ackground: Sarcopenia is characterized by progressive loss of muscle mass with corresponding decline in strength and/or physical function. The economic burden of sarcopenia-associated disability is considerable in the US. Objective: To estimate the cost of hospitalizations in US adults with sarcopenia categorized by age, sex, and race/ethnicity. Design, setting and participants: A retrospective, prevalence based, economic burden study, consisting of 4011 adults aged ≥40 years with and without sarcopenia. Methods: Data on prevalence of low lean mass, functional limitations, and hospitalizations were obtained from the National Health and Nutrition Examination Survey (1999-2004); cost of hospitalizations was obtained from the Healthcare Cost and Utilization Project – National Inpatient Sample (2014), and population estimates were obtained from the US Census (2014). Probability and cost of hospitalizations were estimated by multiple logistic regression and negative binomial regression models, respectively. Results: The total estimated cost of hospitalizations in individuals with sarcopenia was USD $40.4 billion with an average per person cost of USD $260. Within this category, average per person cost was highest for Hispanic women (USD $548) and lowest for Non-Hispanic Black women (USD $25); average per person cost was higher for older adults (≥65 years) (USD $375) than younger adults (40-64 years) (USD $204) with sarcopenia. The total cost of hospitalizations in individuals with sarcopenia (≥65 years) was USD $19.12 billion. Individuals with sarcopenia had greater odds of hospitalization (OR, 1.95; p<.001) compared to those without and had an annual marginal increase in cost of USD $2315.7 per person compared to individuals without sarcopenia. Conclusion: Sarcopenia places considerable economic burden on the US healthcare system. The ethnic disparity and economic burden associated with sarcopenia warrant further investigation.

BackgroundDisease-associated malnutrition has been identified as a prevalent condition, particularly for the elderly, which has often been overlooked in the U.S. healthcare system. The state-level burden of community-based disease-associated malnutrition is unknown and there have been limited efforts by state policy makers to identify, quantify, and address malnutrition. The objective of this study was to examine and quantify the state-level economic burden of disease-associated malnutrition.MethodsDirect medical costs of disease-associated malnutrition were calculated for 8 diseases: Stroke, Chronic Obstructive Pulmonary Disease, Coronary Heart Failure, Breast Cancer, Dementia, Musculoskeletal Disorders, Depression, and Colorectal Cancer. National disease and malnutrition prevalence rates were estimated for subgroups defined by age, race, and sex using the National Health and Nutrition Examination Survey and the National Health Interview Survey. State prevalence of disease-associated malnutrition was estimated by combining national prevalence estimates with states’ demographic data from the U.S. Census. Direct medical cost for each state was estimated as the increased expenditures incurred as a result of malnutrition.Principal FindingsDirect medical costs attributable to disease-associated malnutrition vary among states from an annual cost of $36 per capita in Utah to $65 per capita in Washington, D.C. Nationally the annual cost of disease-associated malnutrition is over $15.5 billion. The elderly bear a disproportionate share of this cost on both the state and national level.ConclusionsAdditional action is needed to reduce the economic impact of disease-associated malnutrition, particularly at the state level. Nutrition may be a cost-effective way to help address high health care costs.

Sarcopenia is the natural age-associated loss of muscle mass/function, often occurring simultaneously with obesity, especially in older adults. Sarcopenia and obesity contribute to poor health outcomes and when occurring together as sarcopenic obesity (SO) can cause further health complications. Few studies have specifically considered these conditions across different racial/ethnic populations. This study examined the prevalence of sarcopenia and SO among U.S. adults by different age, sex, and racial/ethnic groups, using 1999-2004 data from the National Health and Nutrition Examination Survey (NHANES) and its racial/ethnic subpopulation groupings. Sarcopenia was defined as low appendicular lean mass (adjusted for Body Mass Index (BMI) of <0.789 kg/ m 2 for males, <0.512 kg/m 2 for females) and self-reported functional limitation. Obesity was defined as BMI ≥30 kg/m 2 with SO defined as those meeting criteria for both sarcopenia and obesity. The analysis included 4367 adult subjects; for each race/ethnic subpopulation, sarcopenia prevalence increased with age. Sarcopenia prevalence varied by sex and race/ ethnic subpopulation: Hispanic (26.8% male, 27.2% female); Non-Hispanic (NH) White (15.5% male, 15.1% female); NH Black (8.6% male, 1.6% female); and Other (16.5% male, 23.2% female). Sarcopenic obesity also increased with age and varied by sex and race/ethnic subpopulation: Hispanic (8.57% male, 8.87% female); NH White (6.48% male, 8.06% female); NH Black (3.95% male, 1.12% female); and Other (4.46% male, 0.0% female). Increased awareness of variability in sarcopenia/SO may help develop effective screenings/ care management and interventions/public health policies to maintain functionality and reduce health disparities among an increasingly diverse U.S. older adult population.

