Obesity in the elderly diabetic patient: is weight loss beneficial? No

AI Machine Learning-Based Diabetes Prediction in Older Adults in South Korea: Cross-Sectional Analysis

Background

Diabetes is prevalent in older adults, and machine learning algorithms could help predict diabetes in this population.

Objective

This study determined diabetes risk factors among older adults aged ≥60 years using machine learning algorithms and selected an optimized prediction model.

Methods

This cross-sectional study was conducted on 3084 older adults aged ≥60 years in Seoul from January to November 2023. Data were collected using a mobile app (Gosufit) that measured depression, stress, anxiety, basal metabolic rate, oxygen saturation, heart rate, and average daily step count. Health coordinators recorded data on diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, percent body fat, and percent muscle. The presence of diabetes was the target variable, with various health indicators as predictors. Machine learning algorithms, including random forest, gradient boosting model, light gradient boosting model, extreme gradient boosting model, and k-nearest neighbors, were employed for analysis. The dataset was split into 70% training and 30% testing sets. Model performance was evaluated using accuracy, precision, recall, F1 score, and area under the curve (AUC). Shapley additive explanations (SHAPs) were used for model interpretability.

Results

Significant predictors of diabetes included hypertension (χ²1=197.294; P<.001), hyperlipidemia (χ²1=47.671; P<.001), age (mean: diabetes group 72.66 years vs nondiabetes group 71.81 years), stress (mean: diabetes group 42.68 vs nondiabetes group 41.47; t3082=-2.858; P=.004), and heart rate (mean: diabetes group 75.05 beats/min vs nondiabetes group 73.14 beats/min; t3082=-7.948; P<.001). The extreme gradient boosting model (XGBM) demonstrated the best performance, with an accuracy of 84.88%, precision of 77.92%, recall of 66.91%, F1 score of 72.00, and AUC of 0.7957. The SHAP analysis of the top-performing XGBM revealed key predictors for diabetes: hypertension, age, percent body fat, heart rate, hyperlipidemia, basal metabolic rate, stress, and oxygen saturation. Hypertension strongly increased diabetes risk, while advanced age and elevated stress levels also showed significant associations. Hyperlipidemia and higher heart rates further heightened diabetes probability. These results highlight the importance and directional impact of specific features in predicting diabetes, providing valuable insights for risk stratification and targeted interventions.

Conclusions

This study focused on modifiable risk factors, providing crucial data for establishing a system for the automated collection of health information and lifelog data from older adults using digital devices at service facilities.

Prevalence and co-prevalence of comorbidities among Chinese adult patients with type 2 diabetes mellitus: a cross-sectional, multicenter, retrospective, observational study based on 3B study database

Purpose

This study aimed to investigate the prevalence and co-prevalence of comorbidities among Chinese individuals with type 2 diabetes (T2DM).

Methods

Medical records were retrospectively retrieved from the 3B Study database, which provided a comprehensive assessment of comorbid conditions in Chinese adult outpatients with T2DM. Patient characteristics, laboratory measures, and comorbidities were summarized via descriptive analyses, overall and by subgroups of age (<65, 65-74, 75 years) and gender.

Results

Among 25,454 eligible patients, 53% were female, and the median age was 63 years. The median time of diabetes duration was 6.18 years. A total of 20,309 (79.8%) patients had at least one comorbid condition alongside T2DM. The prevalence of patients with one, two, three, and four or more comorbid conditions was 28.0%, 24.6%, 15.6%, and 11.6%, respectively. Comorbidity burden increased with longer T2DM duration. Older age groups also exhibited higher comorbidity burden. Females with T2DM had a higher overall percentage of comorbidities compared to males (42.7% vs. 37.1%). The most common comorbid conditions in T2DM patients were hypertension (HTN) in 59.9%, overweight/obesity in 58.3%, hyperlipidemia in 42.0%, retinopathy in 16.5%, neuropathy in 15.2%, cardiovascular disease (CVD) in 14.9%, and renal disease in 14.4%. The highest co-prevalence was observed for overweight/obesity and HTN (37.6%), followed by HTN and hyperlipidemia (29.8%), overweight/obesity and hyperlipidemia (27.3%), HTN and CVD (12.6%), HTN and retinopathy (12.1%), and HTN and renal disease (11.3%).

Conclusion

The majority of T2DM patients exhibit multiple comorbidities. Considering the presence of multimorbidity is crucial in clinical decision-making.

Systematic review registration

https://clinicaltrials.gov/, identifier NCT01128205.

The effects of pomegranate peel added bread on anthropometric measurements, metabolic and oxidative parameters in individuals with type 2 diabetes: a double-blind, randomized, placebo-controlled study

BACKGROUND/OBJECTIVES

The aim of this study was to evaluate the sensory properties of antioxidant-rich bread made by adding pomegranate peels and their effects on anthropometric measurements and metabolic and oxidative parameters of individuals with type 2 diabetes after consumption.

SUBJECTS/METHODS

This randomized, double-blind, placebo-controlled study was conducted with 22 individuals aged between 19 and 64 years who had been diagnosed with type 2 diabetes for at least 5 years, used only metformin, did not lose more than 10% of their body weight in the last 6 months, and had a body mass index of ≥ 25.0 kg/m². While the study group (n = 11) consumed bread containing 500 mg pomegranate peel daily for 8 wk, the control group (n = 11) consumed standard bread. Anthropometric measurements and metabolic and oxidative parameters of individuals were evaluated at the beginning and end of the study.

RESULTS

Decreases were detected in the waist circumference, waist/hip and waist/height ratios, body fat percentages, blood pressure, and serum insulin, triglyceride, and total cholesterol levels in the individuals in the treatment group, compared with those in the control group (P < 0.05).

CONCLUSIONS

Pomegranate peel consumption by individuals with type 2 diabetes may have positive effects on anthropometric measurements and glycemic and lipid parameters.

Sociodemographic and behavioural risk factors for obesity among community-dwelling older adults in Ghana and Nigeria: A secondary analysis of data from the SIREN study

OBJECTIVES

To explore the prevalence and risk factors of obesity among older adults from low- and middle-income countries (LMICs).

