Distinct super-enhancer elements differentially control Il2ra gene expression in a cell-type specific fashion

Expression of the IL-2 receptor a-chain (IL-2Ra, also known as CD25) is tightly regulated during T cell development and in mature lymphoid populations. IL-2Ra is constitutively expressed on double negative DN2/DN3 thymocytes and regulatory T cells, but its expression is inducible on mature T and natural killer (NK) cells. The Il2ra gene is regulated in part by a super-enhancer that is extensively bound by STAT5, but whether the super-enhancer elements are differentially used to control the cell-specific expression of Il2ra in distinct cell populations is unknown. Here, we generated a comprehensive series of mutant mice harboring deletion of individual or multiple elements within this super-enhancer. Strikingly, deletions in the upstream super-enhancer region dominantly affected CD25 expression on DN2/DN3 thymocytes and Treg cells, whereas deleting an intronic region primarily decreased IL-2-induced CD25 expression on peripheral CD4+ and CD8+ T and NK cells. Thus, distinct elements control constitutive versus inducible expression of the Il2ra gene in a cell-type-specific manner rather than behaving as simple enhancers whose activity is additive/cooperative, as has been observed for the a-globin and Wap super-enhancers. Moreover, the intronic super-enhancer region was critical for chromatin looping, and deletion of this region altered super-enhancer structure throughout the locus. These results demonstrate differential functions for distinct super-enhancer elements, thereby indicating ways to manipulate CD25 expression in a cell-type specific fashion, an area of importance in autoimmune and other disease states.

Sarcopenic obesity and associations with mortality in older women and men - a prospective observational study

Background

The combined effect of sarcopenia and obesity, i.e., sarcopenic obesity, has been associated with disability and worse outcomes in older adults, but results are conflicting. The objectives of this study were to describe the prevalence of sarcopenic obesity (SO) in older adults, and to examine how the risk of mortality is associated with SO and its various components.

Methods

Data were obtained from two Swedish population studies, the Gothenburg H70 Birth Cohort Studies of 521 women and men at the age of 75, and the Uppsala Longitudinal Study of Adult Men (ULSAM), which included 288 men aged 87 years. Sarcopenia was defined using the recently updated EWGSOP2 definition. Obesity was defined by any of three established definitions: body mass index ≥30 kg/m², fat mass > 30%/ > 42% or waist circumference ≥ 88 cm/≥102 cm for women and men, respectively. The Kaplan-Meier survival curve and the Cox proportional hazard model were used for 10-year and 4-year survival analyses in the H70 and ULSAM cohorts, respectively.

Results

SO was observed in 4% of the women and 11% of the men in the H70 cohort, and in 10% of the ULSAM male cohort. The 75-year-old women with SO had a higher risk (HR 3.25, 95% confidence interval (1.2–8.9)) of dying within 10 years compared to those with a “normal” phenotype. A potential similar association with mortality among the 75-year-old men was not statistically significant. In the older men aged 87 years, obesity was associated with increased survival.

Conclusions

SO was observed in 4–11% of community-dwelling older adults. In 75-year-old women SO appeared to associate with an increased risk of dying within 10 years. In 87-year-old men, the results indicated that obesity without sarcopenia was related to a survival benefit over a four-year period.

Functional dissection of the Il2ra superenhancer reveals developmentally regulated and cell type specific elements

The expression of the IL-2 receptor a chain is tightly regulated during early T cell development and in mature lymphoid populations by either cytokine stimulation or T cell receptor interactions. IL-2Ra expression can be either constitutive, as in some double negative thymocytes and T regulatory cells, or inducible, as in CD4+and CD8+mature T cells. Previously, our lab identified a super-enhancer in the mouse Il2ra locus that extensively bound STAT5 and controlled expression of this gene in mature T cells. To further dissect developmental and cell type specific expression of this super-enhancer, Crispr-Cas9 mediated deletion was used to generate mutant mice lacking either individual or groups of STAT5 binding sites in either the upstream region or the first intron. Deletion of the upstream region led to the absence of CD25 expression in DN2 and DN3 thymocytes as well as a significant reduction of CD25 expression on regulatory T cells, but minimal effect on inducible CD25 expression in mature T cells. Analysis of individual upstream elements in reporter assays revealed a specific element that controlled high activity in DN3 cells and a Treg cell line, with markedly diminished activity in the presence of Notch inhibitors. In contrast, deletion of an intronic region markedly diminished both IL-2 and TCR-induced expression of CD25 in vitro, while having little if any effect on CD25 expression in DN thymocytes or Treg cells. These data reveal that the Il2rasuper-enhancer is composed of multiple elements that preferentially mediate either constitutive or inducible Il2ragene expression. Further analysis of these elements will define mechanisms for regulation and potentially manipulation of CD25 expression in autoimmune and other disease states.

