Polypharmacy and malnutrition in older people: A narrative review.

Polypharmacy is the simultaneous use of multiple medicines, usually more than five. Polypharmacy is highly prevalent among older individuals and is associated with several adverse health outcomes, including frailty. The role of polypharmacy in nutritional status seems to be crucial: although a clear association between polypharmacy and malnutrition has been widely reported in older people, the magnitude of the effect of increased number of drugs in combination with their type on the risk for malnutrition remains to be largely explored.

Hypoalbuminemia increases complications in elderly patients operated for hip fracture.

Background: Hip fracture is a major cause of morbidity and mortality in elderly people. A drop in serum albumin after hip surgery has been reported, but few data are available on the effect on complications. The aim of this study was to assess the role of two distinct orthopedic surgical procedures (fixation or prosthesis) and pre-surgery albumin serum level on the development of clinical complications.

How to 'SAVE' antibiotics: effectiveness and sustainability of a new model of antibiotic stewardship intervention in the internal medicine area.

Background: Antibiotic stewardship (AS) is a cornerstone of the fight against antimicrobial resistance; however, evidence on the best practice to improve antibiotic prescription in various hospital settings is still scarce. This study aimed to measure the efficacy of a non-restrictive AS intervention in the internal medicine area of a tertiary-care hospital across a 3-year period.

Methods: The intervention comprised a 3-month 'intensive phase' based on education and guidelines provision, followed by 9 months of audits and feedback activities.

The effectiveness of remote monitoring of elderly patients after hospitalisation for heart failure: The renewing health European project.

Background: The effectiveness of remote monitoring (RM) in the management of the elderly after hospitalisation for heart failure (HF) is uncertain.

Methods And Results: Randomized trial (2:1 design) comparing RM with usual care (UC) in patients >65 years old, hospitalised in the previous 3 months for HF with left ventricular ejection fraction <40% or >40% plus BNP > 400 (or NT-proBNP >1500); the primary end-point (PE) was the combined 12-month incidence of death by any cause or at least one hospital readmission for HF. Overall, 229 and 110 pts were enrolled in the RM and UC group, respectively; in the intention-to-treat analysis, the PE was reached in 101 (44.

Can we reliably predict the level of anticoagulation after enoxaparin injection in elderly patients with renal failure?

Objectives: The aim of this study was to evaluate the activity of anti-activated factor X (anti-Xa) in patients with different degrees of chronic renal failure (CRF), treated with therapeutic doses of low molecular weight heparin.

Design: This prospective study evaluated the effect of age, renal function, BMI, gender, in determining the efficacy and safety of treatment with enoxaparin, evaluated by assessing the anti-Xa. The therapeutic anticoagulant range was set between 0.

Predictors of ectopic fat accumulation in liver and pancreas in obese men and women.

Unlabelled: The aim of the present study was to determine the relationship between body fat distribution, adipocytokines, inflammatory markers, fat intake and ectopic fat content of liver and pancreas in obese men and women. A total of 12 lean subjects (mean age 47.25 ± 14.

Adiponectin gene expression and adipocyte diameter: a comparison between epicardial and subcutaneous adipose tissue in men.

Introduction: Interest has recently focused on epicardial fat, but little is known about epicardial adipocyte size and its relation with insulin resistance and adipokines.

Methods: Biopsies were collected from subcutaneous, epicardial-, and peritoneal fat from 21 males undergoing elective cardiac surgery either for coronary artery bypass grafting (n=11) or for valve replacement (n=10). We assessed epicardial adipocyte size, comparing it with that from subcutaneous fat and peritoneal fat.

Quality of care in congestive heart failure in the elderly: epidemiological evidence of a gap between guidelines and clinical practice.

Background And Aims: This study aimed at evaluating the quality of care in elderly patients hospitalized for heart failure, compared with that received by subjects of younger age.

Methods: A cross-sectional retrospective study was performed on hospitalized subjects for heart failure in the Veneto Region (4.5 million inhabitants), located in North-East Italy, for the year 2004.

Quantification of intermuscular adipose tissue in the erector spinae muscle by MRI: agreement with histological evaluation.

Deposition of fat between skeletal muscle bundles and beneath the muscle fascia, recently called intermuscular adipose tissue (IMAT), is gaining attention as potential contributor to insulin resistance, metabolic syndrome, muscle function impairment, and disability. The aim of this study was to compare IMAT as measured at the erector spinae level by magnetic resonance imaging (MRI), a well-recognized gold standard method to evaluate fat content inside muscles, and histology estimates. In 18 healthy elderly men and women with a wide range of BMI (25.

The quantity of meal fat influences the profile of postprandial hormones as well as hunger sensation in healthy elderly people.

Background: In healthy elderly people, reduced appetite and the consequent decrease in food intake has been defined as the "anorexia of aging"; this condition may lead to malnutrition. The aim of this study was to investigate how different compositions of macronutrients affect satiety and hunger signals as well as subjective sensations after meals in healthy elderly subjects.

