Association of nutrition and immune-endocrine dysfunction with muscle mass and performance in cognitively impaired older adults

BackgroundWith lean mass declining early in Alzheimer’s disease, muscle quality beyond quantity is relevant to physical performance. We sought to identify potentially modifiable factors for the differential loss of muscle mass (pre-sarcopenia) and its performance (sarcopenia) in older adults with mild cognitive impairment (MCI) and mild-to-moderate Alzheimer’s disease (AD).MethodsThis is a cross-sectional study of 108 community-dwelling older adults with MCI and mild-to-moderate AD. Participants were categorized as: (i) No sarcopenia (normal muscle mass), (ii) Pre-sarcopenia (low muscle mass without weakness or slowness), (iii) Sarcopenia (low muscle mass AND weak grip strength and/or slow gait speed) using Asian cut-offs. Muscle quality was defined as the ratio of grip and knee extension strength to average arm and leg lean mass respectively. We measured cognitive, functional and physical (Short Physical Performance Battery, SPPB) performance; physical activity level; nutritional status; and blood biomarkers of inflammation and endocrine dysfunction.ResultsSPPB (p = 0.033) and activity level (p = 0.010) were highest in the pre-sarcopenic group. Pre-sarcopenic group had highest arm muscle quality [10.6 (7.7–12.2) vs 13.9 (12.6–15.7) vs 11.3 (9.7–12.8), p < 0.001], despite significantly lower appendicular lean mass than non-sarcopenic group. In multi-nomial logistic regression reference to non-sarcopenic group, malnutrition independently increased risk for both pre-sarcopenia (Relative risk = 7.53, 95% C.I 1.20–47.51, p = 0.032) and sarcopenia (Relative risk = 11.91, 95% C.I 2.85–49.77, p = 0.001). A combined pro-inflammatory and endocrine deficient state significantly increased the risk of sarcopenia (Relative risk = 5.17, 95% C.I 1.31–20.37, p = 0.019).ConclusionMalnutrition is a precursor for progressive loss of muscle mass, but a pro-inflammatory and endocrine deficient state may potentially aggravate decline in muscle quality to culminate in frank sarcopenia.     

Ultrasonographic evaluation of the calf muscle mass and architecture in elderly patients with and without sarcopenia

Background/objectivesTo sonographically assess the muscle mass and architecture of sarcopenic elderly subjects, and to explore the utility of ultrasound (US) measurements in predicting sarcopenia.MethodsOne hundred elderly subjects were enrolled in this cross-sectional study. Mean age value of our study population was 73.08 ± 6.18 years. The diagnosis of sarcopenia was confirmed by measuring fat-free mass index (using bioelectrical impedance analysis) and handgrip strength. Calf circumference was measured and US evaluations comprised bilateral gastrocnemius muscle (MG) thickness, fascicle length and pennate angles; subcutaneous fat and dermis thicknesses in the calf.ResultsBilateral muscle thickness and fascicle length values were significantly lower in patients with sarcopenia (both p < 0.05). Sarcopenic and nonsarcopenic subjects had similar pennate angles, subcutaneous fat and dermis thicknesses. Median thickness ratio (100 × t (MG)/[t (subcutaneous tissue) + t (dermis) + t (MG)]) values were 64% (40–88%) in the right and 64% (38–86%) in the left calf. Bilateral MG thickness and fascicle length values showed high sensitivity in predicting sarcopenia (all values > 76.92%).ConclusionsGastrocnemius muscle thickness and fascicle length values are lower in sarcopenic elderly and these two parameters can serve as alternative measurements for predicting/quantifying sarcopenia. Calf circumference measurements alone may not be appropriate for assessing sarcopenia. Instead, US imaging can conveniently be used to evaluate different compartments of the musculoskelal system in (sarcopenic) elderly.     