4965Non-transcriptional disruption of Ca2+i homeostasis and Cx43 function in the right ventricle precedes overt arrhythmogenic cardiomyopathy in PKP2-deficient mice

Background

Plakophilin-2 (PKP2) is classically defined as a protein of the desmosome, an intercellular adhesion structure that also acts as a signaling hub to maintain structural and electrical homeostasis. Mutations in PKP2 associate with most cases of gene-positive arrhythmogenic right ventricular cardiomyopathy (ARVC). A better understanding of PKP2 cardiac biology can help elucidate the mechanisms underlying arrhythmic and cardiomyopathic events that occur consequent to its mutation. Here we sought to captureearly molecular/cellular events that can act as nascent substrates for subsequent arrhythmic/cardiomyopathic phenotypes.

Methods

We used multiple quantitative imaging modalities, as well as biochemical and high-resolution mass spectrometry methods to study the functional/structural properties of cells/tissues derived from cardiomyocyte-specific, tamoxifen-activated, PKP2 knockout mice (“PKP2cKO”). Studies were carried out 14 days post-tamoxifen injection, a time point preceding an overt electrical or structural phenotype.Myocytes from right or left ventricular free wall were studied separately, to detect functional/structural asymmetries.

Results

Most properties of PKP2cKO left ventricular (LV) myocytes were not different from control; in contrast, PKP2cKO right ventricular (RV) myocytes showed increased amplitude and duration of Ca2+transients, increased frequency of spontaneous Ca2+release events, increased [Ca2+] in the cytoplasm and sarcoplasmic reticulum compartments, and dynamic Ca2+accumulation in mitochondria. In addition, RyR2 in RV presented enhanced sensitivity to Ca2+and preferential phosphorylation in a domain known to modulate Ca2+gating. RNAseq at 14 days post-TAM showed no relevant difference in transcript abundance between RV and LV, neither in control nor in PKP2cKO cells, suggesting that in the earliest stage, [Ca2+]i dysfunction is not transcriptional. Rather, we found an RV-predominant increase in membrane permeability that can permit Ca2+entry into the cell. Cx43 ablation mitigated the increase in membrane permeability, the accumulation of cytoplasmic Ca2+and the early stages of RV dysfunction.

Conclusions

Loss of PKP2 creates an RV-predominant arrhythmogenic substrate (Ca2+ dysregulation) that precedes the cardiomyopathy and that is, at least in part, mediated by a Cx43-dependent membrane conduit. Given that asymmetric Ca2+ dysregulation precedes the cardiomyopathic stage, we speculate that abnormal Ca2+ handling in RV myocytes can be a trigger for gross structural changes observed at a later stage.

Effect on Body Weight, Quality of Life and Appetite Following Individualized, Nutritional Counselling to Home-Living Elderly after Rehabilitation - An Open Randomized Trial

OBJECTIVES

We examined if individually-adapted nutritional counselling could prevent > 5% weight loss among elderly patients 3 months after discharge from a rehabilitation institution. In addition we assessed quality of life (QoL) and appetite.

DESIGN

An open, randomized trial.

SETTING

Godthaab Health and Rehabilitation Institution in Bærum, Norway.

PARTICIPANTS

Patients identified as being undernourished or at risk of disease-related malnutrition using the Nutritional Risk Screening tool NRS-2002.

INTERVENTION

Shortly before discharge, patients in the intervention group received an individually-tailored nutrition plan. During the subsequent 3 months these patients were contacted 3 times via telephone calls and they received one visit at their homes, for nutrition counselling. Focus on this counselling was on optimizing meal environment, improving appetite, increasing food intake, advice on food preparation, and motivation and support.

MEASUREMENTS

In addition to weight, QoL and appetite were assessed using the EQ-5D questionnaire and a modified version of the Disease-Related Appetite Questionnaire, respectively.

RESULTS

Among 115 considered eligible for the study, 100 were enrolled (72 women and 28 men), with a mean age of 75 years and a mean body mass index of 20 kg/m2. Two in the intervention group (n = 52) and 5 in the control group (n = 48) lost > 5% of their body weight, giving an odds ratio of 0.34 (95% CI: 0.064 - 1.86; p = 0.22). We did not detect any significant differences in the QoL- or appetite scores between the two study groups after three months.

CONCLUSION

An individually-adapted nutritional counselling did not improve body mass among elderly patients 3 months after discharge from a rehabilitation institution. Neither quality of life nor appetite measures were improved. Possibly, nutritional counselling should be accompanied with nutritional supplementation to be effective in this vulnerable group of elderly. The trial is registered in Clinical Trials (ID: NCT01632072).

ESPEN guidelines on definitions and terminology of clinical nutrition

BACKGROUND

A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.

OBJECTIVE

This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.

METHODS

The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.

RESULTS

Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.

CONCLUSION

An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.

