Publications by authors named "Laurence Genton"

105 Publications

Oral function and nutritional status in non-acute hospitalised elders.

Gerodontology 2021 Dec 16. Epub 2021 Dec 16.

Division of Gerodontology and Removable Prosthodontics, University of Geneva, Geneva, Switzerland.

Introduction: Malnutrition and risk of malnutrition continues to be a common finding in elders, yet its association with oral function in hospitalised patients remains unclear.

Material And Methods: Patients aged 70 years or over who had been hospitalised for non-acute rehabilitation were recruited. Nutritional risk was screened using the Mini-Nutritional Assessment Short Form (MNA-SF) and Nutritional Risk Screening (NRS) scores. Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. All participants underwent the oral hypofunction test battery, evaluating oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory and swallowing function. Statistical analyses comprised Mann-Whitney or Kruskal-Wallis tests. Bivariate associations between categorical variables were tested using the Pearson chi-square test; for continuous variables, the Spearman correlation was calculated. A P-value < .05 was considered statistically significant.

Results: Sixty patients aged a mean 82.5 ± 7.0 years participated. Some 88.3% were diagnosed with oral hypofunction, and this was more common in older patients (P = .020). Analysing the 7 oral hypofunction tests as an interval variable (NiOF) revealed additional correlations with number of teeth (ρ = 0.477) as well as the nutritional risk, evaluated by the MNA-SF (ρ = -0.284) and NRS (ρ = 0.317) scores. NiOF scores were higher among denture wearers (P = .003). GLIM did not confirm the correlation with NiOF. Biomarkers such as serum albumin and CRP were not associated with the NiOF score.

Conclusion: In this sample, the association between oral function and nutritional state is more obvious in nutritional risk scores than in the malnutrition diagnosis by GLIM.
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http://dx.doi.org/10.1111/ger.12612DOI Listing
December 2021

Prognostic Role of Subcutaneous and Visceral Adiposity in Hospitalized Octogenarians with COVID-19.

J Clin Med 2021 Nov 24;10(23). Epub 2021 Nov 24.

Division of Geriatrics, Department of Rehabilitation and Geriatrics, Faculty of Medicine, University Hospitals of Geneva, 1205 Geneva, Switzerland.

Background: We investigated the prognostic significance of visceral and subcutaneous adiposity in octogenarians with COVID-19.

Methods: This paper presents a monocentric retrospective study that was conducted in acute geriatric wards with 64 hospitalized patients aged 80+ who had a diagnosis of COVID-19 and who underwent a chest CT scan. A quantification of the subcutaneous, visceral, and total fat areas was performed after segmentations on the first abdominal slice caudal to the deepest pleural recess on a soft-tissue window setting. Logistic regression models were applied to investigate the association with in-hospital mortality and the extent of COVID-19 pneumonia.

Results: The patients had a mean age of 86.4 ± 6.0 years, and 46.9% were male, with a mean BMI of 24.1 ± 4.4Kg/m and mortality rate of 32.8%. A higher subcutaneous fat area had a protective effect against mortality (OR 0.416; 0.183-0.944 95% CI; = 0.036), which remained significant after adjustments for age, sex, and BMI (OR 0.231; 0.071-0.751 95% CI; = 0.015). Inversely, higher abdominal circumference, total fat area, subcutaneous fat area, and visceral fat were associated with worse COVID-19 pneumonia, with the latter presenting the strongest association after adjustments for age, sex, and BMI (OR 2.862; 1.523-5.379 95% CI; = 0.001).

Conclusion: Subcutaneous and visceral fat areas measured on chest CT scans were associated with prognosis in octogenarians with COVID-19.
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http://dx.doi.org/10.3390/jcm10235500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658645PMC
November 2021

The Effects of Shift Work on Cardio-Metabolic Diseases and Eating Patterns.

Nutrients 2021 Nov 22;13(11). Epub 2021 Nov 22.

Nutrition Unit, Service of Endocrinology, Diabetes, Nutrition and Therapeutic Education, Department of Medicine, Geneva University Hospitals (HUG), 1211 Geneva, Switzerland.

Energy metabolism is tightly linked with circadian rhythms, exposure to ambient light, sleep/wake, fasting/eating, and rest/activity cycles. External factors, such as shift work, lead to a disruption of these rhythms, often called circadian misalignment. Circadian misalignment has an impact on some physiological markers. However, these proxy measurements do not immediately translate into major clinical health outcomes, as shown by later detrimental health effects of shift work and cardio-metabolic disorders. This review focuses on the effects of shift work on circadian rhythms and its implications in cardio-metabolic disorders and eating patterns. Shift work appears to be a risk factor of overweight, obesity, type 2 diabetes, elevated blood pressure, and the metabolic syndrome. However, past studies showed discordant findings regarding the changes of lipid profile and eating patterns. Most studies were either small and short lab studies, or bigger and longer cohort studies, which could not measure health outcomes in a detailed manner. These two designs explain the heterogeneity of shift schedules, occupations, sample size, and methods across studies. Given the burden of non-communicable diseases and the growing concerns about shift workers' health, novel approaches to study shift work in real contexts are needed and would allow a better understanding of the interlocked risk factors and potential mechanisms involved in the onset of metabolic disorders.
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http://dx.doi.org/10.3390/nu13114178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8617838PMC
November 2021

Metataxonomic and Metabolic Impact of Fecal Microbiota Transplantation From Patients With Pancreatic Cancer Into Germ-Free Mice: A Pilot Study.

Front Cell Infect Microbiol 2021 19;11:752889. Epub 2021 Oct 19.

Genomic Research Laboratory, University of Geneva, Geneva, Switzerland.

