Hand Grip Strength Predicts Mortality and Quality of Life in Heart Failure: Insights From the Singapore Cohort of Patients With Advanced Heart Failure

BackgroundFrailty is prevalent among patients with heart failure (HF) and is associated with increased mortality rates and worse patient-centered outcomes. Hand grip strength (GS) has been proposed as a single-item marker of frailty and a potential screening tool to identify patients most likely to benefit from therapies that target frailty so as to improve quality of life (QoL) and clinical outcomes. We assessed the association of longitudinal decline in GS with all-cause mortality and QoL. Decline in GS is associated with increased risk of all-cause mortality and worse overall and domain-specific (physical, functional, emotional, social) QoL among patients with advanced HF.MethodsWe used data from a prospective, observational cohort of patients with New York Heart Association class III or IV HF in Singapore. Patients’ overall and domain-specific QoL were assessed, and GS was measured every 4 months. We constructed a Kaplan-Meier plot with GS at baseline dichotomized into categories of weak (≤ 5th percentile) and normal (> 5th percentile) based on the GS in a healthy Singapore population of the same sex and age. Missing GS measurements were imputed using chained equations. We jointly modeled longitudinal GS measurements and survival time, adjusting for comorbidities. We used mixed effects models to evaluate the associations between GS and QoL.ResultsAmong 251 patients (mean age 66.5 ± 12.0 years; 28.3% female), all-cause mortality occurred in 58 (23.1%) patients over a mean follow-up duration of 3.0 ± 1.3 years. Patients with weak GS had decreased survival rates compared to those with normal GS (log-rank P = 0.033). In the joint model of longitudinal GS and survival time, a decrease of 1 unit in GS was associated with a 12% increase in rate of mortality (hazard ratio: 1.12; 95% confidence interval: 1.05–1.20; P = < 0.001). Higher GS was associated with higher overall QoL (β (SE) = 0.36 (0.07); P = < 0.001) and higher domain-specific QoL, including physical (β [SE] = 0.13 [0.03]; P = < 0.001), functional (β [SE] = 0.12 [0.03]; P = < 0.001), and emotional QoL (β [SE] = 0.08 [0.02]; P = < 0.001). Higher GS was associated with higher social QoL, but this was not statistically significant (β [SE] = 0.04 [0.03]; P = 0.122).ConclusionsAmong patients with advanced HF, longitudinal decline in GS was associated with worse survival rates and QoL. Further studies are needed to evaluate whether incorporating GS into patient selection for HF therapies leads to improved survival rates and patient-centered outcomes.     

Gender,self-rated health and functional decline among community-dwelling older adults

ObjectiveThis paper examines the association between self-rated health (SRH) and functional decline (FD) in older Ghanaian cohorts and investigates whether the effect differs by gender and also modified by marital status.MethodsThe study used cross-sectional survey data (N = 1200) from an Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) study conducted in between August 2016 and January 2017. A four-level gendered-stratified logit modeling estimated the SRH-FD association and the interaction terms.ResultsOverall, 23% of male respondents and 34% of women revealed significant FD (p < 0.001). The fully-adjusted model showed that SRH status was a strong predictor of FD across genders but the effect was most pronounced among men. Compared with excellent/very good SRH, fair and poor SRH (β = 0.160; p < 0.05) and (β = 1.700; p < 0.001) for women and (β = 2.202; p < 0.001) and (β= 2.356; p < 0.001) for men respectively were significantly associated with increased FD. However, good (β = − 1.760; p < 0.001), fair (β = − 2.800; p < 0.001) and poor SRH (β = −2.088; p < 0.001) decreased FD if an older woman was married compared with unmarried women with excellent/very good SRH.ConclusionThe strength of SRH-FDs association largely differed with gender and also moderated by marital status for women. Improving the SRH and marital quality could be protective of functional abilities, independence and quality of life for older people.     

