Obesity as a Factor Contributing to Falls by Older Adults

Obstacle clearance performance in individuals with high body mass index

The objective of this study was to quantify performance in an obstacle clearance task among individuals with excess body weight or body mass index (BMI). Task performance was operationalized as the maximum obstacle height cleared, four duration measures of successful task completion and compensatory movements used in the process of task completion. Eighteen participants with a BMI exceeding 30 kg/m² completed a laboratory experiment that required stepping over seven lightweight obstacles. Obstacle heights were sequentially increased from 36 cm in 5 cm increments until participants were unsuccessful or unable to clear the obstacle up to 66 cm. Successful task completions decreased from 100% at an obstacle height of 36 cm to 66.1% at 66 cm. Higher obstacle heights were associated with significantly fewer task completions, longer leading and trailing leg stance and overall task duration, and more frequent use of compensatory movements for successful obstacle clearance. Cox PH regression was used to test the association between probability of obstacle clearance and normalized obstacle height adjusting for BMI, standing balance, and type of compensatory movement used, namely, hover and pivot motions involving the leg, and hands for bracing. The probability of successful task completion significantly decreased with increases in BMI (hazard ratio, HR = 1.14, 95% CI: 1.05-1.25), and increased with use of a leg pivot motion (HR = 0.30, 95% CI: 0.09-0.96) during task completion, after adjusting for standing balance and other types of compensatory movements. Overall, the results demonstrated that obstacle clearance performance is affected by an individual's BMI and the use of compensatory behaviors for regaining stability. The ability to recruit internal and external stabilization techniques could potentially serve as a clinical indicator of reduced fall risk and be the focus of fall prevention interventions. Implications for evaluating stability, fall risk, and identifying modifiable factors for fall prevention in the obese population are discussed.

Multifactorial assessment of older adults able and unable to recover balance during a laboratory-induced trip

BACKGROUND

Older adults are prone to falls, and identifying fallers and non-fallers from a set of fall-related variables is essential while establishing effective preventive programs.

AIMS

This study aimed to analyze if a set of parameters (i.e., strength, functional status, dynamic balance, gait, and obesity-related anthropometric measures) differ between older adults able and unable to recover from an induced trip.

OBJECTIVE

To analyze predictors among older adults able and unable to identify fallers and non-fallers.

METHODS

Thirty healthy old adults were tripped once during the mid-swing phase of the gait. The trip outcome was used as a criterion to assign participants to a recovery (REC; n=21; 71.2±5.7 years; 70.9±12.8 kg; 1.60±0.09 m) or a non-recovery group (NREC; n=9; 69.4±6.8 years; 85.7±11.8 kg; 1.59±0.08 m). The spatiotemporal gait parameters, functional mobility, dynamic balance, and isokinetic muscular function were measured.

RESULTS

The NREC presented larger BMI (33.6±2.7 vs. 27.5±3.4 kg.m-2; p<0.05); greater time for the initiation phase on the voluntary step execution test (197.0±27.9vs. 171.7±31.3s; p<0.05); lower plantarflexor (0.41±0.15 vs. 0.59±0.18 N.m; p<0.05), dorsiflexor (0.18±0.05 vs. 0.24±0.07 N.m; p<0.05), knee extensor (1.03±0.28 vs. 1.33±0.24 N.m; p<0.05) and knee flexor peak torques (0.50±0.15 vs. 0.64±0.13 N.m; p<0.05); and greater time up and go (8.0±0.8 vs. 7.4±0.7s).

CONCLUSIONS

The results showed that it is possible to identify fall risk components based on several fall-related parameters using a laboratory-induced trip as the outcome variable.

SC, Crews RT. Diabetes and Reactive Balance: Quantifying Stepping Thresholds With a Simple Spring Scale to Measure Fall-Risk in Ambulatory Older Adults

BACKGROUND

Fall-risk assessments for patients with diabetes fail to consider reactive responses to balance loss. The purpose of this study was to assess the feasibility of using a simple clinical tool to evaluate the impact of diabetes and fall history on reactive balance in older adults.