Background: Body weight (BW) loss is prevalent in patients with pancreatic cancer (PC). Gut microbiota affects BW and is known to directly shape the host immune responses and antitumor immunity. This pilot study evaluated the link between gut microbiota, metabolic parameters and inflammatory/immune parameters, through the fecal material transplantation (FMT) of PC patients and healthy volunteers into germ-free (GF) mice.

Methods: We transplanted the feces from five PC patients and five age- and gender-matched healthy volunteers into two GF mice each. Mouse BW and energy intake were measured every 1-5 days, oral glucose on day 21, insulin tolerance on day 26, fecal bacterial taxonomic profile by 16S rRNA gene sequencing on day 5, 10, 15 and 30, and gut-associated lymphoid tissue T cells, plasma cytokines and weights of fat and muscle mass at sacrifice (day 34). Results are presented as mean ± SD. The continuous parameters of mice groups were compared by linear univariate regressions, and their bacterial communities by Principal Coordinates Analysis (PCoA), Bray-Curtis similarity and ANCOM test.

Results: Recipients of feces from PC patients and healthy volunteers had similar BW gain and food intake. Visceral fat was lower in recipients of feces from PC patients than from healthy individuals (0.72 ± 0.17 0.92 ± 0.14 g; coeff -0.19, 95% CI -0.38, -0.02, p=0.035). The other non-metataxonomic parameters did not differ between groups. In PCoA, microbiota from PC patients clustered apart from those of healthy volunteers and the same pattern was observed in transplanted mice. The proportions of , , _g24_unclassified and were higher, while those of , Lachnospiraceae PAC000196_s and Coriobacteriaceae_unclassified species were lower in PC patients and in mice transplanted with the feces from these patients.

Conclusion: In this pilot study, FMT from PC patients was associated with a decrease in visceral fat as compared to FMT from healthy individuals. Some of the differences in fecal microbiota between PC and control samples are common to humans and mice. Further research is required to confirm that feces contain elements involved in metabolic and immune alterations.
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http://dx.doi.org/10.3389/fcimb.2021.752889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8560705PMC
November 2021

Synthèse du 6 symposium « Feeding the Microbiota ».

Rev Med Suisse 2021 10;17(756):1855-1857

Service d'infectiologie et Laboratoires de bactériologie et génomique, HUG et UNIGE, 1211 Genève 4.

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October 2021

Precision and accuracy of bioelectrical impedance analysis devices in supine versus standing position with or without retractable handle in Caucasian subjects.

Clin Nutr ESPEN 2021 10 6;45:267-274. Epub 2021 Sep 6.

Clinical Nutrition, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. Electronic address:

Background & Aims: Bioelectrical impedance analysis (BIA) could be facilitated in subjects who are able to stand by using scales without (BIA) or with a retractable handle (BIA), provided that they are as precise as BIA devices commonly used in the supine position in the hospital setting (BIA). This observational prospective cross-sectional study aimed to compare the precision and accuracy of BIA, BIA and BIA in a Caucasian population.

Methods: Fat mass percentage (FM%) was measured in 160 healthy Caucasian subjects (80 men/80 women) aged 20-60 years, with a body mass index (BMI) ≥18.5 and < 30 kg/m, using the HAGRID Body Fat Scales (Huawei Technologies Co., Ltd., China) in BIA or BIA mode, and the Nutriguard-M (Data Input GmbH, Germany) as BIA. Intra-unit and inter-unit precisions of each device were evaluated by calculating the coefficients of variation (CV%) of 3 measurements with 3 different units of each device. Inter-device precisions were evaluated with Pearson correlations, Bland-Altman plots, and repeated measures ANOVA followed by post-hoc Bonferroni tests. Accuracy of these BIA devices was estimated in a subgroup of 16 subjects, using comparison with dual-energy X-ray absorptiometry (DXA).

Results: The study population was 40 ± 12 years old, with a body height and weight of 171 ± 10 cm and 72.2 ± 11.5 Kg, respectively. All three devices were very precise with intra-unit CV% of 0.5%, 0.9%, and 0.3% and inter-unit CV% of 0.5%, 1.1%, and 0.4% for BIA, BIA and BIA, respectively. Inter-device precision was ±2.1% for BIA/BIA, ±1.9% for BIA/BIA, and ±1.3% for BIA/BIA. Bland-Altman plots showed bias ±1.96 SD of 0.3 ± 5.2% for BIA/BIA, -0.4 ± 4.5% for BIA/BIA and -0.6 ± 3.1% for BIA/BIA. Compared to DXA, all three devices tended to underestimate FM% in men with low BMI, while only BIA and BIA tended to overestimate FM% in women with high BMI. FM% measurement accuracy was ±2.6% for BIA/DXA, ±3.3% for BIA/DXA, and ±3.4% for BIA/DXA.

Conclusions: Both BIA and BIA show a good intra- and inter-unit precision close to BIA, making them suitable for rapid body composition assessment in non-bedridden subjects. However, all these three devices should not be used interchangeably, because BIA and BIA tend to accentuate FM% changes during body composition monitoring compared to BIA and DXA.

Trial Registration: ClinicalTrial.gov no. NCT04504799.
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http://dx.doi.org/10.1016/j.clnesp.2021.08.010DOI Listing
October 2021

Gut barrier and microbiota changes with glycine and branched-chain amino acid supplementation in chronic haemodialysis patients.

J Cachexia Sarcopenia Muscle 2021 Dec 18;12(6):1527-1539. Epub 2021 Sep 18.

Genomic Research Lab and Service of Infectious Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.

Background: We have previously shown that glycine increases fat-free mass in chronic haemodialysis patients with features of malnutrition as compared with branched-chain amino acids (BCAAs). This multicentre randomized double-blind crossover study evaluates the impact of these amino acids on the gut barrier and microbiota.

