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Zhang X, Sanders JL, Boudreau RM, Arnold AM, Justice JN, Espeland MA, Kuchel GA, Barzilai N, Kuller LH, Lopez OL, Kritchevsky SB, Newman AB. Association of a Blood-Based Aging Biomarker Index With Death and Chronic Disease: Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2024; 79:glad172. [PMID: 37464278 PMCID: PMC10799760 DOI: 10.1093/gerona/glad172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND A goal of gerontology is to discover phenotypes that reflect biological aging distinct from disease pathogenesis. Biomarkers that are strongly associated with mortality could be used to define such a phenotype. However, the relation of such an index with multiple chronic conditions warrants further exploration. METHODS A biomarker index (BI) was constructed in the Cardiovascular Health Study (N = 3 197), with a mean age of 74 years. The BI incorporated circulating levels of new biomarkers, including insulin-like growth factor-1, interleukin-6, amino-terminal pro-B-type natriuretic peptide, cystatin-C, C-reactive protein, tumor necrosis factor-alpha soluble receptor 1, fasting insulin, and fasting glucose, and was built based on their relationships with mortality. Cox proportional hazards models predicting a composite of death and chronic disease involving cardiovascular disease, dementia, and cancer were calculated with 6 years of follow-up. RESULTS The hazard ratio (HR, 95% CI) for the composite outcome of death or chronic disease per category of BI was 1.65 (1.52, 1.80) and 1.75 (1.58, 1.94) in women and men, respectively. The HR (95% CI) per 5 years of age was 1.57 (1.48, 1.67) and 1.55 (1.44, 1.67) in women and men, respectively. Moreover, BI could attenuate the effect of age on the composite outcome by 16.7% and 22.0% in women and men, respectively. CONCLUSIONS Biomarker index was significantly and independently associated with a composite outcome of death and chronic disease, and attenuated the effect of age. The BI that is composed of plasma biomarkers may be a practical intermediate phenotype for interventions aiming to modify the course of aging.
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Affiliation(s)
- Xiao Zhang
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Jamie N Justice
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Mark A Espeland
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - George A Kuchel
- UConn Center on Aging, UConn Health, Farmington, Connecticut, USA
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Oscar L Lopez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Pollicino F, Dominguez LJ, Barbagallo M. Prolonged liver transplantation survival and aging successfully. Geriatr Care 2023; 9. [DOI: 10.4081/gc.2023.11066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
The traditional definition of successful aging as the absence of disease, disability, and cognitive impairment is not always applicable to patients with long survival despite complex multimorbidity. This case report details the situation of an 87-year-old man, currently partially self-sufficient and partially autonomous, without cognitive impairment, who has been affected with recurrent right knee osteomyelitis since the age of 6. A diagnosis of hepatitis C virus (HCV)-related liver cirrhosis at 41 led to liver transplantation at 56. The immunosuppressive anti-rejection therapy caused a relapse of chronic osteomyelitis and HCV infection, a major cause of graft loss and shortened survival in HCV liver transplant recipients. Other pathologies were also diagnosed during his lifetime. This patient is an example of aging successfully despite complex multimorbidity and disproves the traditional concept of successful aging formerly described in the literature.
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Abstract
Cardiovascular disease (CVD), specifically coronary atherosclerosis, is regulated by an interplay between genetic and lifestyle factors. Most recently, a factor getting much attention is the role epigenetics play in atherosclerosis; particularly the development of coronary artery disease. Furthermore, it is important to understand the intricate interaction between the environment and each individual genetic material and how this interaction affects gene expression and consequently influences the development of atherosclerosis. Our main goal is to discuss epigenetic regulations; particularly, the factors contributing to coronary atherosclerosis and their role in aging and longevity. We reviewed the current literature and provided a simplified yet structured and reasonable appraisal of this topic. This role has also been recently linked to longevity and aging. Epigenetic regulations (modifications) whether through histone modifications or DNA or RNA methylation have been shown to be regulated by environmental factors such as social stress, smoking, chemical contaminants, and diet. These sensitive interactions are further aggravated by racial health disparities that ultimately impact cardiovascular disease outcomes through epigenetic interactions. Certainly, limiting our exposure to such causative events at younger ages seems our "golden opportunity" to tackle the incidence of coronary atherosclerosis and probably the answer to longevity.
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Affiliation(s)
- Khalid Sawalha
- Cardiometabolic Diseases, Truman Medical Centers - University of Missouri Kansas City, Kansas City, USA
| | - Nicholas Norgard
- Pharmacology and Therapeutics, Truman Medical Centers - University of Missouri Kansas City, Kansas City, USA
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Guardino CE, Pan S, Vasan RS, Xanthakis V. Multi-system trajectories and the incidence of heart failure in the Framingham Offspring Study. PLoS One 2022; 17:e0268576. [PMID: 35617332 PMCID: PMC9135195 DOI: 10.1371/journal.pone.0268576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/02/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Heart failure is a multi-system disease, with non-cardiac systems playing a key role in disease pathogenesis. OBJECTIVE Investigate whether longitudinal multi-system trajectories incrementally predict heart failure risk compared to single-occasion traits. METHODS We evaluated 3,412 participants from the Framingham Heart Study Offspring cohort, free of heart failure, who attended examination cycle 5 and at least one examination between 1995-2008 (mean age 67 years, 54% women). We related trajectories for the following organ systems and metabolic functions to heart failure risk using Cox regression: kidney (estimated glomerular filtration rate), lung (forced vital capacity and the ratio of forced expiratory volume in one second/forced vital capacity), neuromotor (gait time), muscular (grip strength), cardiac (left ventricular mass index and heart rate), vascular function (pulse pressure), cholesterol (ratio of total/high-density lipoprotein), adiposity (body mass index), inflammation (C-reactive protein) and glucose homeostasis (hemoglobin A1c). Using traits selected via forward selection, we derived a trajectory risk score and related it to heart failure risk. RESULTS We observed 276 heart failure events during a median follow up of 10 years. Participants with the 'worst' multi-system trajectory profile had the highest heart failure risk. A one-unit increase in the trajectory risk score was associated with a 2.72-fold increase in heart failure risk (95% CI 2.21-3.34; p<0.001). The mean c-statistics for models including the trajectory risk score and single-occasion traits were 0.87 (95% CI 0.83-0.91) and 0.83 (95% CI 0.80-0.86), respectively. CONCLUSION Incorporating multi-system trajectories reflective of the aging process may add incremental information to heart failure risk assessment when compared to using single-occasion traits.
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Affiliation(s)
- Cara E. Guardino
- Division of Cardiology, Warren Alpert Medical School of Brown University and Lifespan Cardiovascular Institute, Providence, Rhode Island, United States of America
- Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Stephanie Pan
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Ramachandran S. Vasan
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Section of Cardiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Vanessa Xanthakis
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
- National Heart, Lung, and Blood Institute’s and Boston University’s Framingham Heart Study, Framingham, Massachusetts, United States of America
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
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Yudkovicz JJ, Minster RL, Barinas-Mitchell E, Christensen K, Feitosa M, Barker MS, Newman AB, Kuipers AL. Pleiotropic effects between cardiovascular disease risk factors and measures of cognitive and physical function in long-lived adults. Sci Rep 2021; 11:17980. [PMID: 34504188 PMCID: PMC8429644 DOI: 10.1038/s41598-021-97298-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Cardiovacular disease (CVD) is the leading cause of death among older adults and is often accompanied by functional decline. It is unclear what is driving this co-occurrence, but it may be behavioral, environmental and/or genetic. We used a family-based study to estimate the phenotypic and shared genetic correlation between CVD risk factors and physical and cognitive functional measures. Participants (n = 1,881) were from the Long Life Family Study, which enrolled families based on their exceptional longevity (sample mean age = 69.4 years, 44% female). Cardiovascular disease risk factors included carotid vessel measures [intima-media thickness and inter-adventitial diameter], obesity [body mass index (BMI) and waist circumference], and hypertension [systolic and diastolic blood pressures]. Function was measured in the physical [gait speed, grip strength, chair stand] and cognitive [digital symbol substitution test, retained and working memory, semantic fluency, and trail making tests] domains. We used SOLAR to estimate the genetic, environmental, and phenotypic correlation between each pair adjusting for age, age2, sex, field center, smoking, height, and weight. There were significant phenotypic correlations (range |0.05–0.22|) between CVD risk factors and physical and cognitive function (all P < 0.05). Most significant genetic correlations (range |0.21–0.62|) were between CVD risk factorsand cognitive function, although BMI and waist circumference had significant genetic correlation with gait speed and chair stand time (range |0.29–0.53|; all P < 0.05). These results suggest that CVD risk factors may share a common genetic-and thus, biologic-basis with both cognitive and physical function. This is particularly informative for research into the genetic determinants of chronic disease.
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Affiliation(s)
- Julia J Yudkovicz
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ryan L Minster
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kaare Christensen
- Department of Epidemiology, Biostatistics and Biodemography, Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark
| | - Mary Feitosa
- Division of Statistical Genomics, Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Megan S Barker
- Department of Neurology, Columbia University, New York, NY, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Allison L Kuipers
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
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Marron MM, Harris TB, Boudreau RM, Clish CB, Moore SC, Murphy RA, Murthy VL, Sanders JL, Shah RV, Tseng GC, Wendell SG, Zmuda JM, Newman AB. A Metabolite Composite Score Attenuated a Substantial Portion of the Higher Mortality Risk Associated With Frailty Among Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci 2021; 76:378-384. [PMID: 32361748 DOI: 10.1093/gerona/glaa112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Frailty is more prevalent among black versus white older Americans. We previously identified 37 metabolites associated with the vigor to frailty spectrum using the Scale of Aging Vigor in Epidemiology (SAVE) among older black men from the Health, Aging, and Body Composition (Health ABC) study. Here, we sought to develop a metabolite composite score based on the 37 SAVE-associated metabolites and determine whether the composite score predicts mortality and whether it attenuates the association between frailty and mortality among older black men. METHODS Plasma metabolites were measured using liquid chromatography-mass spectrometry. Most of the 37 metabolites were organic acids/derivatives or lipids. Metabolites were ranked into tertiles: tertiles associated with more vigorous SAVE scores were scored 0, mid-tertiles were scored 1, and tertiles associated with frailer SAVE scores were scored 2. Composite scores were the sum of metabolite tertile scores. We examined mortality associations using Cox regression. Percent attenuation estimated the extent to which metabolites attenuated the association between frailty and mortality. RESULTS One standard deviation frailer SAVE was associated with 30% higher mortality, adjusting for age and site (p = .0002); this association was attenuated by 56% after additionally adjusting for the metabolite composite score. In this model, one standard deviation higher metabolite composite score was associated with 46% higher mortality (p < .0001). Metabolite composite scores also predicted mortality (p = .045) in a validation sample of 120 older adults (40% men, 90% white). CONCLUSION These metabolites may provide a deeper characterization of the higher mortality that is associated with frailty among older adults.