METHODS

We recruited 72 older adults with and without diabetes. Postural perturbations were applied by a waist-mounted spring scale. Stepping thresholds (STs) in the anterior and posterior directions were defined as the lowest spring-loads that induced a step. Balance was assessed via the National Institutes of Health Toolbox Standing Balance Test, and lower extremity sensation was assessed using vibratory perception threshold and Semmes-Weinstein monofilaments. Fall history over the past year was self-reported. Cox regressions and analysis of variance were used to compare hazard rates for stepping and observed STs between groups.

RESULTS

Anterior STs were elicited in 42 subjects and posterior STs in 65 subjects. Hazard rates for posterior ST were significantly affected by diabetes, with greater hazards for fallers with diabetes versus control fallers and nonfallers, after accounting for balance and sensory loss. For those who stepped, ST was lower in the posterior direction for the diabetes group. Additionally, anterior but not posterior ST was lower in all fallers vs all nonfallers.

CONCLUSIONS

The waist-mounted spring scale is a clinically implementable device that can assess ST in older adults with diabetes. Using the device, we demonstrated that ST was affected by diabetes and could potentially serve as a fall-risk factor independent of balance or sensory loss.

Can the exercise-based and occupational therapy improve the posture, strength, and mobility in elderly Greek subjects with hip fracture? A non-randomized control trial

Objectives

The effects of a rehabilitation program on static balance, mobility, and strength of lower limbs in elderly fallers operated after a hip fracture and non-operated were studied.

Methods

Ninety-one elderly (>65 years) were divided in two groups, the Operated Group (OG, 43 fallers) and the Non-Operated Group (NOG, 48 fallers). Posture during bipedal stance (30s), mobility (Up-and-Go, Falls Efficacy Scale, Berg Balance Scale) and isokinetic strength of several muscular groups in both limbs were evaluated before and after a rehabilitation intervention, consisting in 20 sessions (3 sessions/week) including kinesiotherapy and occupational therapy.

Results

After intervention, the average velocity of Center of Pressure displacement decreased significantly for OG and NOG (p<0.005). Similarly, all other variables describing static balance, mobility (p<0.05) and isokinetic strength (p<0.005) were improved significantly for both groups.

Conclusions

The applied intervention led to improvement in static balance, mobility, and strength of lower limbs after hip fracture. Physical and Rehabilitation Medicine physicians should prescribe evidence-based rehabilitation protocols in elderly fallers because they could show just as remarkable improvements as non-operated patients when the program is carefully designed.

Influence of Load Carriage on the Gait Characteristics of the Obese

Background

Gait mechanism due to overloaded weight of the obese may be altered, but yet uncertain whether an added loaded weight on body weight can alter or not gait characteristics.

Methods

We applied with 0 kg (no load), 5 kg, 10 kg, and 15 kg of the load carriage respectively on the obese (n=11) to grasp a mechanism on the control of impact types and dynamic stability during gait. Gait characteristics was analyzed with three-dimensional cinematography and ground reaction force system consisted of a length of 1 stride, mean velocity of center of gravity during supporting phase, breaking force, propulsive force, dynamic posture stability index (DPSI), and extrapolated centre of mass (XCoM) respectively. We performed repeated measures one-way analysis of variance (0 kg, 5 kg, 10 kg, and 15 kg) and performed the post hoc test (Duncan) at (P<0.05) in case of significant level respectively.

Results

Onestride length and mean velocity were decreased according to gradual increase of a load carriage, but breaking and propulsive force were somewhat increased. Particularly a decrease of gait velocity and stride length kept the range for DPSI and XCoM theta of a level of no-load carriage.

Conclusion

Usually load carriage during prolonged time of the obese is few case, but rather a load carriage of 5 kg may alter a gait posture potentially with prolonged time of load carriage.