Methods: Haemodialysis patients were included if they had plasma albumin <38 g/L or weight loss >5% of dry body weight, and daily dietary intakes <30 kcal/kg and <1 g protein/kg. They consumed glycine or BCAA (7 g twice daily) for 4 months and underwent a 1 month washout period, before crossover of supplementations. Faecal microbiota (16S rRNA gene sequencing) and immunoglobulin A (IgA), serum levels of cytokines, surrogate markers of intestinal permeability, appetite mediators, and endocannabinoids were obtained at the start and end of each supplementation. Supplementations were compared by multiple mixed linear regression models, adjusted for age, sex, month of supplementation (0 and 4 in each period), and period (Period 1: first 4 months; Period 2: last 4 months). Microbiota comparisons were performed using principal coordinate analysis and permutational multivariate analysis of variance, Shannon diversity index estimate and analysis of composition of microbiomes analysis, and Wilcoxon tests.

Results: We analysed 27 patients compliant to the supplementations. Multiple mixed linear regression models were significant only for interleukin-6 (P = 0.002), glucagon-like peptide 1 (P = 0.028), cholecystokinin (P = 0.021), and peptide YY (P = 0.002), but not for the other outcomes. The significant models did not show any impact of the type of supplementation (P < 0.05 in all models). Principal coordinate analysis and permutational multivariate analysis of variance (P = 0.0001) showed strong microbiota clustering by subject, but no effect of the amino acids. Bacterial alpha diversity and zero-radius operational taxonomic unit richness remained stable, whatever the supplementation. Lacticaseibacillus paracasei (0.030; Q1-Q3 0.008-0.078 vs. 0.004; Q1-Q3 0.001-0.070) and Bifidobacterium dentium (0.0247; Q1-Q3 0.002-0.191 vs. 0.003; Q1-Q3 0.001-0.086) significantly decreased with the BCAA supplementation.

Conclusions: The BCAA and glycine supplementations had no impact on the serum levels of cytokines, appetite mediators, intestinal permeability, endocannabinoids, or faecal IgA. Overall faecal microbiota composition and microbial diversity did not change with the glycine or BCAA supplementation but decreased the abundance of L. paracasei and B. dentium.
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http://dx.doi.org/10.1002/jcsm.12781DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718035PMC
December 2021

Glycine increases fat-free mass in malnourished haemodialysis patients: a randomized double-blind crossover trial.

J Cachexia Sarcopenia Muscle 2021 Dec 14;12(6):1540-1552. Epub 2021 Sep 14.

Genomic Research Lab and Service of Infectious Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.

Background: Protein energy wasting is associated with negative outcome in patients under chronic haemodialysis (HD). Branched-chain amino acids (BCAAs) may increase the muscle mass. This post hoc analysis of a controlled double-blind randomized crossover study assessed the impact of BCAAs on nutritional status, physical function, and quality of life.

Methods: We included 36 chronic HD patient features of protein energy wasting as plasma albumin <38 g/L, and dietary intakes <30 kcal/kg/day and <1 g protein/kg/day. Patients received either oral BCAA (2 × 7 g/day) or glycine (2 × 7 g/day) for 4 months (Period 1), followed by a washout period of 1 month, and then received the opposite supplement (Period 2). The outcomes were lean body mass measured by dual-energy X-ray absorptiometry, fat-free mass index measured by bioelectrical impedance, resting energy expenditure, dietary intake and appetite rating, physical activity and function, quality of life, and blood parameters. Analyses were performed by multiple mixed linear regressions including type of supplementation, months, period, sex, and age as fixed effects and subjects as random intercepts.

Results: Twenty-seven patients (61.2 ± 13.7 years, 41% women) were compliant to the supplementations (consumption >80% of packs) and completed the study. BCAA did not affect lean body mass index and body weight, but significantly decreased fat-free mass index, as compared with glycine (coeff -0.27, 95% confidence interval -0.43 to -0.10, P = 0.002, respectively). BCAA and glycine intake had no effect on the other clinical parameters, blood chemistry tests, or plasma amino acids.

Conclusions: Branched-chain amino acid did not improve lean body mass as compared with glycine. Unexpectedly, glycine improved fat-free mass index in HD patients, as compared with BCAA. Whether long-term supplementation with glycine improves the clinical outcome remains to be demonstrated.
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http://dx.doi.org/10.1002/jcsm.12780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8718019PMC
December 2021

Oral function in amyotrophic lateral sclerosis patients: A matched case-control study.

Clin Nutr 2021 08 28;40(8):4904-4911. Epub 2021 Jun 28.

Clinical Nutrition, University Hospitals, Geneva, Switzerland. Electronic address:

Background & Aims: Patients with amyotrophic lateral sclerosis (ALS) develop swallowing difficulties with the progression of the disease. The present study aimed at comparing oral function and body composition between ALS patients and healthy controls, and at evaluating which parameters are the most discriminant between both groups.

Methods: We included ALS patients at the start of their multidisciplinary follow-up at the Geneva University Hospitals and healthy age-, gender-, and dental status-matched adults. We assessed the severity of the disease through the ALS Functional Rating Scale and the swallowing difficulties through the EAT-10 score. We performed an intraoral examination of the dental status, and measured chewing performance, bite, lip and tongue force, saliva weight, and body composition. Group comparisons were performed with t-tests or Mann-Whitney tests as appropriate. Linear discriminant analysis was used to determine the most discriminant parameters between groups.

Results: Twenty-six ALS patients (bulbar onset: n = 7, median (IQR) ALS Functional Rating Scale: 37 (11)) were included. The ALS patients had a significantly lower chewing performance (p < 0.001), lip force (p < 0.001), tongue force (p = 0.002), saliva weight (p < 0.004) and fat-free mass index (p < 0.001) as compared to the healthy individuals, and a higher EAT-10 score (p < 0.001). In ALS patients, a low chewing performance was correlated with a low bite (r = -0.45, p < 0.05)) and tongue force (r = -0.59, p < 0.05). The most discriminant parameters between both groups, by order of importance, were chewing performance, fat-free mass index and saliva weight and allowed the calculation of a discriminant function.

