The protective effect of calcium on bone mass in postmenopausal women with high selenium intake

Objective

Nutritional factors, especially the two essential nutrients calcium and vitamin D, have been shown to play an important role in bone health. We wanted to determine the possible protective effect of calcium intake in adequate amounts on bone mass as assessed by quantitative ultrasound in postmenopausal women who also have a high intake of selenium.

Setting

Health district of Cáceres, Spain.

Participants and Study Design

335 postmenopausal women aged 60.9 (SD = 8.1) years. Women were stratified based on the vitamin D, vitamin E, calcium intake and the calcium/protein and calcium/phosphorous index.

Measurements

Bone status (Ad-SoS measured at the phalanges) was assessed with an ultrasound device model DBM Sonic 1200R. Food intake was quantified using dietetic scales, measuring cups, and spoons based on 7 days of diet records. Urine samples were collected the morning of testing after an overnight fast. Venous blood samples for the hematological and biochemical studies were also obtained in the fasting state.

Results

In the group of women with Ca intake < 800 mg / d we found a significant and negative relationship between Ad-SoS with age (?? = ?4.020, F = 23.327) and selenium intake (?? = ?0.419, F = 10.067), as well as a positive relationship with Ca intake (?? = 0.104 and F = 7.084) (p <0.0001 in all). In the group of women with Ca intake > 800 mg / d, age has a significant and negative relationship (?? = ?4.829 and F = 106.745), whereas folic acid intake has a significant and positive relationship (?? = 0.047 and F = 5.858) (p <0.0001 in both).

Conclusion

Elevated selenium intake negatively affects bone mass measurements in postmenopausal women over the age of 51 but only if calcium intake is also less than 800 mg / day. When calcium intake is greater than 800 mg/day, selenium did not appear to affect bone mass.     

Efficacy of a home-based intervention programme on the physical activity level and functional ability of older people using domestic services: A randomised study

Objective

Our main objective was to assess whether a home-based program supervised by home helpers (HH) during their normal working hours can prevent excessive sedentariness (mainly maximum walking time and distance) and preserve functional status in elderly people at risk for frailty or disability and using domestic services.

Design

A four-month, open label, randomised trial with two groups called ??prevention?? and ??control??.

Setting

In the homes of study participants.

Participants

The participants were all over 78 years old, lived independently at home, and received the visits of HHs at least once a week.

Intervention

The intervention combined a self-administered exercise program, with 10 g amino-acid supplementation under the supervision of HHs.

Measurements

Main outcome measures included physical activity (the PASE questionnaire), functional tests, nutritional and autonomy scores, and compliance (50% or more was considered satisfactory). Non-parametric methods were used for comparisons between the two groups. A linear regression model was fitted to assess the effect of the intervention on the relative variation of outcomes, adjusted for unbalanced baseline co-variables.

Results

One hundred and two persons (prevention n=53, control n=49) with a median age of 85 years were included. Their median Activities of Daily Living and Instrumental Activities of Daily Living (LADL) scores were 6 and 7 respectively. Twenty-three (44%) were good compilers for both interventions. The maximum walking time remained stable while decreasing by 25% in the control group (p=0.0015); and fewer participants had a worsened IADL score in the prevention group (p=0.05). The baseline IADL Score was significantly associated with good compliance to the prevention program (p=0.0011). In good compliers, maximum walking distance and maximum walking time increased by 29.15% (0.0 to 66.7) and 33.3% (?20.0 to 50.0) respectively.

Conclusion

This study confirms the feasibility of a prevention program supervised by HHs, and some benefit from the intervention and identifies predictors for better compliance. It will help in the design of prevention trials for elderly people at risk for frailty.     

The selection of a screening test for frailty identification in community-dwelling older adults

Background

Frailty in older Chinese has been less often studied and the selection of one screening test feasible in primary care and population survey is needed. We attempted to examine the sensitivity and specificity of each of the five Fried’s criteria as a single screening test in the identification of frailty.