METHODS

This is a secondary analysis of data obtained from the SIREN study through in-person interviews and measurements from healthy stroke-free older adults (≥60 years). Overweight/obesity was defined as body mass index ≥25 kg/m². Abdominal obesity was defined as waist-to-hip ratio (WHR) of >0.90 for males and >0.85/females or waist circumference (WC) of >102 cm for males/>88 cm for females. Adjusted odds ratio (aORs) with 95% confidence interval (CIs) of the relationship between obesity and sociodemographic factors were assessed at P < 0.05.

RESULTS

Overall, 47.5% of participants were overweight/obese, 76.6% had a larger than recommended WHR, and 54.4% had a larger than recommended WC. Abdominal obesity (WC; aOR: 9.43, CI: 6.99-12.50), being a Nigerian (aOR: 0.55; CI: 0.42-0.72), living in an urban setting (aOR: 1.92; CI: 1.49-2.46), earning >$100/month (aOR: 1.53; CI: 1.19-1.96), and having formal education (aOR: 1.42; CI: 1.08-1.87) were associated with overweight/obesity.

CONCLUSION

Living in urban settings, earning a higher income, and having a formal education were associated with a higher odds of obesity among older adults from LMICs.

Type 2 diabetes mellitus in older adults: clinical considerations and management

The past 50 years have seen a growing ageing population with an increasing prevalence of type 2 diabetes mellitus (T2DM); now, nearly half of all individuals with diabetes mellitus are older adults (aged ≥65 years). Older adults with T2DM present particularly difficult challenges. For example, the accentuated heterogeneity of these patients, the potential presence of multiple comorbidities, the increased susceptibility to hypoglycaemia, the increased dependence on care and the effect of frailty all add to the complexity of managing diabetes mellitus in this age group. In this Review, we offer an update on the key pathophysiological mechanisms associated with T2DM in older people. We then evaluate new evidence relating particularly to the effects of frailty and sarcopenia, the clinical difficulties of age-associated comorbidities, and the implications for existing guidelines and therapeutic options. Our conclusions will focus on the effect of T2DM on an ageing society.

Does the Impact of Intensive Lifestyle Intervention on Cardiovascular Disease Risk Vary According to Frailty as Measured via Deficit Accumulation?

BACKGROUND

Individuals are often counseled to use behavioral weight loss strategies to reduce risk for cardiovascular disease (CVD). We examined whether any benefits for CVD risk from weight loss intervention extend uniformly to individuals across a range of underlying health states.

METHODS

The time until first occurrence of a composite of fatal and nonfatal myocardial infarction and stroke, hospitalized angina, or CVD death was analyzed from 8 to 11 years of follow-up of 4,859 adults who were overweight or obese, aged 45-76 years with Type 2 diabetes. Individuals had been randomly assigned to either an intensive lifestyle intervention (ILI) or diabetes support and education (DSE). Participants were grouped by intervention assignment and a frailty index (FI) based on deficit accumulation, ordered from fewer (first tertile) to more (third tertile) deficits.

RESULTS

Baseline FI scores were unrelated to intervention-induced weight losses and increased physical activity. The relative effectiveness of ILI on CVD incidence was inversely related to baseline FI in a graded fashion (p = .01), with relative benefit (hazard ratio = 0.73 [95% CI 0.55,0.98]) for individuals in the first FI tertile to no benefit (hazard ratio = 1.15 [0.94,1.42]) among those in the third FI tertile. This graded relationship was not seen for individuals ordered by age tertile (p = .52), and was stronger among participants aged 45-59 years (three-way interaction p = .04).

CONCLUSIONS

In overweight/obese adults with diabetes, multidomain lifestyle interventions may be most effective in reducing CVD if administered before individuals have accrued many age-related health deficits. However, these exploratory analyses require confirmation by other studies.

CLINICAL TRIAL REGISTRATION

NCT00017953.

Acute effects of whey protein on energy intake, appetite and gastric emptying in younger and older, obese men

BACKGROUND

Obesity is becoming more prevalent in older people. A management strategy in obese, young adults is to increase dietary protein relative to other macronutrients. It is not clear if this is effective in obese, older individuals. Obesity may be associated with diminished sensitivity to nutrients. We have reported that a 30-g whey protein drink slows gastric emptying more, and suppresses energy intake less, in older, than younger, non-obese men. The aim of this study was to determine the effect of a 30 g whey protein drink on energy intake, GE and glycaemia in obese, older and younger men.

METHODS

In randomized, double-blind order, 10 younger (age: 27 ± 2 years; BMI: 36 ± 2 kg/m²), and 10 older (72 ± 1 years; 33 ± 1 kg/m²), obese men were studied twice. After an overnight fast, subjects ingested a test drink containing 30 g whey protein (120 kcal) or control (2 kcal). Postprandial gastric emptying (antral area, 2D Ultrasound) and blood glucose concentrations were measured for 180 min. At t = 180 min subjects were given a buffet meal and ad libitum energy intake was assessed.

RESULTS

Older subjects ate non-significantly less (~20%) that the younger subjects (effect of age, P = 0.16). Whey protein had no effect on subsequent energy intake (kcal) compared to control in either the younger (decrease 3 ± 8%) or older (decrease 2 ± 8%) obese men (age effect P > 0.05, protein effect P = 0.46, age × protein interaction effect P = 0.84). Whey protein slowed gastric emptying, to a similar degree in both age groups (50% emptying time: control vs. protein young men: 255 ± 5 min vs. 40 ± 7 min; older men: 16 ± 5 min vs. 50 ± 8 min; protein effect P = 0.001, age effect P = 0.93, age × protein interaction effect P = 0.13).

CONCLUSIONS

Our data suggest that obesity may blunt/abolish the age-related effect of whey protein on suppression of energy intake.

Effectiveness of a community program for older adults with type 2 diabetes and multimorbidity: a pragmatic randomized controlled trial

BACKGROUND

Type II diabetes mellitus (T2DM) affects upwards of 25% of Canadian older adults and is associated with high comorbidity and burden. Studies show that lifestyle factors and self-management are associated with improved health outcomes, but many studies lack rigour or exclude older adults, particularly those with multimorbidity. More evidence is needed on the effectiveness of community-based self-management programs in older adults with T2DM and multimorbidity. The study purpose is to evaluate the effect of a community-based intervention versus usual care on physical functioning, mental health, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with T2DM and 2 or more comorbidities.

