Osteosarcopenic Adiposity and Nutritional Status in Older Nursing Home Residents during the COVID-19 Pandemic

Abstract

The aim was to evaluate body composition and prevalence of osteosarcopenic adiposity (OSA) in nursing home residents (NHR) and to assess their nutritional status. This research builds on our pilot study (conducted prior COVID-19 pandemic) that revealed high OSA prevalence and poor nutritional status in NHR. The current study included newly recruited n = 365 NHR; 296 women, 69 men, aged 84.3 ± 5.6 and 83.1 ± 7.3 years, respectively. Body composition was measured by bioelectrical impedance BIA-ACC®, yielding total bone mass along with all components of lean and adipose tissues. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess nutritional status. Participants reported about their present/past diseases, including COVID-19. Mean duration of stay in nursing homes was 46.3 ± 47.0 months. Approximately 30% of participants had COVID-19 prior (median 6.7 months) to entering the study. OSA was diagnosed in 70.8% women and 47.8% men (p < 0.001). Malnourishment was detected in 5.8% women and 6.2% men while the risk of malnourishment was found in 30.8% women and 30.0% men. No significant differences in age, body composition parameters, prevalence of OSA, malnutrition/risk for malnutrition were found in participants who had COVID-19 compared to those who did not. Regression analysis showed that intramuscular adipose tissue (%) was significantly positively, while bone mass was significantly negatively associated with OSA. In this population, the high prevalence of OSA coincided with the high prevalence of malnutrition/risk of malnutrition. Such unfavorable body composition status is more likely a consequence of potentially poor diet quality in nursing homes, rather than of health hazards caused by COVID-19.

Nutrition and Physical Activity as Modulators of Osteosarcopenic Adiposity: A Scoping Review and Recommendations for Future Research

“…In view of the advanced age and constrained living conditions of nursing home residents, it is expected that some of them will be malnourished and have a poor body composition status. However, it is surprising that COVID-19 infection in the Cvijetić et al, [14] study participants did not show any impact on OSA prevalence, weight loss, or nutritional status. This is contrary to the just published study in French nursing homes [46], where those infected with COVID-19 experienced about 5% of weight loss.…”

“…Table 1 presents characteristics and results of studies with dietary intake or nutritional status as independent/exposure variables related to OSA/OSO. Of the eleven studies in this section, eight were either cross-sectional or observational, examining the relationship between OSA and nutritional status of the participants or their overall dietary intake, and/or intake of specific nutrients [13][14][15][16][17][18][19][20]. Three of them also evaluated engagement in physical activity or sedentary lifestyle [16,17,19].…”

“…The lowest prevalence in women and men (reported as combined) was 6.4% [19]. The studies were conducted on five continents: Europe (Croatia) [14,15], the U.S. [21,22], Asia (South Korea) [13,[16][17][18]20], South America (Brazil) [19] and Australia [23]. See Table 1.…”

“…Briefly, Cvijetic et. al., [14] study was conducted in several nursing homes revealing that more than 1/3 of participants were at the risk of developing malnutrition and ~6% were already malnourished (based on the Mini Nutritional Assessment), but there was no difference in the risk of malnutrition or malnourishment between those with or without OSA. This study was conducted during the COVID-19 pandemic and also revealed no difference in OSA prevalence or nutritional status in those who had COVID and those who had not have a disease.…”

“…Cvijetic et al, and Keser et al, [14,15] studies are interesting as they are the first ones to measure all three body composition compartments (bone, muscle, and fat) with one bioelectrical impedance (BIA) device (BIA-ACC, BioTekna®) to identify OSA. The BIA-ACC, instrument is based on bioelectrical impedance, but unlike other BIA devices, detects the total bone mass (in addition to all soft tissue components and body water).…”