Older but not younger adults rely on multijoint coordination to stabilize the swinging limb when performing a novel cued walking task

Motor flexibility, the ability to employ multiple motor strategies to meet task demands, may facilitate ambulation in complex environments that constrain movements; loss of motor flexibility may impair mobility. The purpose of this study was to determine the effects of obesity (a specific model of mobility impairment) and advanced age on motor flexibility during a task that constrained foot placement while walking. Twenty-one community-dwelling obese (OB) and 25 normal weight (NW) older adults (46 total older adults-OA) and 10 younger adults (YA) walked normally on a treadmill (baseline) then walked while stepping on lighted cues projected onto the treadmill at locations corresponding to average foot placement during normal walking (cued). The uncontrolled manifold (UCM) analysis was used to partition total variance in a set of seven lower-limb segment angles into components that did ("bad" variance) and did not ("good" variance) affect step-to-step variance in the trajectory of the swing foot. Motor flexibility was operationalized as an increase (baseline to cued) in total variance with an increase in good variance that exceeded the change in bad variance. There was no significant group × walking task interaction for total and good variance for OB vs NW, but there was a strong and significant interaction effect for OA vs YA (p < 0.01; Cohen's d > 1.0). Whereas YA reduced both good and bad variance, OA increased good variance beyond the change in bad variance. In OA, these changes were associated with several functional measures of mobility. Cued walking may place greater demands on OA requiring greater reliance on motor flexibility, although otherwise healthy older obese adults may be able to compensate for functional and cognitive declines associated with obesity by increasing motor flexibility under such tasks. The extent to which motor flexibility is employed during novel or constrained tasks may be a biomarker of healthy aging and a target for (re)habilitation.

The Role of the Podiatrist in Assessing and Reducing Fall Risk: An Updated Review

Falls present a tremendous challenge to health care systems. This article reviews the literature from the previous 5 years (2014-2019) in terms of methods to assess fall risk and potential steps that can be taken to reduce fall risk for patients visiting podiatric clinics. With regard to assessing fall risk, we discuss the role of a thorough medical history and podiatric assessments of foot problems and deformities that can be performed in the clinic. With regard to fall prevention we consider the role of shoe modification, exercise, pain relief, surgical interventions, and referrals.

Stand-Biased Desk Intervention on Sleep Quality of High School Students: A Pilot Study Using Tri-Axial Accelerometery

Prolonged sitting is related to a sedentary inactive lifestyle and related to obesity and many metabolic problems caused by inactivity. The problem gets more serious for people who spent most of their work time in a seated position like students or office workers. In this study, we provided standing desk and stool to the local public high school and observed the changes in their behavior in terms of physical activity using tri-axial accelerometer before and after intervention. Previously published study using the same dataset under the larger project reported increased physical activity during school hours. In this study, we extracted more diverse features directly from the raw data instead of using data processed by the software that manufacturer provided. Hence, we were able to analyze the same features (sedentary, physically active time) as well as sleep-related variables. Of the interest, sleep is another important feature that can tell us about participants’ health conditions. Even if the intervention contributed to updating their behavioral patterns, the result might be nullified in the long run if their sleep pattern was compromised. The quantity and quality of sleep was not changed after the intervention. Therefore, the efficacy of standing desks has been confirmed again.

Diet-induced obesity decreases rate-dependent depression in the Hoffmann's reflex in adult mice