Relationship of salivary adipocytokines,diet quality,physical activity,and nutrition status in adult Emirati females in United Arab Emirates

AimsThe United Arab Emirates (UAE) ranks as the fifth most obese country with increasing cardio-metabolic risks. In this paper, relationships of salivary adipocytokines (markers of cardio-metabolic syndrome), diet quality and physical activity in 90 normal-weight, overweight and obese (30 subjects in each group) Emirati adult females were investigated.MethodsA cross-sectional research design was adopted. Anthropometric measurements, diet quality and physical activity questionnaires were administered. Overnight fasting saliva was collected to determine levels of adiponectin, interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-α).ResultsSalivary adiponectin was significantly lower, while TNF-α was higher in obese than normal-weight subjects. IL-10 displayed a lower trend in obese subjects. Though diet quality and physical activity did not exhibit significant differences among the three groups, better diet quality and higher physical activity level were reported among normal-weight subjects. Salivary TNF-α correlated positively with body mass index (BMI) (r = 0.37; p < 0.001) and waist circumference (r = 0.31; p < 0.001), while adiponectin correlated negatively with BMI (r = −0.28; p < 0.05). IL-10 showed negative trend in correlation with obesity measures. Correlations were not observed between diet quality and physical activity with salivary adipocytokines. Interestingly, a significant negative correlation emerged between diet quality and neck circumference (r = −0.24; p < 0.05).ConclusionOur findings demonstrate that salivary adipocytokines correlate with obesity measures and can serve as convenient adjunct method in predicting cardio-metabolic risks in the population.     

Association between lifestyle behaviors and frailty in Atlantic Canadian males and females

PurposeThe aim of this study was to identify lifestyle factors in males and females that are associated with a greater degree of frailty in a Canadian cohort.MethodsCross-sectional data analysis from participants aged 30−74 yrs of the Atlantic PATH cohort. Inclusion criteria included completion of mental health questionnaires and ≥1 vital measure (n = 9133, 70% female, mean age 55 yrs). A frailty index was created based on 38 items with higher values indicating increasing frailty. The association between lifestyle factors and frailty was assessed by logistic regression.Results805 participants had a high level of frailty (frailty index ≥0.30). There was a significant interaction among sex, age, and lifestyle factors such as smoking status (P < 0.001), alcohol consumption (P < 0.001), physical activity level (P = 0.005), time spent sitting (P < 0.001) and sleeping (P < 0.001) on frailty. Smoking was harmful whereas sleep was protective for both males and females (<60 yrs). Females (<60yrs) that sat for ≥4 h/day were more likely to be highly frail whereas females (all ages) that consumed alcohol at least occasionally were less likely to be highly frail. Males, but not females, that engaged in a high level of physical activity were less likely to have a high level of frailty.ConclusionsHigher frailty is more prevalent among participants with unhealthy lifestyle behaviors related to smoking, alcohol consumption, sedentary and physical activity level, diet, and sleep. Differences in lifestyle behaviors of males and females of specific ages should be considered for managing frailty levels.     

Body composition as a predictor of physical performance in older age: A ten-year follow-up of the Helsinki Birth Cohort Study

BackgroundThis study assessed how different measures of body composition predict physical performance ten years later among older adults.MethodsThe participants were 1076 men and women aged 57 to 70 years. Body mass index (BMI), waist circumference, and body composition (bioelectrical impedance analysis) were measured at baseline and physical performance (Senior Fitness Test) ten years later. Linear regression analyses were adjusted for age, education, smoking, duration of the follow-up and physical activity.ResultsGreater BMI, waist circumference, fat mass, and percent body fat were associated with poorer physical performance in both sexes (standardized regression coefficient [β] from −0.32 to −0.40, p < 0.001). Lean mass to BMI ratio was positively associated with later physical performance (β = 0.31 in men, β = 0.30 in women, p < 0.001). Fat-free mass index (lean mass/height²) in both sexes and lean mass in women were negatively associated with later physical performance. Lean mass residual after accounting for the effect of height and fat mass was not associated with physical performance.ConclusionsAmong older adults, higher measures of adiposity predicted poorer physical performance ten years later whereas lean mass was associated with physical performance in a counterintuitive manner. The results can be used when appraising usefulness of body composition indicators for definition of sarcopenic obesity.     

