability to walk independently BACKGROUND The aim of this trial was to compare multimodal optimization with conventional perioperative management in a consecutive series of patients undergoing gastrectomy procedures . METHODS According to r and omized controlled studies and conclusions made by meta-analyses in colorectal surgery , optimized perioperative measures were design ed and applied in gastrectomy surgery . Thirty-three patients were r and omized to the optimized group and 30 patients to a control group .  Two groups were treated in 1 center by a single surgical team in different wards . Both groups used patient-controlled intravenous analgesia for postoperative analgesia . The primary end point was length of postoperative hospital stay . Secondary outcomes included bowel function recovery after surgery , perioperative changes of inflammatory factors , glucocorticoid , insulin resistance , and body composition . Perioperative complications and adverse events were also recorded . RESULTS The groups were similar in terms of age , sex ratio , and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity ( POSSUM score ) . The optimized group was associated with a significantly shorter postoperative hospital stay compared with the conventional care group ( P < .001 ) . Duration s of urinary catheterization and abdominal drainage were also less ( P < .001 ) . The diet program in the optimization group was well tolerated and was associated with an earlier recovery of gut function ( P < .001 ) . Proinflammatory factors were less elevated and body composition was more stable in the optimized group than in controls . There were no differences in morbidity or mortality between the groups . CONCLUSIONS Optimization of care in gastrectomy can shorten postoperative hospital stay and provides multiple beneficial outcomes , including hastening the return of gut function , without increasing morbidity We determined whether essential amino acid and carbohydrate supplementation could offset the catabolic response to prolonged inactivity . Major outcome measures included mixed muscle fractional synthetic rate ( FSR ) , phenylalanine net balance , lean leg mass , and leg extension strength . On d 1 and 28 , vastus lateralis muscle biopsies and femoral arterio-venous blood sample s were obtained during a primed constant infusion of l-[ring-(2)H(5)]phenylalanine .  Net balance and FSR were calculated over 16 h , during which the control group ( CON ) received a nutritionally mixed meal every 5 h ( 0830 , 1330 , and 1830 h ) . The experimental group ( EXP ) also consumed 16.5 g essential amino acids and 30 g carbohydrate ( 1100 , 1600 , and 2100 h ) . The dietary regimen was maintained during bedrest .  FSR was higher in the EXP group on d 1 ( EXP , 0.099 + /- 0.008%/h ; CON : 0.075 + /- 0.005%/h ) and d 28 ( EXP , 0.093 + /- 0.006%/h ; CON , 0.055 + /- 0.007%/h ) . Lean leg mass was maintained throughout bedrest in the EXP group ( + 0.2 + /- 0.3 kg ) , but fell in the CON group ( -0.4 + /- 0.1 kg ) . Strength loss was more pronounced in the CON group ( EXP , -8.8 + /- 1.4 kg ; CON , -17.8 + /- 4.4 kg ) . Essential amino acid and carbohydrate supplementation may represent a viable intervention for individuals at risk of sarcopenia due to immobility or prolonged bedrest Background Lack of appropriate reporting of method ological details has previously been shown to distort risk of bias assessment s in r and omized controlled trials . The same might be true for observational studies . The goal of this study was to compare the Newcastle-Ottawa Scale ( NOS ) assessment for risk of bias between review ers and authors of cohort studies included in a published systematic review on risk factors for severe outcomes in patients infected with influenza . Methods Cohort studies included in the systematic review and published between 2008–2011 were included . The corresponding or first authors completed a survey covering all NOS items . Results were compared with the NOS assessment applied by review ers of the systematic review . Inter-rater reliability was calculated using kappa ( K ) statistics . Results Authors of 65/182 ( 36 % ) studies completed the survey . The overall NOS score was significantly higher ( p < 0.001 ) in the review ers ’ assessment ( median = 6 ; interquartile range [ IQR ] 6–6 ) compared with those by authors ( median = 5 , IQR 4–6 ) . Inter-rater reliability by item ranged from slight ( K = 0.15 , 95 % confidence interval [ CI ] = −0.19 , 0.48 ) to poor ( K = −0.06 , 95 % CI = −0.22 , 0.10 ) . Reliability