The European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria for age-related sarcopenia. EWGSOP included representatives from four participant organisations, i.e. the European Geriatric Medicine Society, the European Society for Clinical Nutrition and Metabolism, the International Association of Gerontology and Geriatrics-European Region and the International Association of Nutrition and Aging. These organisations endorsed the findings in the final document. The group met and addressed the following questions, using the medical literature to build evidence-based answers: (i) What is sarcopenia? (ii) What parameters define sarcopenia? (iii) What variables reflect these parameters, and what measurement tools and cut-off points can be used? (iv) How does sarcopenia relate to cachexia, frailty and sarcopenic obesity? For the diagnosis of sarcopenia, EWGSOP recommends using the presence of both low muscle mass + low muscle function (strength or performance). EWGSOP variously applies these characteristics to further define conceptual stages as 'presarcopenia', 'sarcopenia' and 'severe sarcopenia'. EWGSOP reviewed a wide range of tools that can be used to measure the specific variables of muscle mass, muscle strength and physical performance. Our paper summarises currently available data defining sarcopenia cut-off points by age and gender; suggests an algorithm for sarcopenia case finding in older individuals based on measurements of gait speed, grip strength and muscle mass; and presents a list of suggested primary and secondary outcome domains for research. Once an operational definition of sarcopenia is adopted and included in the mainstream of comprehensive geriatric assessment, the next steps are to define the natural course of sarcopenia and to develop and define effective treatment.

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Sarcopenia: European consensus on definition and diagnosis Report of the European Working Group on Sarcopenia in Older People

Background in 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings. Objectives to increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia. Recommendations sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia. Conclusions EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

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Sarcopenia: Revised European consensus on definition and diagnosis

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Lipid peroxidation can be described generally as a process under which oxidants such as free radicals attack lipids containing carbon-carbon double bond(s), especially polyunsaturated fatty acids (PUFAs). Over the last four decades, an extensive body of literature regarding lipid peroxidation has shown its important role in cell biology and human health. Since the early 1970s, the total published research articles on the topic of lipid peroxidation was 98 (1970–1974) and has been increasing at almost 135-fold, by up to 13165 in last 4 years (2010–2013). New discoveries about the involvement in cellular physiology and pathology, as well as the control of lipid peroxidation, continue to emerge every day. Given the enormity of this field, this review focuses on biochemical concepts of lipid peroxidation, production, metabolism, and signaling mechanisms of two main omega-6 fatty acids lipid peroxidation products: malondialdehyde (MDA) and, in particular, 4-hydroxy-2-nonenal (4-HNE), summarizing not only its physiological and protective function as signaling molecule stimulating gene expression and cell survival, but also its cytotoxic role inhibiting gene expression and promoting cell death. Finally, overviews of in vivo mammalian model systems used to study the lipid peroxidation process, and common pathological processes linked to MDA and 4-HNE are shown.

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Lipid peroxidation: production, metabolism, and signaling mechanisms of malondialdehyde and 4-hydroxy-2-nonenal.

This document represents the first collaboration between 2 organizations-the American Society for Parenteral and Enteral Nutrition and the Society of Critical Care Medicine-to describe best practices in nutrition therapy in critically ill children. The target of these guidelines is intended to be the pediatric critically ill patient (>1 month and 2-3 days in a PICU admitting medical, surgical, and cardiac patients. In total, 2032 citations were scanned for relevance. The PubMed/MEDLINE search resulted in 960 citations for clinical trials and 925 citations for cohort studies. The EMBASE search for clinical trials culled 1661 citations. In total, the search for clinical trials yielded 1107 citations, whereas the cohort search yielded 925. After careful review, 16 randomized controlled trials and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We used the GRADE criteria (Grading of Recommendations, Assessment, Development, and Evaluation) to adjust the evidence grade based on assessment of the quality of study design and execution. These guidelines are not intended for neonates or adult patients. The guidelines reiterate the importance of nutrition assessment-particularly, the detection of malnourished patients who are most vulnerable and therefore may benefit from timely intervention. There is a need for renewed focus on accurate estimation of energy needs and attention to optimizing protein intake. Indirect calorimetry, where feasible, and cautious use of estimating equations and increased surveillance for unintended caloric underfeeding and overfeeding are recommended. Optimal protein intake and its correlation with clinical outcomes are areas of great interest. The optimal route and timing of nutrient delivery are areas of intense debate and investigations. Enteral nutrition remains the preferred route for nutrient delivery. Several strategies to optimize enteral nutrition during critical illness have emerged. The role of supplemental parenteral nutrition has been highlighted, and a delayed approach appears to be beneficial. Immunonutrition cannot be currently recommended. Overall, the pediatric critical care population is heterogeneous, and a nuanced approach to individualizing nutrition support with the aim of improving clinical outcomes is necessary.