Conclusion: Compared to healthy controls, ALS patients have significant alterations of oral function and body composition. The most discriminant parameters between both groups were chewing performance, fat-free mass index and saliva volume. It remains to be demonstrated whether oral parameters predict outcome. CLINICAL TRIAL REGISTRY: clinicaltrials.gov, identifier: NCT01772888.
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http://dx.doi.org/10.1016/j.clnu.2021.06.022DOI Listing
August 2021

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance.

Clin Nutr 2021 May 11. Epub 2021 May 11.

Department of Clinical Nutrition, CHU Clermont-Ferrand, University of Clermont Auvergne, Human Nutrition Unit, CRNH Auvergne, F-63000, Clermont-Ferrand, France.

The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.
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http://dx.doi.org/10.1016/j.clnu.2021.05.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110326PMC
May 2021

Impact of nutritional therapy during the first wave of the COVID-19 pandemic in intensive care patients: A retrospective observational study.

Clin Nutr 2021 Jun 4. Epub 2021 Jun 4.

Division of Intensive Care, Department of Acute Medicine, Geneva University Hospitals and the University of Geneva Faculty of Medicine Geneva, Switzerland. Electronic address:

Background & Aims: The COVID-19 pandemic has caused major organizational challenges to healthcare systems concerning staff, material and bed availability. Nutrition was not a priority in the intensive care unit (ICU) at the beginning of the pandemic with the need for simplified protocols. We aimed to assess the impact of a simplified nutritional protocol for critically ill COVID-19 patients during the pandemic first wave.

Methods: We included all patients with SARS-CoV-2 infections, admitted to the ICU of the Geneva University Hospitals for at least 4 days from March 9 to May 19, 2020. Data on the route and solution of nutritional therapy, prescribed and received volume, calorie and protein intake, amount of insulin, propofol and glucose administered were collected daily during the entire ICU stay. We compared nutritional outcomes between patients admitted to the ICU before and after implementing the simplified nutritional protocol using unpaired t-test.

Results: Out of 119 patients, 48 were hospitalized in the ICU before, 47 across and 24 after the implementation of the nutritional protocol. The mean age was 63.2 (±12.7) years and 76% were men without significant difference between before and after group. The nutritional protocol implementation led to an increase in caloric intake (1070 vs. 1357 kcal/day, p = 0.018) and in the percentage of days within 80-100% of the energy target (11 vs. 20%, p = 0.021). The protein debt decreased significantly from 48 g/day to 37 g/day (p = 0.015). No significant difference in the percentage of days within the protein target (80-100%) was observed.

Conclusions: Calorie and protein coverage improved after the implementation of the simplified nutritional protocol in critically ill COVID-19 patients. Further studies are needed to assess the impact of such an approach on patients' clinical outcomes.
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http://dx.doi.org/10.1016/j.clnu.2021.05.024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8176891PMC
June 2021

Nutritional risk at hospital admission is associated with prolonged length of hospital stay in old patients with COVID-19.

Clin Nutr 2021 Mar 23. Epub 2021 Mar 23.

Clinical Nutrition, University Hospitals of Geneva and University of Geneva, Chemin du Pont-Bochet 3, Geneva, Switzerland. Electronic address:

Background & Aims: To investigate the association of nutritional risk at admission with the length of hospital stay (LOS) and mortality in older patients with COVID-19.

Methods: Retrospective monocentric study in an acute geriatric hospital. Data were collected after an extensive review of medical records and the nutritional risk was assessed according to the Nutritional Risk Screening (NRS). Univariate and multivariate (adjusted for age, sex and comorbidity burden) Cox proportional-hazard and linear regression models were used to investigate the association with the above-mentioned outcomes.

Results: Of a total of 245 patients (86.1 ± 6.4 yrs), 50.6% had a severe nutritional risk with an NRS≥5/7 at admission. Lower BMI, cognitive impairment and swallowing disorders were more prevalent in the patients with a higher NRS. A NRS≥5 was not associated with mortality but prolonged by more than 3 days the LOS among the 173 survivors (β 3.69; 0.71-6.67 95% CI; p = 0.016), with a discharge rate delayed by 1.8 times (HR 0.55; 0.37-0.83 95% CI; p = 0.101).

Conclusion: Among the survivors of COVID-19 in an acute geriatric hospital, a NRS ≥5 at admission was associated with a longer LOS, but not with mortality.
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http://dx.doi.org/10.1016/j.clnu.2021.03.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7985608PMC
March 2021

Early advance care planning in amyotrophic lateral sclerosis patients: results of a systematic intervention by a palliative care team in a multidisciplinary management programme - a 4-year cohort study.

Swiss Med Wkly 2021 03 18;151:w20484. Epub 2021 Mar 18.

Palliative Care Consultation, Division of Palliative Medicine, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Switzerland / Unit for Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Switzerland.

Introduction: Although recommended, the implementation of early advance care planning is suboptimal in amyotrophic lateral sclerosis (ALS) patients. Barriers to advance care planning include healthcare professionals’ and patients’ reluctance, and uncertainty about the right time to initiate a discussion.

Aim Of The Study: To determine how often advance care planning was initiated, and the content of the discussion in a first routine palliative care consultation integrated within a multidisciplinary management programme.

Methods: Between June 2012 and September 2016, a prospective cohort study was conducted in Geneva University Hospitals. Sixty-eight patients were seen every 3 months for a 1-day clinical evaluation in a day care centre.