Genome-wide genetic and transcriptome analyses of early T-cell developmental checkpoint failure and lymphocytic leukemia initiation in Rag1-deficient non-obese diabetic (NOD) mice (111.40)

All T-lineages arise from multipotent progenitors that proliferate and differentiate under the influence of the thymic environment. We previously reported defects around the earliest T-cell developmental checkpoints in both Rag1-deficient and wild type NOD mice. To investigate the genetic and molecular source of the NOD early T-cell defects and possible linkage to T-cell mediated autoimmunity, we carried out genome-wide genetic and transcriptome studies on the checkpoint violation in NOD.Rag1-/- mice. In a QTL analysis, the checkpoint defect mapped to the diabetes susceptibility Idd9/11 region, which was confirmed using congenic mice. Transcriptome analysis, comparing Rag1-deficient NOD and B6 cells, showed a significant enrichment of signal transduction genes among those differentially expressed, implicating signaling in the checkpoint defect. Furthermore, emerging NOD.Rag1-/- breakthrough cells aberrantly co-expressed legacy stem/progenitor genes, including Lmo2 and Kit, which are normally extinguished at the earliest T-cell commitment checkpoint, along with post-β-selection T-cell genes, including Cd4 and Cd5. The gene expression profile resembles early subtypes of human acute T-cell lymphoblastic leukemia (T-ALL), suggesting that the breakthrough cells are the source of T-cell lymphoma/leukemia found in these mice. Our results show that the earliest checkpoints are defective in NOD T-progenitors, with possible consequences for both T-cell leukemia and autoimmunity.

Transcription factor expression pattern differences are present in OP9 culture derived fetal liver origin early thymocytes when compared to fetal and adult thymocytes (64.22)

The advent of the OP9 stromal culture system has tremendously improved our ability to replicate T cell development in vitro. While giving unprecedented access and numerical advantage, these cells may not mirror real thymocytes in their developmental capacity and transcription factor expression patterns. We have examined the pattern of expression of 65 developmentally regulated gene transcripts across the early thymocyte stages of DN1, DN2, DN3 and DN4, in fetal liver derived thymocytes (FLDN) derived from co-culture on OP9 DL-1 cells, and compared them to those found in fetal and adult thymocytes using real time quantitative PCR. Our assessment suggests an overall pattern of similarity between FLDN expression patterns and “real” freshly isolated thymocytes, but some classes of genes are not regulated similarly, and these may have important consequences for development and progression. We present a cluster analysis identifying transcription factors which are differentially regulated in FLDN relative to adult and fetal populations, and identify groups of factors which track with those differentially regulated transcripts. We additionally analyze the effect of long vs. short term culture on these changes in the transcription factor control network that drives T cell development.

Bcl11b: a novel regulator of T-lineage commitment (36.50)

Commitment of HSC to a T-lineage fate is driven by a network of transcription factors and environment cues. Transcription factor Bcl11b is expected to be a crucial component of the network. Bcl11b is an essential regulator for T-cell development. However, little is known about how Bcl11b works in the commitment stage of T-cell development. Using an in vitro growth system, we have found that under certain conditions Bcl11b-deficient pre-T cells fail to pass the DN2/DN3 transition, which is the lineage commitment step in T-cell development. Instead, Bcl11b-deficient cells continuously grow at DN1-like and DN2A-like stages for more than twenty days, while wild-type controls can develop normally to DN3 and DN4 cells. Unlike their wild-type counterparts, the long-term Bcl11b-deficient cells still possess developmental plasticity with an IKDC-like population growing out from the cells. Gene expression profile reveals that Bcl11b-deficient cells express T-cell identity genes including Cd3e and Lck, and continue to silence some important genes associated with major developmental alternatives, such as B-cell factors; however, they fail to turn off stem cell genes and some lineage-regulators, such as Scl, Lyl1, Gfi1b, Id2, Il2rb, Zbtb16 and Bcl11a. The results indicate that Bcl11b plays a major role in T-lineage commitment by controlling the correct exit of T-cell precursors from a progenitor cell state. No other factor has been shown to have this distinctive function.

Extreme GATA-3 dose dependence in early T cell development (36.28)

GATA-3 expression first reaches peak levels during T-lineage commitment, but a specific requirement for GATA-3 at each of the early DN stages in T development has not been proven. Using retroviral expression of shRNA to reduce GATA-3 protein at each of the earliest stages of T-cell differentiation (DN1, DN2, DN3), we identify two dose-dependent effects: a defect in survival or expansion at DN1, and a separable developmental arrest of cells at DN2, which was cell-autonomous, and not relieved by a Bcl2 transgene. The DN2 arrest phenotype was extremely robust; we were able to document this developmental block even in T development assay cultures initiated with a single fetal liver derived precursor. The DN2-stage developmental block was confirmed using transduced Cre to induce deletion of a floxed Gata3 allele. Reduction of GATA-3 also increased PU.1 levels in pro-T cells, despite relatively normal T-lineage gene induction. To test roles of GATA-3 in exclusion of non-T fates, we forced expression of wild type, obligate repressor, and tamoxifen-inducible GATA-3 forms in precursors undergoing B and myeloid development. GATA-3 blocked B cell development via direct repression under conditions which remained permissive for myeloid development. Thus GATA-3 is required for at least two steps of T-cell progression to commitment, and restricts two different alternative fates by distinct mechanisms.

Doctors and nurses on wards with greater access to clinical dietitians have better focus on clinical nutrition

BACKGROUND

According to the Council of Europe, clinical dietitians should assume a more central role in nutritional support. The aim of this study was to assess the opinions among doctors, nurses and clinical dietitians regarding the use of clinical dietitians' expertise in the hospital units and, further, to assess whether the presence of clinical dietitians in hospital departments influenced doctors and nurses focus on clinical nutrition.