METHODS

Community-living older adults with T2DM and two or more chronic conditions were recruited from three Primary Care Networks (PCNs) in Alberta, Canada. Participants were randomly allocated to the intervention or control group in this pragmatic randomized controlled trial comparing the intervention to usual care. The intervention involved up to three in-home visits, a monthly group wellness program, monthly case conferencing, and care coordination. The primary outcome was physical functioning. Secondary outcomes included mental functioning, anxiety, depressive symptoms, self-efficacy, self-management, and the cost of healthcare service use. Intention-to-treat analysis was performed using ANCOVA modeling.

RESULTS

Of 132 enrolled participants (70-Intervention, 62-Control), 42% were 75 years or older, 55% were female, and over 75% had at least six chronic conditions (in addition to T2DM). No significant group differences were seen for the baseline to six-month change in physical functioning (mean difference: -0.74; 95% CI: - 3.22, 1.74; p-value: 0.56), mental functioning (mean difference: 1.24; 95% CI: - 1.12, 3.60; p-value: 0.30), or other secondary outcomes..

CONCLUSION

No significant group differences were seen for the primary outcome, physical functioning (PCS). Program implementation, baseline differences between study arms and chronic disease management services that are part of usual care may have contributed to the modest study results. Fruitful areas for future research include capturing clinical outcome measures and exploring the impact of varying the type and intensity of key intervention components such as exercise and diet.

TRIAL REGISTRATION

NCT02158741 Date of registration: June 9, 2014.

Actual Use of Multiple Health Monitors Among Older Adults With Diabetes: Pilot Study

Background

Previous studies have reported older adults’ perceptions of using health monitors; however, no studies have examined the actual use of multiple health monitors for lifestyle changes over time among older adults with type 2 diabetes (T2D).

Objective

The primary aim of this study was to examine the actual use of multiple health monitors for lifestyle changes over 3 months among older adults with T2D. The secondary aim was to explore changes in caloric intake and physical activity (PA) over 3 months.

Methods

This was a single-group study lasting 3 months. The study sample included participants who were aged ≥65 years with a diagnosis of T2D. Participants were recruited through fliers posted at the Joslin Diabetes Center in Boston. Participants attended five 60-min, biweekly group sessions, which focused on self-monitoring, goal setting, self-regulation to achieve healthy eating and PA habits, and the development of problem-solving skills. Participants were provided with the Lose It! app to record daily food intake and devices such as a Fitbit Alta for monitoring PA, a Bluetooth-enabled blood glucose meter, and a Bluetooth-enabled digital scale. Descriptive statistics were used for analysis.

Results

Of the enrolled participants (N=9), the sample was white (8/9, 89%) and female (4/9, 44%), with a mean age of 76.4 years (SD 6.0; range 69-89 years), 15.7 years (SD 2.0) of education, 33.3 kg/m² (SD 3.1) BMI, and 7.4% (SD 0.8) hemoglobin A_1c. Over the 84 days of self-monitoring, the mean percentage of days using the Lose It!, Fitbit Alta, blood glucose meter, and scale were 82.7 (SD 17.6), 85.2 (SD 19.7), 65.3 (SD 30.1), and 53.0 (SD 34.5), respectively. From baseline to completion of the study, the mean daily calorie intake was 1459 (SD 661) at week 1, 1245 (SD 554) at week 11, and 1333 (SD 546) at week 12, whereas the mean daily step counts were 5618 (SD 3654) at week 1, 5792 (SD 3814) at week 11, and 4552 (SD 3616) at week 12. The mean percentage of weight loss from baseline was 4.92% (SD 0.25). The dose of oral hypoglycemic agents or insulin was reduced in 55.6% (5/9) of the participants.

Conclusions

The results from the pilot study are encouraging and suggest the need for a larger study to confirm the outcomes. In addition, a study design that includes a control group with educational sessions but without the integration of technology would offer additional insight to understand the value of mobile health in behavior changes and the health outcomes observed during this pilot study.

Clinical Profile of Elderly Patients (Over 90 Years) with Type 2 Diabetes Seen at a Diabetes Center in South India

Background: The current life expectancy in India is <70 years. Type 2 diabetes mellitus (T2DM) is known to reduce life expectancy by 6-8 years. Hence elderly people with T2DM in India would be rare. We report on the clinical profile of Asian Indian patients with T2DM who lived beyond 90 years of age and compared them with T2DM patients aged 50 to 60 years. Methods: From the diabetes electronic medical records of >470,000 diabetes patients, we identified T2DM patients who had lived ≥90 years and compared them with those in the 50-60 years age group, matched for gender and duration of diabetes. Clinical data included age at last visit, age at diagnosis, duration of diabetes, family history, smoking and alcohol, details of medications, body mass index (BMI), and blood pressure. Biochemical data included fasting and postprandial plasma glucose, glycated hemoglobin, fasting and stimulated C-peptide levels, lipid profile, and renal function studies. Assessment of retinopathy, nephropathy, neuropathy, coronary artery disease (CAD), and peripheral vascular disease (PVD) was also done. Results: A total of 325 T2DM patients aged ≥90 years and 278 T2DM patients aged between 50 and 60 years were selected for the study. Patients aged ≥90 years had higher systolic blood pressure (P < 0.001) and lower BMI (P < 0.001) than those between 50 and 60 years. Prevalence of retinopathy (29.7% vs. 53.5%) and macroalbuminuria (3.7% vs. 16.0%) was lower in the ≥90 years T2DM patients than in the 50-60 years age group. However, prevalence of neuropathy (89.8% vs. 50.8%), PVD (13.5% vs. 2.0%), and CAD (60.3% vs. 32.0%) was higher among the ≥90 years patients. Eighty-five percent of the T2DM aged ≥90 years were on oral hypoglycemic agents (OHAs), (of whom 64.9% were on sulfonylurea), 12% were on insulin, and 3% on diet alone. Among the 50-60 years old, 87.8% were on OHAs and 12.2% on insulin. Conclusions: This is the first report on the clinical profile of Asian Indians with T2DM aged ≥90 years, and significant differences are seen in their clinical profile compared with younger T2DM patients.

[Problems of optimal nutrition of elderly and senile patients with comorbidities against obesity]

AIM

To analyze the effectiveness of the main and low - calorie standard diets in elderly and senile patients with comorbidities against obesity.