Results: The patients’ mean ± standard deviation age was 68.6 ± 11.9 years, 50% were women. Four patients were excluded because of dementia. Advance care planning was initiated with 49 (77%) patients in the first palliative care consultation. Interventions most often addressed were cardiopulmonary resuscitation (49%), intubation and tracheostomy (47%) and palliative sedation (36.7%). Assisted suicide was discussed with 16 patients (36.6%). Functional disability was the only factor associated with initiation of advance care planning. Nearly half of the patients wrote advance directives (45%) or designated a healthcare surrogate (41%). Bulbar onset, functional disability and noninvasive ventilation were not associated with the completion of advance directives.

Conclusion: Early initiation of advance care planning is feasible in most ALS patients during a routine consultation, and relevant treatment issues can be discussed. All ALS patients should be offered the opportunity to write advance directives as completion was not associated with disease severity. .
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http://dx.doi.org/10.4414/smw.2021.20484DOI Listing
March 2021

Oral Dysbiosis and Inflammation in Parkinson's Disease.

J Parkinsons Dis 2021 ;11(2):619-631

Faculty of Medicine, University of Geneva, CMU, Geneva, Switzerland.

Background: Oral microbiota has largely escaped attention in Parkinson's disease (PD), despite its pivotal role in maintaining oral and systemic health.

Objective: The aim of our study was to examine the composition of the oral microbiota and the degree of oral inflammation in PD.

Methods: Twenty PD patients were compared to 20 healthy controls. Neurological, periodontal and dental examinations were performed as well as dental scaling and gingival crevicular fluid sampling for cytokines measurement (interleukine (IL)-1β, IL-6, IL-1 receptor antagonist (RA), interferon-γ and tumor necrosis factor (TNF)-α). Two months later, oral microbiota was sampled from saliva and subgingival dental plaque. A 16S rRNA gene amplicon sequencing was used to assess bacterial communities.

Results: PD patients were in the early and mid-stage phases of their disease (Hoehn & Yahr 2-2.5). Dental and periodontal parameters did not differ between groups. The levels of IL-1β and IL-1RA were significantly increased in patients compared to controls with a trend for an increased level of TNF-α in patients. Both saliva and subgingival dental plaque microbiota differed between patients and controls. Streptococcus mutans, Kingella oralis, Actinomyces AFQC_s, Veillonella AFUJ_s, Scardovia, Lactobacillaceae, Negativicutes and Firmicutes were more abundant in patients, whereas Treponema KE332528_s, Lachnospiraceae AM420052_s, and phylum SR1 were less abundant.

Conclusion: Our findings show that the oral microbiome is altered in early and mid-stage PD. Although PD patients had good dental and periodontal status, local inflammation was already present in the oral cavity. The relationship between oral dysbiosis, inflammation and the pathogenesis of PD requires further study.
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http://dx.doi.org/10.3233/JPD-202459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150470PMC
December 2021

Incidence, characteristics and clinical relevance of acute stroke in old patients hospitalized with COVID-19.

BMC Geriatr 2021 01 14;21(1):52. Epub 2021 Jan 14.

Division of Radiology, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland.

Background: Stroke in the course of coronavirus disease (COVID-19) has been shown to be associated with more severe respiratory symptoms and higher mortality, but little knowledge in this regard exists on older populations. We aimed to investigate the incidence, characteristics, and prognosis of acute stroke in geriatric patients hospitalized with COVID-19.

Methods: A monocentric cross-sectional retrospective study of 265 older patients hospitalized with COVID-19 on acute geriatric wards. 11/265 presented a stroke episode during hospitalization. Mortality rates and two-group comparisons (stroke vs non-stroke patients) were calculated and significant variables added in logistic regression models to investigate stroke risk factors.

Results: Combined ischemic and hemorrhagic stroke incidence was 4.15%. 72.7% of events occurred during acute care. Strokes presented with altered state of consciousness and/or delirium in 81.8%, followed by a focal neurological deficit in 45.5%. Ischemic stroke was more frequently unilateral (88.8%) and localized in the middle cerebral artery territory (55.5%). Smoking and a history of previous stroke increased by more than seven (OR 7.44; 95% CI 1.75-31.64; p = 0.007) and five times (OR 5.19; 95% CI 1.50-17.92; p = 0.009), respectively, the risk of stroke. Each additional point in body mass index (BMI) reduced the risk of stroke by 14% (OR 0.86; 95% CI 0.74-0.98; p = 0.03). In-hospital mortality (32.1% vs. 27.3%; p > 0.999) and institutionalization at discharge (36.4% vs. 21.1%; p = 0.258) were similar between patients with and without stroke.

Conclusion: Incident stroke complicating COVID-19 in old patients was associated with active smoking, previous history of stroke, and low BMI. Acute stroke did not influence early mortality or institutionalization rate at discharge.
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http://dx.doi.org/10.1186/s12877-021-02006-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807227PMC
January 2021

[Issues and challenges related to COVID-19 in acute geriatric care: lessons learned from the Geneva experience].

Rev Med Suisse 2020 Nov;16(714):2153-2155

Service de médecine interne de l'âgé, Département de réadaptation et gériatrie, HUG, 1211 Genève 14.

The older patients have been the most affected by the SARS-CoV-2 pandemic. In addition, this infection has been responsible for high mortality rate in this population. In this article we wanted to describe the clinical findings we encountered in older people with COVID-19 and share some of the issues and challenges we faced during the COVID-19 pandemic.
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November 2020

Predictors of In-Hospital Mortality in Older Patients With COVID-19: The COVIDAge Study.

J Am Med Dir Assoc 2020 11 15;21(11):1546-1554.e3. Epub 2020 Sep 15.

Divison of Internal Medicine for the aged, University Hospitals of Geneva, Geneva, Switzerland.

Objective: To determine predictors of in-hospital mortality related to COVID-19 in older patients.

Design: Retrospective cohort study.

Setting And Participants: Patients aged 65 years and older hospitalized for a diagnosis of COVID-19.

