Components of Metabolic Syndrome and the Risk of Disability among the Elderly Population

Nutrition for the older adult - Current concepts. Report from an ESPEN symposium

BACKGROUND & AIMS

In view of the global demographic shift, a scientific symposium was organised by the European Society for Clinical Nutrition and Metabolism (ESPEN) to address nutrition-related challenges of the older population and provide an overview of the current state of knowledge.

METHODS

Eighteen nutrition-related issues of the ageing global society were presented by international experts during the symposium and summarised in this report.

RESULTS

Anorexia of ageing, dysphagia, malnutrition, frailty, sarcopenia, sarcopenic obesity, and the metabolic syndrome were highlighted as major nutrition-related geriatric syndromes. Great progress has been made in recent years through standardised definitions of some but not all syndromes. Regarding malnutrition, the GLIM approach has shown to be suitable also in older adults, justifying its continuous implementation. For anorexia of ageing, a consensus definition is still required. Intervention approaches should be integrated and person-centered with the aim of optimizing intrinsic capacity and maintaining functional capacity. Landmark studies like EFFORT and FINGER have impressively documented the potential of individualised and multifactorial interventions for functional and health benefits. Combining nutritional intervention with physical training seems particularly important whereas restrictive diets and drug treatment should generally be used with caution because of undesirable risks. Obesity management in older adults should take into account the risk of promoting sarcopenia.

CONCLUSIONS

In the future, even more individualised approaches like precision nutrition may enable better nutritional care. Meanwhile all stakeholders should focus on a better implementation of currently available strategies and work closely together to improve nutritional care for older adults.

The changing relationship between bodyweight and longevity in high- and low-income countries

Standard measures of bodyweight (overweight and obese, for example) fail to reflect differences across populations and technological progress over time. This paper builds on the pioneering work of Hans Waaler (1984) and Robert Fogel (1994) to empirically estimate how the relationship between body mass index (BMI) and longevity varies across high-, middle-, and low-income countries. Importantly, we show that these differences are so profound that the share of national populations above mortality-minimizing bodyweight is not clearly greater in countries with higher overweight and obesity rates (as traditionally defined)-and in fact, relative to current standards, a larger share of low-income countries' populations can be unhealthily heavy.

Sex- and Age-Specific Associations Between Metabolic Syndrome and Future Functional Disability in the Japanese Older Population

Whether the association between metabolic syndrome (MetS) and functional disability differs depending on sex or age remains unknown. To determine the association between MetS and functional disability in older people separately by sex and age groups. A total of 11 083 participants (4407 men and 6676 women) aged 65 years or over without functional disability were enrolled. MetS was defined according to the revised NCEP ATP III guidelines. Functional disability was defined by a new certification in the long-term care insurance in Japan. Cox proportional hazards models were used to assess the risk of functional disability with adjustment for possible confounding factors. Over the mean observation period of 10.5 years, 1282 men and 2162 women experienced functional disability. For those aged 65 to 74 years, HRs (95% CIs) for functional disability in the MetS group were 1.33 (1.07-1.66) in men and 1.15 (1.000-1.32) in women. For those aged 75 years or older, there was no significant association in men or women. In subjects with a severe care need level, there was a marginal significant association in men aged 65 to 74 years. Among the MetS components that independently increased the risk of functional disability were glucose intolerance and elevated blood pressure (men and women aged 65-74 years), obesity (women aged 65-74 years), and glucose intolerance (women aged 75 years or older). MetS contributed to an increase in a high risk of future functional disability among individuals aged 65 to 74 years. In this age group, improvement of lifestyle, health promotion and interventions for MetS from middle age may prevent future functional disability.

Social isolation and risk of disability in older adults: Effect modification of metabolic syndrome

PURPOSE

Delaying the onset of disabilities is a social challenge, especially in an aging society. Social isolation (SI) and metabolic syndrome (MetS) can coexist and pose the risks of disability onset. However, their interaction is not proven in older adults. Therefore, this study investigated whether SI combined with MetS exacerbates disability onset in older adults.

MATERIALS AND METHODS

A total of 3,738 community-dwelling older adults underwent a health check-up. After baseline assessments, we followed them up to assess disability incidence for five years. SI was defined as a condition in which two or more of the following measures were met: domestic isolation, less social contact, and social disengagement. MetS was defined according to the criteria of the International Diabetes Federation. We used Cox proportional hazard regression used to identify the interaction effect of SI and MetS on the risk of disability onset after adjusting for potential confounding factors.

RESULTS

Multivariate Cox proportional hazard regression showed a significant interaction effect of SI and MetS on disability onset. In the subgroup analysis stratified by MetS status, SI was identified as a risk factor for disability onset only in the MetS group, but not in the non-MetS group.