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Affiliation(s)
- Megan M Marron
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Tamara B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, Maryland
| | | | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland
| | - Rachel A Murphy
- Centre of Excellence in Cancer Prevention, School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, University of Michigan at Ann Arbor, Michigan
| | - Jason L Sanders
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ravi V Shah
- Department of Medicine, Massachusetts General Hospital, Boston
| | - George C Tseng
- Department of Biostatistics, University of Pittsburgh, Pennsylvania.,Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Stacy G Wendell
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pennsylvania
| | - Joseph M Zmuda
- Department of Epidemiology, University of Pittsburgh, Pennsylvania.,Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania.,Department of Medicine, University of Pittsburgh, Pennsylvania
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7
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Kahraman T, Çekok FK, Üğüt BO, Keskinoğlu P, Genç A. One-Year Change in the Physical Functioning of Older People According to the International Classification of Functioning Domains. J Geriatr Phys Ther 2021; 44:E9-E17. [PMID: 30883529 DOI: 10.1519/jpt.0000000000000234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE It is important to determine physical functioning declines in older people according to the International Classification of Functioning, Disability and Health (ICF) framework, given its advantages. This study was performed to investigate 1-year changes in the physical functioning of older people using the ICF framework. METHODS Eighty older people were enrolled and completed baseline measures in this longitudinal, single-group study while 33 of these participants were reassessed at 1 year. Reliable and valid methods commonly used in geriatric rehabilitation settings for determining physical functioning were applied to evaluate ICF domains including Body Functions, Activities (capacity), and Activities and Participation (performance). Body Functions were assessed by measuring lower extremity muscle strength and exercise tolerance test performance. The Activities (capacity) measures included walking, balance, mobility, sit-to-stand, and upper extremity functional performance. The Activities and Participation (performance) domain included the Falls Efficacy Scale-International, Modified Barthel Index, and Rapid Assessment of Physical Activity scale. RESULTS There were significant decreases in muscle strength in both hip abductors and knee extensors (P < .001, d > 0.80) at 1 year versus baseline, but there were no significant changes in exercise tolerance test parameters (P > .05, d = 0.44-0.71), with the exception of diastolic blood pressure (P = .019, d = 0.90). Significant deterioration was observed in all Activities (capacity) measures (P < .05, d > 0.80). No significant changes were observed in the Falls Efficacy Scale-International (P = .051, d = 0.72), Modified Barthel Index (P = .107, d = 0.59), or Rapid Assessment of Physical Activity-Flexibility and Strength subscale (P = .763, d = 0.11). CONCLUSIONS Significant declines were seen in lower extremity muscle strength, walking capacity, speed, mobility, sit-to-stand performance, upper extremity function, and balance performance at 1 year. On the contrary, no significant changes were observed in the levels of participation in activities of daily living, activities related to balance, or physical activity. According to the ICF framework, during 1 year, our sample of older people showed declines in the Body Functions and Activities (capacity) domains, but the Activities and Participation (performance) domain remained stable.
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Affiliation(s)
- Turhan Kahraman
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
| | | | - Birön Onur Üğüt
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey
- Institute of Health Sciences, Dokuz Eylül University, Izmir, Turkey
| | - Pembe Keskinoğlu
- Department of Biostatistics and Medical Informatics, Dokuz Eylül University, Izmir, Turkey
| | - Arzu Genç
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, Izmir, Turkey
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8
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Marron MM, Wendell SG, Boudreau RM, Clish CB, Santanasto AJ, Tseng GC, Zmuda JM, Newman AB. Metabolites Associated with Walking Ability Among the Oldest Old from the CHS All Stars Study. J Gerontol A Biol Sci Med Sci 2020; 75:2371-2378. [PMID: 31970383 DOI: 10.1093/gerona/glaa030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Low walking ability is highly prevalent with advancing age and predicts major health outcomes. Metabolomics may help to better characterize differences in walking ability among older adults, providing insight into potentially altered molecular processes underlying age-related decline in functioning. We sought to identify metabolites and metabolic pathways associated with high versus low walking ability among 120 participants ages 79-95 from the CHS All Stars study. METHODS Using a nested case-control design, 60 randomly selected participants with low walking ability were matched one-to-one on age, gender, race, and fasting time with 60 participants with high walking ability. High versus low walking ability was defined as being in the best versus worst tertiles for both gait speed (≥0.9 vs <0.7 m/s) and the Walking Ability Index (7-9 vs 0-1). Using liquid chromatography-mass spectrometry, 569 metabolites were identified in overnight-fasting plasma. RESULTS Ninety-six metabolites were associated with walking ability, where 24% were triacylglycerols. Triacylglycerols that were higher among those with high walking ability consisted mostly of polyunsaturated fatty acids, whereas triacylglycerols that were lower among those with high walking ability consisted mostly of saturated or monounsaturated fatty acids. Body composition partly explained associations between some metabolites and walking ability. Proline and arginine metabolism was a top pathway associated with walking ability. CONCLUSION These results may partly reflect pathways of modifiable risk factors, including excess dietary lipids and lack of physical activity, contributing to obesity and further alterations in metabolic pathways that lead to age-related decline in walking ability in this older adult cohort.
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Affiliation(s)
- Megan M Marron
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Stacy G Wendell
- Departments of Pharmacology and Chemical Biology and Clinical and Translational Science, University of Pittsburgh, Pennsylvania
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Adam J Santanasto
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - George C Tseng
- Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Joseph M Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.,Departments of Medicine and Clinical and Translational Science, University of Pittsburgh, Pennsylvania
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Barnes N, Walsh B, Samuel D. Feasibility of Using Strength Measures, Including Peak Inspiratory Flow, for Routine Monitoring in Case Management Patients Aged 65 and Over. Geriatrics (Basel) 2020; 5:E59. [PMID: 32967375 PMCID: PMC7555426 DOI: 10.3390/geriatrics5030059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/17/2022] Open
Abstract
Peak inspiratory flow (PIF) is a portable, relatively new method for measuring respiratory function and indirect muscle strength; the feasibility of its routine clinical measurement is unknown. To investigate the acceptability, reliability and short-term stability of PIF, alongside the established measures of peak expiratory flow (PEF) and grip strength in community dwelling case management patients. Patients were tested in a sitting position, initially on two occasions, one week apart; seven patients having repeated measures taken on a further four occasions over a seven-week period. The best of three attempts for all measures were recorded. Reliability was tested using intra-class correlation coefficient (ICC), standard error of measurement (SEM), minimal detectable change (MDC) and Bland-Altman analysis. Eight patients aged 69-91 years (mean age 81.5 ± 7.7 years; 5 males) participated. For between-day reliability using the first two time points, one week apart the ICCs (3,1) were 0.97, 0.98 and 0.99 for PIF, PEF and grip strength respectively; using all five time points resulted in ICCs of 0.92, 0.99 and 0.99 respectively. Bland-Altman plots also illustrated a good level of agreement across days. Feedback on the acceptability of the measures was gathered from patients. PIF, PEF and grip strength showed excellent reliability and acceptability. Whilst excellent reliability was observed over the seven-week period, the occurrence of clinically significant symptoms and adverse events in the presence of unchanging PIF, PEF and grip strength, suggests that the measures may not be suitable to identify patients with multiple health conditions entering a period of acute decline.
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Affiliation(s)
| | | | - Dinesh Samuel
- Faculty of Environmental and Life Sciences, University of Southampton, Highfield Campus, Southampton SO17 1BJ, UK; (N.B.); (B.W.)
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Ariaratnam S, Rodzlan Hasani WS, Krishnapillai AD, Abd Hamid HA, Jane Ling MY, Ho BK, Shariff Ghazali S, Tohit NM, Mohd Yusoff MF. Prevalence of obesity and its associated risk factors among the elderly in Malaysia: Findings from The National Health and Morbidity Survey (NHMS) 2015. PLoS One 2020; 15:e0238566. [PMID: 32915860 DOI: 10.1371/journal.pone.0238566] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Obesity is a crucial public health problem and is rising globally. This study was conducted to determine the prevalence of obesity and its associated factors among the elderly in Malaysia. Methods Data were obtained from the National Health and Morbidity Survey (NHMS) 2015. This was a cross sectional population-based study using a two stage stratified random sampling design. Elderly population aged 60 years and above was selected. Data were collected using pre-tested self-administered questionnaire in the form of sociodemographic profile, non-communicable diseases (NCD) comorbidities (status on hypertension, diabetes and hypercholesterolemia) and NCD risk factors (current smoker and physical activity). Obesity has been defined using the World Health Organization (WHO) Body Mass Index (BMI) guideline, 1998. A complex sampling design analysis was used for the descriptive statistics. The associated risk factors for obesity were identified using Multiple Logistic Regression analysis. Results A total of 3794 respondents were included in this study. The prevalence of obesity among Malaysian elderly was 30.2%. The prevalence of obesity among the elderly was significantly higher in females, respondents from urban areas and Indians. Approximately one third of the elderly with non-communicable diseases such as hypertension (33.1%) and diabetes (38.8%), respectively, were obese. Among elderly who were obese, majority of them (89.8%) had at least one NCD. The prevalence of obesity was 16.8% among current smokers (aOR 0.59). Multiple logistic regression analysis revealed that elderly females (aOR [adjusted odds ratio] 1.52), having secondary education (aOR 1.96) with household income of RM 3000 and above (aOR 1.57) as well as being hypertensive (aOR 1.61) and diabetic (aOR 1.50) were more likely to be obese. In contrast, the Chinese elderly respondents (aOR 0.62) and current smokers (aOR 0.59) were less likely to be obese. There were no significant associations of obesity with hypercholesterolemia or with physical activity. Conclusions A substantial proportion of Malaysian elderly were obese, and factors associated with obesity among them were being female, having secondary education with a household income of RM 3000 and above and being hypertensive or diabetic. Enhanced health promotion and education should be targeted at younger people in order to prevent obesity in the later years.
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Lange-Maia BS, Karavolos K, Avery EF, Strotmeyer ES, Karvonen-Gutierrez CA, Appelhans BM, Janssen I, Dugan SA, Kravitz HM. Contribution of common chronic conditions to midlife physical function decline: The Study of Women's Health Across the Nation. Womens Midlife Health 2020; 6:6. [PMID: 32742664 PMCID: PMC7385881 DOI: 10.1186/s40695-020-00053-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/13/2020] [Indexed: 12/25/2022] Open
Abstract
Background Chronic conditions are associated with worse physical function and commonly develop during midlife. We tested whether the presence of 8 chronic conditions, or the development of these conditions, is associated with declines in physical function among midlife women as they transition into early late life. Methods Participants (N = 2283) were from the Study of Women’s Health Across the Nation. Physical function was assessed at 8 visits starting at the study’s fourth clinic visit in 2000/2001 through follow-up visit 15 (2015/2017) using the Short Form-36 Physical Function subscale. Chronic conditions included diabetes, hypertension, osteoarthritis, osteoporosis, stroke, heart disease, cancer, and depressive symptoms. Repeated-measures Poisson regression modeled associations between 1) prevalent chronic conditions at analytic baseline (visit 4) and longitudinal physical function, and 2) change in physical function associated with developing a new condition. Models were adjusted with the total number of other chronic conditions at visit 4. Results In separate fully-adjusted longitudinal models, prevalent heart disease and osteoporosis were associated with 18% (IRR = 0.815, 95% confidence interval [CI]: 0.755–0.876) and 12% (IRR = 0.876, 95% CI: 0.825–0.927) worse initial physical function, respectively. Prevalent osteoarthritis was associated with approximately 6% (IRR = 0.936, 95% CI: 0.913–0.958) worse initial physical function, and a slight additional worsening over time (IRR = 0.995, 95% CI: 0.994–0.996). A 12% (IRR = 0.878, 95% CI: 0.813–0.950) decrease in physical function concurrent with stroke development was evident, as was accelerated decline in physical function concurrent with heart disease development (IRR = 0.991, 95% CI: 0.988–0.995). Conclusions Initial prevalent conditions related to the musculoskeletal system were associated with worse initial physical function, with some evidence of accelerated decline in physical function with osteoarthritis. Stroke and heart disease are less common than osteoarthritis in this age group, but the severe effects of these conditions on physical function shows the need for a greater focus on cardiovascular health during midlife. Women who develop chronic conditions during midlife may be at particular risk for poor physical function as they age, warranting disability prevention efforts focused on this population.