Challenging the motor control of walking: Gait variability during slower and faster pace walking conditions in younger and older adults

BackgroundGait variability is a measure of motor control of gait. Little is known about age-related changes in the motor control of gait (gait variability) during challenging walking conditions, such as slower and faster pace walking.ObjectiveThe purpose of this study was to examine the impact of challenging walking conditions (slower and faster speeds) on gait variability in younger and older adults.DesignThis study was a cross-sectional, observational design.MethodsForty younger (mean age = 26.6 ± 6.0 years) and 111 community-dwelling older adults (mean age = 77.3 ± 6.0 years), independent in ambulation, were studied. Gait characteristics were collected using a computerized walkway (GaitMat II™). Step length, step width, step time, swing time, stance time and double support time variability were derived as the standard deviation of all steps across the 4 passes.ResultsCompared to younger, older adults had a significant change in their gait variability from usual to slower in step width (-0.006 ± 0.003), step time (0.028 ± 0.006), swing time (0.023 ± 0.004), stance time (0.042 ± 0.008), and double support time (0.024 ± 0.005). Changes in gait variability from usual to faster were not significantly different between younger and older adults.LimitationGait variability was examined during self-selected over-ground walking, where subjects directed to walk “slower”, “usual” and “faster”.ConclusionsWalking slowly is more challenging to the motor control of gait and may be more sensitive to age-related declines in gait than usual and faster speed walks.     

Effects of vitamin D supplementation on body fat accumulation,inflammation, and metabolic risk factors in obese adults with low vitamin D levels — Results from a randomized trial

BackgroundLow plasma 25-hydroxy-vitamin D (25OHD) is associated with obesity. Vitamin D (VD) may be implicated in obesity and its complications such as insulin resistance, hypertension, and low-grade inflammation. We investigated the effects of VD supplementation on fat distribution and on obesity complications in obese adults with low plasma levels of 25OHD.MethodsIn a double-blind design 52 subjects aged 18 to 50 years with BMI > 30 kg/m² and plasma 25OHD < 50 nmol/l were randomized to 26 weeks of treatment with 7000 IU of VD daily or placebo. Body composition was assessed by DXA and subcutaneous (SAT) and visceral adipose tissue (VAT), intrahepatic (IHL) and intramyocellular lipids (IMCL) were evaluated by magnetic resonance imaging and magnetic resonance spectroscopy. Insulin resistance (HOMA-IR), blood pressure, plasma lipids, and circulating inflammatory markers were also investigated.ResultsVD treatment increased mean plasma levels of 25OHD from 33 nmol/l to 110 nmol/l (P < 0.0001) and decreased median parathyroid hormone levels from 5.3 to 4.5 pmol/l (P < 0.01) in the intervention group. Treatment did not change body fat, SAT, VAT, IHL, or IMCL compared with placebo. Neither did treatment affect HOMA, blood pressure, plasma lipids or any of several inflammatory markers investigated including hsCRP.ConclusionIncreasing 25OHD levels by VD treatment for 26 weeks have no effects on obesity complications in obese adults with low baseline plasma 25OHD.     

Effects of exercise training on indicators of adipose tissue angiogenesis and hypoxia in obese rats

ObjectiveTo investigate the effects of obesity and exercise training on regional adipose tissue angiogenesis and hypoxia markers in rats.MethodsLean (Fa/Fa) and obese (fa/fa) male Zucker rats at 2 months of age were randomly assigned to a sedentary or an exercise training group (lean sedentary: n = 7, lean exercise: n = 8, obese sedentary: n = 7, obese exercise: n = 8). The exercise group walked on a rat treadmill 5 times per week for 8 weeks. Inguinal and epididymal adipose tissue vascular endothelial growth factor A (VEGF-A) and lactate levels were determined.ResultsThere were significant effects of obesity in increasing inguinal (P < 0.001) and epididymal (P < 0.05) adipose tissue VEGF-A, and a significant effect of exercise training in increasing epididymal adipose tissue VEGF-A (P < 0.05). There was a significant effect of obesity in increasing inguinal adipose tissue lactate levels (P < 0.001). Compared to lean sedentary animals, obese sedentary animals had significantly higher epididymal adipose tissue lactate levels (P < 0.001); compared to obese sedentary animals, obese exercise rats had significantly lower epididymal adipose tissue lactate levels (P < 0.05).ConclusionsExercise training increased adipose tissue VEGF-A, an important factor of tissue angiogenesis, and lowered adipose tissue lactate, an indicator of adipose tissue hypoxia in obese rats. However, these effects are depot-specific and only observed in intra-abdominal adipose tissue.     