Obesity is associated with balance and motor control deficits. We have recently shown that Group Ia muscle spindle afferents, the sensory arm of the muscle stretch reflex, are less responsive in mice fed a high-fat diet. Here we test the hypothesis that reflex excitability to sensory information from Group Ia muscle spindle afferents is altered in a mouse model of diet-induced obesity. We measured the anesthetized Hoffmann's or H-reflex, the electrical analog of the muscle stretch reflex. Adult mice of both sexes were fed a control diet (CD; 10% kcal from fat) or a high-fat diet (HFD; 60% kcal from fat) for 5, 10, or 15 weeks. We used three quantitative measures of H-reflex excitability: (1) H-reflex latency; (2) the percentage of motor neurons recruited from electrical stimulation of Group Ia muscle spindle afferents (Hmax /Mmax ); and (3) rate-dependent depression (RDD), the decrease in H-reflex amplitude to high frequency stimulation (20 stimuli at 5 Hz). A HFD did not significantly alter H latency (P = 0.16) or Hmax /Mmax ratios (P = 0.06), but RDD was significantly lower in HFD compared to CD groups (P < 0.001). Interestingly, HFD males exhibited decreased RDD compared to controls only after 5 and 10 weeks of feeding, but females showed progressive decreases in RDD that were only significant at 10 and 15 weeks on the HFD. These results suggest that high-fat feeding increases H-reflex excitability. Future studies are needed to determine whether these changes alter muscle stretch reflex strength and/or balance and to determine the underlying mechanism(s).

Functional Connectivity During Handgrip Motor Fatigue in Older Adults Is Obesity and Sex-Specific

The prevalence of obesity in older adults, particularly in females, is increasing rapidly and is associated with declines in both the brain and physical health. Both the obese and the female populations have shown greater motor fatigue than their counterparts, however, the central neural mechanisms for fatigue are unclear. The present study measured fatigue-related functional connectivity across frontal and sensorimotor areas using functional near-infrared spectroscopy (fNIRS). Fifty-nine older adults (30 non-obese and 29 obese) performed submaximal handgrip motor fatigue until voluntary exhaustion. Functional connectivity and cerebral hemodynamics were compared across eight cortical areas during motor fatigue and across obesity and sex groups along with neuromuscular fatigue outcomes (i.e., endurance time, strength loss, and force steadiness). Both obesity- and sex-specific functional architecture and mean activation differences during motor fatigue in older adults were observed, which were accompanied by fatigue-related changes in variability of force steadiness that differed between groups. While primary indicators of fatigue, i.e., endurance and strength loss, did not differ between groups, the motor steadiness changes indicated different neural adaptation strategies between the groups. These findings indicate that obesity and sex differences exist in brain function in older adults, which may affect performance during motor fatigue.

Multicomponent Training Program with High-Speed Movement Execution of Ankle Muscles Reduces Risk of Falls in Older Adults

The purpose of this study was to investigate the effects of multicomponent training program, designed to improve the torque around the ankle joint performing high-speed movement execution, on healthy older adults. Participants were balanced by torque around the ankle joint and randomly allocated to either exercise (n = 12, 69.7 ± 4.8 years, 74.6 ± 16.8 kg, 1.63 ± 0.10 m) or control group (CG) (n = 14, 70.86 ± 6.48 years; 73.5 ± 13.4 kg, 1.56 ± 0.05 m). The exercise group (EG) performed a multicomponent training of resistance, agility, and coordination exercises, focusing on the plantar flexor muscles during 12 weeks (3 days per week). Outcome measures were torque (plantar flexion and extension), reactive capacity (Step test), and functional mobility (gait and timed up and go [TUG] test). The training program was induced to increase peak torque of extensor muscles around the ankle joint to EG (Δ = 50%; d = 1.59) compared to the CG. Such improvement was converted to reactive capacity improvements considering the decrease in the execution time of the Swing phase and in the Total time of the Step test (Δ = 19%; d = 0.93, Δ = 14%; d = 1.02, respectively). Gains in functional mobility were verified by the increase of the walking speed (Δ = 15%; d = 1.37) and by the smaller time of execution of TUG test (Δ = 17%; d = 1.73) in the EG. Therefore, the multicomponent training was effective to reduce or to reverse muscular age-related declines, which are associated with functional capacity and reduction of fall risk in older adults.