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Affiliation(s)
- Brittney S Lange-Maia
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA.,Center for Community Health Equity, Rush University Medical Center, Chicago, IL USA
| | - Kelly Karavolos
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA
| | - Elizabeth F Avery
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA.,Center for Community Health Equity, Rush University Medical Center, Chicago, IL USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | | | - Bradley M Appelhans
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA
| | - Imke Janssen
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA
| | - Sheila A Dugan
- Department of Physical Medicine & Rehabilitation, Rush University Medical Center, Chicago, IL USA
| | - Howard M Kravitz
- Department of Preventive Medicine, Rush University Medical Center, Chicago, IL USA.,Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL USA
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12
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Cawthon PM, Travison TG, Manini TM, Patel S, Pencina KM, Fielding RA, Magaziner JM, Newman AB, Brown T, Kiel DP, Cummings SR, Shardell M, Guralnik JM, Woodhouse LJ, Pahor M, Binder E, D’Agostino RB, Quian-Li X, Orwoll E, Landi F, Orwig D, Schaap L, Latham NK, Hirani V, Kwok T, Pereira SL, Rooks D, Kashiwa M, Torres-Gonzalez M, Menetski JP, Correa-De-Araujo R, Bhasin S. Establishing the Link Between Lean Mass and Grip Strength Cut Points With Mobility Disability and Other Health Outcomes: Proceedings of the Sarcopenia Definition and Outcomes Consortium Conference. J Gerontol A Biol Sci Med Sci 2020; 75:1317-1323. [PMID: 30869772 PMCID: PMC7447857 DOI: 10.1093/gerona/glz081] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 03/13/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Lack of consensus on how to diagnose sarcopenia has limited the ability to diagnose this condition and hindered drug development. The Sarcopenia Definitions and Outcomes Consortium (SDOC) was formed to develop evidence-based diagnostic cut points for lean mass and/or muscle strength that identify people at increased risk of mobility disability. We describe here the proceedings of a meeting of SDOC and other experts to discuss strategic considerations in the development of evidence-based sarcopenia definition. METHODS Presentations and panel discussions reviewed the usefulness of sarcopenia as a biomarker, the analytical approach used by SDOC to establish cut points, and preliminary findings, and provided strategic direction to develop an evidence-based definition of sarcopenia. RESULTS The SDOC assembled data from eight epidemiological cohorts consisting of 18,831 participants, clinical populations from 10 randomized trials and observational studies, and 2 nationally representative cohorts. In preliminary assessments, grip strength or grip strength divided by body mass index was identified as discriminators of risk for mobility disability (walking speed <0.8 m/s), whereas dual-energy X-ray absorptiometry-derived lean mass measures were not good discriminators of mobility disability. Candidate definitions based on grip strength variables were associated with increased risk of mortality, falls, mobility disability, and instrumental activities of daily living disability. The prevalence of low grip strength increased with age. The attendees recommended the establishment of an International Expert Panel to review a series of position statements on sarcopenia definition that are informed by the findings of the SDOC analyses and synthesis of literature. CONCLUSIONS International consensus on an evidence-based definition of sarcopenia is needed. Grip strength-absolute or adjusted for body mass index-is an important discriminator of mobility disability and other endpoints. Additional research is needed to develop a predictive risk model that takes into account sarcopenia components as well as age, sex, race, and comorbidities.
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Affiliation(s)
- Peggy M Cawthon
- California Pacific Medical Center Research Institute, San Francisco Coordinating Center, California
| | - Thomas G Travison
- Department of Medicine, Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | | | - Sheena Patel
- California Pacific Medical Center Research Institute, San Francisco Coordinating Center, California
| | - Karol M Pencina
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Roger A Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Jay M Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Todd Brown
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University, Baltimore, Maryland
| | - Douglas P Kiel
- Department of Medicine, Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts,Longitudinal Studies Section, The National Institute on Aging, Baltimore, Maryland
| | - Steve R Cummings
- California Pacific Medical Center Research Institute, San Francisco Coordinating Center, California
| | - Michelle Shardell
- Longitudinal Studies Section, The National Institute on Aging, Baltimore, Maryland
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Linda J Woodhouse
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | - Ellen Binder
- Division of Geriatrics, Washington University School of Medicine, St Louis, Missouri
| | - Ralph B D’Agostino
- Department of Mathematics, Framingham Heart Study, Boston University, Massachusetts
| | - Xue Quian-Li
- Director of Biostatistics, Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Eric Orwoll
- Division of Endocrinology, Metabolism and Clinical Nutrition, Oregon Health and Sciences University, Portland
| | - Francesco Landi
- Department of Medicine and Geriatrics, Catholic University of Sacred Heart, Rome, Italy
| | - Denise Orwig
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Laura Schaap
- Faculty of Science, Nutrition and Health Aging and Later Life, Free University of Amsterdam, The Netherlands
| | - Nancy K Latham
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vasant Hirani
- School of Life and Environmental Sciences, University of Sydney, Australia
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine,School of Public Health, The Chinese University of Hong Kong, China
| | | | - Daniel Rooks
- Novartis Biomedical Research Institute, Cambridge, Massachusetts
| | | | | | - Joseph P Menetski
- The Foundation for the National Institutes of Health, Bethesda, Maryland
| | | | - Shalender Bhasin
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Address correspondence to: Shalender Bhasin, MB, BS, Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115. E-mail:
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13
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Lai HTM, de Oliveira Otto MC, Lee Y, Wu JHY, Song X, King IB, Psaty BM, Lemaitre RN, McKnight B, Siscovick DS, Mozaffarian D. Serial Plasma Phospholipid Fatty Acids in the De Novo Lipogenesis Pathway and Total Mortality, Cause-Specific Mortality, and Cardiovascular Diseases in the Cardiovascular Health Study. J Am Heart Assoc 2019; 8:e012881. [PMID: 31711385 PMCID: PMC6915264 DOI: 10.1161/jaha.119.012881] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Synthesized fatty acids (FAs) from de novo lipogenesis may affect cardiometabolic health, but longitudinal associations between serially measured de novo lipogenesis-related fatty acid biomarkers and mortality or cardiovascular disease (CVD) are not well established. Methods and Results We investigated longitudinal associations between de novo lipogenesis-related fatty acids with all-cause mortality, cause-specific mortality, and incident CVD among 3869 older US adults, mean (SD) age 75 (5) years and free of prevalent CVD at baseline. Levels of plasma phospholipid palmitic (16:0), palmitoleic (16:1n-7), stearic (18:0), oleic acid (18:1n-9), and other risk factors were serially measured at baseline, 6 years, and 13 years. All-cause mortality, cause-specific mortality, and incident fatal and nonfatal CVD were centrally adjudicated. Risk was assessed in multivariable-adjusted Cox models with time-varying FAs and covariates. During 13 years, median follow-up (maximum 22.4 years), participants experienced 3227 deaths (1131 CVD, 2096 non-CVD) and 1753 incident CVD events. After multivariable adjustment, higher cumulative levels of 16:0, 16:1n-7, and 18:1n-9 were associated with higher all-cause mortality, with extreme-quintile hazard ratios (95% CIs) of 1.35 (1.17-1.56), 1.40 (1.21-1.62), and 1.56 (1.35-1.80), respectively, whereas higher levels of 18:0 were associated with lower mortality (hazard ratio=0.76; 95% CI=0.66-0.88). Associations were generally similar for CVD mortality versus non-CVD mortality, as well as total incident CVD. Changes in levels of 16:0 were positively, and 18:0 inversely, associated with all-cause mortality (hazard ratio=1.23, 95% CI=1.08-1.41; and hazard ratio=0.78, 95% CI=0.68-0.90). Conclusions Higher long-term levels of 16:0, 16:1n-7, and 18:1n-9 and changes in 16:0 were positively, whereas long-term levels and changes in 18:0 were inversely, associated with all-cause mortality in older adults.
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Affiliation(s)
- Heidi T M Lai
- Friedman School of Nutrition Science and Policy Tufts University Boston MA
| | - Marcia C de Oliveira Otto
- Department of Epidemiology Human Genetics and Environmental Sciences University of Texas Health Science Center at Houston TX
| | - Yujin Lee
- Friedman School of Nutrition Science and Policy Tufts University Boston MA
| | - Jason H Y Wu
- The George Institute for Global Health Faculty of Medicine University of New South Wales Newtown NSW Australia
| | | | - Irena B King
- Department of Internal Medicine University of New Mexico Albuquerque NM
| | - Bruce M Psaty
- Department of Medicine, Epidemiology, and Health Services University of Washington Seattle WA.,Cardiovascular Health Research Unit Department of Medicine University of Washington Seattle WA.,Kaiser Permanente Washington Health Research Institute Seattle WA
| | - Rozenn N Lemaitre
- Cardiovascular Health Research Unit Department of Medicine University of Washington Seattle WA
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14
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Sanders JL, Arnold AM, Boudreau RM, Hirsch CH, Kizer JR, Kaplan RC, Cappola AR, Cushman M, Jacob ME, Kritchevsky SB, Newman AB. Association of Biomarker and Physiologic Indices With Mortality in Older Adults: Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci 2019; 74:114-120. [PMID: 29659743 DOI: 10.1093/gerona/gly075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/09/2018] [Indexed: 12/11/2022] Open
Abstract
Background A goal of gerontology is discovering aging phenotypes that reflect biological aging distinct from disease pathogenesis. Biomarkers that strongly and independently associated with mortality and that statistically attenuated chronologic age could be used to define such a phenotype. We determined the association of a Biomarker Index (BI) with mortality and compared it with a validated Physiologic Index (PI) in older adults. Methods The indices were constructed in the Cardiovascular Health Study, mean (SD) age 74.5 (5.1) years. The BI incorporated circulating levels of new biomarkers, including insulin-like growth factor-1, insulin-like growth factor-binding protein 3, amino-terminal pro-B-type natriuretic peptide, dehydroepiandrosterone sulfate, and interleukin-6, and was built in test (N = 2,197) and validation (N = 1,124) samples. The PI included carotid intima-media thickness, pulmonary capacity, brain white matter grade, cystatin-C, and fasting glucose. Multivariable Cox proportional hazards models predicting death were calculated with 10 years of follow-up. Results In separate age-adjusted models, the hazard ratio for mortality per point of the BI was 1.30 (95% confidence interval 1.25, 1.34) and the BI attenuated age by 25%. The hazard ratio for the PI was 1.28 (1.24, 1.33; 29% age attenuation). In the same model, the hazard ratio for the BI was 1.23 (1.18, 1.28) and for the PI was 1.22 (1.17, 1.26), and age was attenuated 42.5%. Associations persisted after further adjustment. Conclusions The BI and PI were significantly and independently associated with mortality. Both attenuated the age effect on mortality substantially. The indices may be feasible phenotypes for developing interventions hoping to alter the trajectory of aging.
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Affiliation(s)
- Jason L Sanders
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle
| | | | - Calvin H Hirsch
- Department of Medicine, University of California-Davis, Sacramento
| | - Jorge R Kizer
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Anne R Cappola
- Department of Medicine, University of Pennsylvania, Philadelphia
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Burlington
| | - Mini E Jacob
- New England GRECC, VA Boston Healthcare System, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts
| | - Stephen B Kritchevsky
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
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15
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Velez MP, Alvarado BE, Rosendaal N, da Câmara SM, Belanger E, Richardson H, Pirkle CM. Age at natural menopause and physical functioning in postmenopausal women: the Canadian Longitudinal Study on Aging. Menopause 2019; 26:958-965. [PMID: 31453956 PMCID: PMC6738924 DOI: 10.1097/gme.0000000000001362] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the association between categories of age at natural menopause (ANM) and gait speed (slowness) and grip strength (weakness), common measures of physical functioning in older women. METHODS We analyzed data from the Canadian Longitudinal Study on Aging, which included participants from seven cities across Canada collected in 2012. The sample was restricted to women who reported to have entered menopause (N = 9,920). Women who had a hysterectomy before menopause were excluded since the age at which this surgical procedure was performed was not available. ANM was categorized into five groups: less than 40 (premature), 40 to 44 (early), 45 to 49, 50 to 54, and more than 54. We conducted linear regressions to assess the association between ANM and gait speed (m/s) and grip strength (kg) adjusting for participant age, education, body mass index, smoking, use of hormone therapy, height, and province of residence. RESULTS Mean ANM was 49.8 (95% confidence interval [CI]: 49.7-50.0), with 3.8% of women having a premature menopause; the average gait speed was 0.98 m/s (standard deviation: 0.22), the average grip strength was 26.6 kg (standard deviation: 6.39). Compared to women with ANM of 50 to 54, women with premature menopause had 0.054 m/s (95% CI -0.083, -0.026) lower gait speed when adjusting for age and study site. In the fully adjusted model, the association was attenuated, 0.032 m/s (95% CI -0.060, -0.004). ANM was not associated with grip strength. CONCLUSION Our study suggests that premature menopause (<40 years) may be associated with lower gait speed (slowness) among Canadian women. No association was observed between ANM and grip strength. Future studies should include a life course approach to evaluate whether social and biological pathways modify the association between age at menopause and physical function in populations from different contexts.