Methods

We recruited 4000 community-dwelling Chinese adults 65 years or older stratified by 3 age-stratum and identified frailty as having 3 or more of Fried’s criteria: underweight(BMI<18.5), handgrip strength(<lowest quintile), walking speed(<lowest quintile), self-reported exhaustion and low physical activity(PASE score<lowest quintile).

Results

The proportion of frailty in the 3 age groups (65–69 years, 70–74 years, 75 years and above) were 2.3%, 3.4% and 11.9% respectively in men and 1.4%, 2.6% and 11.6% in women. Among the 5 criteria, walking speed, grip strength and physical activity (PASE score) divided at their respective lowest quintile values, achieved similar Area Under Curve in the Receiver Operating Characteristics analysis. For walking speed, the sensitivity and specificity were 82.7% and 83.1% in men and 91.9% and 84.5% in women respectively. For grip strength, the corresponding values were 89.5% and 80.6% in men; and 84.5% and 81.9% in women. For physical activity, they were 83.7% and 83.5% in men; and 82.8% and 84.7% in women.

Conclusion

Either walking speed or grip strength measurement may be suitable for frailty screening in primary care or population health survey. A cut-off value of 0.9 m/s in walking speed and 28 kg in grip strength for older men; and a corresponding value of 0.8 m/s and 18 kg for older women is recommended for the screening of frailty in community-dwelling older Chinese adults.     

The prediction of quality of life by physical,psychological and social components of frailty in community-dwelling older people

Purpose

To assess the predictive validity of the 15 components of the Tilburg Frailty Indicator (TFI), a self-report questionnaire, for quality of life domains physical health, psychological, social relations and environmental in community-dwelling older persons in a longitudinal study.

Methods

The predictive validity of the components of the TFI was tested in a sample of 484 community-dwelling persons aged 75 years and older in the Netherlands in 2008 (response rate 42 %). A subset of all respondents participated two years later, in 2010 (n = 261, 54 %), and a subset of these respondents participated again in 2012 (n = 196, 75 %). The WHOQOL-BREF was used for measuring four quality of life domains.

Results

Four physical frailty components (physical unhealthy, difficulty in maintaining balance, difficulty in walking and physical tiredness), one psychological frailty component (feeling down) and one social frailty component (lack of social support) predicted future scores on quality of life domains, even after controlling for background characteristics and diseases.

Conclusion

This longitudinal study showed that quality of life is predicted by physical as well as psychological and social frailty components. This finding emphasizes the relevance of a multidimensional assessment of frailty. To improve quality of life of older persons, special attention should go to the screening and subsequent interventions focusing on the frailty components difficulty in walking, feeling down and lack of social support.     

Influence of nutritional status on health-related quality of life of non-institutionalized older people

Objectives

Health-related quality of life (HRQoL) is a multidimensional health measurement and a key to optimal aging. The aim of this study was to examine the association of nutritional status with HRQoL in the elderly.

Design

Cross-sectional study.

Setting

Villanueva Older Health Study, a community-based study in Villanueva de la Cañada (Madrid, Spain).

Participants

83 (53 women) non-institutionalized inhabitants aged 80 years and above.

Measurement

HRQoL was assessed by EuroQoL-5D (EQ-5D) questionnaire, nutritional risk by Mini Nutritional Assessment (MNA) questionnaire and dietary intake by 24-hour dietary recall. Statistical significance was evaluated at 95% confidence level (P< 0.05).

Results

EQ-5D pointed out differences between men and women (0.782±0.235 and 0.633±0.247; p=0.02). Problems in mobility (total sample) and pain/discomfort (women) dimensions were most frequently reported. MNA (26.5±3.2 men and 24.3±3.2 women; p=0.03) revealed malnutrition in 3.3% of men and 1.9% of women, and risk of malnutrition in 6.7% and 37.7%, respectively. Total sample was at risk of folic acid, zinc, magnesium, vitamin D and vitamin E deficiency. EQ-5D was associated with MNA (p<0.001). EQ-5Dindex was associated with energy intake (p=0.04) and EQ-5Dvas was negatively correlated with body mass index (p=0.02). EQ-5D pain/discomfort dimension was associated with energy (p=0.006), protein (p=0.005), lipid (p=0.03), magnesium (p=0.032), phosphorus (p=0.012), selenium (p=0.043) and niacin (p=0.004) intake.