CONCLUSIONS

This five-year longitudinal study showed that the co-occurrence of SI and MetS increased the risk of disability onset in older adults. This indicates that the assessment of MetS in socially isolated older adults is important for healthcare providers to delay the onset of disabilities.

Osteoarthritis knee and modifiable cardiovascular risk factors: play in tandem

Objective

To know the frequency of modifiable cardiovascular risk factors in knee osteoarthritis patients.

Method

Cross sectional study was done at Department of Rheumatology Indus Medical College, Tando Mohammad Khan from March 25, 2022 to November 24, 2022. Total 246 Osteoarthritis of knee cases with (Kellgren-Lawrence grad-II and above) on x-ray, were selected after demographic details, blood pressure, body mass index and physical examination was done, 5ml of venous blood was drawn by phlebotomist, sent for fasting blood sugar, serum lipids analysis and Framingham 10years risk score was calculated afterward for each participant.

Results

In this study males (126) and females (120). Overall (78%) had risk factors, Patients having one CVD risk factor were (22.8%), two risk factors in (21.1%), three in (21.5%), four (9.8%) and five factors in (1.6%) while frequency of modifiable cardiovascular risk shows obesity (45.5%) hypertension (40.2%) intermediate to high risk of framingham score (40%) diabetes mellitus (25%), smoking (17%), high low density lipoproteins (8.1%). In males obesity(54.2%), hypertension (47.5% ) and (45.8%) were on medication, diabetes mellitus(31.7%), smoker(31%), high risk FRS(39.2%), K-L grade-IV(58.4%) and in females: obesity (42%), hypertension (43.7%) and (40.5%) were on medication, diabetes mellitus in (19%), smoking (4%), high risk FRS (13.5%), K-L Grade-4 (42%), significant association of diabetes mellitus, smoking, FRS and K-L grades with gender (p<0.05).

Conclusion

In OA knee there is high prevalence of modifiable cardiovascular risk factors and together these imposes a major health risk for future cardiac events and disability.

Multimorbidity combinations and their association with functional disabilities among Indian older adults: evidence from Longitudinal Ageing Study in India (LASI)

OBJECTIVE

This study aims to identify the unique multimorbidity combinations (MMCs) and their associations with the functional disability of Indian older adults. Moreover, the population attributable fractions (PAFs) were calculated to assess the potential impact of additional diseases in the nested groups on disability.

DESIGN

A cross-sectional data were analysed in this study.

SETTING AND PARTICIPANTS

The present study uses data from the first wave of the Longitudinal Ageing Study in India (2017-2018). The sample for the study consists of 27 753 aged 60 years and over.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome variable was functional disability, measured by the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index.

RESULTS

Out of 197 uniquely identified MMCs, the combination of hypertension and high depressive symptoms (HDS) was the most prevalent (10.3%). Overall, all MMCs were associated with increased functional limitation. Specifically, the combination of hypertension, arthritis and HDS was associated with greater ADL-IADL disability than any other MMC. The addition of HDS in group 3 (hypertension and arthritis) (incidence rate ratios (IRR)=1.44; 95% CI 1.26 to 1.64) and the addition of arthritis in group 1 (hypertension, HDS) (IRR=1.48; 95% CI 1.28 to 1.71) and group 2 (hypertension, diabetes) (IRR=1.49; 95% CI 1.22 to 1.82) significantly increases the rates of ADL-IADL disability. The estimated PAFs of the group 1 (hypertension and HDS), group 3 (hypertension and arthritis) and group 4 (arthritis and HDS) for ADL-IADL disability were 22.5% (19.2-25.5), 21.6% (18.7-24.4) and 23.5% (20.6-26.3), respectively.

CONCLUSION

The findings from this study underscore the importance of addressing the morbidity combinations which are more disabling than the others in older adults. Understanding the somatic and psychological relevance of the morbidities in functional health is necessary and can help reduce disabilities among older adults.

The association between metabolic syndrome and presence of frailty: a systematic review and meta-analysis

BACKGROUND

Frailty represents a progressive deterioration in multi-system of the body and could increase vulnerability to stressors. Recently, several studies found that metabolic syndrome was significantly associated with frailty and emphasized its role in assessing and preventing frailty. However, these conclusions are controversial. We conducted this systematic review and meta-analysis to evaluate the association between metabolic syndrome and frailty.

METHODS

Databases including Pubmed, Embase, Web of Science, CINAHL Complete, China National Knowledge Infrastructure (CNKI) and Wanfang Data Knowledge Service Platform were searched for studies on the association between metabolic syndrome and frailty, from inception to 17th June 2022. Two researchers independently screened the literature, extracted the data and evaluated the quality. Stata/SE 15.0 software was used to perform the statistical analysis.

