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Ivry-sur-Seine, France

Bouillanne O.,Service de gerontologie 2 | Bouillanne O.,University of Paris Descartes | Curis E.,University of Paris Descartes | Hamon-Vilcot B.,Service de gerontologie 2 | And 7 more authors.
Clinical Nutrition

Background & aims: Aging is associated with a blunted anabolic response to dietary intake, possibly related to a decrease in systemically available amino acids (AAs), which in turn may stem from increased splanchnic AA metabolism. This splanchnic sequestration can be saturated by pulse feeding (80% of daily protein intake in a single meal), enabling increased protein synthesis. This study aimed to evaluate the efficacy of a new nutritional strategy, termed protein pulse feeding. Methods: This prospective randomized study (ClinicalTrials.gov registration number NCT00135590) enrolled 66 elderly malnourished or at-risk patients in an inpatient rehabilitation unit. All were given a controlled diet for 6 weeks. In a spread diet (SD) group (n = 36), dietary protein was spread over the four daily meals. In a pulse diet (PD) group (n = 30), 72% of dietary protein (1.31 g/kg weight/d on average) was consumed in one meal at noon. The patients were evaluated at admission and at 6 weeks for body composition [lean mass (LM), appendicular skeletal muscle mass (ASMM), and body cell mass (BCM) indices, measured by X-ray absorptiometry combined with bioelectrical impedance analysis] (primary outcome), hand grip strength, and activities of daily living (ADL) score. Results: Protein pulse feeding was significantly more efficacious than protein spread feeding in improving LM index (mean changes from baseline for PD group: +0.38 kg/m2; 95% confidence interval (CI), [0; 0.60]; for SD group: -0.21 kg/m2; 95% CI, [-0.61; 0.20]; p = 0.005 between the two groups), ASMM index (+0.21 kg/m2; 95% CI, [0; 0.34] and -0.11 kg/m2; 95% CI, [-0.20; 0.09]; p = 0.022), BCM index (+0.44 kg/m2; 95% CI, [0.08; 0.52] and -0.04 kg/m2; 95% CI, [-0.09; 0.10]; p = 0.004). There was no significant effect for hand-grip strength or ADL score. Conclusions: This study demonstrates for the first time that protein pulse feeding has a positive, clinically relevant effect on lean mass in malnourished and at-risk hospitalized elderly patients. © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. Source

Blonde-Cynober F.,Laboratoire Of Biologie | Cassereau C.,Laboratoire Of Biologie | Morineau G.,Laboratoire Of Biologie | Etienne S.,Service de Gerontologie 1 | And 4 more authors.
Annales de Biologie Clinique

Diagnosis of iron deficiency is not easily performed in inflammatory situation as usually encountered in elderly hospitalized patients (> 70 years old). At first, we determined serum soluble receptor transferrin (RsTf), RsTf/serurn ferritin ratio (RsTf-F index.) and biochemical and haematological values used to evaluate iron status, in iron-depleted subjects (ferritinemia < 50 ug/L) (group 2) (n = 22, 82 ± 7 years) or not (group 1, reference group) (n = 1.8, 82 ± 6 years), without inflammatory diseases. Relevance of the biological parameters to diagnose iron deficiency was evaluated (ROC curve) and a cut-off value of RsTf-F (> 1.85) was established. Then, we selected 60 patients (group 3) suspect of iron deficiency as previously validated with an inflammatory syndrome (CRP > 12 rag/L). Almost all patients (95%) presented at least one risk factor of iron deficiency (anticoagulant: drugs, nutritional or gastrointestinal diseases). In group 3, index. RsTf-F values were increased. (RsTf-F: 2.69 ± 0.82 versus group 1: 1.25 ± 0.34, p<0.05), in anemic patients (women Hb < 120 g/L, men Hb < 130 g/L) (n = 42) and in non-anemic patients (n = 18) (respectively RsTf-F: 2.84 ± 0.87 versus 2.35 ± 0.58, p < 0.05). Thus, in elderly patients with inflammatory disorders, RsTf-F index could suspect iron deficiency before appearance of biological anemia. Source

Siriwardana M.,Service de Gerontologie 4 | Moulias S.,Service de Geriatrie | Benisty S.,Service de Geriatrie | Pautas E.,Service de Gerontologie 4 | And 10 more authors.
Revue de Medecine Interne

Purpose: In the absence of specific recommendations on blood transfusion in elderly subjects, we carried out a survey to assess transfusion practices in geriatric medicine. Methods: A descriptive, national, cross-sectional survey was conducted in 14 French geriatric departments (12 teaching hospitals and two general hospitals). In each department, five patients receiving transfusions were randomly selected in order to analyze their characteristics, the indications of blood transfusion, the criteria for and the methods of transfusion compared with Afssaps recommendations on transfusion thresholds. Results: Data were analyzed for 70 patients (mean age 86 ± 7 years, sex ratio female to male 1.8, with an average of five ± two pathologies and six ± three treatments). The indicators of poor tolerance included confusion (23 %), somnolence (22 %), acute heart failure (17 %) or coronary heart disease (16 %), and differed from the Afssaps criteria in the majority of cases. The transfusion threshold that were considered in the absence of poor tolerance (45 % of transfusions) differed from that recommended by Afssaps in 26 % of cases. The main adverse event in transfusion recipients was heart failure. Conclusion: When criteria for poor anaemia tolerance or transfusion thresholds are considered, transfusion practices in geriatric subjects have specific features. Further studies are needed to validate the appropriateness of the practices described in this survey. © 2009 Société nationale française de médecine interne (SNFMI). Source

Anard-Michelot H.,Service de medecine | Siguret V.,Laboratoire dHematologie | Siguret V.,University of Paris Descartes | Gouin-Thibault I.,Laboratoire dHematologie | And 5 more authors.
Annales de Biologie Clinique

Few data are available regarding biological risk factors for venous thromboembolism in the elderly who are at high risk of thrombosis. In the present study, we assessed the prevalence of antithrombin, protein C, protein S deficiency, G1691A factor V Leiden and G20210A prothrombin (FII) gene variant, and antiphospholipid antibodies in patients over 75 years who were referred to us for thrombophilia testing and who presented with unprovoked recurrent venous thromboembolic disease or venous thrombosis at unusual site. Seventy-eight patients, mean aged 86 years, were included in the cohort.No deficiency in natural coagulation inhibitors was found. Ten patients (12.8%) and 6 patients (7.7%) were found heterozygous carriers of the factor V Leiden and of the G20210A FII mutation, respectively. One patient was a double heterozygote. Two patients were diagnosed with antiphospholipid syndrome. These results are discussed along with those obtained in cohorts of elderly patients or in cohorts of younger patients presenting with idiopathic venous thromboembolic disease, either recurrent or not. Our results trend to confirm the recently published French recommendations regarding inheritedthrombophilia screening in the elderly: in patients aged 60 years or older, testing should be limited given the weak impact of this finding on the anticoagulation management. Source

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