Conclusions

Women showed poorer HRQoL and higher malnutrition risk. A relationship between HRQoL and risk of malnutrition was observed. Results suggest that when energy and protein, lipid, phosphorus, magnesium, selenium and niacin intake increase, HRQoL is promoted, although the increase does not seem to have a strong direct effect on it. The limited influence of energy and nutrient intake on HRQoL observed requires further research.     

Association of marine-origin N-3 polyunsaturated fatty acids consumption and functional mobility in the community-dwelling oldest old

Objective

To examine whether habitual dietary intake of marine-origin n-3 polyunsaturated fatty acids (MOPUFA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are associated with functional mobility in the community-dwelling oldest old, 85 years or older, who are at high risk for physical disability.

Design

A cross-sectional study.

Setting

A community-based survey conducted at university research center or home-based.

Participants

Four hundred seventeen (189 men, 228 women) out of 542 participants in the baseline examination of the Tokyo Oldest Old Survey on Total Health, a community-based ongoing longitudinal study among the oldest old living in the center of Japan.

Measurements

Habitual dietary intake of MOPUFA was assessed by the brief-type self-administered diet history questionnaire (BDHQ), and functional mobility was assessed by the Timed Up and Go test. Plasma inflammatory biomarkers (C-reactive protein, interleukin-6 and tumor necrosis factor-a) were measured. We evaluated the cross-sectional association between habitual intake of MOPUFA and functional mobility using multivariate logistic regression analysis — Prior to the analysis, validation of BDHQ in this study was confirmed among 190 participants (96 men, 94 women) based on the EPA and DHA concentrations in the erythrocyte membrane phospholipids as reference.

Results

Moderate correlation between estimated dietary intake of EPA/DHA and concentration of EPA/DHA in the erythrocyte membrane phospholipids was obtained (Spearman’s r=0.29–0.58, p<0.01). Multivariate logistic regression analysis revealed that a lower habitual intake of EPA+DHA was significantly associated with poor functional mobility in men but not in women (OR (95%CI) per 1 SD increase of EPA+DHA intake; 0.55 (0.33–0.91), 0.88 (0.59–1.32), men and women respectively).

Conclusions

Habitual intake of MOPUFA was associated with functional mobility in community-dwelling oldest old men.     

A maternal erythrocyte DHA content of approximately 6?g% is the DHA status at which intrauterine DHA biomagnifications turns into bioattenuation and postnatal infant DHA equilibrium is reached

Purpose

Higher long-chain polyunsaturated fatty acids (LCP) in infant compared with maternal lipids at delivery is named biomagnification. The decline of infant and maternal docosahexaenoic acid (DHA) status during lactation in Western countries suggests maternal depletion. We investigated whether biomagnification persists at lifelong high fish intakes and whether the latter prevents a postpartum decline of infant and/or maternal DHA status.

Methods

We studied 3 Tanzanian tribes with low (Maasai: 0/week), intermediate (Pare: 2–3/week), and high (Sengerema: 4–5/week) fish intakes. DHA and arachidonic acid (AA) were determined in maternal (m) and infant (i) erythrocytes (RBC) during pregnancy (1st trimester n?=?14, 2nd?=?103, 3rd?=?88), and in mother–infant pairs at delivery (n?=?63) and at 3?months postpartum (n?=?104).

Results

At delivery, infants of all tribes had similar iRBC-AA which was higher than, and unrelated to, mRBC-AA. Transplacental DHA biomagnification occurred up to 5.6?g% mRBC-DHA; higher mRBC-DHA was associated with “bioattenuation” (i.e., iRBC-DHA?Conclusion Uniform high iRBC-AA at delivery might indicate the importance of intrauterine infant AA status. Biomagnification reflects low maternal DHA status, and bioattenuation may prevent intrauterine competition of DHA with AA. A mRBC-DHA of about 6?g% during pregnancy predicts maternal–fetal equilibrium at delivery, postnatal iRBC-DHA equilibrium, but is unable to prevent a postnatal mRBC-DHA decline.     