RESULTS

Eleven studies were included in this review and eight studies were included in the meta-analysis, involving one prospective cohort studies and ten cross-sectional studies with 12,640 participants. The pooled results indicated that metabolic syndrome was significantly associated with frailty (OR = 1.82, 95% CI = 1.46-2.27) with a low heterogeneity (I² = 32.1%), and there were significant associations between MetS and weakness (OR = 1.35, 95% CI = 1.15-1.58, I² = 0.0%), slow gait speed (OR = 1.80, 95% CI = 1.51-2.14, I² = 93.4%), weight loss (OR = 1.77, 95% CI = 1.36-2.29, I² = 0.0%) and decreased physical activity (OR = 1.87, 95% CI = 1.49-2.35, I² = 39.7%).

CONCLUSIONS

The findings of this systematic review and meta-analysis suggested that metabolic syndrome could be significantly associated with the presence of frailly. Future studies need to further consider the effects of measurement tools, age and specific disease status in this association. Furthermore, the casual relationship between them is to be determined.

Examination of the Allostatic Load Construct and Its Longitudinal Association With Health Outcomes in the Boston Puerto Rican Health Study

OBJECTIVE

Despite evidence on allostatic load (AL) as a model explaining associations between stress and disease, there is no consensus on its operationalization. This study aimed to contrast various AL constructs and their longitudinal associations with disease and disability.

METHODS

Baseline and 5-year follow-up data from 738 adults participating in the Boston Puerto Rican Health Study were used. Five AL scores were created by summing the presence of 21 dysregulated multisystem physiological parameters using the following: a) z scores, b) population-based quartile cutoffs, c) clinical-based cutoffs, d) 10 preselected clinical-based cutoffs (AL-reduced), and e) 12 clinical-based cutoffs selected a posteriori based on association with disease (AL-select). Adjusted logistic regression models examined associations between each AL score at baseline and 5-year incident type 2 diabetes (T2D), cardiovascular disease (CVD), activities (or instrumental activities) of daily living (ADL; IADL) for physical impairment, and cognitive impairment.

RESULTS

AL-quartile was associated with greater odds of T2D (odds ratio [OR] = 1.20; 95% confidence interval [CI] = 1.07-1.35) and CVD (OR = 1.14; 95% CI = 1.06-1.22). AL-reduced was associated with higher odds of IADL (OR = 1.21; 95% CI = 1.07-1.37) and AL-clinical with CVD (OR = 1.14; 95% CI = 1.07-1.21), IADL (OR = 1.11; 95% CI = 1.04-1.19), and ADL (OR = 1.15; 95% CI = 1.04-1.26). AL-select showed associations with T2D (OR = 1.35; 95% CI = 1.14-1.61), CVD (OR = 1.21; 95% CI = 1.11-1.32), IADL (OR = 1.15; 95% CI = 1.04-1.26), and ADL (OR = 1.24; 95% CI = 1.08-1.41). No associations were found with AL z-score.

CONCLUSIONS

AL scores computed with clinical-based cutoffs performed robustly in our sample of mainland Puerto Ricans, whereas z scores did not predict disease and disability. AL-select was the most consistent predictor, supporting its use as a disease-predicting model. Future assessment of AL-select in other populations may help operationalize AL.

The association between metabolic syndrome and successful aging- using an extended definition of successful aging

Objectives

To examine the association between metabolic syndrome (MetS) and successful aging among community-dwelling older adults.

Methods

Adults aged ≥ 65 years who participated in the senior health checkup program at National Taiwan University Hospital during 2011–2013 were recruited (N = 467 at baseline). The participants were followed after 4 years and 6 years. MetS was assessed at baseline. Successful aging was evaluated at baseline, 4-year follow-up, and 6-year follow-up. We adopted an extended definition of successful aging, which was defined as three major domains: physiological, psychological, and sociological and economic domains. Generalized linear mixed models were used to assess the association between MetS and successful aging adjusting for time (follow-up years), age, sex, years of education, alcohol consumption and MetS×time interaction term.

Results

The mean age of the study population was 72.9 (SD 5.5) years. The absence of baseline MetS had a positive effect on the probability of successful aging over six years. The absences of abdominal obesity, hyperglycemia, reduced high-density lipoprotein cholesterol, and hypertension were associated with the physiological successful aging. The absence of hypertension was the most significant predictor of physiological successful aging [aOR (95% CI) = 2.76 (1.67–4.58), p<0.001]. Significant increased trend was found in the overall and physiological successful aging across MetS status (No MetS, pre MetS, MetS; P_trend <0.001).