for the overall score was poor ( K = −0.004 , 95 % CI = −0.11 , 0.11 ) . Conclusions Differences in assessment and low agreement between review ers and authors suggest the need to contact authors for information not published in studies when applying the NOS in systematic review Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies BACKGROUND & AIMS Previous studies reported a severely impaired energy balance in COPD patients during the first days of an acute exacerbation , mainly due to a decreased energy and protein intake . The aim of the study was to investigate the feasibility and effectiveness of energy- and protein-rich nutritional supplements during hospitalization for an acute exacerbation in nutritionally depleted COPD patients . METHODS In a r and omized double-blind , placebo-controlled two-center trial , 56 COPD patients were r and omized and 47 patients completed the study .  Nutritional intervention consisted of 3 x 125 ml ( 2.38 MJ/day ) and the placebo group received similar amounts of a non-caloric fluid . Medical therapy and dietetic consultation were st and ardized and dietary intake was measured daily . Body composition , respiratory and skeletal muscle strength , lung function and symptoms were measured on admission and on days 4 and 8 of hospitalization . RESULTS Forty-seven percent of the patients had experienced recent involuntary weight loss prior to admission . The degree of weight loss was inversely related to resting arterial oxygen tension ( r = 0.31 ; P < 0.05 ) . Nutritional intervention result ed in a significant increase in energy ( 16 % vs. placebo ) and protein intake ( 38 % vs. placebo ) . Mean duration of hospitalization was 9 + /- 2 days . Relative to usual care , no additional improvements in lung function or muscle strength were seen after nutritional intervention . CONCLUSIONS Oral nutritional supplementation during hospitalization for an acute exacerbation is feasible in nutritionally depleted COPD patients and does not interfere with normal dietary intake BACKGROUND Recombinant human growth hormone ( rhGH ) has been shown to have powerful anabolic effects and to reduce or even prevent nitrogen catabolism in stressed patients . The effects of rhGH on functional parameters are less clearly defined . The aim of this study was to assess the effects of perioperative rhGH on nutritional markers , skeletal muscle function , and psychological well-being in patients undergoing infrarenal , abdominal aortic aneurysm repair . METHODS Thirty-three patients undergoing elective infrarenal abdominal aortic aneurysm repair were r and omized to one of three groups : ( 1 ) control ( n = 12 ) : placebo for 6 days before and after surgery ; ( 2 ) preop + postop ( n = 10 ) : rhGH ( Genotropin ; Pharmacia Ltd , Uppsala , Sweden ) 0.3 IU/kg/d for 6 days before and after surgery ; and ( 3 ) postop ( n = 11 ) : placebo for 6 days before and rhGH 0.3 IU/kg/d for 6 days after surgery . Patients were assessed on days -7 and -1 before surgery and days 7 , 14 , and 60 after surgery . RESULTS Administration of rhGH result ed in increased insulin-like growth factor 1 levels , the increase being significantly more marked in the group given rhGH preoperatively . Preoperative and postoperative rhGH reduced the postoperative decrease in both serum transferrin and grip strength at day 7 by 30 % and 70 % , respectively . Postoperative respiratory function and arterial oxygenation also were improved , with significant differences in arterial oxygenation between rhGH-treated and untreated groups . No difference in mood was seen between groups after surgery , nor was there any difference between subjective assessment of fatigue scores between groups . CONCLUSIONS This pilot study indicates that rhGH administered preoperatively has beneficial effects on skeletal muscle and respiratory function and may be more useful than postoperative rhGH administration alone CONTEXT The exact relationship between the bed rest-induced loss of skeletal muscle and reductions in muscle strength and physical performance in the older individuals is still unclear . OBJECTIVE We examined the effect of 10 days of bed rest on changes in regional body composition , muscle strength , and functional status , and the relationship between these variables in older individuals . DESIGN , PARTICIPANTS , AND INTERVENTION Regional body composition was measured using dual energy x-ray absorptiometry . We also determined changes in leg strength and several indices of functional status , including walking speed . RESULTS Body