Lipid profiles in children with and without asthma: Interaction of asthma and obesity on hyperlipidemia

AimsThe joint effect of obesity and asthma on hyperlipidemia has never been explored. We aim to examine (1) the association of dyslipidemia and asthma, (2) the interaction effect of asthma and obesity on hyperlipidemia, and (3) whether a gender difference existed in the above relationships.MethodsBetween 2009 and 2010, 10- to 15-year-old children were recruited from 7 schools and 2 hospitals in Northern Taiwan. The population consisted of 237 asthmatic children and 225 non-asthmatic controls, and was further divided into four groups: non-obese controls, obese controls, non-obese asthmatics, and obese asthmatics. Measurements included anthropometric measures and blood samples for analysis of metabolic factors. The Cook's criteria were used to define childhood metabolic syndrome. General linear models were used to analyze how lipid profiles were associated with obesity and asthma.ResultsTotal cholesterol and low density lipoprotein cholesterol levels increased progressively in the group order obese asthmatics > non-obese asthmatics > obese controls > non-obese controls. In boys, low density lipoprotein cholesterol levels were significantly higher in obese asthmatics compared to obese non-asthmatics, with a mean difference of 6.2 mmol/L in the general linear model. We also discovered a significant interactive effect of obesity and asthma on hyperlipidemia in boys (p for interaction = 0.03).ConclusionsAsthma was associated with higher low density lipoprotein cholesterol levels and this association was amplified in overweight and obese subjects. A gender difference was observed in the joint effect of obesity and asthma on hyperlipidemia.     

Hyperphagie boulimique et obésité : aspects épidémiologiques,cliniques et psychopathologiques. étude d’une population d’obèses à Sfax (Tunisie)

ObjectivesTo evaluate the prevalence of binge eating disorder (BED) in a population of obese patients, to appreciate the impact of obesity on BED through a comparison between the obese group and a control group, and to assess anxiety, depression and quality of life in obese patients with BED.Patients and methodsA cross-sectional study including 60 obese patients and 60 controls. BED was diagnosed using the Binge Eating Scale. Quality of life was assessed by the Quality Of Life, Obesity and Dietetics Scale, and depression and anxiety symptoms by the Hospital Anxiety and Depression Scale.ResultsThe obese group had a higher prevalence of BED than the control group (40% versus 8.3%; p < 0.001; OR = 3.5). The average score of BES was also higher (p < 0.001). Obese patients with BED were younger (p = 0.034). BED was correlated with an early onset of obesity (p = 0.01; OR = 1.12), depression (p = 0.002), anxiety (p = 0.008) and a poorer quality of life.ConclusionThis study confirms the relationship between obesity and BED, which is correlated with a high prevalence of anxiety and depression and with a poorer quality of life.     

High prevalence of overweight and obesity in adults with Crohn's disease: Associations with disease and lifestyle factors

Background and aimsObesity and overweight are major public health issues. Although traditionally associated with weight loss, there is now evidence that increasing Body Mass Index (BMI) and overweight are emerging features of Crohn's disease (CD) and may be associated with more severe disease course.The aim of the study was to determine the prevalence of overweight and obesity in patients with CD compared with matched healthy controls and to identify disease-specific and generic factors associated with current BMI in this group.MethodsThis was a prospective case–control study (n = 200), comprising 100 CD outpatients and 100 age-, sex- and socioeconomically-matched healthy controls. BMI, Crohn's disease activity index (CDAI), clinical and lifestyle factors and circulating inflammatory markers were assessed.ResultsOverall, 40% of patients with CD were overweight/obese (BMI ≥ 25 kg/m²) compared with 52% of controls (P = 0.206). On regression analysis, higher current BMI was significantly associated with disease specific factors, namely lower disease activity (CDAI) and lower white cell count, suggesting stable disease, as well as older age and lower physical activity. BMI was not significantly associated with the need for surgery or the need for corticosteroids. We identified a novel association between higher BMI and higher CRP, a marker linked both with obesity in the general population and with CD.ConclusionsOverweight was common in out-patients with CD and appeared to reflect current wellness, older age and sedentary lifestyles. The potential long-term implications of high BMI for CRP and inflammatory load merit further study.     