Physical activity attenuates the association between the IRS1 genotype and childhood obesity in Chinese children

Background and aimsThe insulin receptor substrate 1 (IRS1) rs2943650 was found to be associated with obesity in adults, but the association has not been evaluated in children. The present study aimed to examine whether IRS1 rs2943650 was associated with obesity in Chinese children and investigate the interaction between rs2943650 and physical activity.Methods and resultsIRS1 rs2943650 was genotyped in 3303 Chinese children aged 6–18 years recruited from four independent studies. Logistic regression and linear regression were performed to examine associations. Meta-analyses were conducted to pool the results of the four independent studies. The C-allele carriers of rs2943650 showed a 29% higher risk of obesity than noncarriers (OR (95% CI) = 1.29 (1.05, 1.58), P = 0.02) and a 0.41 kg/m² increase in BMI (β (95% CI) = 0.41 (0.05, 0.78) kg/m², P = 0.02). We also observed significant interactions between rs2943650 and physical activity/sedentary behaviors on obesity (P _{for interaction}<0.05). Compared with the physically active children (physical activity ≥1 h/d and sedentary behaviors <2 h/d), the risk allele (C) of rs2943650 was significantly associated with a 241% increased risk of obesity among inactive children who participated in physical activity <1 h/d and sedentary behaviors ≥2 h/d (OR (95% CI) = 3.41 (1.45, 8.01), P = 0.005).ConclusionsWe found that IRS1 rs2943650 was significantly associated with BMI and risk of childhood obesity. Additionally, we also found significant interaction between IRS1 rs2943650 polymorphism and physical activity/sedentary behaviors on childhood obesity. Our study would provide novel insights into the function of the IRS1 gene and the implementation of effective intervention strategies of childhood obesity.     

Balance dysfunction in adults with haemophilia

Summary. The main focus of lower limb physical performance assessment in people with haemophilia (PWH) has usually been on function, muscle strength and joint flexibility. The impact of haemophilic arthropathy on balance and falls risk is relatively under‐explored. The aim of this study was to evaluate balance and related performance in PWH compared with age and gender matched healthy controls. It involved a comprehensive suite of clinical and laboratory measures of static and dynamic balance, mobility, strength, physical activity and falls efficacy completed in 20 PWH (mean age 39.4, 100% male) and 20 controls. Fifty percent of PWH reported falls in the past 12 months. Moderate impairment of balance and related measures were identified in PWH compared with the controls, with an average 35% difference between groups. Significant differences were evident between groups on both clinical and laboratory measures, including measures of dynamic bilateral stance balance [limits of stability measures on the laboratory test, functional reach; (P < 0.001); dynamic single leg balance (Step Test, P < 0.001)], gait and mobility (gait speed, step width and turning measures on the laboratory test, timed up and go test; P < 0.001); muscle strength (timed sit to stand, P = 0.002; quadriceps strength, P < 0.001); and activity level and falls efficacy, (P < 0.004). The dynamic clinical and laboratory measures testing similar domains of balance, gait and mobility had moderate correlations (0.310 < r < 0.531, P < 0.01). Moderate impairments in balance, mobility and related measures were identified in PWH, compared with the control group. Clinicians should include assessments of balance and related measures when reviewing adults with haemophilia.     

Inverse association between circulating adiponectin levels and skeletal muscle strength in Japanese men and women

Background and aimsIncreased levels of circulating adiponectin in the elderly cause a negative impact on physical function and health status, which suggests that circulating adiponectin may be related to skeletal muscle function. However, data on the relationship between circulating adiponectin levels and skeletal muscle function is limited. Our objective was to investigate the association between serum adiponectin levels and muscle strength in adults.Methods and resultsThis cross-sectional study is a part of the Oroshisho Study of adult employees in Japan from 2008 to 2011. In our study, we used data gathered in 2008–2010 that had included serum adiponectin measurements (n = 1378; age, 19–83 years). From this population, 1259 subjects were evaluated for grip strength (949 men, 310 women), and 965 subjects were evaluated for leg extension power (716 men, 249 women). Multivariate linear regression analyses showed that adiponectin was associated significantly and negatively with both grip strength (β and standard error [SE]: men, −0.09 [0.01], p = 0.010; women, −0.20 [0.03], kg, p = 0.002) and leg extension power (men, −0.09 [0.02], p = 0.014; women, −0.14 [0.07], W, p = 0.032) after adjusting for age, physical activity, nutrient intake, depressive symptoms, metabolic syndrome, C-reactive protein, body mass index, and other lifestyle-related potential confounders.ConclusionThis population-based cross-sectional study indicates an inverse association between serum adiponectin levels and muscle strength in adults. Further studies are necessary to confirm this association and to clarify causality.     