weight , body mass index , and total and lower extremity lean mass decreased with bed rest . There were also significant reductions in knee extension one repetition maximum , isometric knee extension , knee extension 60 ° concentric , stair ascent time , stair ascent power , stair descent time , VO2 max , floor transfer test , 5-minute walk time , and chair st and . The overall change in total and lower extremity lean mass was also directly related to bed rest-induced reductions in one repetition maximum knee extension . CONCLUSIONS Bed rest promoted overall declines in muscle mass , muscle strength , and physical function in older individuals . The changes in lean tissue were closely correlated with the bed rest-induced decline of muscle strength OBJECTIVE To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise program to improve physical health of frail elderly patients scheduled for elective total hip arthroplasty ( THA ) . DESIGN Single-blind pilot r and omized controlled trial . SETTING Patients ' homes and a general hospital in The Netherl and s. PARTICIPANTS Frail patients ( N=30 ) older than 65 years . INTERVENTION A preoperative , home-based program supervised by an experienced physical therapist to train functional activities and walking capacity . The control group received usual care consisting of 1 session of instructions . MAIN OUTCOME MEASURES Feasibility was determined on the basis of adherence to treatment , patient satisfaction , adverse events , walking distance ( measured with a pedometer ) , and intensity of exercise ( evaluated with the Borg scale ) . Preliminary pre- and postoperative effectiveness was determined by the Timed Up & Go ( TUG ) test , 6-minute walk test ( 6MWT ) , Chair Rise Time , and self-reported measures of functions , activities , and participation . RESULTS Patient satisfaction and adherence to the training were good ( median=5 on a 5-point Likert scale ) and no serious adverse events occurred . The Borg score during training was 14 ( range , 13 - 16 ) . Preoperative clinical relevant differences on the TUG test ( 2.9 s ; 95 % confidence interval [ CI ] , -0.9 to 6.6 ) and significant differences on the 6MWT ( 41 m ; 95 % CI , 8 to 74 ) were found between groups . CONCLUSIONS Intensive preoperative training at home is feasible for frail elderly patients waiting for THA and produces relevant changes in functional health . A larger multicenter r and omized controlled trial is in progress to investigate the (cost-)effectiveness of preoperative training Multimodal optimization of surgical care has been associated with reduced hospital stay and improved physical function . The aim of this r and omized trial was to compare multimodal optimization with st and ard care in patients undergoing colonic resection OBJECTIVE To determine the safety and efficacy of the anabolic steroid n and rolone in elderly patients with hip fractures . DESIGN A r and omized double-blind placebo-controlled trial . SETTING The orthopedic ward of a university teaching hospital . PARTICIPANTS 29 frail elderly females with hip fractures . INTERVENTION Subjects received n and rolone 2 mg/kg ( n = 15 ) or placebo ( n = 14 ) by weekly injection for 4 weeks or until discharge . MEASURES Baseline functional status was assessed by the Lawton-Brody ADL and IADL . Hemoglobin , transferrin , thyroid-binding prealbumin , albumin , liver function tests , creatinine , weight , MAMC , bioelectric impedance , st and ard anthropometrics and grip strength were measured at baseline and weekly intervals . Rehabilitation parameters and length of stay were recorded . RESULTS The placebo and n and rolone groups were similar in age , although the control group had slightly higher baseline ADL scores . There was no difference between groups in biochemical parameters , anthropometrics , body composition , grip strength , rehabilitation end points or length of stay . One subject in the n and rolone group had a doubling of AST and was withdrawn from the study . CONCLUSIONS N and rolone can be given safely to frail elderly subjects with hip fractures but is likely to be of minimal benefit at the doses we employed BACKGROUND & AIMS Malnutrition is common in the elderly and increases morbidity and mortality . Most attempts to reverse malnutrition have used liquid supplements , but the findings are inconsistent . This study tests a new approach using a r and omised-controlled design . The aim was to examine whether health care assistants , trained to provide additional support with feeding , can improve acutely