Fruit and vegetable intake and physical activity as predictors of disability risk factors in African-American middle-aged individuals

Objective

To investigate fruit and vegetable intake (FVI) and different dimensions of physical activity (PA) as predictors of change in disabilities and other known precursors of progressive disability in a populationbased sample of African Americans.

Design

Longitudinal investigation of the independent associations of reported FVI and PA with six-year changes in disabilities and other known precursors of progressive disability.

Setting

Longitudinal study of a population-representative cohort of late middle-aged African Americans.

Participants

432 cohort participants with complete information on all measures.

Measurements and Analytic Approach

During wave 8 (2008), FVI was measured using 2005 Behavioral Risk Factor Surveillance System questions and PA dimensions using the Yale Physical Activity Survey (YPAS). Disability measures included basic activities of daily living (ADLs) and instrumental ADLs (IADLs); other precursors included measured gait speed, grip strength, and short physical performance battery (SPPB) and reported lower body functional limitations (LBFLs) and FRAIL scale; these were measured at wave 4 (2004) and wave 10 (2010). Residualchange score linear regression was used to identify FVI and PA factors that were independently associated with six-year changes in disability and other precursors.

Results

The study cohort was less active than the YPASdevelopment group. Longitudinally, leisurely walking was independently associated with better ADL, IADL, grip strength, SPPB, LBFL, and frailty outcomes; standing with better IADL and SPPB; intake of vegetables other than carrots, salads, or potatoes with better grip strength and frailty; and fruit juice intake with worse grip strength and frailty.

Conclusions

In this relatively inactive cohort, leisurely walking was associated with multiple beneficial outcomes. Benefits were also seen with vegetables other than potato intake, and fruit juice intake was associated with detrimental effects. This study highlights the importance of finding strategies to help this population increase PA (especially leisurely walking) and intake of whole fruits and vegetables.

     

Gait variability at fast-pace walking speed: A biomarker of mild cognitive impairment?

Background

The interpretation of the increase in stride-to-stride variability of stride time (STV) regarding the evolution of cognitive deficits across the dementia spectrum is matter of debate.

Objective

The aim of this study was to compare STV at usual and fast-pace walking speeds of MCI patients with that of cognitively healthy individuals (CHI) and Alzheimer’s disease (AD) patients with mild dementia, while considering the effects of potential confounders.

Methods

STV while walking at usual and fast-pace walking speeds was recorded with the GAITRite® system from 116 older adults (mean age 75.6±6.5 years; 55.2% female) divided into 3 groups according to their cognitive status (44 CHI, 39 MCI patients and 33 AD patients with mild dementia).

Results

The full adjusted multiple linear regression models showed that high STV was associated with slow gait speed at usual-pace walking speed (P=0.002) and with the MCI status at fast-pace walking speed (P=0.015).

Conclusions

High STV at fast-pace walking speed was a specific gait disturbance of MCI patients in the sample of studied participants, and thus could be used in the future as a specific biomarker of MCI patients.     

Sexually dimorphic patterns of nutritional intake and eating behaviors in community-dwelling older adults with normal and slow gait speed

Objectives

Assess sex-specific nutritional intake and dietary habits of independently living older adults with normal and slow gait speeds.

Design

New Mexico Aging Process Study, cross-sectional, secondary data analysis.

Setting

Albuquerque, New Mexico USA.

Participants

Three-hundred fifteen adults 60 years and older (194 women and 121 men).

Measurements

Gait speed test, 3-day diet records, Mini-Mental State Examination, and body mass index.

Results

Slow gait speed was associated with lower total calories (?154 kcal/day) and zinc (1mg/day) (.05 < p <.1). Slower men consumed less protein (?4.1g/day), calcium (?140mg), fiber (-2.8g/day) and iron (?2.5mg/day) (p<.05). Slower women consumed less, protein (?5.5g/day), carbohydrate (?19.1g/day), fiber (?2.7gm/day), vitamin C (?18.4mg/day) and higher fat intake (p=0.03). Slower women snacked less, had trouble chewing/biting, and lived alone (p=.04). Slower men were less likely to snack.