METHODS

A questionnaire about the use of clinical nutrition was mailed to 6000 doctors and 6000 nurses working in hospital units where undernutrition is documented to be common, as well as to 678 clinical dietitians working in Scandinavian hospitals.

RESULTS

The response rate of clinical dietitians, nurses and doctors were 53%, 46% and 29%, respectively. Nurses and doctors who saw clinical dietitians often found it less difficult to identify undernourished patients and found that insight into the importance of adequate nutrition was better than those who saw clinical dietitians seldom. Clinical nutrition had a higher priority in units with frequent visits by clinical dietitians.

CONCLUSIONS

The present study shows that doctors and nurses on wards with greater access to clinical dietitians had better focus on clinical nutrition.

Socio-economic gradient in food selection and diet quality among 70-year olds

OBJECTIVE

The aim of this study was to assess social disparities in food choices and diet quality in a population of 70-year old Swedes.

DESIGN

Cross-sectional study among participants in the 2000 Gerontological and Geriatric Population Studies in Goteborg.

PARTICIPANTS

A representative population of men (n=233) and women (n=321) from Goteborg, a city on the south western coast of Sweden.

METHODS

One hour diet history interviews were performed and 35 specific foods and food groups were identified; in addition a diet quality index (DQI) was calculated. Differences in food choices and diet quality scores were tested across educational and socio-economic index categories (SEI).

RESULTS

Men with higher education and SEI had higher diet quality scores than those with lower socio-economic status, while no differences in DQI were noted in women. Further analysis of women based on their husband's occupational group also yielded no differences in diet quality. When studying individual foods, socio-economic differences were observed in women and men.

CONCLUSIONS

Selection of food varies by education and occupational status in both sexes although socio-economic disparities in diet quality were observed in men only.

Secular trends in diet among elderly Swedes – cohort comparisons over three decades

Objective:

The purpose of this study was to compare dietary practices among different birth cohorts of 70-year-old Swedes, who were examined between 1971 and 2000.

Setting:

Göteborg, Sweden.

Design:

Four population-based samples of 1360 70-year-olds, born in 1901, 1911, 1922 and 1930, have undergone health examinations and dietary assessments over a period of almost three decades. One-hour diet history (DH) interviews were conducted in 1971, 1981, 1992 and 2000 with a total of 758 women and 602 women. The formats and contents of the dietary examinations were similar over the years. Statistical analysis of linear trends was conducted, using year of examination as the independent variable, to detect secular trends in food and nutrient intakes across cohorts.

Results:

At the 2000 examination, the majority of 70-year-olds consumed nutritionally adequate diets. Later-born cohorts consumed more yoghurt, breakfast cereals, fruit, vegetables, chicken, rice and pasta than earlier-born cohorts. Consumption of low-fat spread and milk also increased, along with that of wine, light beer and candy. In contrast, potatoes, cakes and sugar were consumed less in 2000 than in 1971. The ratio of reported energy intake to estimated basal metabolic rate did not show any systematic trend over time in women, but showed a significant upward trend in men.

Conclusions:

The diet history method has captured changes in food selections in the elderly without changing in general format over three decades. Dietary quality has improved in a number of ways, and these findings in the elderly are consistent with national food consumption trends in the general population.

Obesity in 70-year-old Swedes: secular changes over 30 years

OBJECTIVE

Secular increases in obesity have been widely reported in middle-aged adults, but less is known about such trends among the elderly. The primary purpose of this paper is to document the most recent wave of the obesity epidemic in population-based samples of 70-y-old men and women from Göteborg. Additionally, we will investigate the influences of physical activity, smoking and education on these secular trends.

POPULATIONS AND METHODS

Five population-based samples of 3702 70-y-olds (1669 men and 2033 women) in Göteborg, Sweden, born between 1901 and 1930, were examined in the Gerontological and Geriatric Population Studies (H70) between 1971 and 2000. Cohort differences in anthropometric measures were the main outcomes studied. Physical activity, smoking habits and education were assessed by comparable methods in all cohorts. Subsamples of the women in the latest two cohorts (birth years 1922 and 1930) were also part of the Prospective Population Study of Women in Göteborg. In these women, it was possible to examine body mass index (BMI) and waist-to-hip circumference ratio (WHR) longitudinally since 1968.

RESULTS AND CONCLUSIONS

Significant upward trends were found for height, weight, BMI, waist circumference (WC), WHR, prevalence of overweight (BMI> or =25 kg/m(2)) and obesity (BMI> or =30 kg/m(2)) across cohorts in both sexes. In 2000, 20% of the 70-y-old men born in 1930 were obese, and the largest increment (almost doubling) had occurred between the early 1980s and the early 1990s. In 70-y-old women the prevalence of obesity was 24% in 2000, a 50% increase compared to the cohort born 8 y earlier. BMI increased over time in all physical activity, smoking and education groups, with the exception of never-smoking men. Although 70-y-old women in 2000 were heavier than cohorts examined 8 y previously, data from the women studied longitudinally revealed that these differences were already present in earlier adulthood. In conclusion, the elderly population is very much part of the obesity epidemic, although secular trends in BMI were detected slightly earlier in men than in women. The health implications of these secular trends should be focused on in future gerontological research.