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Affiliation(s)
- Maria P Velez
- Department of Obstetrics and Gynaecology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Beatriz E Alvarado
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Nicole Rosendaal
- Department of Obstetrics and Gynaecology, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Saionara M da Câmara
- Faculty of Health Sciences of Trairi, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte, Brazil
| | - Emmanuelle Belanger
- Department of Health Services, Policy and Practice, Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI
| | - Harriet Richardson
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Catherine M Pirkle
- Office of Public Health Studies, University of Hawaii at Mānoa, Honolulu, HI
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16
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Abstract
Purpose Frailty and atherosclerotic diseases are prevalent among the older people and usually present the same pathogenesis and risk factors. Therefore, the aim of this study was to determine the association between frailty and atherosclerosis. Patients and methods The enrolled participants were 171 patients aged 60–96 years in Beijing Tongren Hospital. Data that were collected included sex, age, height, weight, calculated body mass index (BMI), past medical history, comorbidities (including hypertension, coronary heart disease [CHD], and diabetes), ability to perform activities of daily living (ADL) as measured using the Barthel index, handgrip strength, 15-feet (4.57 m) walking speed, body composition features determined by bioelectrical impedance analysis, the ankle–brachial index (ABI), and atherosclerosis determined by the cardio-ankle vascular index (CAVI). Patients were divided into frail, pre-frail, and non-frail groups using Fried’s frailty index. ANOVA was used to assess the differences among these groups. Linear correlation analysis was used to examine the relationship between the CAVI and frailty phenotype. Ordinal multivariate logistic regression analysis was used to examine the factors affecting frailty and the relationship between frailty and atherosclerosis. Results The population was categorized as 21.3% frail, 38.4% pre-frail, and 40.3% non-frail. Patients in the frail group were older, had lower handgrip strength, slower walking speed, and a lower ABI and a higher proportion of carotid intima-media thickening with values of at least 1 mm compared with those in the pre-frail and non-frail groups. The CAVI score was higher in the frail group than that in the other two groups. There were significant inverse linear correlations between grip strength, walking speed, and the CAVI. CAVI showed an independent risk factor for frailty (OR: 2.013, 95% CI 1.498–2.703, p<0.001). Conclusion Our study shows that arterial stiffness is associated with frailty in older patients, even when adjusting for multiple factors.
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Affiliation(s)
- Qi Xue
- Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Ming-Zhao Qin
- Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Jing Jia
- Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Jin-Ping Liu
- Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China,
| | - Yun Wang
- Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China,
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17
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Lastra-German IK, Navarrete-Reyes AP, Mejía-Domínguez NR, Agreda-Vásquez GP. Adjusted Chemotherapy According to Frailty Status in Elderly Patients With Diffuse Large B-Cell Lymphoma: Experience From a Single Referral Center in Mexico City. Clin Lymphoma Myeloma Leuk 2019; 19:e98-e106. [PMID: 30545670 DOI: 10.1016/j.clml.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/05/2018] [Accepted: 11/09/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Chemotherapy is associated with significant toxicity in elderly patients treated for hematological malignancies. Adequate tools to identify the best tailored treatment are essential. PATIENTS AND METHODS Medical charts of patients treated with adjusted chemotherapy for diffuse large B-cell lymphoma according to frailty status between August 1, 2013 and June 30, 2016 were included. Three groups were identified: fit, unfit, and frail patients. RESULTS Fifty-six patients with a median age of 70.5 years were analyzed. Adverse prognostic characteristics were more frequent than expected in the frail group, contributing to a worse outcome. The complete response (CR) rate for all patients was 61.2% (66.6%, 78.3%, and 40.0% for fit, unfit, and frail patients, respectively; P = .121). The 2-year overall survival (OS) for all patients was 78% (87%, 82%, and 59% for fit, unfit, and frail patients, respectively; P = .159) and the mean 2-year disease-free survival was 96% (87% for frail patients and 100% for unfit and fit patients; P = .287). Grade 3/4 hematologic toxicity was present in 83.3%, 65.2%, and 45% of fit, unfit, and frail patients, respectively. CR after therapy had a positive effect on OS, whereas ≥ 2 extranodal sites and febrile neutropenia had a negative effect. CONCLUSION Frailty status assessment resulted in the identification of a group of unfit patients who had adequate tolerance to adjusted chemotherapy (R-choP; rituximab with cyclophosphamide, doxorubicin, and vincristine adjusted to 80% of the corresponding total doses in R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone]) with good results.
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18
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Lai HT, de Oliveira Otto MC, Lemaitre RN, McKnight B, Song X, King IB, Chaves PH, Odden MC, Newman AB, Siscovick DS, Mozaffarian D. Serial circulating omega 3 polyunsaturated fatty acids and healthy ageing among older adults in the Cardiovascular Health Study: prospective cohort study. BMJ 2018; 363:k4067. [PMID: 30333104 PMCID: PMC6191654 DOI: 10.1136/bmj.k4067] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the longitudinal association between serial biomarker measures of circulating omega 3 polyunsaturated fatty acid (n3-PUFA) levels and healthy ageing. DESIGN Prospective cohort study. SETTING Four communities in the United States (Cardiovascular Health Study) from 1992 to 2015. PARTICIPANTS 2622 adults with a mean (SD) age of 74.4 (4.8) and with successful healthy ageing at baseline in 1992-93. EXPOSURE Cumulative levels of plasma phospholipid n3-PUFAs were measured using gas chromatography in 1992-93, 1998-99, and 2005-06, expressed as percentage of total fatty acids, including α-linolenic acid from plants and eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid from seafoood. MAIN OUTCOME MEASURE Healthy ageing defined as survival without chronic diseases (ie, cardiovascular disease, cancer, lung disease, and severe chronic kidney disease), the absence of cognitive and physical dysfunction, or death from other causes not part of the healthy ageing outcome after age 65. Events were centrally adjudicated or determined from medical records and diagnostic tests. RESULTS Higher levels of long chain n3-PUFAs were associated with an 18% lower risk (95% confidence interval 7% to 28%) of unhealthy ageing per interquintile range after multivariable adjustments with time-varying exposure and covariates. Individually, higher eicosapentaenoic acid and docosapentaenoic acid (but not docosahexaenoic acid) levels were associated with a lower risk: 15% (6% to 23%) and 16% (6% to 25%), respectively. α-linolenic acid from plants was not noticeably associated with unhealthy ageing (hazard ratio 0.92, 95% confidence interval 0.83 to 1.02). CONCLUSIONS In older adults, a higher cumulative level of serially measured circulating n3-PUFAs from seafood (eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid), eicosapentaenoic acid, and docosapentaenoic acid (but not docosahexaenoic acid from seafood or α-linolenic acid from plants) was associated with a higher likelihood of healthy ageing. These findings support guidelines for increased dietary consumption of n3-PUFAs in older adults.
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Affiliation(s)
- Heidi Tm Lai
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA
| | - Marcia C de Oliveira Otto
- Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rozenn N Lemaitre
- Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA
| | - Barbara McKnight
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Xiaoling Song
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Irena B King
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Paulo Hm Chaves
- Benjamin Leon Center for Geriatric Research and Education at Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Michelle C Odden
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA
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19
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Affiliation(s)
- Anne B Newman
- Department of Epidemiology Katherine M. Detre Endowed Chair of Population Health Sciences Director, Center for Aging and Population Health, Professor of Epidemiology, Medicine, and Clinical and Translational Science Graduate School of Public, Health University of Pittsburgh, A527 Crabtree Hall, 130 DeSoto Street Pittsburgh, PA 15261. E-mail:
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20
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Armstrong NM, Carlson MC, Xue QL, Schrack J, Carnethon MR, Chaves PHM, Gross AL. Role of Late-Life Depression in the Association of Subclinical Cardiovascular Disease With All-Cause Mortality: Cardiovascular Health Study. J Aging Health 2017; 31:652-666. [PMID: 29254423 DOI: 10.1177/0898264317744921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate whether late-life depression mediates the association of subclinical cardiovascular disease (CVD) with all-cause mortality. METHOD Using data from 3,473 Cardiovascular Health Study participants, the Cox proportional hazards model was used to examine the direct and indirect (via late-life depression) effects of the association between baseline subclinical CVD and all-cause mortality with weights derived from multivariable logistic regression of late-life depression on subclinical CVD. RESULTS Subclinical CVD led to a higher risk of all-cause mortality (hazard ratio [HR] = 1.51, 95% confidence interval, [CI] = [1.42, 1.94]). Total effect of subclinical CVD on all-cause mortality was decomposed into direct (HR = 1.41, 95% CI = [1.37, 1.58]) and indirect (HR = 1.07, 95% CI = [1.01, 1.23]) effects; 16.3% of the total effect of subclinical CVD on all-cause mortality was mediated by late-life depression. DISCUSSION Late-life depression accounts for little, if any, of the association between subclinical CVD, a risk factor of all-cause mortality, and all-cause mortality.
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Affiliation(s)
| | | | - Qian-Li Xue
- 1 Johns Hopkins University, Baltimore, MD, USA
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21
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Sanders JL, Arnold AM, Hirsch CH, Thielke SM, Kim D, Mukamal KJ, Kizer JR, Ix JH, Kaplan RC, Kritchevsky SB, Newman AB. Effects of Disease Burden and Functional Adaptation on Morbidity and Mortality on Older Adults. J Am Geriatr Soc 2017; 64:1242-9. [PMID: 27321602 DOI: 10.1111/jgs.14163] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To ascertain whether older adults with extensive disease but relative vigor (adapters) shorten the period at the end of life in which they live with morbidity (compress morbidity). DESIGN Prospective, community-based cohort study in four U.S. cities. SETTING Cardiovascular Health Study. PARTICIPANTS Individuals aged 65 and older. MEASUREMENTS Participants were categorized into three groups according to extent of disease (assessed noninvasively), vigor, and frailty (expected agers (n = 3,528, extent of disease similar to vigor and frailty-reference group), adapters (n = 882, higher disease but vigorous), and prematurely frail (n = 855, lower disease but frail)) and compared according to years of able life (YAL), years of self-reported healthy life (YHL), and mortality using multivariable regression and survival analysis. RESULTS After adjustment, adapters had 0.97 (95% confidence interval (CI) = 0.60-1.33) more YAL and 0.54 (95% CI = 0.19-0.90) more YHL than expected agers, and those who were prematurely frail had -0.99 (95% CI = -1.36 to -0.62) fewer YAL and -0.53 (95% CI = -0.89 to -0.17) fewer YHL than expected agers. Adapters had 0.9 more and prematurely frail had 1.5 fewer years of total life than expected agers (P < .001). Adapters spent 55% of their remaining life able and healthy, those who were prematurely frail spent 37%, and of expected agers spent 47% (P < .001). CONCLUSION Despite similar levels of disease burden, older adults who were more vigorous appeared to compress morbidity and live longer. Older adults with higher frailty lengthened morbidity and had greater mortality. Adaptive factors may compress morbidity and decrease mortality.