Diet induced obesity alters muscle spindle afferent function in adult mice

Populations with obesity are more likely to fall and exhibit balance instability. The reason for this is likely multifactorial, but there is some evidence that sensory function is impaired during obesity. We tested the hypothesis that muscle proprioceptor function is compromised in a mouse model of diet induced obesity. An in vitro muscle-nerve preparation was used to record muscle spindle afferent responses to physiological stretch and sinusoidal vibration. We compared the responses of C57/Bl6 male and female mice on a control diet (10% kcal fat) with those eating a high fat diet (HFD; 60% kcal fat) for 10 weeks (final age 14–15 weeks old). Following HFD feeding, adult mice of both sexes exhibited decreased muscle spindle afferent responses to muscle movement. Muscle spindle afferent firing rates during the plateau phase of stretch were significantly lower in both male and female HFD animals as were two measures of dynamic sensitivity (dynamic peak and dynamic index). Muscle spindle afferents in male mice on a HFD were also significantly less likely to entrain to vibration. Due to the importance of muscle spindle afferents to proprioception and motor control, decreased muscle spindle afferent responsiveness may contribute to balance instability during obesity.

Influence of morbid obesity on physical capacity, knee-related symptoms and overall quality of life: A cross-sectional study

Objective:

To evaluate the impact of morbid obesity on physical capacity, joint-related symptoms, and on the overall quality of life.

Method:

Cross-sectional study carried out at a university hospital, enrolling 39 individuals admitted to a bariatric surgery service. Physical capacity was assessed by Six-Minute Walk Test (SMWT) and the Borg rating of perceived exertion (RPE). Knee-related symptoms were evaluated by Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Lysholm Score. Quality of life was evaluated by Short Form 36 Health Questionnaire (SF-36).

Results:

On SMWT, the mean distance walked was 374.1±107.5 m. The mean Borg score was 12.9±2.4. KOOS questionnaire found the following scores: pain (64.3±24), other symptoms (67.2±25.5), function in daily living (60.4±26.8), function in sport and recreation (28.5±32.2), knee-related quality of life (35.9±33.5), mean Lysholm scale score (55.3±25.4). SF-36 provided the following scores: physical functioning (41±27.4), physical role functioning (34.6±39.2), bodily pain (45.7±23.6), general health perceptions (63.1±26.2), vitality (53.5±12.1), social role functioning (52.6±29.3), emotional role functioning (41±44.9), mental health (55±27.7).

Conclusion:

Obesity led to significant loss of physical capacity, gait impairment, knee-related symptoms, and a negative impact on the overall quality of life.

Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity

BACKGROUND

New evidence suggests that obesity is deleterious for bone health, and obesity treatments could potentially exacerbate this.

MATERIALS AND METHODS

This narrative review, largely based on recent systematic reviews and meta-analyses, synthesizes the effects on bone of bariatric surgery, weight loss pharmaceuticals and dietary restriction.

RESULTS AND CONCLUSIONS

All three obesity treatments result in statistically significant reductions in hip bone mineral density (BMD) and increases in bone turnover relative to pre-treatment values, with the reductions in hip BMD being strongest for bariatric surgery, notably Roux-en Y gastric bypass (RYGB, 8%-11% of pre-surgical values) and weakest for dietary restriction (1%-1.5% of pre-treatment values). Weight loss pharmaceuticals (orlistat or the glucagon-like peptide-1 receptor agonist, liraglutide) induced no greater changes from pre-treatment values than control, despite greater weight loss. There is suggestive evidence that liraglutide may increase bone mineral content (BMC) - but not BMD - and reduce fracture risk, but more research is required to clarify this. All three obesity treatments have variable effects on spine BMD, probably due to greater measurement error at this site in obesity, suggesting that future research in this field could focus on hip rather than spine BMD. Various mechanisms have been proposed for BMD loss with obesity treatments, notably reduced nutritional intake/absorption and insufficient exercise, and these are potential avenues for protection against bone loss. However, a pressing outstanding question is whether this BMD reduction contributes to increased fracture risk, as has been observed after RYGB, and whether any such increase in fracture risk outweighs the risks of staying obese (unlikely).