Methods: Experimental controlled study.

Prevalence of overweight and obesity in Italy (2001-2008): is there a rising obesity epidemic?

Purpose: To provide national, population-based estimates of the prevalence of overweight and obesity in the Italian population.

Methods: Prevalence estimates of overweight and obesity were calculated in seven waves (2001-2008) of the cross-sectional Multipurpose Household Survey organized by the Italian National Institute of Statistics, which are representative of the general adult Italian population. Sampling weights were used to estimate prevalence figures as well as their standard errors.

The effects of adiponectin on interleukin-6 and MCP-1 secretion in lipopolysaccharide-treated 3T3-L1 adipocytes: role of the NF-kappaB pathway.

It was recently suggested that the transcription nuclear factor-kappaB (NF-kappaB) plays an important role in controlling the inflammation and metabolic alterations associated with obesity. In endothelial and monocytic cells, adiponectin acts as a modulator of the inflammatory response, suppressing NF-kappaB activation. The aim of this study was to assess the ability of different forms of adiponectin to modulate the inflammatory response in adipocytes.

Abdominal obesity and subclinical vascular damage in the elderly.

Objective: The aim of the present study was to assess the relationships between metabolic syndrome, its components and arterial stiffness as well as evaluate the waist measurement that would accurately identify subclinical vascular damage.

Methods: Ninety-one participants (16 men) free of cardiovascular diseases with mean age 68.5 +/- 5.

Adipose tissue infiltration in skeletal muscle of healthy elderly men: relationships with body composition, insulin resistance, and inflammation at the systemic and tissue level.

Background: Association between inflammatory markers and intermuscular adipose tissue (IMAT) has been reported. We hypothesized that subclinical inflammation of adipose tissue surrounding and infiltrating muscle could be related to the metabolic and functional abnormalities of the "aging muscle."

Methods: In 20 healthy elderly men undergoing elective vertebral surgery, IMAT within erector spinae was evaluated by magnetic resonance imaging and body composition by dual-energy x-ray absorptiometry.

In vitro aging of 3T3-L1 mouse adipocytes leads to altered metabolism and response to inflammation.

We used an in vitro model to evaluate the effects of cellular aging and inflammation on the gene expression and protein secretion profiles of adipocytes. 3T3-L1 mouse preadipocytes were cultured according to standard conditions and analyzed at different time points both at the basal state and after an acute stimulation with LPS. The mRNA levels of CCAAT/enhancer-binding protein (C/EBP)alpha, peroxisome proliferator-activated receptor (PPAR)gamma and S100A1 were maximal during adipocyte differentiation and then significantly decreased.

Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial.

Background: Chronic plaque psoriasis is frequently associated with obesity. The effect of a hypoenergetic diet on psoriasis has not been investigated.

Objective: The objective was to investigate whether moderate weight loss (ie, 5-10% of body weight) increases the therapeutic response to a low dose of cyclosporine in obese patients with moderate-to-severe chronic plaque psoriasis.

Sarcopenic obesity: a new category of obesity in the elderly.

Background And Aim: In elderly patients, age-related changes in body composition, as well as the increased prevalence of obesity, determine a combination of excess weight and reduced muscle mass or strength, recently defined as sarcopenic obesity (SO). This review examines the main studies regarding sarcopenic obesity in the elderly.

Data Synthesis: Definition of SO necessarily combines those of sarcopenia and obesity.

Longitudinal body composition changes in old men and women: interrelationships with worsening disability.

Background: Few studies have evaluated prospectively age-related body composition changes and their relationships with worsening disability in the elderly population.

Methods: Ninety-seven women and 62 men aged 71.4+/-2.

The anorexia of aging.

Malnutrition in the elderly is one of the greatest threats to health, well-being and autonomy, it is therefore crucial to understand and to contrast the causal factors of inadequate energy intake. This review focuses on the mechanisms of the so-called 'anorexia of aging'. In recent years, it has been shown that elderly subjects have abnormal peripheral signal patterns and alterations in central hypothalamic control relays.

High baseline values of fat mass, independently of appendicular skeletal mass, predict 2-year onset of disability in elderly subjects at the high end of the functional spectrum.

Background And Aims: To evaluate the relation between baseline body composition and 2- year onset of functional limitation in elderly subjects at the high end of the functional spectrum.

Methods: Anthropometric measurements, physical functioning as measured by a modified version of the Activities of Daily Living Scale, and baseline albumin, were evaluated in 145 men and women aged 66-78 years, free of functional limitations, selected from the general population of Verona. In each subject, total body fat mass (FM) and appendicular FFM (ASMM) were measured by dual-energy X-ray absorptiometry; the FM (FMI) and ASMM indexes (ASMMI) were also calculated by dividing each body composition variable by height squared.