ill elderly in- patients ' clinical outcomes . METHODS The study was carried out on three acute medicine for the elderly wards at Hammersmith Hospitals NHS Trust , London . In all , 592 patients , all over 65 years old , were recruited . RESULTS The results showed that the median time patients received feeding support was 16 days , and the assisted group was given less intravenous antibiotics  ( P=0.007 ) . However , the groups did not differ in markers of nutritional status , Barthel score , grip strength , length of stay or mortality . CONCLUSION It was concluded that the use of health care assistants in this specialised role , in an acute setting , without change to the food provision or without targeting higher risk patients , reduced the need for intravenous antibiotics . However , the intervention did not improve nutritional status or have an effect on length of stay in the time span studied . The results highlight the difficulties of improving the intake of acutely ill elderly patients during a hospital stay BACKGROUND New evidence indicates that increased dietary protein ingestion promotes health and recovery from illness , and also maintains functionality in older adults . The present study aim ed to investigate whether a novel food service concept with protein-supplementation would increase protein and energy intake in hospitalised patients at nutritional risk . METHODS A single-blinded r and omised controlled trial was conducted . Eighty-four participants at nutritional risk , recruited from the departments of Oncology , Orthopaedics and Urology , were included . The intervention group ( IG ) received the protein-supplemented food service concept . The control group ( CG ) received the st and ard hospital menu . Primary outcome comprised the number of patients achieving ≥75 % of energy and protein requirements . Secondary outcomes comprised mean energy and protein intake , body weight , h and grip strength and length of hospital stay . RESULTS In IG , 76 % versus 70 % CG patients reached ≥75 % of their energy requirements ( P = 0.57 ) ; 66 % IG versus 30 % CG patients reached ≥75 % of their protein requirements ( P = 0.001 ) . The risk ratio for achieving ≥75 % of protein requirements : 2.2 ( 95 % confidence interval = 1.3 - 3.7 ) ; number needed to treat = 3 ( 95 % confidence interval = 2 - 6 ) . IG had a higher mean intake of energy and protein when adjusted for body weight ( CG : 82 kJ kg(-1 ) versus IG : 103 kJ kg(-1 ) , P = 0.013 ; CG : 0.7 g protein kg(-1 ) versus 0.9 g protein kg(-1 ) , P = 0.003 ) . Body weight , h and grip strength and length of hospital stay did not differ between groups . CONCLUSIONS The novel food service concept had a significant positive impact on overall protein intake and on weight-adjusted energy intake in hospitalised patients at nutritional risk OBJECTIVE The objective of this study was to describe postoperative undernutrition in terms of postoperative losses of appendicular skeletal muscle mass ( ASMM ) with respect to complications , quality of life , readmission , and 1-y mortality  after cardiac surgery . METHODS Patients undergoing cardiac surgery were prospect ively followed . ASMM was measured 2 wk before and 2 mo after surgery using dual-energy X-ray absorptiometry . ASMM consists of arm skeletal muscle mass ( SMM ) and leg SMM . The association between ≥5 % of ASMM decrease and postoperative outcome was analyzed using the chi-square test . A similar approach was used to analyze arm SMM and leg SMM decreases separately . RESULTS Twenty-nine patients were included ( 23 male , 34.5 % ≥65 y old ) . Postoperatively , seven patients ( 24.1 % ) lost ≥5 % ASMM . When analyzed separately , a ≥5 % decrease in leg SMM was associated with a decrease in experienced vitality ( odds ratio 13.0 , 95 % confidence interval 1.32 - 128.11 , P = 0.03 ) . In contrast , a ≥5 % loss of arm SMM was associated with fewer in-hospital complications ( odds ratio 0.20 , 95 % confidence interval 0.04 - 0.98 , P = 0.04 ) . These patients were characterized by a higher preoperative fat-free mass index ( kilograms per meter squared ; P = 0.01 ) . CONCLUSIONS The results suggest that a preoperatively higher fat-free mass index indicates better ability to cope with operative stress , result ing in fewer complications . In addition , postoperative loss of muscle mass was associated with decreased vitality . We advocate further research investigating the effect of preoperative and postoperative nutritional intervention combined with physical exercise programs to increase lean