The effects of physical training without equipment on pain perception and balance in the elderly: A randomized controlled trial

BACKGROUND

Research supports a link between exercise and falls prevention in the older population.

OBJECTIVES

Our aims were to evaluate pain perception and balance skills in a group of elderly subjects and to examine the consequences of a standardized equipment-free exercise program intervention on these variables. The study utilized a randomized controlled trial method.

METHODS

92 subjects were recruited from a rural Sicilian village (Resuttano, Sicily, Italy). Subjects were randomly split into two groups, an experimental group (EG; n = 49) and a control group (CG; n = 43). Qualified fitness instructors delivered the standardized physical exercise program for the EG whilst the CG did not receive this exercise intervention. The Berg Balance Scale and the Oswestry Disability Index were administered in both groups before (T0) and after the intervention (T1).

RESULTS

At T1, the EG group significantly improvement in balance (p < 0.0001) and pain perception (p < 0.0001). No significant differences were found within the CG both in BBS and ODI, respectively.

CONCLUSIONS

Our findings suggest that a 13-weeks standardized exercise equipment-free program is effective in improving balance and perception of pain in the elderly. This type of intervention can consequently provide a low cost strategy to counteract the rate of disability in elderly.

Obesity-specific neural cost of maintaining gait performance under complex conditions in community-dwelling older adults

BACKGROUND

Recent evidence of obesity-related changes in the prefrontal cortex during cognitive and seated motor activities has surfaced; however, the impact of obesity on neural activity during ambulation remains unclear. The purpose of this study was to determine obesity-specific neural cost of simple and complex ambulation in older adults.

METHODS

Twenty non-obese and obese individuals, 65years and older, performed three tasks varying in the types of complexity of ambulation (simple walking, walking+cognitive dual-task, and precision walking). Maximum oxygenated hemoglobin, a measure of neural activity, was measured bilaterally using a portable functional near infrared spectroscopy system, and gait speed and performance on the complex tasks were also obtained.

FINDINGS

Complex ambulatory tasks were associated with ~2-3.5 times greater cerebral oxygenation levels and ~30-40% slower gait speeds when compared to the simple walking task. Additionally, obesity was associated with three times greater oxygenation levels, particularly during the precision gait task, despite obese adults demonstrating similar gait speeds and performances on the complex gait tasks as non-obese adults.

INTERPRETATION

Compared to existing studies that focus solely on biomechanical outcomes, the present study is one of the first to examine obesity-related differences in neural activity during ambulation in older adults. In order to maintain gait performance, obesity was associated with higher neural costs, and this was augmented during ambulatory tasks requiring greater precision control. These preliminary findings have clinical implications in identifying individuals who are at greater risk of mobility limitations, particularly when performing complex ambulatory tasks.

Falls resulting from a laboratory-induced slip occur at a higher rate among individuals who are obese

Falls due to slipping are a serious concern, with slipping estimated to cause 40-50% of all fall-related injuries. Epidemiological data indicates that older and obese adults experience more falls than young, non-obese individuals. An increasingly heavier and older U.S. population and workforce may be exacerbating the problem of slip-induced falls. The purpose of this study was to investigate the effects of obesity and age on slip severity and rate of falling resulting from laboratory-induced slips. Four groups of participants (young obese, young non-obese, older obese, older non-obese) were slipped while walking at a self-selected, slightly hurried pace. Slip severity (slip distance, slip duration, mean slip speed and peak slip speed) and slip outcome (fall or recovery) were compared between groups. Obese individuals experienced 22% faster slips than non-obese individuals in terms of mean slip speed (p=0.022). Obesity did not affect slip distance, slip duration or peak slip speed. Obese individuals also exhibited a higher rate of falls; 32% of obese individuals fell compared to 10% of non-obese (p=0.005). Obese individuals were more than eight times more likely to experience a fall than non-obese individuals when adjusting for age, gender and gait speed. No age effects were found for slip severity or slip outcome. These results, along with epidemiological data reporting higher fall rates among the obese, indicate that obesity may be a significant risk factor for experiencing slip-induced falls. Slip severity thresholds were also reported that may have value in developing controls for fall prevention.