Obesity is Associated with Higher Long-term Mortality After Aortic Valve Replacement with Small Prosthesis

ObjectiveAlthough many studies have evaluated the impacts of obesity on various medical treatments, it is not known whether obesity is related to late mortality with implantation of small aortic prosthesis. This study evaluated the effect of obesity on late survival of patients after aortic valve replacement (AVR) with implantation of small aortic prosthesis (size ≤21 mm).MethodsFrom January 1998 to December 2008, 536 patients in our institution who underwent primary AVR (307 patients with smaller prostheses) survived the 30 days after surgery. Patients were categorised as normal weight if body mass index (BMI) was ≤25 kg/m², as overweight if BMI 25–30 kg/m², and as obese if BMI ≥30 kg/m². Data were collected at the third-month (M), sixth-M, first-year (Y), third-Y, fifth-Y, and eighth-Y after operation.ResultsBy multivariable analysis, obesity was a significant independent factor of late mortality (hazard ratio [HR]: 1.59; p = 0.006). The obese and overweight groups of patients exhibited lower survival (p < 0.001) and a higher proportion in NYHA class III/IV (p < 0.01) compared with the normal group. Lower EOAI and higher left ventricular mass index were found in the obese and overweight groups, but we saw no significant variance in LVEF among the three groups.ConclusionsObesity was associated with increased late mortality of patients after AVR with implantation of small aortic prosthesis. Being obese or and overweight may also affect the NYHA classification, even in the longer term.     

Calibration of a semi-automated segmenting method for quantification of adipose tissue compartments from magnetic resonance images of mice

ObjectiveTo use an automated water-suppressed magnetic resonance imaging (MRI) method to objectively assess adipose tissue (AT) volumes in whole body and specific regional body components (subcutaneous, thoracic and peritoneal) of obese and lean mice.Materials/MethodsWater-suppressed MR images were obtained on a 7 T, horizontal-bore MRI system in whole bodies (excluding head) of 26 week old male C57BL6J mice fed a control (10% kcal fat) or high-fat diet (60% kcal fat) for 20 weeks. Manual (outlined regions) versus automated (Gaussian fitting applied to threshold-weighted images) segmentation procedures were compared for whole body AT and regional AT volumes (i.e., subcutaneous, thoracic, and peritoneal). The AT automated segmentation method was compared to dual-energy X-ray (DXA) analysis.ResultsThe average AT volumes for whole body and individual compartments correlated well between the manual outlining and the automated methods (R² > 0.77, p < 0.05). Subcutaneous, peritoneal, and total body AT volumes were increased 2–3 fold and thoracic AT volume increased more than 5-fold in diet-induced obese mice versus controls (p < 0.05). MRI and DXA-based method comparisons were highly correlative (R² = 0.94, p < 0.0001).ConclusionsAutomated AT segmentation of water-suppressed MRI data using a global Gaussian filtering algorithm resulted in a fairly accurate assessment of total and regional AT volumes in a pre-clinical mouse model of obesity.     

Serum FSH level is lower in dysovulating than in ovulating non-PCOS obese women,independently of body mass index

ObjectivesThe prevalence of ovulation disorder (OD) is 3-fold higher in obese than normal-weight women. Most ODs are associated with concomitant polycystic ovary syndrome (PCOS), but obesity by itself can cause OD, through mechanisms that remain poorly documented. The literature on obese non-PCOS women with OD is sparse. The aim of the present study was to analyze a population of obese non-PCOS women with OD to shed further light on the mechanism of ovulation disorder.Material and methodsThis retrospective observational study of infertile obese women without PCOS compared a control group without OD (n = 45) to a study group with OD (n = 30) (OD group). Clinical, hormonal, and ultrasound characteristics were collected between cycle days 2 and 5. Women older than 37 years and women with PCOM (polycystic ovarian morphology) or hormonal disorder were excluded.ResultsBody mass index (BMI) was significantly higher in the OD group, as were waist circumference and insulin and leptin serum levels. Conversely, serum follicle stimulating hormone (FSH) levels were significantly lower. After adjustment for BMI, only serum FSH level remained significantly different between the 2 groups. Discriminant analysis suggested that FSH may have a much stronger effect on OD than BMI.ConclusionLow serum FSH level may contribute to OD in some obese women, independently of BMI. The pathophysiological mechanism of this finding and its impact on therapeutic strategies must be clarified.     