Conclusions

We found sex-specific nutritional differences associated with gait speed. Those presenting with slow gait speed may need encouragement to increase meat and whole grain breads/cereal. Those with trouble eating should be advised on adapting diet to maintain adequate nutrition and encouraged on regular snacking to achieve higher nutrient intake. Prospective and randomized controlled studies are needed to confirm these findings and provide further evidence for putting these suggestions into practice.     

Effects of Resistance Exercise Training on Cognitive Function and Physical Performance in Cognitive Frailty: A Randomized Controlled Trial

Background

Cognitive frailty is defined as the presence of both physical frailty and cognitive impairment (clinical dementia rating score = 0.5), in the absence of dementia. It is characterized by concurrent physical frailty and potentially reversible cognitive impairment. In this study, we sought to elucidate the effects of high-speed resistance exercise training on cognitive function and physical performance in older adults with cognitive frailty.

Methods

We conducted a parallel-group, randomized controlled trial involving community-living older adults with cognitive frailty. The participants’ mean age was 73.9 (± 4.3 SD) years, and 69.8% (n=30) were female. Two different 4-month interventions included high-speed resistance exercise training group (n=22) and a control group (balance and band stretching, n=23). Frailty score, cognitive function (memory, processing speed, cognitive flexibility, working memory, executive function), physical function (SPPB, TUG, gait speed), and muscle strength (grip strength, knee extension strength) were assessed at baseline, 8 weeks, and 16 weeks.

Results

Statistical analysis showed that exercise improved performance significantly in the tests for cognitive function (processing speed and executive function, both p < 0.05), physical function (SPPB, TUG, gait speed, both p < 0.05), and muscle strength (grip strength, knee extension strength, both p < 0.05). However, no significant changes in frailty score were observed between intervention and either control group (p < 0.05).

Conclusion

In conclusion, our findings indicate that high-speed resistance exercise training approaches are effective in improving cognitive function and physical performance in older adults with cognitive frailty. This study shows that it is feasible to identify older adults with cognitive frailty in the community and primary care setting for effective intervention to reduce their level of frailty and cognitive impairment.

     

The association between body mass index, weight loss and physical function in the year following a hip fracture

Objectives

To determine whether body mass index (BMI) at the time of hospitalization or weight change in the period immediately following hospitalization predict physical function in the year after hip fracture.

Design

Prospective observational study.

Setting

Two hospitals in Baltimore, Maryland.

Participants

Female hip fracture patients age 65 years or older (N=136 for BMI analysis, N=41 for analysis of weight change).

Measurements

Body mass index was calculated based on weight and height from the medical chart. Weight change was based on DXA scans at 3 and 10 days post fracture. Physical function was assessed at 2, 6 and 12 months following fracture using the Lower Extremity Gain Scale (LEGS), walking speed and grip strength.

Results

LEGS score and walking speed did not differ across BMI tertiles. However, grip strength differed significantly across BMI tertiles (p=0.029), with underweight women having lower grip strength than normal weight women at all time points. Women experiencing the most weight loss (>4.8%) had significantly lower LEGS scores at all time points, slower walking speed at 6 months, and weaker grip strength at 12 months postfracture relative to women with more modest weight loss. In adjusted models, overall differences in function and functional change across all time points were not significant. However, at 12 months post fracture,women with the most weight loss had an average grip strength 7.0kg lower than women with modest weight loss (p=0.030).

Conclusions

Adjustment for confounders accounts for much of the relationships between BMI and function and weight change and function in the year after fracture. However, weight loss is associated with weakness during hip fracture recovery. Weight loss during and immediately after hospitalization appears to identify women at risk of poor function and may represent an important target for future interventions.     

Antidiabetic activity of isoquercetin in diabetic KK -Ay mice

Background

Protective effects of omega-3 fatty acids against cellular damages of high glucose were studied on retinal pigmented epithelial (RPE) cells.