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Affiliation(s)
- Jason L Sanders
- Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital, Boston, Massachusetts
| | - Alice M Arnold
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Calvin H Hirsch
- Department of Medicine, University of California Davis, Sacramento, California
| | - Stephen M Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.,Geriatric Research, Education, and Clinical Center, Puget Sound VA Medical Center, Seattle, Washington
| | - Dae Kim
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jorge R Kizer
- Department of Medicine, Yeshiva University, Bronx, New York
| | - Joachim H Ix
- Department of Medicine, University of California San Diego, San Diego, California
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Yeshiva University, Bronx, New York
| | - Stephen B Kritchevsky
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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Franzon K, Byberg L, Sjögren P, Zethelius B, Cederholm T, Kilander L. Predictors of Independent Aging and Survival: A 16-Year Follow-Up Report in Octogenarian Men. J Am Geriatr Soc 2017; 65:1953-1960. [DOI: 10.1111/jgs.14971] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kristin Franzon
- Division of Geriatrics; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Liisa Byberg
- Division of Orthopedics; Department of Surgical Sciences; Uppsala University; Uppsala Sweden
| | - Per Sjögren
- Division of Clinical Nutrition and Metabolism; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Björn Zethelius
- Division of Geriatrics; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Medical Products Agency; Uppsala Sweden
| | - Tommy Cederholm
- Division of Clinical Nutrition and Metabolism; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | - Lena Kilander
- Division of Geriatrics; Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
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Michel JJ, Griffin P, Vallejo AN. Functionally Diverse NK-Like T Cells Are Effectors and Predictors of Successful Aging. Front Immunol 2016; 7:530. [PMID: 27933066 PMCID: PMC5121286 DOI: 10.3389/fimmu.2016.00530] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/10/2016] [Indexed: 12/16/2022] Open
Abstract
The fundamental challenge of aging and long-term survivorship is maintenance of functional independence and compression of morbidity despite a life history of disease. Inasmuch as immunity is a determinant of individual health and fitness, unraveling novel mechanisms of immune homeostasis in late life is of paramount interest. Comparative studies of young and old persons have documented age-related atrophy of the thymus, the contraction of diversity of the T cell receptor (TCR) repertoire, and the intrinsic inefficiency of classical TCR signaling in aged T cells. However, the elderly have highly heterogeneous health phenotypes. Studies of defined populations of persons aged 75 and older have led to the recognition of successful aging, a distinct physiologic construct characterized by high physical and cognitive functioning without measurable disability. Significantly, successful agers have a unique T cell repertoire; namely, the dominance of highly oligoclonal αβT cells expressing a diverse array of receptors normally expressed by NK cells. Despite their properties of cell senescence, these unusual NK-like T cells are functionally active effectors that do not require engagement of their clonotypic TCR. Thus, NK-like T cells represent a beneficial remodeling of the immune repertoire with advancing age, consistent with the concept of immune plasticity. Significantly, certain subsets are predictors of physical/cognitive performance among older adults. Further understanding of the roles of these NK-like T cells to host defense, and how they integrate with other physiologic domains of function are new frontiers for investigation in Aging Biology. Such pursuits will require a research paradigm shift from the usual young-versus-old comparison to the analysis of defined elderly populations. These endeavors may also pave way to age-appropriate, group-targeted immune interventions for the growing elderly population.
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Affiliation(s)
- Joshua J Michel
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Patricia Griffin
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Abbe N Vallejo
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Pittsburgh Claude Pepper Older Americans Independence Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Shea S, Lima J, Diez-Roux A, Jorgensen NW, McClelland RL. Socioeconomic Status and Poor Health Outcome at 10 Years of Follow-Up in the Multi-Ethnic Study of Atherosclerosis. PLoS One 2016; 11:e0165651. [PMID: 27875557 DOI: 10.1371/journal.pone.0165651] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
Background/Objectives Predictors of healthy aging have not been well-studied using longitudinal data with demographic, clinical, subclinical, and genetic information. The objective was to identify predictors of poor health outcome at 10 years of follow-up in the Multi-Ethnic Study of Atherosclerosis (MESA). Design Prospective cohort study. Setting Population-based sample from 6 U.S. communities. Participants 4,355 participants In the MESA Study. Measurements Poor health outcome at 10 years of follow-up was defined as having died or having clinical cardiovascular disease, depression, cognitive impairment, chronic obstructive pulmonary disease, or cancer other than non-melanoma skin cancer. Absolute risk regression was used to estimate risk differences in the outcome adjusting for demographic variables, clinical and behavioral risk factors, subclinical cardiovascular disease, and ApoE genotype. Models were weighted to account for selective attrition. Results Mean age at 10 years of follow-up was 69.5 years; 1,480 participants had a poor health outcome, 2,157 participants were in good health, and 718 were unknown. Older age, smoking, not taking a statin, hypertension, diabetes, and higher coronary calcium score were associated with higher probability of poor health outcome. After multivariable adjustment, participants in the lowest income and educational categories had 7 to 14% greater absolute risk of poor health outcome at 10 years of follow-up compared to those in the next highest categories of income or education (P = 0.002 for both). Those in the lowest categories of both income and education had 21% greater absolute risk of poor health outcome compared to those in the highest categories of both income and education. Conclusions Low income and educational level predict poor health outcome at 10 years of follow-up in an aging cohort, independent of clinical and behavioral risk factors and subclinical cardiovascular disease.
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Angulo J, El Assar M, Rodríguez-Mañas L. Frailty and sarcopenia as the basis for the phenotypic manifestation of chronic diseases in older adults. Mol Aspects Med 2016; 50:1-32. [PMID: 27370407 DOI: 10.1016/j.mam.2016.06.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/18/2016] [Indexed: 12/13/2022]
Abstract
Frailty is a functional status that precedes disability and is characterized by decreased functional reserve and increased vulnerability. In addition to disability, the frailty phenotype predicts falls, institutionalization, hospitalization and mortality. Frailty is the consequence of the interaction between the aging process and some chronic diseases and conditions that compromise functional systems and finally produce sarcopenia. Many of the clinical manifestations of frailty are explained by sarcopenia which is closely related to poor physical performance. Reduced regenerative capacity, malperfusion, oxidative stress, mitochondrial dysfunction and inflammation compose the sarcopenic skeletal muscle alterations associated to the frailty phenotype. Inflammation appears as a common determinant for chronic diseases, sarcopenia and frailty. The strategies to prevent the frailty phenotype include an adequate amount of physical activity and exercise as well as pharmacological interventions such as myostatin inhibitors and specific androgen receptor modulators. Cell response to stress pathways such as Nrf2, sirtuins and klotho could be considered as future therapeutic interventions for the management of frailty phenotype and aging-related chronic diseases.
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Affiliation(s)
- Javier Angulo
- Unidad de Investigación Cardiovascular (IRYCIS/UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mariam El Assar
- Instituto de Investigación Sanitaria de Getafe, Getafe, Madrid, Spain
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Newman AB, Sanders JL, Kizer JR, Boudreau RM, Odden MC, Zeki Al Hazzouri A, Arnold AM. Trajectories of function and biomarkers with age: the CHS All Stars Study. Int J Epidemiol 2016; 45:1135-1145. [PMID: 27272182 DOI: 10.1093/ije/dyw092] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Multimorbidity is a major driver of physical and cognitive impairment, but rates of decline are also related to ageing. We sought to determine trajectories of decline in a large cohort by disease status, and examined their correspondence with biomarkers of ageing processes including growth hormone, sex steroid, inflammation, visceral adiposity and kidney function pathways. METHODS We have followed the 5888 participants in the Cardiovascular Health Study (CHS) for healthy ageing and longevity since 1989-90. Gait speed, grip strength, modified mini-mental status examination (3MSE) and the digit symbol substitution test (DSST) were assessed annually to 1998-99 and again in 2005-06. Insulin-like growth hormone (IGF-1), dehydroepiandrosterone sulphate (DHEAS), interleukin-6 (IL-6), adiponectin and cystatin-C were assessed 3-5 times from stored samples. Health status was updated annually and dichotomized as healthy vs not healthy. Trajectories for each function measure and biomarker were estimated using generalized estimating equations as a function of age and health status using standardized values. RESULTS Trajectories of functional decline showed strong age acceleration late in life in healthy older men and women as well as in chronically ill older adults. Adiponectin, IL-6 and cystatin-C tracked with functional decline in all domains; cystatin-C was consistently associated with functional declines independent of other biomarkers. DHEAS was independently associated with grip strength and IL-6 with grip strength and gait speed trajectories. CONCLUSIONS Functional decline in late life appears to mark a fundamental ageing process in that it occurred and was accelerated in late life regardless of health status. Cystatin C was most consistently associated with these functional declines.
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Affiliation(s)
- Anne B Newman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason L Sanders
- Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital, and Brigham and Women's Hospital Department of Emergency Medicine, Boston, MA, USA
| | - Jorge R Kizer
- Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, Bronx, NY, USA
| | - Robert M Boudreau
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michelle C Odden
- Department of Epidemiology, Oregon State University, Corvallis, OR, USA
| | | | - Alice M Arnold
- Collaborative Health Studies Coordinating Center, University of Washington, Seattle, WA, USA
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Santanasto AJ, Coen PM, Glynn NW, Conley KE, Jubrias SA, Amati F, Strotmeyer ES, Boudreau RM, Goodpaster BH, Newman AB. The relationship between mitochondrial function and walking performance in older adults with a wide range of physical function. Exp Gerontol 2016; 81:1-7. [PMID: 27084585 DOI: 10.1016/j.exger.2016.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Age related declines in walking performance may be partly attributable to skeletal muscle mitochondrial dysfunction as mitochondria produce over 90% of ATP needed for movement and the capacity for oxidative phosphorylation decreases with age. METHODS Participants were from two studies: an ancillary to the Lifestyle Interventions and Independence for Elders (LIFE) Study (n=33), which recruited lower functioning participants (Short Physical Performance Battery [SPPB], 7.8±1.2), and the Study of Energy and Aging-Pilot (SEA, n=29), which enrolled higher functioning (SPPB, 10.8±1.4). Physical activity was measured objectively using the Actigraph accelerometer (LIFE) and SenseWear Pro armband (SEA). Phosphocreatine recovery following muscle contraction of the quadriceps was measured using (31)P magnetic resonance spectroscopy and ATPmax (mM ATP/s) was calculated. Walking performance was defined as time (s) to walk 400m at a usual-pace. The cross-sectional association between mitochondrial function and walking performance was assessed using multivariable linear regression. RESULTS Participants were 77.6±5.3years, 64.2% female and 67.2% white. ATPmax was similar in LIFE vs. SEA (0.52±0.14 vs. 0.55±0.14, p=0.31), despite different function and activity levels (1.6±2.2 vs.77.4±73.3min of moderate activity/day, p<0.01). Higher ATPmax was related to faster walk-time in SEA (r(2)=0.19, p=0.02,); but not the LIFE (r(2)<0.01, p=0.74) cohort. CONCLUSIONS Mitochondrial function was associated with walking performance in higher functioning, active older adults, but not lower functioning, sedentary older adults.
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Aneke-Nash CS, Dominguez-Islas C, Bůžková P, Qi Q, Xue X, Pollak M, Strickler HD, Kaplan RC. Agreement between circulating IGF-I, IGFBP-1 and IGFBP-3 levels measured by current assays versus unavailable assays previously used in epidemiological studies. Growth Horm IGF Res 2016; 26:11-16. [PMID: 26774400 PMCID: PMC4724357 DOI: 10.1016/j.ghir.2015.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/30/2015] [Accepted: 12/06/2015] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Levels of insulin-like growth factor (IGF) proteins are associated with the risk of cancer and mortality. IGF assays produced by Diagnostic Systems Laboratories (DSL) were widely used in epidemiological studies, were not calibrated against recommended standards and are no longer commercially available. DESIGN In a split sample study among 1471 adults participating in the Cardiovascular Health Study, we compared values obtained using DSL assays with alternative assays for serum IGF-I (Immunodiagnostic Systems, IDS), IGFBP-1 (American Laboratory Products Company, ALPCO) and IGFBP-3 (IDS). RESULTS Results were compared using kernel density estimation plots, quartile analysis with weighted kappa statistics and linear regression models to assess the concordance of data from the different assays. Participants had a mean age of 77years. Results between alternative assays were strongly correlated (IGF-I, r=0.93 for DSL versus IDS; log-IGFBP-1, r=0.90 for DSL versus ALPCO; IGFBP-3, r=0.92 for DSL versus IDS). Cross tabulations showed that participants were usually in the same quartile categories regardless of the assay used (overall agreement, 74% for IGF-I, 64% for IGFBP-1, 71% for IGFBP-3). Weighted kappa also showed substantial agreement between assays (kw, 0.78 for IGF-I, 0.69 for IGFBP-1, 0.76 for IGFBP-3). Regressions of levels obtained with DSL assays (denoted X) to alternative assays were, IGF-I: 0.52X+15.2ng/ml, log-IGFBP-1: 1.01X-1.73ng/ml IGFBP-3: 0.87X+791.1ng/ml. Serum values of IGF-I, IGFBP-1 and IGFBP-3 measured using alternative assays are moderately correlated. CONCLUSIONS Care is needed in the interpretation of data sets involving IGF analytes if assay methodologies are not uniform.