body mass and thereby improve postoperative recovery after cardiac surgery OBJECTIVES To estimate the prevalence of different levels of mobility in a hospitalized older cohort , to measure the degree and rate of adverse outcomes associated with different mobility levels , and to examine the physician activity orders and documented reasons for bedrest in the lowest mobility group . DESIGN A prospect i ve cohort study . SETTING An 800-bed university teaching hospital . PARTICIPANTS Four hundred ninety-eight hospitalized medical patients , aged 70 and older . MEASUREMENTS Using average mobility level , scored from 0 to 12 , the low-mobility group was defined as having a score of 4 or less , intermediate as a score of higher than 4 to 8 , and high as higher than 8 . Outcomes were functional decline , new institutionalization , death , and death or new institutionalization . RESULTS Low and intermediate levels of mobility were common , accounting for 80 ( 16 % ) and 157 ( 32 % ) study patients , respectively . Overall , any activity of daily living ( ADL ) decline occurred in 29 % , new institutionalization in 13 % , death in 7 % , and death or new institutionalization in 22 % of patients in this cohort . When compared with the high mobility group , the low and intermediate groups were associated with the adverse outcomes in a grade d fashion , even after controlling for multiple confounders . The low-mobility group had an adjusted odds ratio ( OR ) of 5.6 ( 95 % confidence interval (CI)=2.9 - 11.0 ) for ADL decline , 6.0 ( 95 % CI=2.5 - 14.8 ) for new institutionalization , 34.3 ( 95 % CI=6.3 - 185.9 ) for death , and 7.2 ( 95 % CI=3.6 - 14.4 ) for death or new institutionalization . The intermediate group had adjusted ORs of 2.5 ( 95 % CI=1.5 - 4.1 ) , 2.9 ( 95 % CI=1.4 - 6.0 ) , 10.1 ( 95 % CI=1.9 - 52.9 ) , and 3.3 ( 95 % CI=1.8 - 5.9 ) for ADL decline , new institutionalization , death , and death or new institutionalization , respectively . Bedrest was ordered at some point during hospitalization in 165 ( 33 % ) patients . For most patients , mobility was limited involuntarily ( bedrest orders ) , and almost 60 % of bedrest episodes in the lowest mobility group had no documented medical indication . CONCLUSION Low mobility and bedrest are common in hospitalized older patients and are important predictors of adverse outcomes . This study demonstrated that the adverse outcomes associated with low mobility and bedrest may be viewed as iatrogenic events leading to complications , such as functional decline BACKGROUND : Previous work has shown that the administration of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinical ly significant short term benefits . AIMS : This study aim ed firstly to re-evaluate these short term effects , and secondly to establish whether there are any long term benefits . SUBJECTS : One hundred patients admitted for elective moderate or major gastrointestinal surgery . METHODS : In the inpatient phase , patients were r and omised to receive a normal ward diet postoperatively , or the same diet supplemented with an oral dietary supplement . In the outpatient phase , patients were further r and omised to receive their home diet , or their home diet supplemented with the oral dietary supplement for four months . RESULTS : During the inpatient phase , patients treated with oral supplements had a significantly improved nutritional intake and lost less weight ( 2.2 , 95 % confidence interval ( 95 % CI ) 0.9 kg ) compared with control patients ( 4.2 ( 0.78 ) kg , p < 0.001 ) . Supplemented patients maintained their h and grip strength whereas control patients showed a significant reduction in grip strength ( p < 0.01 ) . Subjective levels of fatigue increased significantly above preoperative levels in control patients ( p < 0.01 ) but not in the supplemented group . Twelve patients in the control group developed complications compared with four in the supplemented group ( p < 0.05 ) . In the outpatient phase , supplemented patients had improved nutrient intakes but there were no significant differences in indices of nutritional status or wellbeing between the groups . CONCLUSIONS : The prescription of oral dietary supplements to patients who have undergone gastrointestinal surgery results in clinical ly significant benefits . These benefits , however , are restricted to the inpatient phase Objective : To evaluate effects of early intensive physiotherapy during acute illness on post hospitalization activity daily living autonomy ( ADL ) . Design : Prospect i ve r and omized