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Purpose The WHO has proposed a novel model of healthy aging called intrinsic capacity (IC). However, the association between dietary patterns and IC is unclear. We aimed to investigate the prospective associations between dietary patterns and IC trajectories over a 3-year period in community-dwelling Japanese adults aged ≥ 60 years. Methods A prospective cohort study which contained nutritional status, mental status, and physical function was used. A validated 34-item food frequency questionnaire was used to determine dietary intake and to derive five dietary patterns (“fruits and vegetables”, “sugar and fat”, “salt and pickles”, “noodle and alcohol”, and “protein-rich”) using principal component analysis. The composite IC score was calculated as the mean of the locomotion Z-score, cognition Z-score, psychological Z-score, vitality Z-score, and sensory regression score. A generalized estimating equation was applied for longitudinal analysis. Results A total of 666 enrollees were included in the analysis. The mean baseline IC was 0.07 ± 0.47. The “fruits and vegetables” dietary pattern was positively associated with composite IC score changes after adjusting for confounders (Q4 vs. Q1: mean difference [0.069], P  = 0.019). Similarly, a positive correlation was observed for the “protein-rich” dietary pattern with the composite IC score changes (Q4 vs. Q1: mean difference [0.092], Q3 vs. Q1: mean difference [0.101], Q2 vs. Q1: mean difference [0.083]; all P  < 0.01). However, adherence to the “sugar and fat” dietary pattern was negatively associated with composite IC score changes (Q4 vs. Q1: mean difference [− 0.072], P  = 0.026). Furthermore, the percentage of animal protein to total protein intake showed a significant incremental trend in the “protein-rich” dietary pattern ( P for trend < 0.001). Conclusion The “fruits and vegetables” and “protein-rich” (animal-based protein in particular) dietary patterns were positively associated with IC changes, whereas the “sugar and fat” dietary pattern was negatively associated with IC changes. Identification and promotion of healthy dietary patterns in older adults may inform future health policies and research.

Background Social frailty is associated with poor health outcomes; however, its effects on healthy aging indicators have not been adequately investigated. This study assessed the longitudinal association between social frailty and the intrinsic capacity of community-dwelling older adults. Methods A total of 663 participants (56.7% women) aged ≥60 years from in Nagoya, Japan, were included in the study. The first measurement occurred in 2014, and annual follow-ups occurred until 2017. Social frailty was determined based on four items: financial difficulty, household status, social activity, and regular contact with others. A deficit score of 0 represented social robustness, 1 represented social prefrailty, and ≥ 2 represented social frailty. Intrinsic capacity was evaluated by the locomotion, cognition, psychological function, vitality, and sensory function domains. The longitudinal association was analyzed using generalized estimating equations. Results The prevalence of social prefrailty and social frailty at baseline was 31.2 and 6.3%, respectively. The social prefrailty group (β = − 0.132, P  < 0.001) and social frailty group (β = − 0.258, P  < 0.001) were associated with a greater reduction in the composite intrinsic capacity scores than the social robustness group, especially in the cognition, psychological function, and vitality domains. Men with social prefrailty/social frailty demonstrated a greater decrease in the psychological function domain score (− 0.512 vs. − 0.278) than women. Additionally, the cognition domain score only decreased in men in the social prefrailty/social frailty group (β = − 0.122, P  = 0.016). Conclusions Social frailty was associated with intrinsic capacity and its subdomains longitudinally. Men with social frailty were more vulnerable than women to a decline in their psychological function and cognition domains. Therefore, the advanced management of social frailty is necessary to facilitate healthy aging.

Background: Nitrogen balance studies have traditionally been used to estimate protein requirements in adults. However, ethical and practical constraints have made new studies increasingly difficult to conduct. This systematic review and meta-analysis aimed to compile and analyze the most comprehensive individual-level dataset to date. Methods: We included 31 studies that reported nitrogen intake and excretion data for healthy adults. Studies were selected based on strict eligibility criteria that required data from at least three intake levels per individual. Nitrogen requirements were estimated using regression analysis. In total, data from 395 individuals were analyzed. We used a random effects model for the meta-analysis. Subgroup comparisons and meta-regression were conducted based on sex, age, climate, and protein source. Results: The overall mean nitrogen requirement was 104.2 mg N/kg/day. No significant differences were found by sex, age group (<60 vs. ≥60 years), climate (temperate vs. tropical), or protein source (animal, plant, or mixed). Subgroup and meta-regression analyses did not reveal consistent moderator effects. Substantial heterogeneity was observed (I2 > 90%). Conclusions: This analysis provides the most extensive compilation of individual-level nitrogen balance data to date. While the average nitrogen requirement was consistent with previous estimates, the high heterogeneity limits definitive conclusions. Nonetheless, this dataset provides a valuable foundation for revising protein intake recommendations and guiding future research on human nitrogen metabolism in the absence of new studies.