Factors associated with functional disability in patients with rheumatoid arthritis

To determine factors associated with functional disability in patients with rheumatoid arthritis (RA). A total of 100 RA patients were reviewed retrospectively. Multiple regression analysis was used to investigate associations between the dependent variable (health assessment questionnaire) and independent variables (age, disease duration, hand grip strength values, VAS and DAS-28 scores). Main factors associated with functional disability were disease activity score as reflected in a high score on the DAS-28 (r = 0.68, p < 0.001) and disease duration (r = 0.23, p < 0.05). Increased age, decreased grip strength and high pain level were associated with lower functional ability, but none of these was a predictor of disability in the regression model. The results indicate that age, disease duration, disease activity, pain intensity and hand grip strength are related to physical disability in patients with RA. However, only disease activity has an impact on physical function. Thus, treatment of RA patients should focus on early inhibition of disease activity in order to achieve a good functional outcome.     

Vision impairment and cognitive function among urban-dwelling malaysians aged 55 years and over from the Malaysian Elders Longitudinal Research (MELoR) study

IntroductionPublished literature on vision impairment and cognitive function amongst older Malaysians remains scarce. This study investigates the association between vision impairment and cognitive function in an older Malaysian population.MethodsSubjects aged 55 years and above from the Malaysian Elders Longitudinal Research (MELoR) study with available information on vision and Montreal Cognitive Assessment (MoCA) scores were included. Data were obtained through a home-based interview and hospital-based health check by trained researchers. Visual acuity (VA) was assessed with logMAR score with vision impairment defined as VA 6/18 or worse in the better-seeing eye. Cognition was evaluated using the MoCA-Blind scoring procedure. Those with a MoCA-Blind score of <19/22 were considered to have cognitive impairment.ResultsData was available for 1144 participants, mean (SD) age = 68.57 (±7.23) years. Vision impairment was present in 143 (12.5 %) and 758 (66.3 %) had MoCA-Blind score of <19. Subjects with vision impairment were less likely to have a MoCA-Blind score of ≥19 (16.8 % vs 36.2 %, p < 0.001). Vision impairment was associated with poorer MoCA-Blind scores after adjustments for age, gender, and ethnicity (β = 2.064; 95 % CI, −1.282 to 3.320; P = 0.003). In those who had > 6 years of education attainment, vision impairment was associated with a significant reduction of cognitive function and remained so after adjustment for age and gender (β = 1.863; 95 % CI, 1.081–3.209; P = 0.025).ConclusionOur results suggest that vision impairment correlates with cognitive decline. Therefore, maintaining good vision is an important interventional strategy for preventing cognitive decline in older adults.     

Effect of sarcopenic obesity on deterioration of physical function in the elderly

BackgroundBoth sarcopenia and obesity are associated with decreased physical function of the elderly. Sarcopenic obesity (SO), which is the coexistence of sarcopenia and obesity, is expected to have a synergistic effect on physical function deterioration, but previous studies have shown varied results. This study aimed to investigate the impact of SO on the physical function of the elderly.MethodsCommunity-dwelling elderly subjects (1091 males; 1212 females; 70–84 years) were recruited in South Korea (eight cities). Body composition was measured via dual-energy X-ray absorptiometry and physical function was measured by grip strength, timed up and go test, and short physical performance battery (SPPB).ResultsIn males, grip strength and the total SPPB score in the SO group were significantly lower than those in the normal or pure obesity groups (p < 0.05). However, physical functions were not significantly different between the SO and the pure sarcopenia groups (p > 0.05). The trend for grip strength in females was similar to that in males, but the total SPPB score of the SO group was significantly lower than that of the other three groups (p < 0.05). Logistic regression analysis after covariate adjustment revealed that SO group males exhibited the highest risk of being in the lower SBBP score category (OR, 2.12; 95 % CI = 1.04–4.31); this trend was more prominent in females (OR, 3.75; 95 % CI = 2.01–7.00).ConclusionSO has a synergistic effect on physical function deterioration in the elderly compared with sarcopenia or obesity alone. Additionally, such an effect is more remarkable in females.     