MATERIALS AND METHODS

Retrospective analysis of the inpatient data. Patients received the main or low - calorie standard diet at the Nutrition clinic. The analysis included clinical, laboratory, body composition (bioimpedance) parameters and the results of indirect calorimetry. The primary endpoint was anthropometric and body composition data. Statistical analysis was performed using Statistica 10.0 for Windows 6.1 (StatSoft Inc., USA).

RESULTS AND DISCUSSION

46 patients were included in the analysis. The average age was 65 years (95% CI 63.63-66.37 years). All patients had abdominal obesity. 44 patients (97.78%) had hypertension, 32 (71.11%) - osteoarthrosis, 28 (60.87%) - dyslipidemia, 16 (35.56%) - diabetes mellitus; and сoronary artery disease was detected in 9 patients (20%). Diet therapy caused a statistically significant decrease in body weight, waist and hip circumferences, fat mass, lean mass, total body fluid and muscle mass (in particular, 25.35% weight loss was due to muscle mass loss), as well as the improvement of lipid profile.

CONCLUSION

Dietary interventions, such as main and low - calorie standard diets, routinely used for inpatient settings allow us to reduce body weight and improve anthropometric parameters in elderly and senile obese patients with comorbidities, which is accompanied by positive changes in lipid and carbohydrate metabolism even in a short - term follow - up. However, the protein content for standard diets is insufficient for this target group and leads to the loss of both fat and muscle mass.

Efficacy and safety of insulin glargine/lixisenatide (iGlarLixi) fixed-ratio combination in older adults with type 2 diabetes

AIMS

This study assessed the efficacy and safety of iGlarLixi (a titratable, fixed-ratio combination of insulin glargine [iGlar] plus lixisenatide) in older patients with type 2 diabetes.

METHODS

This post hoc analysis used patient-level data from patients aged ≥65 years from the phase III LixiLan-O and LixiLan-L studies, which compared iGlarLixi with iGlar and lixisenatide (LixiLan-O only). Efficacy endpoints were changes in glycated hemoglobin A1C, fasting plasma glucose, postprandial glucose, weight, and achievement of A1C <7.0% (53 mmol/mol). Safety measures included incidence of documented symptomatic hypoglycemia (defined as typical symptoms of hypoglycemia plus self-measured plasma glucose ≤70 mg/dL [3.9 mmol/L]), severe hypoglycemia (requiring assistance of another person), and incidence of gastrointestinal adverse events. Results were compared with those from patients aged <65 years.

RESULTS

In both trials, older patients treated with iGlarLixi achieved significantly greater reductions in A1C at Week 30 than comparators. Treatment with iGlarLixi mitigated insulin-associated weight gain and lixisenatide-associated gastrointestinal events. Results were largely comparable between patients aged ≥65 versus <65 years.

CONCLUSIONS

iGlarLixi provides significant improvements in glycemic control in patients aged ≥65 years without increasing hypoglycemia risk. As a once-daily injection, it simplifies treatment regimens and may contribute to improved adherence in this patient population.

Laparoscopic Sleeve Gastrectomy and Gastric Bypass for The Aging Population

BACKGROUND

Laparoscopic Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the two most common bariatric surgeries for treating morbid obesity. The purpose of this study is to determine differences in outcomes from RYGB or SG between patients ages ≥ 60 years and < 60 years.

METHODS

A retrospective review of patients who underwent RYGB and SG at our institution from 01/2008 to 05/2012 was conducted. Forty patients from each group (≥60 years and < 60 years) were matched based on gender, body mass index (BMI), co-morbidities, and type of bariatric surgery performed, and their charts were reviewed up to 1 year post-operatively. Primary end points measured were mean length of stay, operative time, incidence of complications, and readmissions in the first post-operative year. A secondary end point measured was percent total weight loss (%TWL) and excess weight loss (%EWL).

RESULTS

There were no significant differences between group < 60 and group ≥ 60 in operative time (210 vs. 229 min; p = 0.177), in-hospital post-operative complication rates (2.5 vs. 5 %; p = 1.0), long-term complication rates (2.5 vs. 10 %; p = 0.359), and 30-day readmission rates (2.5 vs. 12.5 %; p = 0.2). Patients in group < 60 had shorter lengths of stay (2.2 vs. 2.7 days; p = 0.031), but this difference is not clinically significant. Both groups achieved similar %TWL (21.4 vs. 20.5 %; p = 0.711) and %EWL (50.6 vs. 50.7 %; p = 0.986).

CONCLUSIONS

Advanced age (≥60 years) is not a significant predictor of a worse outcome for SG and RYGB.

Obesity and its Association with Food Consumption, Diabetes Mellitus, and Acute Myocardial Infarction in the Elderly

Background

Obesity affects a large part of elderly individuals worldwide and is considered a risk predictor for the development of chronic diseases such as cardiac diseases, the leading causes of death in the elderly population.

Objective

To investigate the prevalence of obesity and associated factors, with emphasis on the occurrence of other diseases and on food consumption in elderly individuals treated at the Brazilian Unified Health System (Sistema Único de Saúde, SUS).

Methods

Cross-sectional sampling study performed in the city of Goiânia (Brazil) including elderly individuals (≥ 60 years) receiving primary care. During home visits, we performed anthropometric measurements and applied a structured, standardized, and pre-tested questionnaire assessing socioeconomic, demographic and lifestyle conditions, occurrence of diseases, and food consumption. We performed multiple Poisson regression analysis using a hierarchical model and adopting a significance level of 5%.

Results

We evaluated 418 elderly patients with a mean age of 70.7 ± 7 years. Their body mass indices had a mean value of 27.0 kg/m² and were higher in women than in men (27.4 kg/m² versus 26.1 kg/m², respectively, p = 0.017). Obesity had a prevalence of 49.0%, a risk 1.87 times higher between the ages of 60-69 years and 70-79 years, and a rate 1.4 times higher among individuals with more than four morbidities. On multivariate analysis, the factors associated with obesity were age 60-69 and 70-79 years, inadequate consumption of whole-wheat grains and adequate consumption of fruit, musculoskeletal diseases, diabetes mellitus, and acute myocardial infarction.

Conclusions

Obesity had a high prevalence in the evaluated elderly population and was associated with food consumption, musculoskeletal disease, diabetes mellitus, and acute myocardial infarction.