Slow gait speed is associated with executive function decline in older people with mild to moderate dementia: A one year longitudinal study

ObjectivesThis study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia.MethodsOne hundred and seventy-seven older people with dementia (Mini-Mental State Examination 11–23; Addenbrooke’s Cognitive Examination-Revised <83) residing in the community or low level care facility completed baseline neuropsychological, physical and functional assessments. Of these, 134 participants agreed to reassessment of the above measures one year later.ResultsOverall, many neuropsychological, physical and functional performance measures declined significantly over the one year study period. Baseline gait speed was significantly associated with decline in verbal fluency (B(109) = 2.893, p = 0.046), specifically phonemic/letter fluency (B(109) = 2.812, p = 0.004) while controlling for age, education, dementia drug use and baseline cognitive performance. There was also a trend for an association between baseline gait speed and decline in clock drawing performance (B(107) = 0.601, p = 0.071).ConclusionsOlder people with mild to moderate dementia demonstrate significant decline in neuropsychological, physical and functional performance over one year. Baseline gait speed is associated with decline in executive function over one year, suggesting shared pathways/pathology between gait and cognition.     

Relationship of RIC-3 gene rs1528133 polymorphism with varying degrees of body weight and eating behavior

AimsThe aim of this study was to determine the allele frequencies of resistance to inhibitors of cholinesterase 3 homologue (RIC-3) gene rs1528133 polymorphism in overweight + obese + morbid obese and non-obese (non-OB) subjects. The effects of rs1528133 genotypes on anthropometric, diabetes and obesity related parameters, self-reported macronutrient intake and drugs were also evaluated. The study was performed on overweight + obese + morbid obese and non-obese subjects.MethodsRIC-3 gene rs1528133 genotypes were determined with qPCR.ResultsThe RIC-3 rs1528133 genotype frequencies were respectively as 89.4% for homozygous wild type (A/A), 10.6% for heterozygous (A/C) genotypes in overweight + obese + morbid obese patients and 92.7% for A/A, 7.3% for A/C genotypes in non-OB subjects. The homozygous mutant genotype (C/C) was not detected in our study population. Genotype frequencies were not significantly different among study groups. Heterozygous genotype carriers for the rs1528133 polymorphism were found to prefer higher glycemic load, fat and protein diet content compared to homozygous wild type genotype carriers (p = 0.0001). The frequency of rs1528133 heterozygous individuals (16.7%) using antihypertensive drugs was lower (p = 0.045) in comparison to wild type genotype carriers (46.9%) in the whole study population.ConclusionsRIC-3 gene rs1528133 variation was not found to be effective over any analyzed obesity related parameter, but associated with higher glycemic load, protein and fat eating behavior and antihypertensive drug use.     

Gait speed and risk assessment for falls among men aged 80 years and older: A prospective cohort study in Taiwan

PurposeTo evaluate the effectiveness of adding gait speed to the history of falls in predicting falls among men aged 80 years and older in Taiwan.MethodsThis prospective cohort study recruited 230 ambulatory men aged 80 years and older in 2012 and followed for 12 months. In addition to demographic characteristics and history of falls, a comprehensive geriatric assessment was performed for all study subjects. Gait speed was obtained by the 6-m walk and three different cut-offs (< 0.5, ≤ 0.8 and < 1.0 m/s) were tested in improving the ability of predicting subsequent falls by using history of falls.ResultsAmong all subjects (mean age: 85.5 ± 4.0 years), 26.1% (60/230) reported falls during follow-up period. Univariate analysis showed that polypharmacy, urinary incontinence, history of falls, pain, poorer baseline physical function, depressive mood, and gait speed < 0.5 m/s were associated with falls. Logistic regression showed that history of falls (OR: 4.255, 95% CI 2.089–8.667; P < 0.001), pain (OR: 2.674, 95% CI 1.332–5.369; P = 0.006), older age (OR: 1.128, 95% CI 1.031–1.234; P = 0.008), and slow gait speed (OR: 2.964, 95% CI 1.394–6.300; P = 0.005) were all independent risk factors for falls. Fast gait speed (defined as ≥ 1 m/s) was a protective factor for falls, even among subjects with history of falls, but slow gait speed (defined as < 0.5 m/s) was an independent risk factor even among subjects without history of falls.ConclusionsCombined history of falls and gait speed is a simple and effective tool in risk assessment of falls among older old population.     