Conclusions

We found that MetS is a risk factor of successful aging among community-dwelling older adults. Public health policy should aim at avoidance of MetS in order to facilitate successful aging in older population.

Factors associated with mobility decrease leading to disability: a cross-sectional nationwide study in Japan, with results from 8681 adults aged 20-89 years

Background

Mobility decrease leading to disability can gradually develop during early life, however, its related factors are not well clarified. Therefore, we investigate the related factors of mobility decrease at various levels, using nationwide data in Japan.

Methods

In total, 8681 independent community dwellers aged 20-89 years were analysed (average age, 51.6 years; 58.5% women). Three stages of mobility decrease were based on the locomotive syndrome risk test: Stage 1, emerging; Stage 2, progressing; Stage 3, progressed to restrict social engagement. Age was analysed using a simple quadratic function model.

Results

The prevalence of Stages 1-3 was 31.6% (n = 2746), 5.8% (n = 504), and 3.2% (n = 278), respectively. On the multivariable logistic regression, increased age in participants aged ≥40 years (stage 1: odds ratio[OR] 1.05-1.20, stage 2: OR 1.04-1.22, stage 3: OR 1.05-1.22), female (stage 1: OR 2.28, 95% confidence interval [CI] 1.99-2.61, stage 2: OR 2.40, 95% CI 1.77-3.25, stage 3: OR 1.80, 95% CI 1.19-2.72), overweight status (stage 1: OR 1.56, 95% CI 1.34-1.82, stage 2: OR 3.19, 95% CI 2.38-4.27, stage 3: OR 2.87, 95% CI 1.90-4.32), hypertension (stage 1: OR 1.20, 95% CI 1.01-1.41, stage 2: OR 1.99, 95% CI 1.49-2.64, stage 3: OR 2.10, 95% CI 1.44-3.05), and diabetes mellitus (stage 1: OR 1.62, 95% CI 1.17-2.24, stage 2: OR 1.57, 95% CI 0.93-2.66, stage 3: OR 2.10, 95% CI 1.13-3.90) were positively associated. The frequency of physical activity/sports, even a few per month, was inversely associated with all stages (stage 1: OR 0.59-0.72, stage 2: OR 0.50-0.67, stage 3: 0.36-0.53). A one-year increase in age had a stronger impact on mobility decrease in older adults than in younger ones. Increased age in participants aged < 40 years and smoking were associated with Stage 1, while intake of various foods was inversely associated with Stages 1 and 2.

Conclusion

Increased age (< 40 years) was associated with emerging mobility decrease, while that (≥ 40 years) was associated with any levels of mobility decrease. Female, lifestyle habits, including physical activities and overweight status, were associated with mobility decrease at every level.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02600-4.

Frailty and Quality of Life in Older Adults with Metabolic Syndrome - Findings from the Healthy Older People Everyday (HOPE) Study

OBJECTIVES

Metabolic syndrome (MetS) and frailty are both associated with increased morbidity and mortality. Frailty is associated with reduced quality of life (QoL) but association of QoL with MetS have produced mixed results suggesting that other factors such as disease burden, obesity and depression may have a more significant influence. We aim to investigate the demographics of frail participants with MetS, and relationship between frailty and QoL in MetS.

METHODS

Cross-sectional population study involving 292 older adults ≥ 65 years with MetS. MetS was defined using the Modified ATP III for Asians which requires the presence of 3 or more of the following 5 components 1) waist circumference ≥ 90cm for males or ≥ 80cm for females, 2) TG ≥ 150mg/dL, 3) HDLc < 40mg/dL in males or < 50mg/dL in females, 4) blood pressure ≥ 130/85mmHg or use of anti-hypertensive medication, and 5) fasting plasma glucose ≥ 100mg/dL or use of pharmacological treatment for diabetes mellitus. Data were collected on demographics, frailty (FRAIL), QoL (Euroqol-5D), perceived health, functional status, cognition, Timed-Up-and-Go (TUG), and hand-grip strength (HGS).

RESULTS

40.4% of the participants were pre-frail (MetSprefrail) and 7.2% were frail (MetSfrail). MetSfrail were significantly older, had lower education level, higher polypharmacy burden and higher prevalence of diabetes. The prevalence of at least 1 activity of daily living impairment was 4 times higher, and depression 9 times higher than their robust counterparts. MetSfrail also had longer TUG, higher prevalence of poor grip strength and poor perceived health. After adjusting for age, gender and education, MetSfrail was significantly associated with much higher odds of EQ-5D moderate to extreme problems with mobility (Odds Ratio (OR) =10.99, CI 2.62-46.14), usual activities (OR=37.82, CI 3.77-379.04) and pain (OR=10.79, CI 3.18-36.62). EQ-5D Index Value and Perceived Health improved by 0.1 (Mean Difference (MD) =0.07, CI 0.04-0.10) and 6.0 (MD=6.01, CI 3.29-8.73) respectively as frailty status improved.