Methods

Retinal epithelial cells were incubated with omega-3 marine oils rich in EPA and DHA and then with high glucose (25 mM) for 48 hours. Cellular responses were compared to normal glucose (5 mM): intracellular redox status, reactive oxygen species (ROS), mitochondrial succinate deshydrogenase activity, inflammatory cytokines release and caveolin-1 expression were evaluated using microplate cytometry, ELISA and flow cytometry techniques. Fatty acids incorporation in retinal cell membranes was analysed using chromatography.

Results

Preincubation of the cells with fish oil decreased ROS overproduction, mitochondrial alterations and TNFα release. These protective effects could be attributed to an increase in caveolin-1 expression induced by marine oil.

Conclusion

Marine formulations rich in omega-3 fatty acids represent a promising therapeutic approach for diabetic retinopathy.     

Vitamin B12 as a potential compliance marker for fish intake

Objectives

The aim of the present study was to investigate whether the following four markers: vitamin B₁₂, selenium, vitamin D, and parvalbumin may be used as compliance markers for fish intake.

Methods

Blood samples from a randomized cross-over herring intervention study (n = 32) were analysed by HPLC and immunochemistry. The criteria were that plasma or serum concentrations of candidate compliance markers after the herring diet should increase significantly compared to starting concentrations. In addition, the reference meat diet should not yield an increase in plasma concentration of the candidate marker.

Results

Vitamin B₁₂ and selenium met the set criteria for indicating a correlation between the marker and fish intake with significant increases in serum concentrations at 8.9 % (p = 0.008) and 4.6 % (p = 0.02), respectively, after a 6-week herring intervention (5 meals a week). Parvalbumin and 25-hydroxy vitamin D₃ levels did not increase significantly after the herring interventions.

Conclusions

Vitamin B₁₂ may be suitable as a compliance marker for fish intake. Although selenium also met the criteria, the change in selenium serum concentrations was small compared to the change in vitamin B₁₂ levels.     

High-technology based gait assessment in frail people: Associations between spatio-temporal and three-dimensional gait characteristics with frailty status across four different frailty measures

Objective

We analyzed associations between a battery of gait characteristics and frailty status across four different frailty instruments in old patients.

Design

Cross-sectional study.

Setting

Geriatric wards of a general hospital.

Participants

123 hospitalized patients aged ≥65 years.

Measurements

Spatio-temporal and three-dimensional gait characteristics were assessed by an electronic walkway and a shoe-mounted, inertial sensor-based mobile gait analysis system. Frailty status was assessed by the frailty phenotype (FP), Clinical Frailty Scale (CFS), frailty index (FI), and frailty index based on a comprehensive geriatric assessment (FI-CGA).

Results

A reduction in walking speed (FP, FI, FI-CGA), stride length (FP, FI, FI-CGA), maximum toe clearance (FP, CFS, FI, FI-CGA), toe off angle (FP, CFS, FI, FI-CGA), heal strike angle (FI-CGA) and greater stride length variability (FP, CFS, FI, FI-CGA), stride time variability (FP, FI), double support time (FP, FI), and stride width (CFA, FI-CGA) were associated with frailty status across the four frailty instruments (all P < 0.05, respectively). Walking speed (FP, CFS, FI, FI-CGA), stride length (FP, CFS, FI, FI-CGA), maximum toe clearance (FP, CFS, FI, FI-CGA), toe off angle (FP, CFS, FI, FI-CGA), heal strike angle (FP, FI), stride length variability (CFS, FI, FI-CGA), stride time variability (FI), double support time (FP), and stride width (FP, CFS, FI) were related with frailty severity across the four frailty instruments independent of age and sex (all P adjusted < 0.05, respectively).

Conclusions

Gait changes in frail patients include more than solely a reduction in walking speed.

     

Nutritional status according to the Mini Nutritional Assessment (MNA®) and frailty in community dwelling older persons: A close relationship

Objective

This study investigates the association between MNA results and frailty status in community-dwelling older adults. In addition the relevance of singular MNA items and subscores in this regard was tested.

Design

Cross-sectional study.

Setting

Community-dwelling older adults were recruited in the region of Nürnberg, Germany.

Participants

206 volunteers aged 75 years or older without cognitive impairment (Mini Mental State Examination >24 points), 66.0% female.