Predictors of insulin resistance in the obese with metabolic syndrome

BackgroundIn the obese, the metabolic syndrome (MetS) is assumed to reflect insulin resistance.ObjectiveTo determine the predictors of insulin resistance in obese subjects with MetS.DesignWe used the 90th percentile of the homeostasis model assessment (HOMA) to define insulin resistance in 4958 nondiabetic adults evaluated in the National Health and Nutrition Examination Surveys, 1999–2004, and compared the 373 obese subjects who were insulin-resistant (HOMA 9.52 ± 5.73) to a control group of 373 obese who had the highest sensitivity to insulin (HOMA 1.79 ± 0.44).MeasurementsMetS was present in 312 (83.6%) obese with insulin resistance and in 156 (41.8%) obese from the insulin-sensitive control group. Demographic, metabolic, and lifestyle variables were analyzed with logistic regression.ResultsIn a logistic model of insulin resistance given the presence of MetS, the significant predictors were triglycerides (P = 0.0021), body mass index (P = 0.0096), HDL-cholesterol (P = 0.0098), age (P = 0.0242) and smoking (P = 0.0366).LimitationsCross-sectional design prevents elucidation of causality for the association between insulin resistance and MetS.ConclusionsInsulin resistance is not an obligatory correlate of MetS in the obese. Its likelihood can be predicted by cigarette smoking and by the severity of obesity and dyslipidemia.     

Changes in markers of oxidative stress and DNA damage in human visceral adipose tissue from subjects with obesity and type 2 diabetes

AimsIn the past 30 years, prevalence of obesity has almost trebled resulting in an increased incidence of type 2 diabetes mellitus and other co-morbidities. Visceral adipose tissue is believed to play a vital role, but underlying mechanisms remain unclear. Our aim was to investigate changes in markers of oxidative damage in human visceral adipose tissue to determine levels of oxidative burden that may be attributed to obesity and/or diabetes.MethodsVisceral adipose tissue samples from 61 subjects undergoing abdominal surgery grouped as lean, obese and obese with type 2 diabetes mellitus, were examined using 3 different markers of oxidative stress. Malondialdehyde (MDA) concentration was measured as a marker of lipid peroxidation, telomere length and Comet assay as markers of oxidative DNA damage.ResultsNo significant difference in MDA concentration, telomere length and DNA damage was observed between groups, although longer telomere lengths were seen in the obese with diabetes group compared to the obese group (P < 0.05). Lower MDA concentration and longer telomere length were seen in subjects with diabetes compared to those without (P < 0.05). DNA damage, analysed via Comet assay, was significantly lower in subjects with diabetes compared to those without (P < 0.05).ConclusionA paradoxical decrease in oxidative stress and DNA damage was observed in samples from subjects with type 2 diabetes mellitus. Further work is required to investigate this further, however this phenomenon may be due to an up regulation of antioxidant defences in adipose tissue.     

Differences in skeletal and non-skeletal factors in a diverse sample of men with and without type 2 diabetes mellitus

AimsPatients with type 2 diabetes mellitus (T2DM) have increased fracture risk yet higher bone mineral density (BMD), but data are inconsistent in men. We compared skeletal and non-skeletal (e.g., muscle mass, strength) factors in men with/without T2DM.MethodsCross-sectional study of 1137 Boston men 30–79 years in the Boston Area Community Health/Bone Survey. Diabetes status was self-reported, and BMD and body composition were measured by DXA, and grip strength by hand dynamometer. Physical function was assessed by walking speed and chair stands. Multivariable linear regressions examined associations of T2DM with skeletal/non-skeletal factors.ResultsMean age was 48 years. The population was 24.6% Black, 13.0% Hispanic, and 62.4% White. Prevalence of T2DM was 12.5%; average disease duration was 7.4 years. While subjects with T2DM did not differ in skeletal factors (e.g., BMD), they had significantly lower appendicular lean mass [mean difference (MD) = − 1.04 kg; standard error (SE) = 0.50; p = 0.04], arms lean mass (MD = − 0.42 kg; SE = 0.15; p = 0.006) and grip strength (MD = − 3.02 kg; SE = 1.25; p = 0.025) after adjustment for age, race/ethnicity, and BMI.ConclusionsMen with T2DM have lower muscle mass and strength, but similar BMD, compared to their non-diabetic counterparts. These differences in non-skeletal factors might explain, at least in part, the higher incidence of falls and fractures observed in T2DM patients.     