CONCLUSION

Frailty in MetS is associated with depression, polypharmacy, greater functional impairment, poorer QoL and perceived health. Frailty screening and personalized management is crucial in MetS as frailty may be a mediator for negative outcomes in MetS, and frailty may be reversible.

Efficacy of statin treatment based on cardiovascular outcomes in elderly patients: a standard meta-analysis and Bayesian network analysis

Objective

Statins have been shown to be beneficial for the prevention of cardiovascular events. In elderly individuals, the efficacy of statins remains controversial and the comparative effect of statins has not been assessed.

Methods

MEDLINE, Embase, and the Cochrane Central database were searched for randomized controlled trials that assessed statins in older patients.

Results

Seventeen trials were analyzed. When used for secondary prevention, statins were associated with reduced risk of cardiovascular events, all-cause mortality, cardiovascular mortality, revascularization, and stroke. When used for primary prevention, statins reduced the risk of myocardial infarction and revascularization, but did not significantly affect other outcomes. A modest difference between pharmaceutical statin products was found, and high-quality evidence indicated that intensive atorvastatin had the greatest benefits for secondary prevention.

Conclusions

In secondary prevention, evidence strongly suggests that statins are associated with a reduction in the risk of all-cause mortality, cardiovascular events, cardiovascular mortality, and revascularization. However, differences in the effects of various statins do not appear to have significant effects on therapy in secondary prevention for the elderly.

The relationship between lead and cadmium levels and functional dependence among elderly participants

The adverse impacts of lead and cadmium exposure on health outcomes have been reported in the past. Few studies have been conducted on the relationship between lead and cadmium exposures and disability. We evaluated whether lead and cadmium exposures were associated with functional dependence including the total number of disabilities, activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA) in an elderly population. A total of 5513 eligible subjects were enrolled in the study from the National Health and Nutrition Examination Survey 2001-2006. Serum lead and cadmium exposure assessments were performed using atomic absorption spectrometry. Functional dependence was assessed by 19 structured questions. The relationships between lead and cadmium exposures and functional dependence were investigated using by multivariable linear regression models. Q2, Q3, and Q4 of lead exposure were significantly associated with the total number of disabilities, with β coefficients of - 0.62 (95% CI - 0.99, - 0.24), - 0.64 (95% CI - 1.02, - 0.26), and - 0.81 (95% CI - 1.19, - 0.42), respectively. This relationship remained significant in males. Furthermore, we analyzed the relationships between lead and cadmium exposure quartiles and various functional dependence metrics, and we determined that lead content was significantly associated with decreased ADL, LEM, and GPA (p < 0.05) and cadmium content was inversely associated with ADL (p < 0.05). Our study demonstrated a strong relationship between exposure to lead and cadmium and functional dependence in an elderly population.

Variations in the pattern and distribution of non-obese components of metabolic syndrome across different obesity phenotypes among Iranian adults' population

AIMS

To investigate the association of obesity phenotypes with non-obese components of metabolic syndrome (MetS) by considering the presence of general adiposity and central obesity.

METHODS

We analyzed the data of population-based cross-sectional study of 981 adults' individuals who were community dwelling in urban population of Babol, the north of Iran. The demographic characteristics and anthropometric measures and hypertension were collected with standard method by trained nurses. The fasting blood sugar, CHL, TG, HDL-C and LDL-C were measured by enzymatic method. The presence of cardiometabolic risk factors were analyzed according to the combination of obesity phenotypes either overweight/obese or central obese. The logistic regression model was used to calculate the adjusted odds ratio (OR) of obesity phenotypes in compared with normal weight not central obese in association of presence of metabolic abnormality.

RESULTS

The 394 (40.6%) individuals were both overweight/obese and central obese and 295 (30.1%) persons were "normal weight not central obese" and the minority 28(2.9%) were normal weight but central obese and the remainder 260 (26.5%) were "overweight/obese not central obese". Overweight/obese not central obese increased significantly the odds of presence of ≥2 non-obese components of metabolic abnormality by 2.17 times (95%CI OR: 1.51, 3.13) but the OR was elevated for the joint phenotypes of overweight/obese and central obese (OR = 4.16 (95%CI: 2.85, 6.06) as compare with normal weight not central obese.