•Nutritional status improved in 11.2% of hospitalized patients with pneumonia.•Nutritional improvement is associated with improvements in activities of daily living and dysphagia.•The causes of malnutrition and the need for rehabilitation nutrition intervention must be assessed. The aim of this study was to examine the effect of improved nutritional status on activities of daily living (ADLs) and dysphagia in elderly patients with pneumonia who were admitted to acute care hospitals. A retrospective cohort study was conducted using registry data from the Japan Rehabilitation Nutrition Database of patients with pneumonia who were admitted to acute care hospitals. Patients were divided into two groups based on the Mini Nutritional Assessment Short-Form (MNA-SF) status at discharge: Patients with no status change or with decreased status were allocated to the unimproved nutritional status (UN) group and those with increased status were assigned to the improved nutritional status (IN) group. The primary outcome was ADLs as assessed by Barthel Index (BI) score at hospital discharge. Secondary outcomes included dysphagia as assessed by the Food Intake Level Scale (FILS) at discharge. The study included 143 patients with a mean age of 84.7 ± 7.8 y. Based on the MNA-SF categories at discharge, 127 (88.8%) patients were assigned to the UN group and 16 (11.2%) to the IN group. Patients in the IN group had significantly higher BI and FILS scores than those in the UN group. Multiple regression analysis indicated that improvement in nutritional status was independently associated with BI gain (B = 9.916; β = 0.153; 95% confidence interval [CI], 1.929–11.761; P = 0.017) and FILS gain (B = 1.259; β = 0.167; 95% CI, 1.224–2.814; P = 0.044). Nutritional improvement is associated with improvements in ADL and dysphagia in patients with pneumonia and malnutrition.

Japanese diet adherence has been inversely correlated with muscle weakness. In this study, we aimed to validate that association. Longitudinal data from 1699 individuals aged ≥50 years (mean age 62.5 ± 6.9 years, 50.4% female) at two time points (2007 and 2011) were used. Participants without muscle weakness from several regions in Japan were included. The 12-component revised Japanese Diet Index (rJDI12) classified by tertiles assessed adherence to the Japanese dietary pattern. Muscle weakness was defined as a handgrip strength of ˂18 kg for females and ˂28 kg for males based on the Asian Working Group for Sarcopenia criteria 2019. A multivariate logistic approach was used to determine the relationship between rJDI12 tertile and the occurrence of muscle weakness by calculating the odds ratio (OR) and its 95% confidence interval (95% CI) throughout the observation period. Muscle weakness was negatively correlated with the highest rJDI12 tertile (OR [95% CI] 0.891 [0.814, 0.973] for T3). This association was consistent in sensitivity analyses with multiple imputations of missing values. Closely following the Japanese dietary pattern appears to reduce the occurrence of muscle weakness among the aging population in this study, suggesting it may prevent frailty and sarcopenia in the aging population.

Key summary points Aim This study concerns an investigation of whether social isolation is associated with the new onset of physical frailty among healthy Japanese older adults. Findings Fourfold higher risk of developing prefrailty during 1-year follow-up. Friendship-related social isolation increases the risk of prefrailty. Message Improving the social isolation of friendship may prevent the transition to frailty. Purpose Social factors are often overlooked when considering physical frailty. The purpose of this study was to determine whether social isolation is associated with new onset of physical frailty among healthy Japanese older adults. Methods This was a 1-year prospective cohort study conducted in Japan from August 2014 to August 2015. The participants were 229 Japanese older people (106 men, 123 women, mean age = 69.3 ± 4.2 years) who did not have prefrailty or frailty at baseline and who were current students or graduates of a community college for older people in Japan. Social isolation was assessed using the Lubben Social Network Scale-6 in terms of overall social isolation, family-related social isolation, and friendship-related social isolation. Frailty was categorized using the Fried frailty criteria. The association between new onset of physical frailty and baseline characteristics, including social isolation, was investigated. Results At 1-year follow-up, 180 (78.6%) of the participants remained robust, while 49 (21.4%) were identified as prefrail; no participants were identified as frail. Prefrailty was only associated with friendship-related social isolation (odds ratio: 4.58, 95% confidence interval 2.11–9.92, P  < 0.001) at baseline. No significant associations were observed for any other baseline characteristics, including overall social isolation, family-related social isolation, comorbidities, body composition, and physical function. Conclusion Older adults with friendship-related social isolation are four times more likely to develop prefrailty from robust during the 1-year follow-up. The results suggest that friendship-related social isolation increases the risk of healthy older adults transitioning from robust to prefrail.