Mice lacking GPR3 receptors display late-onset obese phenotype due to impaired thermogenic function in brown adipose tissue

We report an unexpected link between aging, thermogenesis and weight gain via the orphan G protein-coupled receptor GPR3. Mice lacking GPR3 and maintained on normal chow had similar body weights during their first 5 months of life, but gained considerably more weight thereafter and displayed reduced total energy expenditure and lower core body temperature. By the age of 5 months GPR3 KO mice already had lower thermogenic gene expression and uncoupling protein 1 protein level and showed impaired glucose uptake into interscapular brown adipose tissue (iBAT) relative to WT littermates. These molecular deviations in iBAT of GPR3 KO mice preceded measurable differences in body weight and core body temperature at ambient conditions, but were coupled to a failure to maintain thermal homeostasis during acute cold challenge. At the same time, the same cold challenge caused a 17-fold increase in Gpr3 expression in iBAT of WT mice. Thus, GPR3 appears to have a key role in the thermogenic response of iBAT and may represent a new therapeutic target in age-related obesity.

Relationship between self-reported weight change, educational status, and health-related quality of life in patients with diabetes in Luxembourg

BACKGROUND

The aim of this study was to assess the relationship between self-reported weight change, socio-economic status, and health-related quality of life (HRQOL) in patients with diabetes, 5 years after they underwent coronary angiography.

METHODS

Between 2013 and 2014, 1873 of 4391 patients (319 with diabetes) who underwent coronary angiography between 2008 and 2009 participated in a follow-up study. Three out of four domains of the World Health Organization Quality of Life (WHOQOL)-BREF (physical health, psychological health and social relationships) were surveyed during the follow-up period. To assess the relationship between weight change and HRQOL, generalized linear models were constructed for every dimension of the WHOQOL-BREF, with educational level as a predictor and sex, age, marital status, smoking status, hypertension, cholesterol, ischemic heart disease, acute myocardial infarction, and stable angina pectoris as covariates.

RESULTS

The mean age of the patients was 70 years and almost three-quarters of the patients (72.7 %) were men. During the 12 months preceding the follow-up survey, 22.6 % of the patients reported weight loss, 20 % reported weight gain, and 57.4 % reported no weight change. There were significant differences in the HRQOL scores between patients who reported weight loss and those who reported either weight gain or unchanged weight. The most affected domains were physical and psychological health, with higher scores for patients who reported weight loss (54.7 and 67.2, respectively) than those who reported weight gain (46.3 and 58.5, respectively). The generalized linear model confirmed higher HRQOL scores among patients who reported weight loss and revealed an association between the HRQOL score and education level.

CONCLUSION

Weight change and education level were associated with HRQOL in patients with diabetes. Self-reported weight loss and no weight change were positively associated with HRQOL in patients with diabetes, while weight gain was negatively associated with HRQOL.

Aging, Nutritional Status and Health

The older population is increasing worldwide and in many countries older people will outnumber younger people in the near future. This projected growth in the older population has the potential to place significant burdens on healthcare and support services. Meeting the diet and nutrition needs of older people is therefore crucial for the maintenance of health, functional independence and quality of life. While many older adults remain healthy and eat well those in poorer health may experience difficulties in meeting their nutritional needs. Malnutrition, encompassing both under and over nutrition increases health risks in the older population. More recently the increase in obesity, and in turn the incidence of chronic disease in older adults, now justifies weight management interventions in obese older adults. This growing population group is becoming increasingly diverse in their nutritional requirements. Micro-nutrient status may fluctuate and shortfalls in vitamin D, iron and a number of other nutrients are relatively common and can impact on well-being and quality of life. Aging presents a number of challenges for the maintenance of good nutritional health in older adults.

Diabetes self-care and the older adult

The prevalence of diabetes is highest in older adults, a population that is increasing. Diabetes self-care is complex with important recommendations for nutrition, physical activity, checking glucose levels, and taking medication. Older adults with diabetes have unique issues that impact self-care. As people age, their health status, support systems, physical and mental abilities, and nutritional requirements change. Furthermore, comorbidities, complications, and polypharmacy complicate diabetes self-care. Depression is also more common among the elderly and may lead to deterioration in self-care behaviors. Because of concerns about cognitive deficits and multiple comorbidities, adults older than 65 years are often excluded from research trials. Thus, little clinical evidence is available and the most appropriate treatment approaches and how to best support older patients' self-care efforts are unclear. This review summarizes the current literature, research findings, and expert and consensus recommendations with their rationales.

Long-term safety and tolerability of saxagliptin add-on therapy in older patients (aged ≥ 65 years) with type 2 diabetes

Background

Treatment decisions for older patients with type 2 diabetes mellitus must balance glycemic control and adverse event risk. The objective of this study was to evaluate the long-term safety and tolerability of saxagliptin 5 mg as add-on therapy to common antihyperglycemic drugs in patients aged ≥65 years and <65 years.

Methods

Pooled adverse event data from three placebo-controlled trials of 76–206 weeks’ duration in older (≥65 years) and younger (<65 years) patients receiving saxagliptin 5 mg or matching placebo added to metformin, glyburide, or a thiazolidinedione were analyzed. Measurements were calculated from day of first dose to specified event or last dose and included time at risk for adverse events, treatment-related adverse events, serious adverse events, adverse events leading to discontinuation, and events of special interest. Weighted incidence rates (number of events/total time) and incidence rate ratios (saxagliptin/placebo) with 95% confidence intervals were calculated (Mantel-Haenszel test).

Results

A total of 205 older (mean age 69 years; saxagliptin, n=99; placebo, n=106) and 1,055 younger (mean age 52 years; saxagliptin, n=531; placebo, n=524) patients were assessed. Regardless of age category, the adverse event incidence rates were generally similar between treatments, with confidence intervals for incidence rate ratios bridging 1. Treatment-related adverse events occurred in 36 older patients receiving saxagliptin versus 32 receiving placebo (incidence rate 34.1 versus 27.1 per 100 person-years) and in 150 younger patients in both treatment groups (incidence rate 24.0 versus 27.8 per 100 person-years). With saxagliptin versus placebo, serious adverse events occurred in eight versus 14 older (incidence rate 5.7 versus 9.9 per 100 person-years) and 49 versus 44 younger patients (incidence rate 6.5 versus 6.6 per 100 person-years). There were two deaths (one patient ≥65 years) with saxagliptin and six (none aged ≥65 years) with placebo. Older patients rarely experienced symptomatic confirmed hypoglycemia (fingerstick glucose ≤50 mg/dL; saxagliptin, n=1; placebo, n=2).