The Relationship between Diet Quality and Falls Risk, Physical Function and Body Composition in Older Adults

OBJECTIVES

We aimed to examine associations between diet quality, falls risk, physical function, physical activity and body composition.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

Data collected from 171 men and women, aged 60-88 years old, as part of the Falls Risk and Osteoporosis Longitudinal Study.

MEASUREMENTS

Dietary Intake (Dietary Questionnaire for Epidemiological Studies Version 2 (DQES v2)), Falls Risk (FES-I, ABC, Berg Balance and Physiological Profile Assessment), Physical Function (SPPB), Physical Activity (PASE) and Body Composition (fat mass, lean mass, BMD, BMI, android/gynoid ratio) were ascertained. Diet quality was determined using two measures (Healthy Eating Index - HEI and Healthy Diet Indicator - HDI). One-way Analysis of Variance was used to compare mean scores between females and males and Pearson product-moment correlation coefficients were calculated to examine bivariate relationships.

RESULTS

Although females and males were analysed separately, the HDI-total score showed more associations that the HEI in both genders. The HDI showed, in females weak negative associations with BMI (r =-.21, p=.04), gynoid fat (r = -.20, p=.01), total fat mass (r = -.20, p=.02), with a weak positive association between HDI and percentage lean mass (r =.20, p=.03). Males showed positive associations between HDI and age (r =.30 p=.02) physical function (SPPB)(r =.26, p=.04), and subjective falls-risk (ABC) (r =.26, p=.03). In addition, in males, a negative association was found between HDI and FES-I (r = -.25, p=.04). The only measure that was significantly associated with the HEI-total score was the android/gynoid ratio in males (r = -.29, p=.04). When controlling for age, females demonstrated weak positive associations between gynoid (r = .19 p = .02), android (r = .19, p = .02) and total fat mass (r = .20 p = .02) as well as weak negative correlation with lean mass (r = 1.19, p = .03). Age also impacts on the FES-I (r = .29 p <.01) and ABC (r = -.23 p <.01).

CONCLUSIONS

The relationships between dietary quality and body composition, falls risk and physical function in older community dwelling, higher functioning adults appear to be gender specific. Better diet quality in females, is associated with lower BMI and fat mass, and higher lean mass, compared to males that are older and appear to have better physical function, are less likely to self-report falls risk, and have a better fat distribution i.e. a lower android/gynoid ratio have better diet quality. Furthermore, age is an important confounder and should be taken into consideration when assessing diet quality in older adults. In addition these gender and age differences may be clinically relevant and could aid in the delivery of targeted interventions.

The neuropeptide Y-ergic system: potential therapeutic target against bone loss with obesity treatments

Obesity is no longer considered to provide protection against osteoporosis. Moreover, treatments for obesity are now suspected of reducing bone mass. With the escalating incidence of obesity, combined with increases in the frequency, duration and intensity of interventions used to combat it, we face a potential increase in health burden due to osteoporotic fractures. The neuropeptide Y-ergic system offers a potential target for the prevention and anabolic treatment of bone loss in obesity, due to its dual role in the regulation of energy homeostasis and bone mass. Although the strongest stimulation of bone mass by this system appears to occur via indirect hypothalamic pathways involving Y2 receptors (one of the five types of receptors for neuropeptide Y), Y1 receptors on osteoblasts (bone-forming cells) induce direct effects to enhance bone mass. This latter pathway may offer a suitable target for anti-osteoporotic treatment while also minimizing the risk of adverse side effects.