CONCLUSIONS

Overweight/obese alone increased the risk of cardiometabolic abnormality but being overweight/obese and central obese a further elevated the risk compared with "normal weight not central obese".

Exposure to polycyclic aromatic hydrocarbons and risk of disability among an elderly population

Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants. Exposure to PAHs is associated with several adverse health outcomes. However, no previous study has examined the relationship between PAH exposure and functional dependence in an elderly population. Our aim was to examine whether PAH exposure was associated with functional dependence including total disability, activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA) in an elderly population. A total of 5816 elderly adults from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2006 were examined. PAH exposure was measured by urinary biomarkers. Functional dependence was assessed by 19 structured questions. The association between PAH exposures with functional dependence was performed by using a multivariable linear regression model. After adjusting for pertinent variables, positive associations were observed between the total number of disabilities and 2-naphthalene and 1-pyrene quartiles (all P_trend < 0.05). There was a dose-dependent relationship between 1-pyrene quartiles and all functional dependence domains, and the higher quartile of 1-pyrene was more closely associated with functional impairment (all P_trend < 0.05). PAH exposure is associated with functional dependence in American elderly adults. Future research is needed to bring to light the pathophysiological underlying mechanisms related to these findings.

Association between HOMA-IR and Frailty among U.S. Middle-aged and Elderly Population

Previous literatures revealed that homeostasis model assessment-estimated insulin resistance (HOMA-IR) was one of the cardio-metabolic risk factors. This study was conducted to access the association between HOMA-IR and frailty in the United States of America (U.S.) middle-aged and elderly high-risk insulin-resistant population. In the National Health and Nutrition Examination Survey (NHANES III) from 1988 to 1994, the study included 3,893 participants. In order to exam the association between HOMA-IR and frailty in the middle-aged and elderly population through the regression model adjusted for multiple covariates, we divided the participants into middle aged group (Age <65 years) and elderly group (Age > = 65 years) in this study. Each group was then divided into tertiles depending on their HOMA-IR levels. Higher level of HOMA-IR was significantly associated with frailty in the elderly group, but this association was not seen in the middle-aged population. These results demonstrated that the HOMA-IR level can be a novel risk assessment of frailty in elderly high-risk insulin-resistant individuals (Age > = 65 years).

Exploring the link between metabolic syndrome and risk of dysmobility syndrome in elderly population

Dysmobility syndrome (DMS) was considered as a comprehensive approach to evaluate the condition of musculoskeletal system and adverse health problems in older population. The objective of our study was to examine the association between metabolic syndrome (MetS) and DMS in a U.S. adult population. 1760 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 1999-2002 were enrolled in the study. The criteria of DMS consisted of six domains including increased body fat, declined muscle mass, reduced muscle strength, osteoporosis, slow gait speed, and balance problem. A multivariate regression analysis was investigated to clarify the relationship among MetS and its components and DMS. A positive association between increased number of MetS components and the presence of DMS achieved significance (β = 0.142, 95%CI = 0.035, 0.249, p = 0.009). Among the components of MetS, hyperglycemia had a central place in the DMS after adjustment of clinical variables (β = 0.083, 95%CI = 0.030, 0.136, p = 0.002). Notably, insulin resistance assessed by homeostatic model assessment (HOMA-IR) was correlated to increased body fat (r = 0.092, p<0.05), osteoporosis (r = -0.105, p<0.05) and balance (r = 0.105, p<0.05) among these participants with MetS. Our study demonstrated a strong relationship between DMS and the presence of MetS and its components in elderly population, highlighting a possible mechanism through insulin resistance.

The impact of occupational psychological hazards and metabolic syndrome on the 8-year risk of cardiovascular diseases-A longitudinal study

There was little information concerning the combined effect of occupational psychosocial hazards such as long working hours, high job stress, and high fatigue on the risk of cardiovascular and cerebrovascular diseases (CVD). The aim of this study was to investigate the interaction among occupational psychosocial hazards and the impact of metabolic syndrome (MetS) on the risk of CVD among bus drivers. The Taiwan Bus Driver Cohort Study involving 1014 professional drivers was established in 2005 and comprehensively studied. The interactions among occupational psychosocial hazards and the impact of MetS on the risk of CVD were measured. A working pattern questionnaire, job stress questionnaires, the Swedish occupational fatigue inventory, the stress satisfaction offset score, biochemical measurements, and physical examinations were used to assess psychosocial hazards and the presence of metabolic syndrome. There were 707 eligible bus drivers with a mean age of 43.5years old. During the 8-years of follow-up, 77 drivers were diagnosed with CVD. Long working hours, high job stress, and high fatigue were associated with an increased risk of cardiovascular disease incidence in the multivariate analysis. There were synergistic effects among long working hours, high job stress, and high fatigue only in drivers with MetS. A combination of long working hours, high job stress, and high fatigue increased the risk of developing CVD in bus drivers with MetS.

