Nutritional needs and physical function in community dwelling geriatric outpatients to counteract sarcopenia and ultimately preserve daily function

Sarcopenia, low muscle mass, is one of the undesirable factors leading to
physical disability, poor quality of life, loss of independence, and death in
older persons. The absence of physical activity diminishes muscle health and a
sufficient intake of nutrients, especially protein, has been shown to increase
protein synthesis, necessary to regain muscle health.
Very limited data exist in the vulnerable group of elderly referred to
geriatric outpatient clinics regarding their muscle related parameters.
However, data is lacking on energy expenditure and nutritional status in
geriatric outpatients. In geriatric outpatients, the prevalence of
undernutrition is significantly higher compared to the general population.
Nutritional requirements of the geriatric outpatient population are largely
unknown, and therefore nutritional deficiencies are also poorly understood.
In clinical practice, optimization of physical and nutritional intervention
(*tailored therapy*) to overcome sarcopenia is prevented by lack of knowledge
on estimated needs of patients and the interrelation of physical ability and
nutritional status. The present study aims to define clusters of patients based
on muscle related parameters, energy expenditure and nutritional status in an
inception cohort of patients referred to the geriatric outpatient clinic of the
Center of Geriatric Medicine Amsterdam (COGA), VU medical center in Amsterdam.

To understand the interrelations between muscle related parameters (muscle
mass, muscle strength, physical performance), energy expenditure (actual
physical activity and basal metabolic rate), and nutritional status (energy
intake and protein status) in geriatric outpatients.

This is an observational, longitudinal study which includes geriatric
outpatients with mobility problems and falls referred to the Center of
Geriatric Medicine Amsterdam (COGA), VU University Medical Center next to
healthy age matched controls.
A total of 220 outpatients and 50 healthy age matched controls will undergo
standardized phenotyping on a first visit based on regular care or research
setting respectively. On the second visit which takes place one week later,
patients will be informed on the results from the first visit and appropriate
interventions are prescribed or started. Four months after the first visit,
subjects are subsequently measured again to evaluate results of interventions.

Visit 1 includes the following investigations:
- Phenotypic characterization by questionnaires and a Comprehensive Geriatric
Assessment (CGA); cognition, depressive symptoms, anthropometric data, physical
functioning, cardiovascular functioning, neurological functioning, vision and
hearing, blood parameters
- Muscle related parameters assessed by Dual- energy X-ray absorptiometry (DXA)
and Bioelectrical Impedance Analysis (BIA)
- Energy expenditure assessed by an accelerometer and indirect calorimetry
- Nutritional status assessed by screening and a food diary.
- Skin biopsy

Visit 2 includes the following investigations:
- Results from the first visit and appropriate interventions

Visit 3 will be a follow up of four months and includes the following
investigations:
- Phenotypic characterization; an abbreviated Comprehensive Geriatric
Assessment (CGA)
- Muscle related parameters assessed by Bioelectrical Impedance Analysis (BIA)
- Energy expenditure assessed by an accelerometer
- Nutritional status assessed by screening and a food diary

There are only risks associated with the skin biopsy i.e. bleeding of the wound
or scar formation.