Methods: Data from hospital admission were collected from the electronic medical records. Logistic regression and Cox proportional hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis, and imaging results.

Results: Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Nonsurvivors had a shorter number of days from initial symptoms to hospitalization (P = .007) and the length of stay in acute wards than survivors (P < .001). Similarly, they had a higher prevalence of heart failure (P = .044), peripheral artery disease (P = .009), crackles at clinical status (P < .001), respiratory rate (P = .005), oxygen support needs (P < .001), C-reactive protein (P < .001), bilateral and peripheral infiltrates on chest radiographs (P = .001), and a lower prevalence of headache (P = .009). Furthermore, nonsurvivors were more often frail (P < .001), with worse functional status (P < .001), higher comorbidity burden (P < .001), and delirium at admission (P = .007). A multivariable Cox model showed that male sex (HR 4.00, 95% CI 2.08-7.71, P < .001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, P < .001), and crackles (HR 2.42, 95% CI 1.15-6.06, P = .019) were the best predictors of mortality, while better functional status was protective (HR 0.98, 95% CI 0.97-0.99, P = .001).

Conclusions And Implications: In older patients hospitalized for COVID-19, male sex, crackles, a higher fraction of inspired oxygen, and functionality were independent risk factors of mortality. These routine parameters, and not differences in age, should be used to evaluate prognosis in older patients.
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http://dx.doi.org/10.1016/j.jamda.2020.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491997PMC
November 2020

Results from an Epidemiological Follow-Up Survey on Home Artificial Nutrition in Switzerland from 2010 to 2015.

Ann Nutr Metab 2020 20;76(5):345-353. Epub 2020 Oct 20.

Swiss Society for Clinical Nutrition (SSCN/GESKES), Geneva/Bern, Switzerland,

Background: Home artificial nutrition (HAN) is an established treatment for malnourished patients. Since July 2012, the costs for oral nutrition supplements (ONS) are covered by the compulsory health insurance providers in Switzerland if the patient has a medical indication based on the Swiss Society for Clinical Nutrition guidelines. Therefore, the purpose of our study was to analyse the development of HAN, including ONS, before and after July 2012.

Methods: We obtained the retrospective and anonymized data from the Swiss association for joint tasks of health insurers (SVK), who registered patients on HAN. Since not all health insurers are working with SVK, this retrospective study recorded nearly 65% of all new patients on HAN in Switzerland from January 1, 2010, to December 31, 2015.

Results: A total of 33,410 patients (49.1% men and 50.9% women) with a mean BMI of 21.3 ± 4.5 kg/m2 and mean age of 68.9 ± 17.8 years were recorded. The number of patient cases on ONS increased from 808 cases in 2010 to 18,538 cases in 2015, while patient cases on home enteral nutrition (HEN) and home parenteral nutrition (HPN) remained approximately the same. The relative distribution of type of HAN changed from 26.2% cases on ONS, 68.7% cases on HEN and 5.1% cases on HPN in 2010 to 86.1% cases on ONS, 12.8% cases on HEN, and 1.1% cases on HPN in 2015. Treatment duration decreased for ONS from 698 ± 637 days to 171 ± 274 days, for HEN from 416 ± 553 days to 262 ± 459 days, and for HPN from 96 ± 206 days to 72 ± 123 days. Mean costs per patient decreased for ONS from 1,330 CHF in 2010 to 606 CHF in 2015. Total costs for HAN increased from 16,895,373 CHF in 2010 to 32,868,361 CHF in 2015.

Conclusion: Our epidemiological follow-up study showed an immense increase in number of patients on HAN in Switzerland after July 2012. Due to shorter therapy duration and reduced mean costs per patient, total costs were only doubled while the number of patients increased 7-fold.
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http://dx.doi.org/10.1159/000510796DOI Listing
September 2021

Nutritional Intervention to Prevent the Functional Decline in Community-Dwelling Older Adults: A Systematic Review.

Nutrients 2020 Sep 15;12(9). Epub 2020 Sep 15.

Department of Rehabilitation and Geriatrics, Geneva University Hospital, 1211 Geneva, Switzerland.

Aging is a global public health concern. From the age of 50, muscle mass, muscle strength and physical performance tend to decline. Sarcopenia and frailty are frequent in community-dwelling older adults and are associated with negative outcomes such as physical disability and mortality. Therefore, the identification of therapeutic strategies to prevent and fight sarcopenia and frailty is of great interest. This systematic review aims to summarize the impact of nutritional interventions alone or combined with other treatment(s) in older community-dwelling adults on (1) the three indicators of sarcopenia, i.e., muscle mass, muscle strength and physical performance; and (2) the hospitalization and readmission rates. The literature search was performed on Medline and included studies published between January 2010 and June 2020. We included randomized controlled trials of nutritional intervention alone or combined with other treatment(s) in community-living subjects aged 65 or older. In total, 28 articles were retained in the final analysis. This systematic review highlights the importance of a multimodal approach, including at least a combined nutritional and exercise intervention, to improve muscle mass, muscle strength and physical performance, in community-dwelling older adults but especially in frail and sarcopenic subjects. Regarding hospitalization and readmission rate, data were limited and inconclusive. Future studies should continue to investigate the effects of such interventions in this population.
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http://dx.doi.org/10.3390/nu12092820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551991PMC
September 2020

Easy-to-prescribe nutrition support in the intensive care in the era of COVID-19.

Clin Nutr ESPEN 2020 10 31;39:74-78. Epub 2020 Jul 31.

Division of Intensive Care, Department of Acute Medicine, Geneva University Hospitals, Switzerland. Electronic address:

Background & Aims: COVID-19 pandemic had resulted in a massive increase in the number of patients admitted to intensive care units (ICUs). This created significant organizational challenges including numerous non-specialist ICU caregivers who came to work in the ICU. In this context, pragmatic protocols were essential to simplify nutritional care. We aimed at providing a simple and easy-to-prescribe nutritional protocol and evaluated its usefulness with questionnaires sent to physicians involved in the care of ICU COVID-19 patients.