Metabolic syndrome and disability in Chinese nonagenarians and centenarians

BACKGROUND

Little is known about the relationship between metabolic syndrome (MetS) and disability in the oldest old.

AIMS

To investigate the possible association between MetS and disability among community-dwelling older adults aged ≥ 90 years.

METHODS

This was a secondary analysis of a cross-sectional study. MetS was defined by the International Diabetes Federation Criteria. Activities of daily living (ADL) and instrumental activities of daily living (IADL) disabilities were evaluated using the physical self-maintenance scale and the Lawton-Brody IADL scale, respectively.

RESULTS

We included 725 participants (mean age: 93.8 ± 3.1 years). The prevalence of MetS was 13.0% in women and 9.8% in men, respectively. In women, ADL and IADL disabilities were more prevalent in the MetS group compared with the non-MetS group (ADL: 43.1 vs. 30.6%, p = 0.044; IADL: 73.8 vs. 59.8%, p = 0.030). After adjusting for relevant confounders, participants with MetS was associated with an increased risk of either ADL (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.22-3.45) or IADL disability (OR 2.12, 95% CI 1.31-4.78) compared with those without MetS. In men, similar results were found with respect to the prevalence of ADL or IADL disability and the adjusted ORs, but the results were not statistically significant.

CONCLUSION

MetS is associated with an increased risk of either ADL or IADL disability in a study population of long-lived adults, especially in women.

Coffee consumption and risk of physical function impairment, frailty and disability in older adults

PURPOSE

Habitual coffee consumption has been associated with lower risk of type 2 diabetes and cardiovascular disease. Since these diseases are main determinants of functional limitations, we have tested the hypothesis that coffee intake is associated with lower risk of physical function impairment, frailty and disability in older adults. We focused on women and those with obesity, hypertension or type 2 diabetes because they are at higher risk of functional limitations.

METHODS

Prospective study with 3289 individuals ≥ 60 years from the Seniors-ENRICA cohort. In 2008-2010 coffee consumption was measured through a validated dietary history. Participants were followed up until 2015 to ascertain incident impaired physical function, frailty and disability, assessed by both self-report and objective measures.

RESULTS

Compared with non-drinking coffee, consumption of ≥ 2 cups of coffee/day was associated with lower risk of impaired agility in women (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.51-0.97, P trend 0.04) and in those with obesity (HR 0.60; 95% CI 0.40-0.90, P trend 0.04). Intake of ≥ 2 cups of coffee/day was also linked to reduced risk of impaired mobility in women (HR 0.66; 95% CI 0.46-0.95, P trend 0.02) and among individuals with hypertension (HR 0.70, 95% CI 0.48-1.00, P trend 0.05). Moreover, among subjects with diabetes, those who consumed ≥ 2 cups/day had lower risk of disability in activities of daily living (HR 0.30, 95% CI 0.11-0.76, P trend 0.01).

CONCLUSIONS

In older people, habitual coffee consumption was not associated with increased risk of functional impairment, and it might even be beneficial in women and those with hypertension, obesity or diabetes.

Calf Circumference as a Novel Tool for Risk of Disability of the Elderly Population

Disability became increasingly common with age, and crude rates of disability were rising around the globe. The aim of this study was to investigate the association between calf circumference (CC) and disability in the U.S. elderly population. From the 1999-2006 National Health and Nutrition Examination Survey, a total of 4,245 participants with an age range of 60-84 years were included. Disability was defined as the total number of difficulties within the following 5 major domains of disability, such as activities of daily living (ADL), instrumental ADL, general physical activities, lower extremity mobility, and leisure and social activities. The association between CC and disability was investigated through the regression model adjusted for multiple covariates. According to the fully adjusted model regarding disability, the β coefficients for each quartile of increasing CC were -0.041 for quartile 2 (P = 0.096), -0.060 for quartile 3 (P = 0.027), and -0.073 for quartile 4 (P = 0.026) respectively, compared with lowest quartile. There was a negative association between CC and disability among the elderly population. Calf circumference may be a novel risk assessment for disability of elderly people.

Change in health-related quality of life and social cognitive outcomes in obese, older adults in a randomized controlled weight loss trial: Does physical activity behavior matter?