Measurements

Frailty was defined according to Fried et al. as presence of three, pre-frailty as presence of one or two of the following criteria: weight loss, exhaustion, low physical activity, low handgrip strength and slow walking speed. Malnutrition (<17 points) and the risk of malnutrition (17–23.5 points) were determined by MNA®.

Results

15.1% of the participants were at risk of malnutrition, no participant was malnourished. 15.5 % were frail, 39.8% pre-frail and 44.7% non-frail. 46.9% of the frail, 12.2% of the pre-frail and 2.2% of the non-frail participants were at risk of malnutrition (p<0.001). Hence, 90% of those at risk of malnutrition were either pre-frail or frail. For the anthropometric, dietary, subjective and functional, but not for the general MNA subscore, frail participants scored significantly lower than pre-frail (p<0.01), and non-frail participants (p<0.01). Twelve of the 18 MNA items were also significantly associated with frailty (p<0.05).

Conclusions

These results underline the close association between frailty syndrome and nutritional status in older persons. A profound understanding of the interdependency of these two geriatric concepts will represent the basis for successful treatment strategies.     

And mortality in older Chinese adults: Results from the Beijing longitudinal study of aging

Objectives

Falls are well known to be associated with adverse health outcomes, especially when complicated by fracture. Falls are more common in people who are frail and readily related to several items in the frailty phenotype. Less is known about the relationship between falls and frailty defined as deficit accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation.

Design

Representative cohort study, with 8 year follow-up.

Setting

The Beijing Longitudinal Study of Aging (BLSA).

Participants

3,257 Chinese people aged 55+ years at baseline.

Measurements

A frailty index (FI) was constructed using 33 health deficits, but excluding falls and fractures. The rates of falls, fractures and death as a function of age and the FI were analyzed. Multivariable models evaluated the relationships between frailty and the risk of recurrent falls, fractures, and mortality adjusting for age, sex, and education. Self or informant reported fall and fracture data were verified against participants?? health records.

Results

Of 3,257 participants at baseline (1992), 360 people (11.1%) reported a history of falls, and 238 (7.3%) reported fractures. By eight years, 1,155 people had died (35.3%). The FI was associated with an increased risk of recurrent falls (OR=1.54; 95% confidence interval (CI)=1.34?C1.76), fractures (OR=1.07; 95% CI=0.94?C1.22), and death (OR=1.50, 95% CI=1.41?C1.60). The FI showed a significant effect on mortality in a multivariate Cox regression model (Hazard Rate=1.29, 95% CI=1.25?C1.33). When adjusted for the FI, neither falls nor fractures were associated with mortality.

Conclusion

Falls and fractures were common in older Chinese adults, and associated with frailty. Only frailty was independently associated with death.     

Fish oil supplementation increases event-related posterior cingulate activation in older adults with subjective memory impairment

Objective

To determine the effects of long-chain omega-3 (LCn-3) fatty acids found in fish oil, including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on cortical blood oxygen level-dependent (BOLD) activity during a working memory task in older adults with subjective memory impairment.

Design

Randomized, double-blind, placebo-controlled study.

Setting

Academic medical center.

Participants

Healthy older adults (62–80 years) with subjective memory impairment, but not meeting criteria for mild cognitive impairment or dementia.

Intervention

Fish oil (EPA+DHA: 2.4 g/d, n=11) or placebo (corn oil, n=10) for 24 weeks.

Measurements

Cortical BOLD response patterns during performance of a sequential letter n-back working memory task were determined at baseline and week 24 by functional magnetic resonance imaging (fMRI).