Masticatory ability in 80-year-old subjects and its relation to intake of energy, nutrients and food items

OBJECTIVE

The aim of the present study was to analyse the relationship between masticatory ability (self-assessed masticatory ability and bite force) and intake of energy, nutrients and food items in a population sample of elderly subjects.

DESIGN AND SUBJECTS

From a population sample of 80-year-old people, 160 individuals (74 men and 86 women) took part in an odontological study.

MAIN OUTCOME MEASURES

A dental examination including bite force recording, a questionnaire focusing on self-assessed masticatory ability, and a dietary interview.

SETTING

Department of Geriatric Medicine, Göteborg University, Sweden.

RESULTS

The dental status among the participants varied much (from edentulous in both jaws--22%--to more than 20 natural teeth--30%). The mean maximum bite force was higher in men (165 N) than in women (105 N). Bite force was significantly correlated to the Eichner index and to the number of teeth. One third of the subjects reported no masticatory problem, whereas 18% identified > or = 3 such problems. The intake of energy and nutrients varied much but the means were well above recommended values. The correlations between dental status and bite force on one side and dietary intake on the other side were in general weak and most often statistically non-significant. Impaired general health and reduced dentition were both associated with more masticatory problems.

CONCLUSION

The examined sample of 80-year-old subjects had a great variation in dental status, bite force and self-assessed masticatory ability, but these factors had only a minor influence on dietary selection and intake, which on average were well above recommended values.

Height and body weight in elderly adults: a 21-year population study on secular trends and related factors in 70-year-olds

BACKGROUND

Body size in elderly adults is partly due to aging and partly to secular trends. This study describes secular trends in three anthropometric measures (i.e., height, body weight [BW], and body mass index [BMI]) of 70-year-olds over a period of 21 years and their relation to social and lifestyle factors.

METHODS

A total of 3128 70-year-olds from four birth cohorts born between 1901 and 1922 in Gothenburg, Sweden, were examined between 1971 and 1992 in the Geriatric Medicine Department, Göteborg University. Trends in anthropometric measures were examined by permutation test. Influence of the subjects' birth year, physical activity, smoking habits, and education on anthropometric measures were investigated by multiple linear regression.

RESULTS

Individuals in later-born cohorts were found to be 1 to 2 cm taller and 1.5 to 6.3 kg heavier than earlier-born cohorts. For BMI, a positive trend was significant only in 70-year-old male participants. "Year of birth" was a positive predictor for BW (p <.001) and BMI (p <.001) in male participants and for height (p <.05) and BW (p <.01) in female participants. Physical inactivity was a positive (p <.01) and "current smoking" a negative (p <.001) predictor for BMI in both sexes. "More than basic education" was a positive predictor for height (p <.001) in both sexes and a negative predictor for body weight (p <.01) and BMI (p <.001) in female participants only.

CONCLUSIONS

Trends of increasing height, BW, and BMI were found among the Swedish elderly participants. This may be partly due to differences in smoking habits, physical activity, education, food habits, childhood nutrition, and living conditions between the cohorts.

Body mass index, weight change and mortality in the elderly. A 15 y longitudinal population study of 70 y olds

OBJECTIVE

To examine the relationship between body mass index (BMI) at age 70, weight change between age 70 and 75, and 15 y mortality.

DESIGN

Cohort study of 70-y-olds.

SETTING

Geriatric Medicine Department, Göteborg University, Sweden.

SUBJECTS

A total of 2628 (1225 males and 1403 females) 70-y-olds examined in 1971--1981 in Gothenburg, Sweden.

RESULTS

The relative risks (RRs) for 15 y mortality were highest in the lowest BMI quintiles of males 1.20 (95% CI 0.96--1.51) and females 1.49 (95% CI 1.14--1.96). In non-smoking males, no significant differences were observed across the quintiles for 5, 10 and 15 y mortality. In non-smoking females, the highest RR (1.58, 95% CI 1.15--2.16) for 15 y mortality was in the lowest quintile. After exclusion of first 5 y death, no excess risks were found in males for following 5 and 10 y mortality across the quintiles. In females, a U-shaped relation was observed after such exclusions. BMI ranges with lowest 15 y mortality were 27--29 and 25--27 kg/m(2) in non-smoking males and females, respectively. A weight loss of > or = 10% between age 70 and 75 meant a significantly higher risk for subsequent 5 and 10 y mortality in both sexes relative to individuals with 'stable' weights.

CONCLUSION

Low BMI and weight loss are risk factors for mortality in the elderly and smoking habits did not significantly modify that relationship. The BMI ranges with lowest risks for 15 y mortality are relatively higher in elderly. Exclusion of early deaths from the analysis modified the weight-mortality relationship in elderly males but not in females.

Can skin wrinkling in a site that has received limited sun exposure be used as a marker of health status and biological age?

OBJECTIVES

to determine if skin wrinkling in a site that had received limited sun exposure may be a marker of health status and biological age.