Conclusion

Saxagliptin add-on therapy was generally well tolerated in older patients aged ≥65 years with type 2 diabetes mellitus, with a long-term safety profile similar to that of placebo.

The effect of age and NT-proBNP on the association of central obesity with 6-years cardiovascular mortality of middle-aged and elderly diabetic people: the population-based Casale Monferrato study

BACKGROUND

Among people with type 2 diabetes the relationship between central obesity and cardiovascular mortality has not been definitely assessed. Moreover, NT-proBNP is negatively associated with central obesity, but no study has examined their combined effect on survival. We have examined these issues in a well-characterized population-based cohort.

METHODS AND FINDINGS

Survival data of 2272 diabetic people recruited in 2000 who had no other chronic disease have been updated to 31 December 2006. NT-proBNP was measured in a subgroup of 1690 patients. Cox proportional hazards modeling was employed to estimate the independent associations between cardiovascular and all-cause mortality and waist circumference. Mean age was 67.9 years, 49.3% were men. Both age and NT-proBNP were negatively correlated with waist circumference (r = -0.11, p<0.001 and r = -0.07, p = 0.002). Out of 2272 subjects, 520 deaths (221 for CV mortality) occurred during a median follow-up of 5.4 years. Central obesity was not associated with CV mortality (hazard ratio, HR, adjusted for age, sex, diabetes duration, 1.14, 95% CI 0.86-1.52). NTproBNP was a negative confounder and age a strong modifier of this relationship (p for interaction<0.001): age<70 years, fully adjusted model HR = 3.52 (1.17-10.57) and age ≥70 years, HR = 0.80 (0.46-1.40). Respective HRs for all-cause mortality were 1.86 (1.03-3.32) and 0.73 (0.51-1.04).

CONCLUSIONS

In diabetic people aged 70 years and lower, central obesity was independently associated with increased cardiovascular mortality, independently of the negative effect of NT-proBNP. In contrast, no effect on 6-years survival was evident in diabetic people who have yet survived up to 70 years.

Different obesity phenotypes, and incident cardiovascular disease and mortality events in elderly Iranians: Tehran lipid and glucose study

AIM

To determine the impact of body mass index and the presence of metabolic syndrome (MetS) on cardiovascular disease (CVD) and mortality events in an elderly Tehranian population.

METHODS

A population-based cohort of 1199 participants aged ≥65 years were followed for a mean of 9.74 years. Participants were stratified according to body mass index categories and MetS status. Cox regression analyses were used to estimate the hazard ratio of CVD and mortality events, given overweight participants without MetS as reference.

RESULT

During follow up, 271 CVD events and 239 deaths (106 CVD deaths) occurred. Regarding CVD, multivariate-adjusted hazard ratios for CVD events in normal weight and obese participants without MetS were 1.21 (95% CI 0.77-1.91) and 1.46 (95% CI 0.64-3.34), respectively, and for normal weight, overweight and obese participants with MetS were 2.07 (95% CI 1.23-3.28), 1.72 (95% CI 1.13-2.62), and 1.53 (95% CI 0.95-2.45), respectively. Corresponding hazard ratios for CVD mortality were 2.08 (95% CI 0.93-4.82), 1.07 (95% CI 0.13-8.78), 3.71 (95% CI 1.55-8.85), 2.42 (95% CI 1.06-5.51) and 3.31 (95% CI 1.39-7.88), and for all-cause mortality were 1.41 (95% CI 0.9-2.23), 1.33 (95% CI 0.51-3.47), 1.84 (95% CI 1.1-3.09), 1.46 (95% CI 0.93-2.34) and 1.5 (95% CI 0.91-2.56), respectively. In the presence of diabetes in place of MetS, all of the diabetic participants regardless of body mass index category highlighted a significant risk for CVD and mortality events.

CONCLUSION

Among the elderly population, the presence of MetS was necessary for exploring the risk of CVD events and its mortality; however, only the normal weight population with MetS had a significant risk for all-cause mortality

Obesity-related inflammation: implications for older adults

The combination of age-related increases in obesity and inflammation can lead to chronic disease, decreased strength, and physical disability. Lifestyle interventions that include moderate caloric restriction along with aerobic and resistance exercise have shown improvements in metabolic outcomes, strength, and physical function in obese older adults. Although few weight loss studies have addressed diet quality, evidence summarized in this review suggests that encouraging intake of antioxidant-rich fruits and vegetables, high-quality protein, low-glycemic index carbohydrates, and omega-3 fatty acids may further ameliorate obesity-related inflammation. Future controlled trials are indicated to examine the effects of incorporating these foods into multimodal weight loss interventions.

Long-term weight change in adulthood and incident diabetes mellitus: MY Health Up Study

AIM

To investigate whether long-term weight/BMI change in adulthood has a significant impact on the incidence of diabetes, independent of attained weight status.

METHODS

A number of 13,700 participants (2962 men and 10,738 women) aged 36 to 55 years were followed for up to 5 years using data from annual health checkups. Incident cases of diabetes were identified from self-reports or single fasting plasma glucose measurements (≥7.0 mmol/l). Weight/BMI change was calculated from participants' weight/BMI values at age 20 years and weight/BMI values at a given point during follow-up and used as a time-dependent variable in age-stratified multivariate Cox proportional hazards models.

RESULTS

During the 5 year follow-up, 408 participants (137 men and 271 women) developed diabetes. Even after adjusting for BMI during follow-up and other possible confounders, weight/BMI gain since age 20 years was significantly associated with an increased risk of developing diabetes. The hazard ratios were: 2.30 (95% confidence interval (CI): 1.31-4.04) for those who gained 6.0 to <10.0 kg and 3.09 (95% CI: 1.79-5.34) for those who gained ≥10.0 kg [reference: <2.0 kg change]; and 2.61 (95% CI: 1.58-4.31) for those who gained 3.0 to <5.0 kg/m(2) and 3.70 (95% CI: 2.22-6.16) for those who gained ≥5.0 kg/m(2) [reference: <1.0 kg/m(2) change].

CONCLUSIONS

The results indicate that long-term weight/BMI gain in adulthood is a significant predictor for the development of diabetes, independent of attained weight status. Because weight gain within the normal weight range could increase the risk of diabetes, non-obese people should also be warned against possible weight gain.

