Fatigue is characterized by reduced energy level, decreased muscle strength, and a variable degree of cognitive impairment. Recent evidences seem to link vitamin D deficiency to fatigue. The aim of this study was to assess and compare vitamin D status in a cohort of older subjects with and without fatigue. We recruited a total of 480 subjects, 240 patients with fatigue and 240 controls without fatigue, from the Cannizzaro Hospital of Catania (Italy). Fatigue severity was measured by the fatigue severity scale, whereas mental and physical fatigue were measured through the Wessely and Powell fatigue scale, respectively. We also measured several blood parameters and 25-OH vitamin D. Subjects with fatigue showed lower levels of vitamin D as compared with those without fatigue. Blood levels of parameters related to fatigue were normal in both groups of subjects, however, platelet, hemoglobin, hematocrit (p < 0.05), mean corpuscular volume, C-reactive protein (CRP), iron, vitamin B12, and folic acid (p < 0.001) were significantly higher in the fatigue group with respect to the control group. Moreover, compared to controls, patients showed higher scores in the physical (p < 0.001), mental (p < 0.001), and severity (p < 0.001) fatigue scales. Finally, vitamin D inversely correlated with fatigue severity (r = −0.428, p < 0.01), whereas creatine kinase and CRP levels did not correlate with vitamin D. In conclusion, our data showed a direct link between vitamin D and fatigue in older subjects, suggesting translational implications in the diagnosis and management of these patients. Full article

Although malnutrition is frequent in the old, little is known about its association with fatigue. We evaluated the relation of self-reported severe weight loss with fatigue and the predictors for fatigue in old patients at hospital discharge. Severe weight loss was defined according to involuntary weight loss ≥5% in the last three months. We determined fatigue with the validated Brief Fatigue Inventory questionnaire. The regression analyses were adjusted for age, sex, number of comorbidities, medications/day, and BMI. Of 424 patients aged between 61 and 98 y, 34.1% had severe weight loss. Fatigue was higher in patients with severe weight loss (3.7 ± 2.3 vs. 3.2 ± 2.3 points, p = 0.021). In a multinomial regression model, weight loss was independently associated with higher risk for moderate fatigue (OR:1.172, CI:1.026–1.338, p = 0.019) and with increased risk for severe fatigue (OR:1.209, CI:1.047–1.395, p = 0.010) together with the number of medications/day (OR:1.220, CI:1.023-1.455, p = 0.027). In a binary regression model, severe weight loss predicted moderate-to-severe fatigue in the study population (OR:1.651, CI:1.052-2.590, p = 0.029). In summary, patients with self-reported severe weight loss at hospital discharge exhibited higher fatigue levels and severe weight loss was an independent predictor of moderate and severe fatigue, placing these patients at risk for impaired outcome in the post-hospital period. Full article

Benefits to the host metabolism resulting from Saccharomyces boulardii (Sb) supplementation have been described; however, no study has investigated the effects of this supplementation on aerobic metabolism and performance during physical exercise. Thus, in the present study, we addressed the effects of Sb supplementation on the rate of oxygen consumption (VO₂), mechanical efficiency (external work divided by VO₂), and aerobic performance of rats subjected to fatiguing, incremental-speed exercise. Twenty-six male Wistar rats were randomly divided into two groups: (1) non-supplemented, in which rats received 0.1 mL of a saline solution, and (2) Sb-supplemented, in which rats received 0.1 mL of a suspension containing 8.0 log₁₀ colony-forming units. The rats received the treatments by gavage for 10 consecutive days; they were then subjected to fatiguing treadmill running. Sb supplementation did not change the VO₂ values or mechanical efficiency during submaximal exercise intensities. In contrast, at fatigue, VO_2MAX was increased by 12.7% in supplemented rats compared with controls (p = 0.01). Moreover, Sb improved aerobic performance, as evidenced by a 12.4% increase in maximal running speed attained by the supplemented rats (p < 0.05). We conclude that Sb supplementation for 10 days increases VO_2MAX and aerobic performance in rats. Full article

The effect of inflammation on appetite and food intake has been rarely studied in humans. In this study, we examined the association of C-reactive protein (CRP), as an inflammatory marker, with appetite and food intake among older hospitalized patients. A total of 200 older individuals, who were consecutively admitted to a geriatric acute care ward, participated in this prospective observational study. Appetite was evaluated using the Edmonton Symptom Assessment System (ESAS) and the Simplified Nutritional Appetite Questionnaire (SNAQ), respectively. Food intake was measured according to plate diagram method and participants were categorized as having food intake <75% and ≥75% of meals served. Nutritional status was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). In addition, serum CRP was analyzed and the levels >3.0 (mg/dL) were considered as moderate to severe inflammation. Of total population with mean age 81.4 ± 6.6 years (62.5% females), 51 (25.5%) had no inflammation and 88 (44.0%) and 61 (30.5%) had mild and moderate to severe inflammation, respectively. According to MNA-SF, 9.0% and 60.0% had normal nutritional status or a risk of malnutrition, respectively, whereas 31.0% were malnourished. Based on the SNAQ-appetite-question, 32.5% of the patients demonstrated poor and very poor appetite whereas 23.5% reported severe loss of appetite according to ESAS. Ninety-five (48.0%) of the participants had food intake <75% of the meals offered. Significant associations between SNAQ-appetite (p = 0.003) and ESAS-appetite (p = 0.013) scores and CRP levels were observed. In addition, significant differences were observed in CRP levels between intake ≥75% and <75% of meals served (p < 0.001). Furthermore, there were significant associations between appetite and nutritional status whereas malnourished older patients demonstrated a decreased appetite compared to those with normal nutritional status (p = 0.011). In a regression analysis, inflammation was the major independent risk factor for patients’ appetite (p = 0.003) and food intake (p = 0.011) whereas other variables such as infection (p = 0.960), chronic inflammatory diseases (p = 0.371), age (p = 0.679) and gender (p = 0.447) do not show any impact on appetite. Our findings confirm that poor appetite and low food intake are associated with inflammation in older hospitalized patients, suggesting that inflammation may contribute an important aspect to the development of malnutrition in these patients. Full article

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, p < 0.001. men: ß −0.43; 95% CI −0.48 to −0.39, p < 0.001) and a reduction of FFMI in men (ß −0.20; 95% CI −0.26 to −0.15, p < 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. Full article

Accumulating data indicates a link between a pro-inflammatory status and occurrence of chronic disease-related fatigue. The questions are whether the observed inflammatory profile can be (a) improved by anti-inflammatory diets, and (b) if this improvement can in turn be translated into a significant fatigue reduction. The aim of this narrative review was to investigate the effect of anti-inflammatory nutrients, foods, and diets on inflammatory markers and fatigue in various patient populations. Next to observational and epidemiological studies, a total of 21 human trials have been evaluated in this work. Current available research is indicative, rather than evident, regarding the effectiveness of individuals’ use of single nutrients with anti-inflammatory and fatigue-reducing effects. In contrast, clinical studies demonstrate that a balanced diet with whole grains high in fibers, polyphenol-rich vegetables, and omega-3 fatty acid-rich foods might be able to improve disease-related fatigue symptoms. Nonetheless, further research is needed to clarify conflicting results in the literature and substantiate the promising results from human trials on fatigue. Full article