DESIGN

population-based, cross-sectional study.

PARTICIPANTS

we evaluated the health status of representative samples of elderly Greek-born people living in Melbourne, Greeks living in rural Greece, Anglo-Celtic Australians living in Melbourne and Swedes living in Sweden. We carried out microtopographic assessment of their skin and measured plasma dehydroepiandrosterone concentrations.

METHODS

we derived activities of daily living, well-being, memory and general health status scores from a cross-cultural questionnaire. We measured skin wrinkling using cutaneous microtopographic methods and plasma dehydroepiandrosterone by enzyme immuno-assay.

RESULTS

skin wrinkling was positively correlated with age (r(s)=0.27, P<0.0001) and negatively with body mass index (r(s)=-0.19, P<0.0001). Therefore, all analyses were controlled for these variables. Plasma dehydroepiandrosterone was higher in smokers than non-smokers (2.86 vs 2.08; P<0.001) and men had significantly higher plasma dehydroepiandrosterone than women (2.74 vs 1.69; P<0.0001). In the pooled data, skin wrinkling was negatively associated with general health score (r(s)=-0.13, P<0.01) and activities of daily living score (r(s)=-0.14, P<0.05) after controlling for age, body mass index and smoking. These associations were more pronounced in women. Finally, those with the least skin wrinkling had the highest dehydroepiandrosterone level (r(s)=-0.12, P=0.06) after adjusting for age, smoking and sex.

CONCLUSION

skin wrinkling in a site with limited sun exposure might be used as a marker of health status and, to some extent, biological age--particularly for women.

Aspects on nutrition of the elderly at home--a review

This review deals with the elderly at home and their nutrition in health and disease. The increasing relative and absolute number of elderly in most countries and the high prevalence of disease in the higher age groups make this item a burning one. Both the ageing process per se and the effects of disease on nutritional status add difficulties to this issue. Not only disease but also factors such as impaired vision, presbyacusis, oral health, smoking, and alcohol use or misuse may complicate nutrition in the elderly. Cohort differences may have a marked impact on nutrition regarding several factors. In many countries meal habits and intake of energy and nutrients in at least "young elderly" are on average acceptable. However, variation is marked. In this review practical aspects on preventive nutrition and dietary habits in the elderly at home are also included.

Height and body weight in the elderly. I. A 25-year longitudinal study of a population aged 70 to 95 years

OBJECTIVE

To describe longitudinal changes in height and body weight between the ages of 70 and 95 y.

DESIGN

Longitudinal cohort study with representative sample of 70-y-olds.

SETTING

Department of Geriatric Medicine, Göteborg University, Sweden.

SUBJECTS

449 males and 524 females, aged 70 y, living in Göteborg were examined in 1971-72 and this study population participated on 11 occasions during a 25-year follow-up.

RESULTS

Mean height decreased 4 and 4.9 cm in males and females respectively and the trend was significant between the ages of 70 and 95 y in both sexes. Between 70 and 75 y of age, a significant difference was found between quintiles of body height where in the highest quintile height was lowered by 0.4 and 0. 3 cm/y, in males and females respectively, and in the lowest quintile by 0.1 cm/y in both sexes. Mean body weight decreased 3.2 and 5.1 kg in males and females respectively, from age 70 to 95 y. The trend was significant over 22 and 20 y for males and females, respectively. Between the ages of 70 and 80 y, individuals in highest quintile of body weight decreased at a rate of 0.8 and 0.6 kg/y, three times higher than those in lowest quintile. Due to the decrease in both height and weight over time, body mass index (BMI) was less affected.

CONCLUSION

Height, body weight and BMI decreased significantly in both sexes after age 70 y, and there was a gender difference in the trend. The results can be used as reference data for Swedish elderly and might be of importance to the understanding of anthropometry with the ageing process.

SPONSORSHIP

See acknowledgements.

Energy intake and expenditure: validation of a diet history by heart rate monitoring, activity diary and doubly labeled water

OBJECTIVE

To validate a diet history (DH).

DESIGN

Energy intake (EI) estimated by a diet history (DH) was validated against total energy expenditure (TEE) measured by doubly labeled water (DLW) (n = 12) used as reference, by heart rate monitoring (HR) and by an activity diary (AD).

SETTING

Department of Geriatric Medicine, Göteborg University, Vasa Hospital, Gothenburg, Sweden.

SUBJECTS

20 healthy free-living elderly subjects (73 years) from the gerontological and geriatric population studies, Gothenburg, Sweden (H70).

RESULTS

Mean value for EI was 9.02 (s.d. 2.30), for TEE by HR was 9.66 (s.d. 2.25) MJ/d, and for TEE by AD was 9.40 (s.d. 2.08) MJ/d. In the 12 individuals measured with DLW, EI was 8.62 (s.d. 2.06), TEE by DLW was 9.90 (s.d. 1.43) MJ/d, TEE by HR was 8.94 (s.d. 1.96) MJ/d, and TEE by AD was 9.24 (s.d. 2.15)MJ/d. Mean difference between DH and DLW was 1.28 (s.d. 2.17) MJ (NS) and the DH/DLW ratio was 0.88. Four subjects were identified as under-reporters and one as an over-reporter.