Obesity in the ageing man

As the population is ageing globally, both ageing and obesity are recognized as major public health challenges. The aim of this narrative review is to present and discuss the current evidence on the changes in body composition, energy balance and endocrine environment that occur in the ageing man. Obesity in the ageing man is related to changes in both body weight and composition due to alterations in energy intake and total energy expenditure. In addition, somatopenia (decreased GH secretion), late-onset hypogonadism (LOH), changes in thyroid and adrenal function, as well as changes in appetite-related peptides (leptin, ghrelin) and, most importantly, insulin action are related to obesity, abnormal energy balance, redistribution of the adipose tissue and sarcopenia (decreased muscle mass). A better understanding of the complex relationship of ageing-related endocrine changes and obesity could lead to more effective interventions for elderly men.

Obesity is associated with lower mortality risk in elderly diabetic subjects: the Casale Monferrato study

The relationship between obesity and mortality in people with type 2 diabetes has not been definitely assessed. We have examined this issue in a well-characterized population-based cohort of Mediterranean diabetic people. Standardized anthropometric data from the population-based Casale Monferrato Study have been prospectively analyzed. The cohort included 1,475 people (62.6% aged ≥65 years) who had been recruited in 1991 and followed-up to December 31, 2006. Cox proportional hazards modeling was employed to estimate the independent associations between all-cause and cardiovascular mortality and BMI. Out of 1,475 people, 972 deaths occurred during a 15-year follow-up. Cox regression analyses showed that with respect to BMI <24.2 kg/m(2), values of 30.0 kg/m(2) and over were associated with lower all-cause and cardiovascular mortality risk (HR = 0.68, 95% CI 0.56-0.85, P for trend = 0.001; HR = 0.59, 0.44-0.80, P for trend = 0.002), independently of classical and new risk factors. As interaction between age and BMI was significant, we performed a stratified analysis by age, providing evidence that our finding was entirely due to a significant protective effect of BMI of 30.0 kg/m(2) and over in the elderly (all-cause mortality HR = 0.75, 95% CI 0.58-0.96; cardiovascular mortality HR = 0.67, 95% CI 0.45-0.95). In contrast, obesity was not significantly associated with mortality risk in diabetic subjects aged <65 years. Results were confirmed even excluding from the analysis individuals who died within 2 years of follow-up, smokers and those with CHD. In Mediterranean diabetic people aged ≥65 years, obesity is significantly associated with lower 15-year mortality risk. In contrast, it was not significantly associated with mortality risk in diabetic subjects aged <65 years. As more than two-thirds of people with type 2 diabetes are elderly, our findings, if confirmed, could have clinical implications.

Obesity and diabetes as accelerators of functional decline: can lifestyle interventions maintain functional status in high risk older adults?

Obesity and diabetes are known risk factors for the development of physical disability among older adults. With the number of seniors with these conditions rising worldwide, the prevention and treatment of physical disability in these persons have become a major public health challenge. Sarcopenia, the progressive loss of muscle mass and strength, has been identified as a common pathway associated with the initial onset and progression of physical disability among older adults. A growing body of evidence suggests that metabolic dysregulation associated with obesity and diabetes accelerates the progression of sarcopenia, and subsequently functional decline in older adults. The focus of this brief review is on the contributions of obesity and diabetes in accelerating sarcopenia and functional decline among older adults. We also briefly discuss the underexplored interaction between obesity and diabetes that may further accelerate sarcopenia and place obese older adults with diabetes at particularly high risk of disability. Finally, we review findings from studies that have specifically tested the efficacy of lifestyle-based interventions in maintaining the functional status of older persons with obesity and/or diabetes.

Metabolic syndrome defined by modified International Diabetes Federation criteria and type 2 diabetes mellitus risk: a 9-year follow-up among the aged in Finland

The aim was to analyse the relationship between metabolic syndrome and type 2 diabetes mellitus risk among the aged. This was a prospective population-based study, with a 9-year follow-up. All subjects of the municipality of Lieto in Finland aged ≥64 in 1998-1999 with no type 2 diabetes mellitus at baseline (n=1117) were included. Hazard ratios for incident type 2 diabetes mellitus predicted by metabolic syndrome (defined by modified International Diabetes Federation criteria) were estimated. During the 9-year follow-up, a total of 69 participants (6.2%) developed type 2 diabetes mellitus. After multivariable adjustment (age, gender, smoking, frequency of exercise, cardiovascular disease and low-density lipoprotein-cholesterol), type 2 diabetes mellitus (hazard ratio, 95% confidence interval) (3.15, 1.89-5.25, p < 0.001) was more common in subjects with metabolic syndrome compared to subjects without it. Evaluating metabolic syndrome components individually, impaired fasting glucose (5.09, 2.64-9.82, p < 0.001) and obesity (1.71, 1.05-2.97, p = 0.034) predicted a higher incidence of type 2 diabetes mellitus. Our findings suggest that metabolic syndrome predicts onset of type 2 diabetes mellitus even in late life. Impaired fasting glucose and obesity should be targets for primary prevention of diabetes among the aged with metabolic syndrome.

Food addiction: detox and abstinence reinterpreted?

The senior patient and/or the geriatrician are confronted with a confusing literature describing how patients interested in combating metabolic syndrome, diabesity (diabetes plus obesity) or simple obesity might best proceed. The present paper gives a brief outline of the basic disease processes that underlie metabolic pro-inflammation, including how one might go about devising the most potent and practical detoxification from such metabolic compromise. The role that dietary restriction plays in pro-inflammatory detoxification (detox), including how a modified fast (selective food abstinence) is incorporated into this process, is developed. The unique aspects of geriatric bariatric medicine are elucidated, including the concepts of sarcopenia and the obesity paradox. Important caveats involving the senior seeking weight loss are offered. By the end of the paper, the reader will have a greater appreciation for the challenges and opportunities that lie ahead for geriatric patients who wish to overcome food addiction and reverse pro-inflammatory states of ill-heath. This includes the toxic metabolic processes that create obesity complicated by type 2 diabetes mellitus (T2DM) which collectively we call diabesity. In that regard, diabesity is often the central pathology that leads to the evolution of the metabolic syndrome. The paper also affords the reader a solid review of the neurometabolic processes that effectuate anorexigenic versus orexigenic inputs to obesity that drive food addiction. We argue that these processes lead to either weight gain or weight loss by a tripartite system involving metabolic, addictive and relational levels of organismal functioning. Recalibrating the way we negotiate these three levels of daily functioning often determines success or failure in terms of overcoming metabolic syndrome and food addiction.