Results

At 24 weeks erythrocyte membrane EPA+DHA composition increased significantly from baseline in participants receiving fish oil (+31%, p≤0.0001) but not placebo (?17%, p=0.06). Multivariate modeling of fMRI data identified a significant interaction among treatment, visit, and memory loading in the right cingulate (BA 23/24), and in the right sensorimotor area (BA 3/4). In the fish oil group, BOLD increases at 24 weeks were observed in the right posterior cingulate and left superior frontal regions during memory loading. A region-of-interest analysis indicated that the baseline to endpoint change in posterior cingulate cortex BOLD activity signal was significantly greater in the fish oil group compared with the placebo group during the 1-back (p=0.0003) and 2-back (p=0.0005) conditions. Among all participants, the change in erythrocyte EPA+DHA during the intervention was associated with performance in the 2-back working memory task (p = 0.01), and with cingulate BOLD signal during the 1-back (p = 0.005) with a trend during the 2-back (p = 0.09). Further, cingulate BOLD activity was related to performance in the 2-back condition.

Conclusions

Dietary fish oil supplementation increases red blood cell omega-3 content, working memory performance, and BOLD signal in the posterior cingulate cortex during greater working memory load in older adults with subjective memory impairment suggesting enhanced neuronal response to working memory challenge.

     

Dietary protein and beef consumption predict for markers of muscle mass and nutrition status in older adults

Objective

To determine the relationship of beef and protein intake to nutrition status, body composition, strength, and biochemical measures of vitamin and mineral status, inflammation and blood lipids in older adults.

Design

Cross-sectional observational study.

Setting

State of Ohio, U.S A.

Participants

142 adults ages 60?C88.

Measurements

Subjects completed a Diet History Questionnaire, and questionnaires related to nutrition status and activity. Subjects also underwent measurements of body composition and strength, and a subset took part in a blood draw for biochemical measurements.

Results

Beef intake (g/d) was positively correlated to muscle mass measured by mid-arm muscle area (R=0.128, p=0.030). From multiple linear regression analysis, a loz/d (??28g/d) increase in beef consumption predicts for a 2.3cm² increase in mid-arm muscle area. Beef intake was negatively correlated to total (R=?0.179, p=0.035) and HDL (R=?0.247, p=0.004) cholesterol, and there was no association between beef and LDL-cholesterol, triglycerides, liver enzymes, or inflammatory markers. Protein intake (% of total energy) was positively correlated to nutrition status measured by the Mini Nutrition Assessment (R=0.196, p=0.020), and calf circumference (R=0.190, p=0.024), and these correlations remained when potential confounders were accounted for in multiple linear regression models. Protein intake was also positively correlated with BMI when analyzed with multiple linear regression.

Conclusions

Beef intake was positively associated with mid-arm muscle area, and protein intake was positively associated with nutrition status, calf circumference, and BMI in older adults. Consuming lean cuts of beef in moderation may be a healthy way in which older adults can increase protein intake, preserve muscle mass and improve nutrition status.     

Cognitive Frailty is Associated with Fall-Related Fracture among Older People

Objective

Cognitive frailty refers to cognitive impairment and physical frailty. Both cognitive impairment and physical frailty include risks of falling. The purpose of the study is to examine cognitive frailty and falling with/without a fracture.

Design

Cross-sectional observation study.

Setting

General communities in Japan.

Participants

Data of 10,202 older adults aged ≥ 65 years were collected.

Measurements

Physical frailty was characterized as slow walking speed and/or muscle weakness. Assessment of cognitive function included word lists memory, attention, executive function, and processing speed. Cognitive impairment refers to one or more cognitive decline indicated by at least 1.5 standard deviations below the threshold after adjusting for age and education. We operationally defined cognitive frailty as having both cognitive impairment and physical frailty. Participants were interviewed about their falling, history of fall-related fractures, and several potentially confounding factors such as demographic characteristics.

Results

Multinomial logistic regression analysis revealed that functional decline in all groups, as compared to the robust group, was significantly associated with falling without fractures, after adjusting for the covariates; cognitive impairment group (P =.017), physical frailty group (P =.002), and cognitive frailty group (P <.001). Only the cognitive frailty group had a significant association with fall-related fracture after adjusting for the covariates (OR 1.92, 95% CI: 1.20–3.08, P =.007).

Conclusion

Cognitive frailty is associated with not only falling but also fall-related fractures. Cognitive frailty may have a greater risk for fall-related fractures than cognitive impairment or physical frailty alone. Future research should examine causal the relationship between fall-related fractures and cognitive frailty.