CONCLUSION

The DH slightly underestimated EI compared to the HR, but was in concordance with the AD. Compared to DLW, DH underestimated EI by 12%. On group level, the DH method gave comparable values to HR and AD. The DH was not valid for ranking of individuals. Compared to DLW, the HR method seemed to perform somewhat better than the AD for detection of under- and over-reporters.

Dietary intake and functional ability between 70 and 76 years of age

Functional ability as well as the sociological, psychological, physiological, and nutritional status are important parts of the multi-dimensional problems of older persons. The aim was to study the relationships between ability/disability in daily life activities (ADL) and dietary intake in elderly persons studied longitudinally between 70 and 76 years of age (N = 97) in Göteborg, Sweden. People living in sheltered accommodations were excluded. Dependence in ADL was measured by "The Staircase of ADL"; dietary intake was measured by a Diet History (DH) questionnaire. Most persons had no difficulties, or were dependent on personal help in ADL at age 70 (females 70%, males 80%), but the proportion decreased at the age of 76 (females 43%, males 54%). The sample was divided into subjects without disability both at 70 and 76 years of age (N = 41), subjects disabled only at 76 (N = 31), and subjects disabled both at 70 and 76 years of age (N = 20). Food choice was not affected by disability neither at age 70, nor at age 76. Dietary intake decreased between 70 and 76 years in all three groups. However, despite the fact that one could have expected a relationship between food and nutrient intake, and ADL, we did not find significant relationships. The main reason might be that the group is relatively young, and with ADL problems mainly in instrumental ADLs. It might, therefore, be anticipated that such trends could be more marked in higher age groups.

[New height and weight standards for the middle aged and aged. Weight increases more than height]

This article presents new weight and height data collected during three large surveys of representative middle-aged and elderly men and women from Gothenburg in 1990-93. Based on these data, weight and height tables are provided as an aid in clinical evaluation. Additionally, weights and heights collected during previous examinations in the 1970s (Läkartidningen 1981; 78: 3152-4) make it possible to describe secular changes nearly two decades later. These comparative data suggest that height and weight have increased in both men and women. However, body weight has increased more than height, resulting in an increase in mean body mass index (RMI) in most groups, with the exception of 75-year old women.

Apoptosis induced by serum deprivation of PC12 cells is not preceded by growth arrest and can occur at each phase of the cell cycle

Previous studies have shown that PC12 cells undergo apoptosis (programmed cell death) when deprived of serum. In the present study, we examined the relationship of this death process to the cell cycle. PC12 cell populations synchronized at different, specific phases of the cell cycle exhibit similar kinetics of cell death following deprivation of serum. Flow cytometry analysis was used to examine the levels of apoptotic death in these cell populations in relationship to their progression in the cell cycle during the course of serum deprivation. Such analysis revealed that the cells die during the G0-G1, S, and perhaps G2-M phases and at the G2 to G1 transition. These results, therefore, suggest that the death of synchronized, serum-deprived PC12 cells occurs throughout the cell cycle and is not dependent on growth arrest. Flow cytometry methodology (acridine orange staining), which determines the RNA content of cells in relationship to their position in the cell cycle, was used to address these questions in nonsynchronized cells. These experiments revealed that, upon serum deprivation, an immediate loss of RNA occurred from cells in G1, S, and G2-M phases. This loss is accompanied by a slower appearance of cells with degraded DNA content. These results show that cells from all phases of the cell cycle are damaged upon serum deprivation and thus suggest that the apoptotic cell death of nonsynchronized PC12 cells may occur from each phase of the cell cycle.

The Johanneberg study--a sociomedical survey in an urban elderly population. I. General presentation of the study including an analysis of non-response and identification of risk groups

This study is the Swedish part of a world-wide transcultural and interdisciplinary study in elderly populations which addresses food habits, health and life-style. The aim of this paper is to present the general design including an analysis of non-response, and to identify risk-groups for intervention programmes. The study comprised 217 noninstitutionalized males (n = 73) and females (n = 144), aged 70 and over (mean age 78 years) in a small urban area. Home visits and clinical examinations with standard methods were used. The participation rate was 76%. Significant differences between non-respondents and respondents could be seen, which may be important when planning health promotion. On the basis of experiences during the examinations, a risk-group was identified for prospective and intervention study purposes, based on a multiple variable model and a clinical model.

Validation of the food frequency questionnaire with the 4-day record method and analysis of 24-h urinary nitrogen

OBJECTIVE

To validate a semi-quantitative food frequency questionnaire (FFQ).

DESIGN

FFQ was evaluated by a 4-day food record (FR), four consecutive 24-h urinary collections, and study-specific cut-off limits for ratio between energy intake (EI) and basal metabolic rate (BMR).

SETTING

Department of geriatric medicine, Göteborg University, Vasa Hospital, Gothenburg, Sweden.

SUBJECTS

76 consecutive 70-year-olds from representative population studies.