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Affiliation(s)
- Chino S Aneke-Nash
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States.
| | | | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Qibin Qi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Michael Pollak
- Department of Medicine and Oncology, McGill University, Montreal, Quebec, Canada
| | - Howard D Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, United States
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Aneke-Nash CS, Parrinello CM, Rajpathak SN, Rohan TE, Strotmeyer ES, Kritchevsky SB, Psaty BM, Bůžková P, Kizer JR, Newman AB, Strickler HD, Kaplan RC. Changes in insulin-like growth factor-I and its binding proteins are associated with diabetes mellitus in older adults. J Am Geriatr Soc 2015; 63:902-9. [PMID: 25989565 DOI: 10.1111/jgs.13390] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether changes in insulin-like growth factor (IGF) protein levels are greater in participants with type 2 diabetes mellitus or worsening glycemia than in normoglycemic individuals over a 9-year follow-up period. DESIGN Retrospective analysis of a cohort study. SETTING Participants were recruited from North Carolina, California, Maryland, and Pennsylvania. PARTICIPANTS Cardiovascular Health Study All Stars participants, a cohort study of community-dwelling adults aged 65 and older (N=897). MEASUREMENTS Plasma IGF-I, IGF binding protein (IGFBP)-1, and IGFBP-3 levels were assessed and American Diabetes Association cut-points for impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and diabetes mellitus were used to classify participants at baseline (1996-97) and follow-up (2005-06). RESULTS At baseline, mean age was 76.3±3.6, and 18.5% had diabetes mellitus. Participants with IFG alone and IGT plus IFG had higher IGF-I levels and lower IGFBP-1 levels than those with normoglycemia or diabetes mellitus. The greatest percentage change in IGF levels occurred in those who had diabetes mellitus at baseline (9-year changes: -9.3% for IGF-I, 59.7% for IGFBP-1, -13.4% for IGFBP-3), the smallest in individuals who remained normoglycemic at follow-up (9-year changes: -3.7% for IGF-I, 25.6% for IGFBP-1, -6.4% for IGFBP-3), and intermediate in those who were normoglycemic but developed IFG at follow-up. CONCLUSION Degrees of glycemic impairment are associated with varying degrees of change in IGF protein levels. The changes observed in the diabetes mellitus group have been previously shown to be associated with heart failure, cancer, and noncancer mortality.
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Affiliation(s)
- Chino S Aneke-Nash
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Christina M Parrinello
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Swapnil N Rajpathak
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Merck & Co., Inc., Whitehouse Station, New Jersey
| | - Thomas E Rohan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen B Kritchevsky
- Sticht Center on Aging, Section on Gerontology and Geriatric Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Bruce M Psaty
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Petra Bůžková
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Jorge R Kizer
- Departments of Medicine and Public Health, Weill Medical College, Cornell University, New York, New York
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Howard D Strickler
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Robert C Kaplan
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
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Eifert EK, Wideman L, Oberlin DJ, Labban J. The relationship between physical activity and perceived health status in older women: findings from the Woman's College Alumni Study. J Women Aging 2015; 26:305-18. [PMID: 25133943 DOI: 10.1080/08952841.2014.906878] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Using data collected from the Woman's College (WC) Alumni Study, the purpose of this study was to determine whether perceived health status is related to physical activity in older women. A multiple linear regression analysis was conducted to examine the relationship between amounts of physical activity and self-reported health status. The results of the current study reveal that the level of physical activity is significantly correlated with perceived health status. The findings of this study have implications for the assessment of older individuals' health and may lead to interventions that are tailored to increase physical activity among older women.
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Affiliation(s)
- Elise K Eifert
- a Department of Public Health Education , University of North Carolina at Greensboro , Greensboro , NC
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Bůžková P, Lumley T. Time to Diagnosis: Accounting for Differential Endpoint Follow-up in Multi-Cohort Studies. COMMUN STAT-SIMUL C 2015. [DOI: 10.1080/03610918.2013.773344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kolovou GD, Kolovou V, Mavrogeni S. We are ageing. Biomed Res Int 2014; 2014:808307. [PMID: 25045704 DOI: 10.1155/2014/808307] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 05/27/2014] [Accepted: 05/27/2014] [Indexed: 02/01/2023]
Abstract
Ageing and longevity is unquestioningly complex. Several thoughts and mechanisms of ageing such as pathways involved in oxidative stress, lipid and glucose metabolism, inflammation, DNA damage and repair, growth hormone axis and insulin-like growth factor (GH/IGF), and environmental exposure have been proposed. Also, some theories of ageing were introduced. To date, the most promising leads for longevity are caloric restriction, particularly target of rapamycin (TOR), sirtuins, hexarelin and hormetic responses. This review is an attempt to analyze the mechanisms and theories of ageing and achieving longevity.
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Bell CL, Chen R, Masaki K, Yee P, He Q, Grove J, Donlon T, Curb JD, Willcox DC, Poon LW, Willcox BJ. Late-life factors associated with healthy aging in older men. J Am Geriatr Soc 2014; 62:880-8. [PMID: 24779449 DOI: 10.1111/jgs.12796] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To identify potentially modifiable late-life biological, lifestyle, and sociodemographic factors associated with overall and healthy survival to age 85. DESIGN Prospective longitudinal cohort study with 21 years of follow-up (1991-2012). SETTING Hawaii Lifespan Study. PARTICIPANTS American men of Japanese ancestry (mean age 75.7, range 71-82) without baseline major clinical morbidity and functional impairments (N = 1,292). MEASUREMENTS Overall survival and healthy survival (free from six major chronic diseases and without physical or cognitive impairment) to age 85. Factors were measured at late-life baseline examinations (1991-1993). RESULTS Of 1,292 participants, 1,000 (77%) survived to 85 (34% healthy) and 309 (24%) to 95 (<1% healthy). Late-life factors associated with survival and healthy survival included biological (body mass index, ankle-brachial index, cognitive score, blood pressure, inflammatory markers), lifestyle (smoking, alcohol use, physical activity), and sociodemographic factors (education, marital status). Cumulative late-life baseline risk factor models demonstrated that age-standardized (at 70) probability of survival to 95 ranged from 27% (no factors) to 7% (≥ 5 factors); probability of survival to 100 ranged from 4% (no factors) to 0.1% (≥ 5 factors). Age-standardized (at 70) probability of healthy survival to 90 ranged from 4% (no factors) to 0.01% (≥ 5 factors). There were nine healthy survivors at 95 and one healthy survivor at 100. CONCLUSION Several potentially modifiable risk factors in men in late life (mean age 75.7) were associated with markedly greater probability of subsequent healthy survival and longevity.
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Affiliation(s)
- Christina L Bell
- Department of Geriatric Medicine, John A. Hartford Center of Excellence in Geriatrics, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Sanders JL, Ding V, Arnold AM, Kaplan RC, Cappola AR, Kizer JR, Boudreau RM, Cushman M, Newman AB. Do changes in circulating biomarkers track with each other and with functional changes in older adults? J Gerontol A Biol Sci Med Sci 2014; 69:174-81. [PMID: 23811185 PMCID: PMC4038245 DOI: 10.1093/gerona/glt088] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/24/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is unclear if changes in proposed circulating biomarkers of aging are strongly correlated to each other or functional change. We tested if biomarker changes track with each other and with functional measures over 9 years in older adults. METHODS Dehydroepiandrosterone sulfate (DHEAS), adiponectin, insulin-like growth factor 1 (IGF-1), IGF binding proteins 1 (IGFBP-1) and 3 (IGFBP-3), interleukin-6 (IL-6), cholesterol, and function (gait speed, grip strength, Modified Mini Mental Status Exam [3MSE] and Digit Symbol Substitution Test [DSST] scores) were measured in 1996-1997 and 2005-2006 in the Cardiovascular Health Study All Stars study (N = 901, mean [standard deviation, SD] age 85.3 [3.6] years in 2005-2006). Adjusted Pearson correlations illustrated if biomarkers tracked together. Multivariable linear regression demonstrated if biomarker changes tracked with functional changes. RESULTS Correlations among biomarker changes were mostly <0.2. In models with each biomarker entered separately, a 1-SD increase biomarker change was associated with change in function as follows: grip strength (DHEAS β = 0.61kg, p = .001; IL-6 β = -0.46kg, p = .012; cholesterol men β = 0.79kg, p = .016); gait speed (DHEAS β = 0.02 meters per second, p = .039; IL-6 β = -0.018 meters per second, p = .049); and DSST score (DHEAS women β = 1.46, p = .004; IL-6 β = -0.83, p = .027). When biomarkers were entered in the same model, significant associations remaining were as follows: grip strength (DHEAS β = 0.54kg, p = .005; IL-6 β = -0.43kg, p = .022); 3MSE score (IGF-1 β = 0.96, p = .04; IGFBP-3 β = -1.07, p = .024); and DSST score (DHEAS women β = 1.27, p = .012; IL-6 β = -0.80, p = .04). CONCLUSION Changes in biomarkers were poorly correlated, supporting a model of stochastic, independent change across systems. DHEAS and IL-6 tracked most closely with function, illustrating that changes in inflammation and sex steroids may play dominant roles in changes of these functional outcomes.
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Affiliation(s)
- Jason L Sanders
- Bellefield Professional Building 4th Floor, 130 North Bellefield Avenue, Pittsburgh, PA 15213.
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Canavan M, Glynn LG, Smyth A, Mulkerrin EC, Murphy AW, Mulqueen J, McGrath ER, O'Donnell MJ. Vascular risk factors, cardiovascular disease and functional impairment in community-dwelling adults. Gerontology 2014; 60:212-21. [PMID: 24457648 DOI: 10.1159/000356744] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Older adults report preservation of functional independence as one of the most important constructs of successful ageing. Vascular risk factors may increase the risk of functional impairment due to clinical and subclinical vascular disease. OBJECTIVE To describe the association between vascular risk factors and impaired ability to perform daily living activities, independent of established cardiovascular disease. METHODS We conducted an analysis of the Clarity Cohort, which is a cross-sectional study of 9,816 community-dwelling Irish adults. Of the total cohort, 3,499 completed standardized self-reported health questionnaires, which included questions on activities of daily living. Functional impairment was defined as self-reported impairment in self-care, mobility or household tasks. Using logistic regression analyses, we determined the association between vascular risk factors and functional impairment, independent of demographics, prior coronary artery disease, stroke, congestive heart failure, and peripheral vascular disease. RESULTS Functional impairment was reported in 40.4% (n = 1,413) of the cohort overall and in 23% of those with established cardiovascular disease. The mean age was 66.2 ± 10.3 years, 52% of the cohort were aged over 65 and 45.6% were male. Some difficulty with instrumental activities of daily living was reported by 35.4% (n = 1,240) while 29.4% (n = 1,029) reported some difficulty with basic activities of daily living. On multivariable analysis, older age [OR 1.03 (1.02, 1.04) per year], current smoking [OR 1.43 (1.08, 1.89)], atrial fibrillation [OR 1.68 (1.07, 2.65)], former alcohol use [OR 1.87 (1.36, 2.57)] and prior stroke [OR 1.91 (1.24, 2.93)] were associated with an increased risk of functional impairment. Older age leaving education [OR 0.96 (0.94, 0.99)], non-use of alcohol [OR 0.76 (0.61, 0.93)] and increased high-density lipoprotein levels [OR 0.70 (0.56, 0.88)] were associated with reduced risk of functional impairment. CONCLUSIONS Independent of established cardiovascular disease, some vascular risk factors are associated with functional impairment. Modification of these risk factors is expected to have a large impact on preservation of functional independence through prevention of overt and covert vascular disease.