Recent evidence suggests that fructose consumption is associated with weight gain, fat deposition and impaired cognitive function. However it is unclear whether the detrimental effects are caused by fructose itself or by the concurrent increase in overall energy intake. In the present study we examine the impact of a fructose diet relative to an isocaloric glucose diet in the absence of overfeeding, using a mouse model that mimics fructose intake in the top percentile of the USA population (18% energy). Following 77 days of supplementation, changes in body weight (BW), body fat, physical activity, cognitive performance and adult hippocampal neurogenesis were assessed. Despite the fact that no differences in calorie intake were observed between groups, the fructose animals displayed significantly increased BW, liver mass and fat mass in comparison to the glucose group. This was further accompanied by a significant reduction in physical activity in the fructose animals. Conversely, no differences were detected in hippocampal neurogenesis and cognitive/motor performance as measured by object recognition, fear conditioning and rotorod tasks. The present study suggests that fructose per se, in the absence of excess energy intake, increases fat deposition and BW potentially by reducing physical activity, without impacting hippocampal neurogenesis or cognitive function.

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Results demonstrate the importance of protein source for cognition and satiety enhancing effects of a high-protein meal.

Background Alpha-tocopherol (αT), the bioactive constituent of vitamin E, is essential for fertility and neurological development. Synthetic αT (8 stereoisomers; all rac-αT) is added to infant formula at higher concentrations than natural αT (RRR-αT only) to adjust for bio-potency differences, but its effects on brain development are poorly understood. Objectives The objective was to determine the impact of bio-potency–adjusted dietary all rac-αT versus RRR-αT, fed to dams, on the hippocampal gene expression in weanling mice. Methods Male/female pairs of C57BL/6J mice were fed AIN 93-G containing RRR-αT (NAT) or all rac-αT (SYN) at 37.5 or 75 IU/kg (n = 10/group) throughout gestation and lactation. Male pups were euthanized at 21 days. Half the brain was evaluated for the αT concentration and stereoisomer distribution. The hippocampus was dissected from the other half, and RNA was extracted and sequenced. Milk αT was analyzed in separate dams. Results A total of 797 differentially expressed genes (DEGs) were identified in the hippocampi across the 4 dietary groups, at a false discovery rate of 10%. Comparing the NAT-37.5 group to the NAT-75 group or the SYN-37.5 group to the SYN-75 group, small differences in brain αT concentrations (10%; P &lt; 0.05) led to subtle changes (&lt;10%) in gene expression of 600 (NAT) or 487 genes (SYN), which were statistically significant. Marked differences in brain αT stereoisomer profiles (P &lt; 0.0001) had a small effect on fewer genes (NAT-37.5 vs. SYN-37.5, 179; NAT-75 vs. SYN-75, 182). Most of the DEGs were involved in transcription regulation and synapse formation. A network analysis constructed around known vitamin E interacting proteins (VIPs) revealed a group of 32 DEGs between NAT-37.5 vs. SYN-37.5, explained by expression of the gene for the VIP, protein kinase C zeta (Pkcz). Conclusions In weanling mouse hippocampi, a network of genes involved in transcription regulation and synapse formation was differentially affected by dam diet αT concentration and source: all rac-αT or RRR-αT.

With the recent approval of specific ICD‐10 codes for sarcopenia, it is likely there will be increased clinical awareness of and research on this condition. Sarcopenia is the natural age‐associated loss of muscle mass and function and often occurs simultaneously with obesity especially in older adults. Sarcopenia and obesity are each risk factors contributing to poor health outcomes, yet the occurrence of both together as sarcopenic obesity can cause even more health complications. Although there may be genetic variability in BMI and possibly body composition, few studies have specifically examined the prevalence of sarcopenia and sarcopenic obesity across different racial/ethnic populations. The objective of this study was to examine the prevalence of sarcopenia and sarcopenic obesity among older adults in the U.S. by different racial/ethnic groups. 2458 subjects aged 65 or older were identified from the National Health and Nutrition Examination Survey (NHANES) from 1999–2004 (the dataset from this timeframe allowed identification of sarcopenia). Racial/ethnic subpopulations were grouped as defined by NHANES; non‐Hispanic White (Whites), non‐Hispanic Black (Blacks), Hispanics, and others. Sarcopenia was defined as having low appendicular lean mass adjusted for body mass index (< 0.789 kg/m2 for males and < 0.512 kg/m2 for females) and having self‐reported functional limitation. Subjects fulfilling the criteria for sarcopenia and obesity (body fat ≥ 25% for males and ≥ 35% for females) were defined as having sarcopenic obesity. In the older adult population, the overall prevalence of sarcopenia was 15.5%, with sarcopenic obesity being closely associated and having a prevalence of 15.3%. The prevalence of sarcopenia varied by gender and race/ethnic subpopulation: 26.8% in male and 27.2% in female among Hispanics, 15.5% in male and 15.1% in female among Whites, 8.6% in male and 1.6% in female among Blacks, and 16.5% in male and 23.2% in female among other racial and ethnic groups. Sarcopenic obesity also varied by gender and race/ethnic subpopulation: 26.4% in male and 27.2% in female among Hispanics, 15.2% in male and 14.9% in female among Whites, 8.1% in male and 1.6% in female among Blacks, and 16.5% in male and 21.0% in female among other racial and ethnic groups. The results of this study demonstrated large variability in prevalence of sarcopenia and sarcopenic obesity among racial/ethnic subpopulations of older adults. Hispanics had the highest prevalence of sarcopenia and sarcopenic obesity, whereas Blacks had the lowest. Increased awareness of these variabilities may be important to consider when developing effective health screenings/interventions for an increasingly diverse older adult population in the US.