Methods: A simplified nutrition protocol was distributed to all physicians (n = 122) of the ICU medical team during COVID-19 pandemic. Clinical dieticians estimated energy targets for acute and post-acute phases at patient's admission and suggested adaptations of nutrition therapy. More complex situations were discussed with clinical nutrition doctors and, if required, a clinical evaluation was performed. To further facilitate the procedure, a chart with prescription aids was also distributed to the whole medical ICU team. At the end of the current pandemic wave, a 13-item questionnaire was emailed to the ICU medical team to obtain their opinion on the suggested nutritional therapy.

Results: Answers were received from 81/122 medical doctors (MDs) (66% response rate), from intensive care physicians (41%), anaesthesiologists (53%) and MDs from other specialties (6%). Thirty-two percent of MDs felt that their knowledge of nutrition management was insufficient and 45% of the physicians surveyed did not face nutrition management in their daily practice prior to the pandemic. The initially proposed nutritional protocol, the chart with prescription aids and the suggested nutritional proposals were considered as useful to very useful by the majority of physicians surveyed (89.9, 90.7 and 92.1% respectively). The protocol was followed by 92% of MDs, and almost all participants (95%) were convinced that adaptations of nutritional therapy had beneficial effects on patients' outcomes.

Conclusions: Nutritional therapy in critically ill COVID-19 patients is a challenge and the implementation of this specific pandemic simplified nutritional protocol was assessed as useful by a great majority of physicians. Pragmatic and simplified protocols are useful for ensuring the quality of nutritional therapy and could be used in future studies to assess its actual impact on the clinical outcomes of COVID-19 patients.
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http://dx.doi.org/10.1016/j.clnesp.2020.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837278PMC
October 2020

Multidisciplinary care in amyotrophic lateral sclerosis: a 4-year longitudinal observational study.

Swiss Med Wkly 2020 Jun 9;150:w20258. Epub 2020 Jun 9.

Division of Pulmonary Diseases, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland / Faculty of Medicine, University of Geneva, Switzerland.

Over a four-year period, ALS patients complied with the modalities of the multidisciplinary management follow-up without any drop-outs. The multidisciplinary management structure also contributes to increasing the experience and knowledge of the clinicians involved in managing patients suffering from this rare disease.
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http://dx.doi.org/10.4414/smw.2020.20258DOI Listing
June 2020

[Microbiota specificities among the elderly Summary of the 5th symposium « Feeding the Microbiota »].

Rev Med Suisse 2020 Jun;16(698):1266-1269

Service des maladies infectieuses, HUG, 1211 Genève 14.

The microbiota is a subject of particular interest and research. It is defined as all microorganisms present in tissues and on body surfaces. It sits at the interface with many systems, including the immune system, plays a role in the metabolism, immunity, or inflammation and is thought to be associated with some pathological mechanisms. Its composition and metabolic activity are influenced by diverse factors such as aging. This article summarizes the 5th symposium « Feeding the Microbiota » (Geneva University Hospitals, February 6, 2020), focused on microbiota and aging.
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June 2020

Association of phase angle and running performance.

Clin Nutr ESPEN 2020 06 15;37:65-68. Epub 2020 Apr 15.

Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Switzerland.

Background: A high phase angle derived from bioelectrical impedance analysis has been linked to a high level of physical activity. However, it is unknown whether a high phase angle is related to running performance.

Methods: We included all subjects who participated for the first time to the Course de l'Escalade between 1999 and 2016, a yearly city run occurring in Geneva. The subjects underwent a measurement by 50-kHz tetrapolar bioelectrical impedance analysis (Nutriguard®). Running time was converted to running speed in km/h. Results are shown as mean (SD) and as frequencies. We performed sex-specific univariate and multivariate regressions, adjusted for age, body mass index, categories of running distance and year of measurement, to evaluate whether the phase angle is associated with running speed.

Results: We analyzed 2264 subjects (1025 women and 1239 men). In univariate regressions, phase angle was significantly related to running speed in women (coeff 0.52, 95% CI 0.35-0.67, p < 0.001, adjusted R 0.037) and men (coeff 0.57, 95% CI 0.42-0.73, p < 0.001, adjusted R 0.039). Multivariate regressions showed that the phase angle was still significantly associated with running speed in women and men (p < 0.001 for both models), with an adjusted R of 0.262 and 0.282, respectively.

Conclusions: The phase angle is positively associated with running performance in men and women. It remains to be demonstrated if this association reflects the benefit of regular training and whether the phase angle might be suitable to monitor improvements in running performance. CLINICAL TRIAL REGISTRY: clinicaltrials.gov, identifier: NCT03400761.
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http://dx.doi.org/10.1016/j.clnesp.2020.03.020DOI Listing
June 2020

Reliability and comparability of methods for assessing oral function: Chewing, tongue pressure and lip force.

J Oral Rehabil 2020 Jul 21;47(7):862-871. Epub 2020 Apr 21.

Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.

Background: Quantitative clinical assessment tests for oral function have become popular in patient assessment; however, their comparability remains unclear.

Objective: To assess the reliability and comparability of pairs of different instruments for measuring maximum tongue pressure (MTP), chewing function (CF) and maximum lip force (MLF), and to analyse the influence of subjects' characteristics on the applied instruments.

Methods: Each pair of instruments, as well as a single device measuring the maximum voluntary bite force (MBF), was assessed across 26 healthy volunteers. The respective pairs of devices were compared using Bland-Altman plots and linear regression analysis. Furthermore, the influence of age, occlusal support zones, number of functional occlusal units, MBF, MTP and MLF were investigated as predictors on CF using a generalised estimating equation model.