The effects of social frailty on diet and nutrition are under-investigated. Our study aimed to assess the association between social frailty and diet quality, diet quantity, and nutrition over a 3-year period in community-dwelling older Japanese adults. This prospective cohort study recruited individuals aged ≥60 years from a community college and followed up 666 participants annually. Social frailty was determined using a 4-item questionnaire. Diet quantity (energy and macronutrient intake) and diet quality (dietary diversity score and Diet Quality Index-International) were assessed using a food frequency questionnaire. Nutrition was evaluated using the Mini-Nutritional Assessment (MNA). Out of the 666 participants (56.5% women), 250 (37.5%) were categorized as having social prefrailty or frailty. Regarding diet quantity, energy intake (β = −1.59kcal/kg/day, p < 0.01) and nutrient intake (protein intake, β = −0.08g/kg/day; fat intake, β = −0.06g/kg/day; carbohydrate intake, β = −0.18g/kg/day; fiber intake, β = −0.01g/kg/day; all p < 0.05) were lower in men with social prefrailty or frailty than in men with social robustness. Dietary diversity score (β = −0.25, p = 0.01) and MNA score (β = −0.32, p = 0.04) decreased in men with social prefrailty or frailty. However, these associations were not observed in women. Social frailty is associated with lower dietary intake, poor diet quality, and poor nutrition among community-dwelling older men. Future studies are required to determine the benefits of sex-specific interventions targeting social frailty on nutritional outcomes.

Background Patients with end-stage renal failure may exhibit sarcopenia and protein-energy wasting (PEW). We report a case of improvement in physical function, muscle mass, and muscle strength by management of rehabilitation nutrition in a maintenance hemodialysis patient with PEW and sarcopenia. Case presentation A 60-year-old man with an 8-year history of dialysis was admitted for pneumococcal meningitis. When he was transferred for rehabilitation 36 days following the onset, he was transferred to our hospital for rehabilitation and hemodialysis. On admission, energy intake was 1200 kcal/day, via a nasogastric tube, due to sarcopenic dysphagia. He was diagnosed with PEW, based on results from a biochemical examination, physical examination, and his low dietary intake. His height, dry weight, body mass index, Mini Nutritional Assessment-Short Form, albumin, C-reactive protein, and Geriatric Nutritional Risk Index were 166 cm, 46.5 kg, 16.9 kg/m 2 , 1 point, 2.1 g/dL, 0.22 mg/dL, and 63, respectively, indicating malnutrition. He was also diagnosed with sarcopenia because of low muscle mass, muscle strength, and physical function. Functional Independence Measure (FIM) was 58 points (motor 27, cognition 31). He was improved by a combination of rehabilitation including activities of daily living training, swallowing training, and nutrition management. Nutritional requirement was 1752 kcal/day of energy and 55.5 g/day (1.2 g/kg/day) of protein. Energy intake was added energy accumulation (300 kcal/day) to improve muscle mass and strength. On day 108, he was discharged to go home, he could walk outdoors, and his sarcopenic dysphagia improved. Conclusion Aggressive management of rehabilitation nutrition to increase dry weight may improve PEW and sarcopenic dysphagia in patients undergoing maintenance hemodialysis.

Malnutrition negatively affects the quality of life of patients with dysphagia. Despite the need for nutritional status assessment in patients with dysphagia, standard, effective nutritional assessments are not yet available, and the identification of optimal nutritional assessment items for patients with dysphagia is inadequate. We conducted a scoping review of the use of nutritional assessment items in adult patients with oropharyngeal and esophageal dysphagia. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched to identify articles published in English within the last 30 years. Twenty-two studies met the inclusion criteria. Seven nutritional assessment categories were identified: body mass index (BMI), nutritional screening tool, anthropometric measurements, body composition, dietary assessment, blood biomarkers, and other. BMI and albumin were more commonly assessed in adults. The Global Leadership Initiative on Malnutrition (GLIM), defining new diagnostic criteria for malnutrition, includes the categories of BMI, nutritional screening tool, anthropometric measurements, body composition, and dietary assessment as its required components, but not the blood biomarkers and the “other” categories. We recommend assessing nutritional status, including GLIM criteria, in adult patients with dysphagia. This would standardize nutritional assessments in patients with dysphagia and allow future global comparisons of the prevalence and outcomes of malnutrition, as well as of appropriate interventions.

The association of Japanese and Mediterranean dietary patterns with muscle weakness in middle-aged and older Japanese individuals is unclear. This cross-sectional study investigated the association between Japanese and Mediterranean dietary patterns and muscle weakness in community-dwelling, middle-aged, and older Japanese individuals (enrolled from 2007 to 2011). Based on the dietary consumption information obtained from the brief self-administered diet history questionnaire, we assessed adherence to the Japanese (12-component revised Japanese diet index (rJDI12)) and Mediterranean (alternate Mediterranean diet (aMed) score) dietary patterns. Muscle weakness was defined as handgrip strength <28 and <18 kg for men and women, respectively. Logistic regression was used to ascertain the relationship between dietary pattern and muscle weakness. In our study, with 6031 participants, the Japanese, but not Mediterranean, dietary pattern was inversely associated with muscle weakness (p for trend = 0.031 and 0.242, respectively). In the model adjusted for confounders, including energy intake, the highest quartile of rJDI12 scores (9–12 points), and the rJDI12 scores, entered as continuous variables, showed an independent association (odds ratio (95% CI), 0.703 (0.507–0.974), and 0.933 (0.891–0.977), respectively). Our findings showed that adherence to the Japanese dietary pattern is associated with a low prevalence of muscle weakness.