Obesity and the elderly

The prevalence of obesity is rising progressively, even among older age groups. By the year 2030 to 2035 over 20% of the adult US population and over 25% of the Europeans will be aged 65 years or older. The predicted prevalence of obesity in Americans, 60 years and older was 37% in 2010. The predicted prevalence of obesity in Europe in 2015 varies between 20% and 30% dependent on the model used. This means 20.9 million obese 60 years or older people in the United States in 2010 and 32 million obese elders in 2015 in EU. Although cutoff values of body mass index, waist circumference, and percentages of fat mass have not been defined for the elderly, it is clear from several meta-analyses that mortality and morbidity associated with overweight and obesity only increases at a body mass index >30 kg/m(2). Thus, treatment should only be offered to patients who are obese rather than overweight and who have functional impairments, metabolic complications, or obesity-related diseases, that can benefit from weight loss. The weight loss therapy should minimize muscle and bone loss and vigilance as regards the development of sarcopenic obesity--a combination of an unhealthy excess of body fat with a detrimental loss of muscle and fat-free mass including bone--is important. Lifestyle intervention should be the first step and consists of a diet with a 500 kcal energy deficit and an adequate intake of protein of high biological quality, together with calcium and vitamin D, behavioral therapy, and multicomponent exercise. Multicomponent exercise includes flexibility training, balance training, aerobic exercise, and resistance training. The adherence rate in most studies is around 75%. Knowledge of constraints and modulators of physical inactivity should be of help to engage the elderly in physical activity. The role of pharmacotherapy and bariatric surgery in the elderly is largely unknown as in most studies people aged 65 years and older were excluded.

Associations between diet quality, health status and diabetic complications in patients with type 2 diabetes and comorbid obesity

OBJECTIVE

Patients with type 2 diabetes (T2DM) demonstrate low dietary adherence and this is further aggravated with comorbid obesity. The aim of the present study was to assess diet quality in patients with T2DM and comorbid obesity compared to patients with T2DM alone and to examine the associations between comorbidities and diet quality.

METHODS

The sample consisted of 59 adult patients with diabesity (T2DM and comorbid obesity) and 94 patients with T2DM alone. All diabetes comorbidities and complications were recorded and diet quality was assessed with the Healthy Eating Index (HEI).

RESULTS

Mean raw HEI of the diabese subjects was 81.9±7.1 and the diabetic subjects was 80.2±6.9. When HEI was adjusted to the sex, age and weight status, the diabese demonstrated a higher HEI. Among comorbidities, only renal disease decreased HEI. According to the principal component analysis of the total sample, adequate diet quality was explained by cardiovascular disease, cigarette smoking, alcohol consumption, peptic ulcer, sex, diabesity and diabetic foot syndrome. In the diabese, adequate HEI was explained by diabetic foot syndrome, smoking, drinking alcohol and having a family history of diabetes.

CONCLUSIONS

Adult patients with T2DM demonstrate adequate diet quality. Different factors are associated with the adoption of a high quality diet between the diabese and the T2DM alone.

Self-reported disability in adults with severe obesity

Self-reported disability in performing daily life activities was assessed in adults with severe obesity (BMI ≥ 35 kg/m(2)) using the Health Assessment Questionnaire (HAQ). 262 participants were recruited into three BMI groups: Group I: 35-39.99 kg/m(2); Group II: 40-44.99 kg/m(2); Group III: ≥45.0 kg/m(2). Progressively increasing HAQ scores were documented with higher BMI; Group I HAQ score: 0.125 (median) (range: 0-1.75); Group II HAQ score: 0.375 (0-2.5); Group III HAQ score: 0.75 (0-2.65) (Group III versus II P < 0.001; Group III versus I P < 0.001; Group II versus I P = 0.004). HAQ score strongly correlated with BMI and age. Nearly three-fourths of the study participants reported some degree of disability (HAQ score > 0). The prevalence of this degree of disability increased with increasing BMI and age. It also correlated to type 2 diabetes, metabolic syndrome, and clinical depression, but not to gender. Our data suggest that severe obesity is associated with self-reported disability in performing common daily life activities, with increasing degree of disability as BMI increases over 35 kg/m(2). Functional assessment is crucial in obesity management, and establishing the disability profiles of obese patients is integral to both meet the specific healthcare needs of individuals and develop evidence-based public health programs, interventions, and priorities.

Diabetes prediction, lipid accumulation product, and adiposity measures; 6-year follow-up: Tehran lipid and glucose study

Background

The body mass index (BMI) is the most commonly used marker for evaluating obesity related risks, however, central obesity measures have been proposed to be more informative. Lipid accumulation product (LAP) is an alternative continuous index of lipid accumulation, which is computed from waist circumference (WC, cm) and triglycerides (TGs, mmol/l): (WC-65) ×TG (men) and (WC-58) ×TG (women). We sought in this study to assess if LAP can outperform BMI, waist-to-height-ratio (WHtR), or waist-to-hip-ratio (WHpR) in identifying prevalent and predicting incident diabetes.

Results

The cross-sectional analyses were performed on a sample included 3,682 men and 4,989 women who were not pregnant, aged ≥ 20 years. According to the age (≥ 50 and <50 years) - and sex-specific analyses, odds ratios (ORs) of LAP for prevalent diabetes were higher than those of BMI, WHpR, or WHtR among women, after adjustment for mean arterial pressure and family history of diabetes. The OR of LAP in old men was lower than those of other adiposity measures; in young men, however, LAP was superior to BMI but identical to WHpR and WHtR in identifying prevalent diabetes. Except in young men, LAP showed highest area under the receiver operating characteristic curves (AROC) for prevalent diabetes (P for trend ≤ 0.005).

For longitudinal analyses, a total of 5,018 non-diabetic subjects were followed for ~6 years. The ORs of BMI, WHpR, and WHtR were the same as those of LAP in both sexes and across age groups; except in young men where LAP was superior to the BMI. AROCs of LAP were relatively the same as anthropometric adiposity measures.

Conclusions

LAP was a strong predictor of diabetes and in young individuals had better predictability than did BMI; it was, however, similar to WHpR and WHtR in prediction of incident diabetes.