Results: Neither the two assessments of CF, nor of MLF were correlated to each other, but there was a significant correlation between the assessments of MTP. Hue-Check Gum was able to demonstrate a significantly higher CF in younger compared to older individuals (P = .004) and individuals with high numbers compared to low numbers of occlusal units (P < .001). Those differences could not be demonstrated with the Vivident chewing gum.

Conclusion: The absolute values of MTP assessed by the two applied devices cannot directly be compared, although normalised values may be directly comparable. Moreover, our observations suggest that the Hue-Check Gum was able to discriminate the effects of age and the number of occlusal units on CF. Our observations suggest that the two gums cannot be used interchangeably.
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http://dx.doi.org/10.1111/joor.12976DOI Listing
July 2020

Dénutrition chez la personne âgée - À quoi penser et quelle prise en charge par le médecin de premier recours ?

Rev Med Suisse 2020 Jan;16(679):189-190

Service de médecine interne et de réadaptation Loex Bellerive, Département de réadaptation et gériatrie, HUG, 1211 Genève 14.

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January 2020

[Vegetarian and vegan diets and their impact on health].

Rev Med Suisse 2019 Oct;15(667):1849-1853

Service de médecine interne générale, Département de médecine, HUG, 1211 Genève 14.

Vegetarian and vegan diets are increasing in the population, but the prevalence remains low (< 3 %). Vegetarians consume diary and eggs while vegans do not consume or use any animal derived products. Vegetarians have a low risk of deficiency except for iron deficiency with anemia in pre-menopausal women. Vegans should receive a mandatory vitamin B12 substitution because of an important risk of deficiency. Furthermore, vegans are at higher risk of iron and calcium deficiency with higher rates of osteoporotic fracture and iron deficiency anemia. Dietary advice is recommended, particularly for vegans, even though no clear recommendations can be found in the literature. These diets seem to be associated with a reduction in cardio-vascular risk factors, but this association remains to be confirmed.
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October 2019

Targeting the Gut Microbiota to Treat Cachexia.

Front Cell Infect Microbiol 2019 12;9:305. Epub 2019 Sep 12.

Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.

Cachexia occurs in many chronic diseases and is associated with increased morbidity and mortality. It is treated by nutritional support but often with limited effectiveness, leading to the search of other therapeutic strategies. The modulation of gut microbiota, whether through pro-, pre-, syn- or antibiotics or fecal transplantation, is attracting ever-growing interest in the field of obesity, but could also be an interesting and innovative alternative for treating cachexia. This article reviews the evidence linking the features of malnutrition, as defined by the Global Leadership Initiative on Malnutrition [low body mass index (BMI), unintentional body weight loss, low muscle mass, low appetite, and systemic inflammation] and the gut microbiota in human adults with cachexia-associated diseases, and shows the limitations of the present research in that field with suggestions for future directions.
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http://dx.doi.org/10.3389/fcimb.2019.00305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751326PMC
July 2020

Clinical Value of Muscle Mass Assessment in Clinical Conditions Associated with Malnutrition.

J Clin Med 2019 Jul 17;8(7). Epub 2019 Jul 17.

Clinical Nutrition, Geneva University Hospital, 1205 Geneva, Switzerland.

Malnutrition results from a reduction of food intake or an alteration of nutrient assimilation and leads to decreased lean mass. Strong evidence shows that malnutrition associated with loss of muscle mass negatively impacts clinical outcomes. The preservation or improvement of muscle mass represents a challenge. This review aims to (1) describe current methods to assess muscle mass in clinical practice, (2) describe the associations between muscle mass and clinical outcomes, and (3) describe the impact of interventions aiming at increasing muscle mass on clinical outcomes. It highlights the importance of assessing muscle mass as part of the screening and the follow-up of malnutrition in clinical practice.
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http://dx.doi.org/10.3390/jcm8071040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6678556PMC
July 2019

An Increase in Fat Mass Index Predicts a Deterioration of Running Speed.

Nutrients 2019 Mar 25;11(3). Epub 2019 Mar 25.

Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland.

A low fat mass is associated with a good running performance. This study explores whether modifications in body composition predicted changes in running speed. We included people who underwent several measurements of body composition by bioelectrical impedance analysis between 1999 and 2016, at the "Course de l'Escalade", taking place yearly in Geneva. Body composition was reported as a fat-free mass index (FFMI) and fat mass index (FMI). Running distances (men: 7.2 km; women: 4.8 km) and running times were used to calculate speed in km/h. We performed multivariate linear mixed regression models to determine whether modifications of body mass index, FFMI, FMI or the combination of FFMI and FMI predicted changes in running speed. The study population included 377 women (1419 observations) and 509 men (2161 observations). Changes in running speed were best predicted by the combination of FFMI and FMI. Running speed improved with a reduction of FMI in both sexes (women: ß -0.31; 95% CI -0.35 to -0.27, < 0.001. men: ß -0.43; 95% CI -0.48 to -0.39, < 0.001) and a reduction of FFMI in men (ß -0.20; 95% CI -0.26 to -0.15, < 0.001). Adjusted for body composition, the decline in running performance occurred from 50 years onward, but appeared earlier with a body mass, FFMI or FMI above the median value at baseline. Changes of running speed are determined mostly by changes in FMI. The decline in running performance occurs from 50 years onward but appears earlier in people with a high body mass index, FFMI or FMI at baseline.
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http://dx.doi.org/10.3390/nu11030701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471649PMC
March 2019

Nutrition-dénutrition-mobilité.

Authors:
Laurence Genton

Rev Med Suisse 2019 Jan;15(636):254-256

Nutrition clinique, Service d'endocrinologie, diabétologie, hypertension et nutrition, HUG, 1211 Genève 14.

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January 2019
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