controlled trial of intensive physiotherapy rehabilitation on day 1 to 2 after admission until clinical stability or usual care . Setting : acute care geriatric medicine ward . Patients : A total of 76 acutely ill patients , acutely bedridden or with reduced mobility but who were autonomous for mobility within the previous 3 months . Patients in palliative care or with limiting mobility pathology were excluded . Mean age was 85.4 ( SD 6.6 ) years . Measurements : At admission , at clinical stability and one month later : anthropometry , energy and protein intakes , h and grip strength , ADL scores , and baseline inflammatory parameters . An exploratory principal axis analysis was performed on the baseline characteristics and general linear models were used to explore the course of ADL and nutritional variables . Results : A 4-factor solution was found explaining 71.7 % of variance with a factor “ nutrition ” , a factor “ function ” ( 18.8 % of variance ) for ADL , h and grip strength , bedridden state , energy and protein intakes , serum albumin and C-reactive protein concentrations ; a factor “ strength ” and a fourth factor . During follow-up , dietary intakes , h and grip strength , and ADL scores improved but no changes occurred for anthropometric variables . Intervention was associated only with an increase in protein intake . Better improvement in ADL was found in intervention group when model was adjusted on “ function ” factor items . Conclusion : Physical intervention programs should be proposed according to nutritional intakes with the aim of preventing illness induced disability Background and Aims : Major surgery is often followed by fatigue and reduced physical function . We wished to study if postoperative physical training reduced fatigue and improved physical function . Material and Methods : R and omised , placebo-controlled , single-blinded study . Participants were unselected patients ≥ 60 years undergoing elective colorectal surgery without disseminated cancer or inflammatory bowel disease . Group A trained muscular strength and work capacity . Group B performed relaxation exercises and received hot wrappings and massage . Main outcome measures were : fatigue ( visual analogue scale ) , muscular strength , walking speed , physical performance test , and physical function questions ( SF-36 ) . Results : Preoperatively the two groups were similar except that A was more fatigued than B. By postoperative day seven fatigue had increased compared to preoperatively , more in B than A , but by day 30 and 90 there were no significant differences between groups . All indices of physical function decreased postoperative day seven and were at the preoperative level day 90 with no significant differences between groups in change in function . Day seven the change in knee extension strength tended to be lower in B than A but by day 30 changes were similar in both groups . Conclusion : Postoperative training did not improve physical function , but reduced fatigue in hospital Major surgery is associated with postoperative insulin resistance which is attenuated by preoperative carbohydrate ( CHO ) treatment . The effect of this treatment on clinical outcome after major abdominal surgery has not been assessed in a double‐blind r and omized trial OBJECTIVE A postoperative regimen using a multimodal approach with enforced mobilization and early oral nutrition has been reported to improve convalescence but has not been compared with other postoperative regimens . METHODS Forty patients undergoing elective colorectal surgery were r and omly allocated to an intervention group receiving comprehensive information on the importance of mobilization , balanced anesthesia , and postoperative analgesia including epidural local anesthetics and enforced postoperative mobilization or a control group receiving anesthesia without epidural local anesthetics , postoperative analgesia with epidural morphine , and mobilization without fixed goals . All patients were offered early oral nutrition . The regimens were compared by means of ambulation time and physical activity , voluntary muscle strength , pulmonary function , and body composition . RESULTS The ambulation time improved substantially within 22 h in the intervention group versus 3 h in the control group on day 1 ( P = 0.0004 ) and within 8 h versus 2 h on day 4 ( P = 0.0003 ) . The voluntary strength of the quadriceps muscle decreased by 3 % in the intervention group versus 15 % in the control group on day 7 ( P = 0.04 ) . Two months postoperatively , the