This article compared the effect of dietary weight loss administered alone (WL) or in combination with aerobic training (WL + AT) or resistance training (WL + RT) on health related quality of life, walking self-efficacy, stair climb self-efficacy, and satisfaction with physical function in older adults with cardiovascular disease or the metabolic syndrome. Participants (N = 249; M _age = 66.9) engaged in baseline assessments and were randomly assigned to one of three interventions, each including a 6-month intensive phase and a 12-month follow-up. Those in WL + AT and WL + RT engaged in 4 days of exercise training weekly. All participants engaged in weekly group behavioral weight loss sessions with a goal of 7-10% reduction in body weight. Participants in WL + AT and WL + RT reported better quality of life and satisfaction with physical function at 6- and 18-months relative to WL. At month 6, WL + AT reported greater walking self-efficacy relative to WL + RT and WL, and maintained higher scores compared to WL at month 18. WL + AT and WL + RT reported greater stair climbing efficacy at month 6, and WL + RT remained significantly greater than WL at month 18. The addition of either AT or RT to WL differentially improved HRQOL and key psychosocial outcomes associated with maintenance of physical activity and weight loss. This underscores the important role of exercise in WL for older adults, and suggests health care providers should give careful consideration to exercise mode when designing interventions.

Comorbidities and health-related quality of life in Koreans with knee osteoarthritis: Data from the Korean National Health and Nutrition Examination Survey (KNHANES)

Objectives

This study aimed to evaluate the association of knee osteoarthritis (OA) with comorbidities and health-related quality of life (HRQOL).

Methods

A total of 8,907 (weighted n = 13,687,058) participants aged ≥50 years who had undergone knee radiography were selected from the 2010–2012 Korea National Health and Nutrition Examination Survey. OA was classified into four subgroups based on the presence or absence of pain and radiographic OA (ROA): non-OA (Pain-/ROA-), pain only (Pain+/ROA-), ROA only (Pain-/ROA+), and painful ROA (Pain+/ROA+). ROA was defined as Kellgren–Lawrence grade ≥ 2. HRQOL measurements including EuroQOL visual analogue scale (EQ-VAS) scores and the five dimensions and summary index of the EuroQOL-5 dimension (EQ-5D index) were also analyzed. Multivariable logistic regression and linear regression analyses were performed.

Results

After adjustment for socioeconomic and lifestyle characteristics, cardiovascular disease, malignancy, and other comorbidities were not significantly associated with OA. Pain only and painful ROA were each significantly associated with limitations in physical activity (odds ratio (OR) 2.66, 95% CI 2.07–3.44, p < 0.001 and OR 2.83, 95% CI 2.25–3.58, p < 0.001, respectively), lower EQ-VAS (β-coefficient = -10.95, p < 0.001 and β-coefficient = -9.75, p < 0.001, respectively), and EQ-5D index (β-coefficient = -0.10, p < 0.001 and β-coefficient = -0.13, p < 0.001) compared with the non-OA group, whereas ROA only was not associated with limitations in physical activity or lower HRQOL score.

Conclusions

Comorbidities were not significantly associated with knee OA after adjustment. Knee OA was associated with physical activity and HRQOL. Painful knee OA, with or without ROA, was more strongly associated with decreased physical activity and lower quality of life than ROA without pain.

Community Weight Loss to Combat Obesity and Disability in At-Risk Older Adults

BACKGROUND

Among older, overweight, and obese adults with either cardiovascular disease or the metabolic syndrome, reduced mobility and loss of leg strength are important risk factors for morbidity, disability, and mortality. It is unclear whether community-based approaches to weight loss may be an effective solution to this public health challenge.

METHODS

An 18-month three-site, randomized controlled trial conducted by YMCA staff, with blinded assessors, enrolled 249 older, overweight, and obese adults with either cardiovascular disease or metabolic syndrome with randomization to three interventions: weight loss alone (WL), weight loss + aerobic training (WL + AT), and weight loss + resistance training (WT + RT). The dual primary outcomes were 400-m walk time in seconds and knee extensor strength in Newton meters.

RESULTS

All groups lost weight from baseline: average baseline adjusted change of -6.1% (95% confidence interval [CI]: -7.5 to -4.7) for WL only, -8.6% (95% CI: -10.0 to -7.2) for WL + AT, and -9.7% (95% CI: -11.1 to -8.4) for WL + RT. Combined, the two physical activity + WL training groups had greater improvement in walk time than WL alone (mean difference 16.9 seconds [95% CI: 9.7 to 24.0], p < .0001). Baseline adjusted change in knee extensor strength was no greater with WL + RT than WL + AT (mean difference -3.6 Nm [95% CI: -7.5 to 0.3], p = .07).

CONCLUSIONS

At risk, older, overweight and obese adults can achieve clinically significant reductions in body weight with community-based weight loss programs. The change in percent weight loss and improvements in mobility are significantly enhanced when either RT or AT is combined with dietary WL.