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Affiliation(s)
- Michelle Canavan
- Department of Geriatric Medicine, Galway University Hospital, Galway, Ireland
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Rillamas-Sun E, LaCroix AZ, Waring ME, Kroenke CH, LaMonte MJ, Vitolins MZ, Seguin R, Bell CL, Gass M, Manini TM, Masaki KH, Wallace RB. Obesity and late-age survival without major disease or disability in older women. JAMA Intern Med 2014; 174:98-106. [PMID: 24217806 PMCID: PMC3963496 DOI: 10.1001/jamainternmed.2013.12051] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE The effect of obesity on late-age survival in women without disease or disability is unknown. OBJECTIVE To investigate whether higher baseline body mass index and waist circumference affect women's survival to 85 years of age without major chronic disease (coronary disease, stroke, cancer, diabetes mellitus, or hip fracture) and mobility disability. DESIGN, SETTING, AND PARTICIPANTS Examination of 36,611 women from the Women's Health Initiative observational study and clinical trial programs who could have reached 85 years or older if they survived to the last outcomes evaluation on September 17, 2012. Recruitment was from 40 US clinical centers from October 1993 through December 1998. Multinomial logistic regression models were used to estimate odds ratios and 95% CIs for the association of baseline body mass index and waist circumference with the outcomes, adjusting for demographic, behavioral, and health characteristics. MAIN OUTCOMES AND MEASURES Mutually exclusive classifications: (1) survived without major chronic disease and without mobility disability (healthy); (2) survived with 1 or more major chronic disease at baseline but without new disease or disability (prevalent diseased); (3) survived and developed 1 or more major chronic disease but not disability during study follow-up (incident diseased); (4) survived and developed mobility disability with or without disease (disabled); and (5) did not survive (died). RESULTS Mean (SD) baseline age was 72.4 (3.0) years (range, 66-81 years). The distribution of women classified as healthy, prevalent diseased, incident diseased, disabled, and died was 19.0%, 14.7%, 23.2%, 18.3%, and 24.8%, respectively. Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. Relative to healthy-weight women, adjusted odds ratios (95% CIs) of mobility disability were 1.6 (1.5-1.8) for overweight women and 3.2 (2.9-3.6), 6.6 (5.4-8.1), and 6.7 (4.8-9.2) for class I, II, and III obesity, respectively. Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability. CONCLUSIONS AND RELEVANCE Overall and abdominal obesity were important and potentially modifiable factors associated with dying or developing mobility disability and major chronic disease before 85 years of age in older women.
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Affiliation(s)
- Eileen Rillamas-Sun
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington2Group Health Research Institute, Seattle, Washington
| | - Andrea Z LaCroix
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington2Group Health Research Institute, Seattle, Washington
| | - Molly E Waring
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | | | - Michael J LaMonte
- Department of Social and Preventive Medicine, University at Buffalo, The State University of New York, Buffalo
| | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Rebecca Seguin
- Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington7Division of Nutritional Sciences, Cornell University, Ithaca, New York
| | - Christina L Bell
- Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Margery Gass
- The North American Menopause Society, Cleveland, Ohio
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Kamal H Masaki
- Department of Geriatric Medicine, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - Robert B Wallace
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City
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Affiliation(s)
- Majon Muller
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. E mail
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van Peet PG, Drewes YM, de Craen AJM, Westendorp RGJ, Gussekloo J, de Ruijter W. Prognostic value of cardiovascular disease status: the Leiden 85-plus study. Age (Dordr) 2013; 35:1433-1444. [PMID: 22760858 PMCID: PMC3705125 DOI: 10.1007/s11357-012-9443-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 06/07/2012] [Indexed: 06/01/2023]
Abstract
This study aimed to explore the prognosis of very old people depending on their cardiovascular disease (CVD) history. This observational prospective cohort study included 570 participants aged 85 years from the general population with 5-year follow-up for morbidity, functional status, and mortality. At baseline, participants were assigned to three groups: no CVD history, "minor" CVD (angina pectoris, transient ischemic attack, intermittent claudication, and/or heart failure), or "major" CVD (myocardial infarction [MI], stroke, and/or arterial surgery). Follow-up data were collected on MI, stroke, functional status, and cause-specific mortality. The composite endpoint included cardiovascular events (MI or stroke) and cardiovascular mortality. At baseline, 270 (47.4 %) participants had no CVD history, 128 (22.4 %) had minor CVD, and 172 (30.2 %) had major CVD. Compared to the no CVD history group, the risk of the composite endpoint increased from 1.6 (95 % confidence interval [CI], 1.1-2.4) for the minor CVD group to 2.7 (95 % CI, 2.0-3.9) for the major CVD group. Similar trends were observed for cardiovascular and all-cause mortality risks. In a direct comparison, the major CVD group had a nearly doubled risk of the composite endpoint (hazard ratio, 1.8; 95 % CI, 1.2-2.7), compared to the minor CVD group. Both minor and major CVD were associated with an accelerated decline in cognitive function and accelerated increase of disability score (all p < 0.05), albeit most pronounced in participants with major CVD. CVD disease status in very old age is still of important prognostic value: a history of major CVD (mainly MI or stroke) leads to a nearly doubled risk of poor outcome, including cardiovascular events, functional decline, and mortality, compared with a history of minor CVD.
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Affiliation(s)
- Petra G van Peet
- Department of Public Health and Primary Care, Leiden University Medical Center, Postzone V0-P, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Schaap LA, Koster A, Visser M. Adiposity, Muscle Mass, and Muscle Strength in Relation to Functional Decline in Older Persons. Epidemiol Rev 2012; 35:51-65. [DOI: 10.1093/epirev/mxs006] [Citation(s) in RCA: 228] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 12/13/2022] Open
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Shastri S, Katz R, Rifkin DE, Fried LF, Odden MC, Peralta CA, Chonchol M, Siscovick D, Shlipak MG, Newman AB, Sarnak MJ. Kidney function and mortality in octogenarians: Cardiovascular Health Study All Stars. J Am Geriatr Soc 2012; 60:1201-7. [PMID: 22724391 DOI: 10.1111/j.1532-5415.2012.04046.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the association between kidney function and all-cause mortality in octogenarians. DESIGN Retrospective analysis of prospectively collected data. SETTING Community. PARTICIPANTS Serum creatinine and cystatin C were measured in 1,053 Cardiovascular Health Study (CHS) All Stars participants. MEASUREMENTS Estimated glomerular filtration rate (eGFR) was determined using the Chronic Kidney Disease Epidemiology Collaboration creatinine (eGFR(CR) ) and cystatin C one-variable (eGFR(CYS) ) equations. The association between quintiles of kidney function and all-cause mortality was analyzed using unadjusted and adjusted Cox proportional hazards models. RESULTS Mean age of the participants was 85, 64% were female, 66% had hypertension, 14% had diabetes mellitus, and 39% had prevalent cardiovascular disease. There were 154 deaths over a median follow-up of 2.6 years. The association between eGFR(CR) and all-cause mortality was U-shaped. In comparison with the reference quintile (64-75 mL/min per 1.73 m(2) ), the highest (≥ 75 mL/min per 1.73 m(2) ) and lowest (≤ 43 mL/min per 1.73 m(2) ) quintiles of eGFR(CR) were independently associated with mortality (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.36-4.55; HR = 2.28, 95% CI = 1.26-4.10, respectively). The association between eGFR(CYS) and all-cause mortality was linear in those with eGFR(CYS) of less than 60 mL/min per 1.73 m(2) , and in the multivariate analyses, the lowest quintile of eGFR(CYS) (<52 mL/min per 1.73 m(2) ) was significantly associated with mortality (HR = 2.04, 95% CI = 1.12-3.71) compared with the highest quintile (>0.88 mL/min per 1.73 m(2) ). CONCLUSION Moderate reduction in kidney function is a risk factor for all-cause mortality in octogenarians. The association between eGFR(CR) and all-cause mortality differed from that observed with eGFR(CYS) ; the relationship was U-shaped for eGFR(CR) , whereas the risk was primarily present in the lowest quintile for eGFR(CYS) .
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Affiliation(s)
- Shani Shastri
- Division of Nephrology, University of Texas Southwestern, Dallas, Texas 75390, USA.
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Bernabeu-wittel M, Ollero-baturone M, Ruiz-cantero A, Moreno-gaviño L, Barón-franco B, Fuertes A, Murcia-zaragoza J, Ramos-cantos C, Alemán A. Functional Decline Over 1-year Follow-up in a Multicenter Cohort of Polypathological Patients: A New Approach to Functional Prognostication. INT J GERONTOL 2012; 6:68-74. [DOI: 10.1016/j.ijge.2011.09.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Stineman MG, Henry-Sánchez JT, Kurichi JE, Pan Q, Xie D, Saliba D, Zhang Z, Streim JE. Staging activity limitation and participation restriction in elderly community-dwelling persons according to difficulties in self-care and domestic life functioning. Am J Phys Med Rehabil 2012; 91:126-40. [PMID: 22248806 DOI: 10.1097/PHM.0b013e318241200d] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to describe the conceptual foundation and development of an activity limitation and participation restriction staging system for community-dwelling people 70 yrs or older according to the severity and types of self-care (activities of daily living [ADLs]) and domestic life (instrumental ADLs (IADLs)) limitations experienced. DESIGN Data from the second Longitudinal Study of Aging (N = 9447) were used to develop IADL stages through the analyses of self- and proxy-reported difficulties in performing IADLs. An analysis of activity limitation profiles identified hierarchical thresholds of difficulty that defined each stage. IADL stages are combined with ADL stages to profile status for independent living. RESULTS IADL stages define five ordered thresholds of increasing activity limitations and a ``not relevant'' stage for those who normally have someone else do those activities. Approximately 42% of the population experience IADL limitations. To achieve a stage, a person must meet or exceed stage-specific thresholds of retained functioning defined for each activity. Combined ADL and IADL stages define 29 patterns of activity limitations expressing the individual's potential for participating in life situations pertinent to self-care and independent community life. CONCLUSIONS ADL and IADL stages can serve to distinguish between groups of people according to both severity and the types of limitations experienced during home or outpatient assessments, in population surveillance, and in research.
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Jenny NS, French B, Arnold AM, Strotmeyer ES, Cushman M, Chaves PHM, Ding J, Fried LP, Kritchevsky SB, Rifkin DE, Sarnak MJ, Newman AB. Long-term assessment of inflammation and healthy aging in late life: the Cardiovascular Health Study All Stars. J Gerontol A Biol Sci Med Sci 2012; 67:970-6. [PMID: 22367431 DOI: 10.1093/gerona/glr261] [Citation(s) in RCA: 100] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Associations of inflammation with age-related pathologies are documented; however, it is not understood how changes in inflammation over time impact healthy aging. METHODS We examined associations of long-term change in C-reactive protein (CRP) and interleukin-6 (IL-6) with concurrent onset of physical and cognitive impairment, subsequent cardiovascular disease (CVD), and mortality in 1,051 participants in the Cardiovascular Health Study All Stars Study. Biomarkers were measured in 1996-1997 and 2005-2006. RESULTS In 2005-2006, median age was 84.9 years, 63% were women and 17% non-white; 21% had at least a doubling in CRP over time and 23% had at least a doubling in IL-6. Adjusting for demographics, CVD risk factors, and 1996-1997 CRP level, each doubling in CRP change over 9 years was associated with higher risk of physical or cognitive impairment (odds ratio 1.29; 95% confidence interval 1.15, 1.45). Results were similar for IL-6 (1.45; 1.20, 1.76). A doubling in IL-6 change over time, but not CRP, was associated with incident CVD events; hazard ratio (95% confidence interval) 1.34 (1.03, 1.75). Doubling in change in each biomarker was individually associated with mortality (CRP: 1.12 [1.03, 1.22]; IL-6 1.39 [1.16, 1.65]). In models containing both change and 2005-2006 level, only level was associated with CVD events and mortality. CONCLUSIONS Although increases in inflammation markers over 9 years were associated with higher concurrent risk of functional impairment and subsequent CVD events and mortality, final levels of each biomarker appeared to be more important in determining risk of subsequent events than change over time.