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)

Do Obese Patients Have Specific Nutrition Goals in Cases of Cancer

Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland and b Accurate nutrition prescription is an essential component of patient care as it promotes favorable clinical outcome. Precise measurement of the energy needs reduces the risks of under and overfeeding. Although commonly used, formula to estimate energy expenditure are known to be inaccurate, especially in patients with clinical conditions associated with low or high energy expenditure. The majority of predictive formula have been developed in healthy Individuals and are unable to account for alterations in energy expenditure related to changes in body composition or acute conditions. Furthermore, consensus on which formula to use is often limited in these conditions. It is, therefore, generally recommended to measure energy expenditure in clinical conditions by indirect calorimetry. Unfortunately, indirect calorimeters available on the market have been found insufficiently accurate, time-consuming, cumbersome, and expensive. This observation has incited a group of investigators to initiate the International Calorimetry Study Initiative (ICALIC) with the aim to develop a new indirect calorimeter, which meets the clinician’s needs [1]. A bottom-up strategy of technical development led to the definition of the characteristics/criteria required for the new indirect calorimeter to fulfill for optimal clinical activity, as well as for clinical and basic research use. The main criteria included high accuracy, fast sampling rate, no need for device calibration, easy disinfection method, no warming up of electric circuitry, compatibility with mechanical ventilators, ability to measure air enriched with oxygen up to 70%, battery-powered device, reduced-weight and reducedsize device, robustness for intensive use, and affordability. Initially, these criteria were viewed as impossible to reach by a number of engineers. Thinking out of the box allowed generation of genuine concepts and developments to make this possible! Among the revolutionary developments were: Center for Translational Research in Aging and Longevity, Department Health and Kinesiology, Texas A&M University, College Station, Texas, USA (1)

Editorial: Energy needs: quick and easy to measure.

But de l'etude. Documenter l'etat nutritionnel et les apports caloriques de patients souffrant de BPCO severe, sous oxygenotherapie continue a domicile (OCD), et correler ces informations avec le tableau clinique, l'importance de l'atteinte respiratoire et la distance parcourue quotidiennement, ceci de maniere prospective. Patients et methodes. Cinquante patients BPCO cliniquement stables, sous OCD depuis 33 mois (extremes 4-106) chez lesquels on mesure a domicile : les fonctions pulmonaires, les pressions statiques maximales inspiratoires et expiratoires (PIMAX et PEMAX), la force manuelle de serrement, la distance moyenne parcourue quotidiennement (podometre porte pendant une semaine), l'indice de masse corporelle (IMC), la composition corporelle par bioimpedance electrique et les apports caloriques. Resultats. Trente-quatre pour cent des patients presentaient un exces ponderal (IMC >27 kg/m 2 ); 42% avaient un etat de nutrition normal (IMC: 20-27 kg/m 2 ); 24 % etaient denutris (IMC <20 kg/m 2 ). Les patients denutris ont, de maniere statistiquement significative, une obstruction bronchique plus severe, une saturation en oxygene et une PEMAX plus basses, ainsi qu'une distance de deplacement quotidienne inferieure aux sujets avec exces ponderal. Ils ont toutefois des apports caloriques nettement plus eleves (39±5 kcal/kg/j) que les patients ayant un poids normal (29±11 kcal/kg/j) ou un exces ponderal (25±8 kcal/kg/j). Sur le plan clinique, aucun des patients denutris ne remplit les criteres cliniques de bronchiteux chronique, par opposition a 61% des sujets ayant un etat de nutrition normal et a 94% des sujets presentant un exces ponderal. Conclusions. Dans ce collectif de BPCO severe, sous OCD, 25 % des patients souffraient de denutrition, et ce malgre des apports caloriques nettement superieurs a leurs besoins theoriques. Ceci suggere qu'une augmentation supplementaire de leurs apports alimentaires semble une solution difficilement realisable. Ces sujets presentaient aussi un handicap ventilatoire plus important et un tableau clinique caracterise par l'absence des signes classiques de bronchite chronique.

Patients BPCO sous oxygénothérapie à domicile : étude des paramètres cliniques, de l'état nutritionnel et de la capacité de déambulation

Resume Une nutrition enterale ou parenterale optimale ne suffit pas a corriger le catabolisme proteique dans les etats de stress majeur ou a ameliorer systematiquement l'anabolisme proteique lors de malnutrition chronique. L'administration de facteurs anabolisants s'impose alors logiquement. La disponibilite de l'hormone de croissance (rhGH) et de l' Insulin-like Growth Factor-I (rhIGF-I) recombinantes humaines permet d'envisager leur utilisation dans ces indications. Sur le plan metabolique, leur efficacite est globalement demontree. Par contre, les donnees concernant un eventuel benefice sur le plan clinique sont quasiment inexistantes, et les rapports risquebenefice et cout-benefice restent a evaluer. Cette revue resume les principales etudes cliniques utilisant la rhGH ou le rhIGF-I en situation de deficit proteique. Un rappel circonstancie des bases physiopathologiques y est associe.

Manipulation pharmacologique de l'anabolisme : l'exemple de l'hormone de croissance

Pp037-mon an early nutrition-exercise program can positively affect the body composition and physical function (pf) of frail prostate cancer patients receiving androgen deprivation therapy (adt)

Claude Pichard

Papers

Do Obese Patients Have Specific Nutrition Goals in Cases of Cancer

Editorial: Energy needs: quick and easy to measure.

Patients BPCO sous oxygénothérapie à domicile : étude des paramètres cliniques, de l'état nutritionnel et de la capacité de déambulation

Manipulation pharmacologique de l'anabolisme : l'exemple de l'hormone de croissance

Pp037-mon an early nutrition-exercise program can positively affect the body composition and physical function (pf) of frail prostate cancer patients receiving androgen deprivation therapy (adt)