difference between groups was the same ( P = 0.02 ) . CONCLUSION This active per- and postoperative regimen based on a multimodal approach improved ambulation time and muscle function during admission and late convalescence OBJECTIVE An acute disease is regularly associated with inflammation , decreased food intake , and low physical activity ; the consequence is loss of muscle mass . However , the restoration of muscle tissue is problematic , especially in older patients . Loss of muscle mass leads to further decrease of physical activity which leads , together with recurring disease , to the progressive muscle mass loss accompanied by loss of self-sufficiency . Early nutrition support and physical activity could reverse this situation . Therefore , the aim of this study was to determine whether an active approach based on early nutritional therapy and exercise would influence the development of sarcopenia and impaired self-sufficiency during acute illness . METHODS Two hundred patients > 78 y were admitted to a hospital internal medicine department and participated in a prospect i ve , r and omized controlled study . The patients were r and omized to a control group receiving st and ard treatment ( n = 100 ) or to an intervention group ( n = 100 ) . The intervention consisted of nutritional supplements ( 600 kcal , 20 g/d protein ) added to a st and ard diet and a simultaneous intensive rehabilitation program . The tolerance of supplements and their influence on spontaneous food intake , self-sufficiency , muscle strength , and body composition were evaluated during the study period . The patients were then regularly monitored for 1 y post-discharge . RESULTS The provision of nutritional supplements together with early rehabilitation led to increased total energy and protein intake while the intake of st and ard hospital food was not reduced . The loss of lean body mass and a decrease in self-sufficiency were apparent at discharge from the hospital and 3 mo thereafter in the control group . Nutritional supplementation and the rehabilitation program in the study group prevented these alterations . A positive effect of nutritional intervention and exercise during the hospital stay was apparent at 6 mo post-discharge . CONCLUSIONS The early nutritional intervention together with early rehabilitation preserves muscle mass and independence in ill older patients hospitalized because of acute disease PURPOSE : This study was design ed to investigate the clinical outcome and recovery before and immediately after implementation of the enhanced recovery after surgery enhanced recovery after surgery protocol in colonic and rectal resection . METHODS : One hundred and sixty-eight consecutive patients in a single center underwent colorectal surgery before ( traditional , n = 69 ) and immediately after implementing enhanced recovery after surgery ( n = 99 ) . Rectal surgery was performed in 77 patients . Postoperative food and fluid intake , mobilization , physiologic function , and clinical outcome were measured prospect ively . RESULTS : Resumption of oral diet was achieved on postoperative day postoperative day 1 in the enhanced recovery after surgery group . In the enhanced recovery after surgery group , mobilization more than 6 hours daily was achieved on postoperative day 2 to 3 and passage of stool occurred on postoperative day 2 vs. postoperative day 5 in the traditional group ( P < 0.0001 ) . Muscle strength and lung function were less reduced in the enhanced recovery after surgery group ( P < 0.05 ) . Median hospital stay was reduced by 2 days ( P < 0.01 ) . Readmission rates increased ( 4 percent vs. 15 percent , P < 0.01 ) but total hospital stay was still lower in the enhanced recovery after surgery group ( P < 0.01 ) . After colonic resection , postoperative complications decreased in enhanced recovery after surgery ( 37 percent vs. 18 percent , P < 0.05 ) , whereas no change was found after rectal resection . CONCLUSION : Immediately after implementing enhanced recovery after surgery , recovery was improved and length of hospital stay was reduced . Notably , postoperative morbidity decreased only in patients undergoing colonic resection IMPORTANCE Major postoperative complications and delirium contribute independently to adverse outcomes and high re source use in patients who undergo major surgery ; however , their interrelationship is not well examined . OBJECTIVE To evaluate the association of major postoperative complications and delirium , alone and combined , with adverse outcomes after surgery . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study in 2 large academic medical centers of 566 patients who were 70 years or older without recognized dementia or a history of delirium and underwent elective major orthopedic , vascular , or abdominal surgical procedures with a minimum 3-day hospitalization between June 18 , 2010 , and August 8 , 2013 . Data analysis took place from December 13 , 2013 , through May 1 , 2015 . MAIN OUTCOMES AND MEASURES Major postoperative complications , defined as life-altering or life-threatening events ( Accordion Severity grade 2 or higher ) , were identified by expert-panel adjudication . Delirium was measured daily with the Confusion Assessment Method and a vali date d medical record review method . The following 4 subgroups were analyzed : ( 1 ) no complications or delirium ; ( 2 ) complications only ; ( 3 ) delirium only ; and ( 4 ) complications and delirium . Adverse outcomes included a length of stay ( LOS ) of more than 5 days , institutional discharge , and rehospitalization within 30 days of discharge . RESULTS In the 566 participants , the mean ( SD ) age was 76.7 ( 5.2 ) years , 236 ( 41.7 % ) were male , and 523 ( 92.4 % ) were white . Forty-seven patients ( 8.3 % ) developed major complications and 135 ( 23.9 % ) developed delirium . Compared with no complications or delirium as the reference group , major complications only contributed to prolonged LOS only ( relative risk [ RR ] , 2.8 ; 95 % CI , 1.9 - 4.0 ) ; by contrast , delirium only significantly increased all adverse outcomes , including prolonged LOS ( RR , 1.9 ; 95 % CI , 1.4 - 2.7 ) , institutional discharge ( RR , 1.5 ; 95 % CI , 1.3 - 1.7 ) , and 30-day readmission ( RR , 2.3 ; 95 % CI , 1.4 - 3.7 ) . The subgroup with complications and delirium had the highest rates of all adverse outcomes , including prolonged LOS ( RR , 3.4 ; 95 % CI , 2.3 - 4.8 ) , institutional discharge ( RR , 1.8 ; 95 % CI , 1.4 - 2.5 ) , and 30-day readmission ( RR , 3.0 ; 95 % CI , 1.3 - 6.8 ) . Delirium exerted the highest attributable risk at the population level ( 5.8 % ; 95 % CI , 4.7 - 6.8 ) compared with all other adverse events ( prolonged LOS , institutional discharge , or readmission ) . CONCLUSIONS AND RELEVANCE Major postoperative complications and delirium are separately associated with adverse events and demonstrate a combined effect . Delirium occurs more frequently and has a greater effect at the population level than other major complications BACKGROUND & AIMS Older individuals are more likely to experience extended hospitalization and become protein malnourished during hospitalization . The concomitant compulsory inactivity results in functional decline . Increasing protein intake in hospitalized patients improves nitrogen balance , but effects on function are unknown . In the present study , we examined the effects of increasing protein intake by essential amino acid ( EAA ) supplementation in older individuals subjected to 10 d bed rest on LBM and muscle function . METHODS Subjects were given a placebo ( n=12 , 68+/-5 ( SD ) yrs , 83+/-19 kg ) or 15 g of EAA ( n=10 , 71+/-6 , 72+/-8 kg ) 3 times per day throughout 10d of bed rest . LBM , muscle protein synthesis , and muscle function were determined before and after bed rest . Due to an imbalance in r and omized gender distribution between groups , gender and beginning functional and LBM measures were utilized for analyses by repeated measures analysis of covariance ( RMANCOVA ) . RESULTS Analyses revealed the potential for the preservation of functional outcomes with EAA supplementation . CONCLUSIONS Increasing protein intake above the RDA may preserve muscle function in the elderly during compulsory inactivity . EAA supplementation is potentially an efficient method of increasing protein intake without affecting satiety
target: In conclusion , decrease in muscle strength and muscle mass in older patients is dependent on the type of admission .
  HIGHLIGHTSPhysical inactivity during hospitalization is associated with detrimental outcome .Muscle strength and muscle mass decreased in electively admitted older patients .Muscle strength and muscle mass did not change in acutely admitted older patients
background: ABSTRACT Hospitalization may induce a decrease of muscle strength and muscle mass in older patients due to physical inactivity , malnutrition and diseases , negatively affecting health outcome .
  We aim ed to examine the literature on change in muscle strength and muscle mass in older patients during hospitalization .