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Affiliation(s)
- Nancy S Jenny
- Department of Pathology, University of Vermont College of Medicine, 208 South Park Drive, Colchester, VT 05446, USA.
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Griffin P, Michel JJ, Huysman K, Logar AJ, Vallejo AN. Integration of immunity with physical and cognitive function in definitions of successful aging. Aging Dis 2012; 3:34-50. [PMID: 22500270 PMCID: PMC3320803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 02/27/2012] [Accepted: 02/27/2012] [Indexed: 05/31/2023] Open
Abstract
Studies comparing chronologically "young" versus "old" humans document age-related decline of classical immunological functions. However, older adults aged ≥65 years have very heterogeneous health phenotypes. A significant number of them are functionally independent and are surviving well into their 8(th)-11(th) decade life, observations indicating that aging or old age is not synonymous with immune incompetence. While there are dramatic age-related changes in the immune system, not all of these changes may be considered detrimental. Here, we review evidences for novel immunologic processes that become elaborated with advancing age that complement preserved classical immune functions and promote immune homeostasis later in life. We propose that elaboration such of late life immunologic properties is indicative of beneficial immune remodeling that is an integral component of successful aging, an emerging physiologic construct associated with similar age-related physiologic adaptations underlying maintenance of physical and cognitive function. We suggest that a systems approach integrating immune, physical, and cognitive functions, rather than a strict immunodeficiency-minded approach, will be key towards innovations in clinical interventions to better promote protective immunity and functional independence among the elderly.
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Affiliation(s)
- Patricia Griffin
- Department of Pediatrics, University of Pittsburgh School of Medicine; and Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
| | - Joshua J. Michel
- Department of Pediatrics, University of Pittsburgh School of Medicine; and Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
| | - Kristy Huysman
- Department of Pediatrics, University of Pittsburgh School of Medicine; and Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
| | - Alison J. Logar
- Department of Pediatrics, University of Pittsburgh School of Medicine; and Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
| | - Abbe N. Vallejo
- Department of Pediatrics, University of Pittsburgh School of Medicine; and Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA 15224, USA
- Department of Immunology, the Pittsburgh Cancer Institute, and the McGowan Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
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Vallejo AN. Aging Successfully: a Research and Public Health Priority for the 21(st) Century. Aging Dis 2012; 3:1-4. [PMID: 22500267 PMCID: PMC3320800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 02/29/2012] [Accepted: 02/29/2012] [Indexed: 05/31/2023] Open
Affiliation(s)
- Abbe N. Vallejo
- Correspondence should be addressed to: Dr. Abbe N. de Vallejo, Children’s Hospital of Pittsburgh Rangos Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA.
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Kizer JR, Arnold AM, Benkeser D, Ix JH, Djousse L, Zieman SJ, Barzilay JI, Tracy RP, Mantzoros CS, Siscovick DS, Mukamal KJ. Total and high-molecular-weight adiponectin and risk of incident diabetes in older people. Diabetes Care 2012; 35:415-23. [PMID: 22148099 PMCID: PMC3263897 DOI: 10.2337/dc11-1519] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To delineate the associations of total adiponectin, high-molecular-weight (HMW) adiponectin, and the HMW-to-total adiponectin ratio with diabetes in older adults. RESEARCH DESIGN AND METHODS Total and HMW adiponectin were measured in a population-based study of older adults. The relations of total adiponectin, HMW adiponectin, and their ratio with incident diabetes (n = 309) were assessed in 3,802 individuals. RESULTS Total and HMW adiponectin were highly correlated (r = 0.94). Analysis using cubic splines revealed that the associations between total and HMW adiponectin and new-onset diabetes were not linear. Specifically, after adjustment for confounders, there were similar inverse relationships for total (hazard ratio per SD 0.49 [95% CI 0.39-0.63]) and HMW adiponectin (0.42 [0.32-0.56]) with diabetes up to values of 20 and 10 mg/L, respectively, above which the associations plateaued. These associations persisted after adjustment for potential mediators (blood pressure, lipids, C-reactive protein, and homeostasis model assessment of insulin resistance [HOMA-IR]). There was, however, evidence of interaction by HOMA-IR in the lower range of adiponectin, with stronger inverse associations among insulin-sensitive than insulin-resistant participants. HMW-to-total adiponectin ratio showed a linear adjusted association with outcome, but this was abolished by inclusion of mediating variables. CONCLUSIONS In this older cohort, increasing concentrations of total and HMW adiponectin were associated with comparably lower risks of diabetes, but these associations leveled off with further increases above concentrations of 20 and 10 mg/L, respectively. The more pronounced risk decreases at the lower range among participants without insulin resistance support a role for adiponectin that is independent of baseline hyperinsulinemia, but this will require further investigation.
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Affiliation(s)
- Jorge R Kizer
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA.
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Vallejo AN, Hamel DL, Mueller RG, Ives DG, Michel JJ, Boudreau RM, Newman AB. NK-like T cells and plasma cytokines, but not anti-viral serology, define immune fingerprints of resilience and mild disability in exceptional aging. PLoS One 2011; 6:e26558. [PMID: 22028907 PMCID: PMC3197651 DOI: 10.1371/journal.pone.0026558] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 09/28/2011] [Indexed: 12/22/2022] Open
Abstract
Exceptional aging has been defined as maintenance of physical and cognitive function beyond the median lifespan despite a history of diseases and/or concurrent subclinical conditions. Since immunity is vital to individual fitness, we examined immunologic fingerprint(s) of highly functional elders. Therefore, survivors of the Cardiovascular Health Study in Pittsburgh, Pennsylvania, USA were recruited (n = 140; mean age = 86 years) and underwent performance testing. Blood samples were collected and examined blindly for humoral factors and T cell phenotypes. Based on results of physical and cognitive performance testing, elders were classified as "impaired" or "unimpaired", accuracy of group assignment was verified by discriminant function analysis. The two groups showed distinct immune profiles as determined by factor analysis. The dominant immune signature of impaired elders consisted of interferon (IFN)-γ, interleukin (IL)-6, tumor necrosis factor-α, and T cells expressing inhibitory natural killer-related receptors (NKR) CD158a, CD158e, and NKG2A. In contrast, the dominant signature of unimpaired elders consisted of IL-5, IL-12p70, and IL-13 with co-expression of IFN-γ, IL-4, and IL-17, and T cells expressing stimulatory NKRs CD56, CD16, and NKG2D. In logistic regression models, unimpaired phenotype was predicted independently by IL-5 and by CD4(+)CD28(null)CD56(+)CD57(+) T cells. All elders had high antibody titers to common viruses including cytomegalovirus. In cellular bioassays, T cell receptor (TCR)-independent ligation of either CD56 or NKG2D elicited activation of T cells. Collectively, these data demonstrate the importance of immunological parameters in distinguishing between health phenotypes of older adults. NKR(+) T cells and cytokine upregulation indicate a unique physiologic environment in old age. Correlation of particular NKR(+) T cell subsets and IL-5 with unimpaired performance, and NKR-driven TCR-independent activation of T cells suggest novel immunopathway(s) that could be exploited to improve immunity in old age.
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Affiliation(s)
- Abbe N Vallejo
- Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States of America.
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Vallejo AN. Immune aging and challenges for immune protection of the graying population. Aging Dis 2011; 2:339-345. [PMID: 22396886 PMCID: PMC3295083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 10/20/2011] [Accepted: 10/22/2011] [Indexed: 05/31/2023] Open
Affiliation(s)
- Abbe N. Vallejo
- Correspondence should be addressed to: Dr. Abbe N. de Vallejo, Children’s Hospital of Pittsburgh Rangos Research Center, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA.
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Houston DK, Tooze JA, Davis CC, Chaves PHM, Hirsch CH, Robbins JA, Arnold AM, Newman AB, Kritchevsky SB. Serum 25-hydroxyvitamin D and physical function in older adults: the Cardiovascular Health Study All Stars. J Am Geriatr Soc 2011; 59:1793-801. [PMID: 22091492 DOI: 10.1111/j.1532-5415.2011.03601.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the association between 25-hydroxyvitamin D (25(OH)D) and physical function in adults of advanced age. DESIGN Cross-sectional and longitudinal analysis of physical function over 3 years of follow-up in the Cardiovascular Health Study All Stars. SETTING Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. PARTICIPANTS Community-dwelling adults aged 77 to 100 (N = 988). MEASUREMENTS Serum 25-hydroxyvitamin D 25(OH)D), Short Physical Performance Battery (SPPB), and grip and knee extensor strength assessed at baseline. Mobility disability (difficulty walking half a mile or up 10 steps) and activities of daily living (ADLs) disability were assessed at baseline and every 6 months over 3 years of follow-up. RESULTS Almost one-third (30.8%) of participants were deficient in 25(OH)D (<20 ng/mL). SPPB scores were lower in those with deficient 25(OH)D (mean (standard error) 6.53 (0.24)) than in those with sufficient 25(OH)D (≥30 ng/mL) (7.15 (0.25)) after adjusting for sociodemographic characteristics, season, health behaviors, and chronic conditions (P = .006). Grip strength adjusted for body size was also lower in those with deficient 25(OH)D than in those with sufficient 25(OH)D (24.7 (0.6) kg vs 26.0 (0.6) kg, P = .02). Participants with deficient 25(OH)D were more likely to have prevalent mobility (OR = 1.44, 95% confidence interval (CI)) = 0.96-2.14) and ADL disability (OR = 1.51, 95% CI = 1.01-2.25) at baseline than those with sufficient 25(OH)D. Furthermore, participants with deficient 25(OH)D were at greater risk of incident mobility disability over 3 years of follow-up (hazard ratio = 1.56, 95% CI = 1.06-2.30). CONCLUSION Vitamin D deficiency was common and was associated with poorer physical performance, lower muscle strength, and prevalent mobility and ADL disability in community-dwelling older adults. Moreover, vitamin D deficiency predicted incident mobility disability.
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Affiliation(s)
- Denise K Houston
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Sticht Center on Aging, Wake Forest School of Medicine, Winston Salem, NC 27157, USA.
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Strotmeyer ES, Kamineni A, Cauley JA, Robbins JA, Fried LF, Siscovick DS, Harris TB, Newman AB. Potential explanatory factors for higher incident hip fracture risk in older diabetic adults. Curr Gerontol Geriatr Res 2011; 2011:979270. [PMID: 21837239 DOI: 10.1155/2011/979270] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 03/22/2011] [Accepted: 05/24/2011] [Indexed: 01/08/2023] Open
Abstract
Type 2 diabetes is associated with higher fracture risk. Diabetes-related conditions may account for this risk. Cardiovascular Health Study participants (N = 5641; 42.0% men; 15.5% black; 72.8±5.6 years) were followed 10.9 ± 4.6 years. Diabetes was defined as hypoglycemic medication use or fasting glucose (FG) ≥126 mg/dL. Peripheral artery disease (PAD) was defined as ankle-arm index <0.9. Incident hip fractures were from medical records. Crude hip fracture rates (/1000 person-years) were higher for diabetic vs. non-diabetic participants with BMI <25 (13.6, 95% CI: 8.9–20.2 versus 11.4, 95% CI: 10.1–12.9) and BMI ≥25 to <30 (8.3, 95% CI: 5.7–11.9 versus 6.6, 95% CI: 5.6–7.7), but similar for BMI ≥30. Adjusting for BMI, sex, race, and age, diabetes was related to fractures (HR = 1.34; 95% CI: 1.01–1.78). PAD (HR = 1.25 (95% CI: 0.92–1.57)) and longer walk time (HR = 1.07 (95% CI: 1.04–1.10)) modified the fracture risk in diabetes (HR = 1.17 (95% CI: 0.87–1.57)). Diabetes was associated with higher hip fracture risk after adjusting for BMI though this association was modified by diabetes-related conditions.
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