RESULTS

FFQ provided consistently higher intakes of energy and nutrients than FR (1.18-2.51 of the FR values). For energy 95% CI estimates were 7167-8083 KJ and 9333-10579 KJ, by FR and FFQ methods, respectively. The correlation coefficients varied between 0.35 (total sugar) and 0.60 (energy and fat). The proportions and distribution of macronutrients were in good agreement between FFQ and FR. 95% CIs for the ratio between protein intake estimated by dietary methods and urinary protein were 1.14-1.36 and 1.00-1.13 for the FFQ and FR methods, respectively. However, the EI/BMR ratio for FR (1.27) was not in conformity with habitual energy expenditure compared to cut-off limits.

CONCLUSION

This validity study showed that the agreement regarding distribution of energy from macronutrients between dietary methods and the reasonable ratio of FFQ-EI/BMR allow the conclusion that the FFQ method well reflects habitual intake of elderly Swedes.

Intake of energy, nutrients and food items in an urban elderly population

This study is part of a transcultural investigation under the auspices of the International Union of Nutritional Sciences, where dietary habits are studied with similar methodology in different populations throughout the world. The present paper describes and evaluates the intake of energy and nutrients, and food habits in an urban elderly population in Sweden, in relation to existing standards. The study population comprised 66 males and 122 females, aged 70 years and over (average 78 years) living in the city of Gothenburg. Energy intake was on average 11.5 MJ in males and 9.9 MJ in females. Nutrient intakes were on average above recommendations, and neither intake nor food choice seemed to change much with increasing age. A validation by a 4-day record and 24-hour urinary nitrogen determination was performed in a subsample, and indicated a probable systematic overestimation of at least 10% for protein consumed. The data from this study support the view that people 70 years of age and older in Sweden are generally healthy, active and have good food habits. This population, however, was not a representative sample. They were all living in a well defined area, with a stable social situation, and belonged generally to middle class. With this background the nutrient data seem reasonable. As long as elderly people stay healthy and do not have other serious risk factors, they seem to keep good food habits and nutritional status up into their eighties and nineties.

Radiation leukemia virus and X-irradiation induce in C57BL/6 mice two distinct T-cell neoplasms: a growth factor-dependent lymphoma and a growth factor-independent lymphoma

Two different classes of neoplastic T cells were isolated from radiation leukemia virus (RadLV)-inoculated and from X-ray-treated C57BL/6 mice. One consisted of growth factor-dependent T-cell lymphoma (FD-TCL) lines which were established from the spleens and thymuses of treated mice within a day of lymphoma detection. FD-TCL cells were often eudiploid and could be grown in pure culture only at high concentrations, or on stromal feeder layers. Non-thymic, factor-dependent TCL cells produced interleukin-2 upon lectin stimulation, and were autostimulatory because they secreted growth factor(s) constitutively. Single cell cloning of FD-TCL cells in semisolid medium required the addition of exogenous conditioned medium. In vivo, FD-TCL cells that were injected intraperitoneally or intravenously homed to the spleen, proliferated in it and killed the injected mice. FD-TCL cells did not produce local tumors at the site of subcutaneous injection. The isolation and study of FD-TCL cells was facilitated by their cultivation on stromal hematopoietic monolayers in supplemented "lymphocyte medium", until an autostimulating, self-sustaining concentration of FD-TCL cells was obtained. FD-TCL cells could not be grown from lymphoid tissue of normal, control mice. In contrast, T-cell lymphoma (TCL) lines, which were established from virus-induced thymomas which had been kept in situ for 4-6 weeks after detection, consisted of factor-independent cells that possessed an aneuploid karyotype (in some cases trisomic for chromosome No. 15), and produced local tumors at the site of subcutaneous injection. These cells could be cloned in semisolid medium without addition of exogenous factor(s). The phenotypic markers of TCL cells differed from those of FD-TCL cells, suggesting heterogeneity in the stages of differentiation at which cells can give rise to growth factor-independent (TCL) and to growth factor-dependent (FD-TCL) lines.

Proliferation of thymic stem cells with and without receptors for interleukin 2. Implications for intrathymic antigen recognition

We have tested the dividing cells in the mouse thymus for expression of interleukin 2 (IL-2) receptors (IL-2-R) using the rat monoclonal antibody 7D4. A discrete subpopulation of the lymphoblasts clearly expressed IL-2-R at levels comparable to those on mitogen-activated peripheral T cells. This subpopulation, however, represented a small minority of the proliferating cells. IL-2-R-bearing cells were depleted from the PNA+ (peanut agglutinin) lymphoblast population, which contains the direct precursors of most of the cells in the thymus. The majority of receptor-bearing cells were found in the PNA- lymphoblast population, where they constituted only approximately 12% of the cells. Thus, virtually all the PNA+ and most of the PNA- blast cells were in cycle without detectable IL-2-R expression. This indicates that they were not dividing in response to IL-2, and implies that they were not dividing in response to antigen, but rather to novel thymus-specific mitogenic stimuli. On the other hand, the proliferating cells that do express IL-2-R were enriched 4-5-fold in the rapidly growing neonatal thymus, suggesting that they may also play a key role in T cell development.