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS)

BackgroundMultimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength.MethodsA cross-sectional analysis was conducted of 5877 respondents (2744 = male, 3103 = female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg).ResultsAs the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b = 3.1, 95% CI = 2.3–3.9, p < 0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength.ConclusionMultimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.     

Obesity,chronic kidney disease progression and the role of the adipokine C1q/TNF related protein-3

Introduction and aimsObesity is a risk factor for incident chronic kidney disease (CKD). C1q/TNF related protein 3 (CTRP3) is an adipokine with multiple effects and may modulate the association between obesity and vascular diseases. The aim of the study is to explore potential links between obesity, CTRP3 levels and CKD progression.MethodsPatients with stage 3 and 4 CKD without previous cardiovascular events were enrolled and divided into groups according to body mass index (BMI) and sex. Demographic, clinical, analytical data and CTRP3 levels were collected at baseline. During follow-up, renal events (defined as dialysis initiation, serum creatinine doubling or a 50% decrease in estimated glomerular filtration rate were registered).Results81 patients were enrolled. 27 were obese and 54 non-obese. Baseline CTRP3 was similar between both groups (90.1 ± 23.8 vs 84.5 ± 6.2; p = 0.28). Of the sum, 54 were men and 27 women, with higher CTRP3 in women (81.4 ± 24.7 vs 106 ± 24.7; p < 0.01). During a mean follow-up of 68 months, 15 patients had a renal event. Patients in the higher CTRP3 tertile had less events but without statistical significance (p = 0.07). Obese patients in the higher CTRP3 tertile significantly had less renal events (p = 0.049). By multiple regression analysis CTRP3 levels could not predict renal events (HR 0.98; CI95% 0.96–1.06).ConclusionsCTRP3 levels are higher in woman than men in patients with CKD, with similar levels between obese and non obese. Higher CTRP3 levels at baseline were associated with better renal outcomes in obese patients.     

Prevalence of obesity and systemic hypertension among diabetes mellitus patients attending an out-patient diabetes clinic in a Ghanaian Teaching Hospital

AimsDiabetes Mellitus is now a prevalent disease in both developed and developing countries. Overweight/obesity and hypertension are potential modifiable risk factors for diabetes mellitus and persist during the course of the disease. This study was aimed at reporting the prevalence of overweight/obesity and systemic hypertension and their association to blood glucose levels in persons with diabetes mellitus attending a diabetic clinic in Ghanaian Teaching Hospital.Materials and MethodsThis cross-sectional study was conducted among 100 previously diagnosed diabetes mellitus patients attending a diabetic clinic at the Tamale Teaching Hospital, Ghana. Anthropometric variables of age, weight and height were measured with appropriate instruments, computed into BMI and classified according to WHO classifications. Systolic and diastolic blood pressures were measured by an appropriate instrument and classified by WHO standards. Fasting plasma glucose levels of the study participants were recorded from their personal health folder. All data was analysed by GraphPad prism version 5.ResultsIn general, 7.0% of the participants were underweight and 32.0% were overweight or obese. The mean ± SD weight, height and BMI of the participants were 67.53 ± 13.32, 1.68 ± 0.12 and 24.18 ± 5.32. Twenty-one percent of the studied participants were hypertensive. Mean ± SD fasting plasma glucose of 7.94 ± 2.82 was observed among the diabetic patients. As the prevalence of hyperglycaemia was higher among patients aged ≤40 years (88.9% vs. 75.8%), normoglycaemia (11.1% vs. 24.2%) was higher among those over 40 years. The differences were not significant. The prevalence of hyperglycaemia was significantly higher in participants with overweight/obese (0.0% vs. 41.6%, p < 0.0001) than those with underweight (26.1% vs. 1.3%, p = 0.0005) and normal weight (73.9% vs. 57.1%, p = 0.2228).ConclusionA high prevalence of overweight/obesity and systemic hypertension was found. Hyperglycaemia was more prevalent among overweight/obese participants.