The relationship between pulse pressure,insulin resistance,and beta cell function in non-diabetic Korean adults

AimsThe present study was conducted to assess the association of pulse pressure (PP) with insulin resistance and beta cell function in Korean non-diabetic populations.MethodsThis study used the data from the 2015 Korean National Health and Nutrition Examination Survey including 4380 adults, aged 20 or older.ResultsA multivariate analysis revealed that systolic blood pressure (SBP) (β = 0.089, 95% confidence interval [CI], 0.004–0.011; p < 0.001), diastolic blood pressure (DBP) (β = ?0.057, 95% CI ?0.014 to ?0.003; p = 0.002), and PP (β = 0.069, 95% CI 0.004–0.011; p < 0.001) were significant factors determining the homeostasis model assessment of insulin resistance (HOMA-IR). SBP (β = 0.070, 95% CI, 0.113–0.420; p = 0.001), DBP (β = ?0.068, 95% CI ?0.676 to ?0.203; p < 0.001), and PP (β = 0.050, 95% CI 0.115–0.422; p = 0.001) were significant factors determining the homeostasis model assessment of beta cell function (HOMA-B). In the analysis of covariance test, after adjusting for related variables (except age), the quartiles of PP were not associated with HOMA-IR (p = 0.191) and were inversely associated with HOMA-B (p < 0.001). However, when further adjusting for age, the quartiles of PP were positively associated with both HOMA-IR (p < 0.001) and HOMA-B (p = 0.027).ConclusionPP was positively associated with insulin resistance and beta cell function in non-diabetic Korean adults.     

Effects of Tai Chi exercise on cardiovascular disease risk factors and quality of life in adults with essential hypertension: A meta-analysis

BackgroundHypertension is the major attributable risk factor for cardiovascular disease. The effect of Tai Chi on essential hypertension (EH) is contentious.ObjectivesIn this study, we investigated the effects of Tai Chi on the risk factors for cardiovascular disease and quality of life in adults with EH.MethodsUsing data collected from 15 databases up to December 2018, we meta-analyzed randomized controlled trials of the effect of Tai Chi on EH.ResultsTai Chi exercise was associated with lower systolic blood pressure (SBP) (WMD −12.47, 95%CI −16.00 to −8.94, P < 0.001) and diastolic blood pressure (DBP) (WMD −6.46, 95%CI −8.28 to −4.64, P < 0.001); better quality of life (SMD 0.62, 95% CI 0.35 to 0.90, P < 0.001); lower lipid profiles, including total cholesterol (WMD −0.49, 95% CI −0.62 to −0.37, P < 0.001), triglycerides (WMD −0.49, 95% CI −0.92 to −0.07, P = 0.02), and low-density lipoprotein-cholesterol (LDL-C) (WMD −0.86, 95% CI −1.30 to −0.43, P < 0.001); and lower blood glucose (WMD −0.91, 95% CI −1.59 to −0.23, P = 0.009). Tai Chi had no significant effect on high-density lipoprotein–cholesterol (WMD −0.92, 95% CI −2.21 to −0.37, P = 0.16).ConclusionsTai Chi lowers blood pressure, total cholesterol, triglycerides, LDL-C, and blood glucose and significantly increases the quality of life in adults with EH. There is strong evidence for the short-term efficacy of Tai Chi exercises. Larger well-designed RCTs focused on the long-term effect of Tai Chi exercises and patient adherence are needed.     

Association of physical performance and self-rated health with multimorbidity among older adults: Results from a nationwide survey in Japan

ObjectivesTo examine the association of physical performance measures and self-rated health with multimorbidity among older Japanese adults aged ≥60 years using cross-sectional data from a nationwide longitudinal survey.MethodsUsing respondents’ self-reported data from the 2012 National Survey of the Japanese Elderly, we analyzed multimorbidity involving nine major chronic diseases (heart disease, arthralgia, hypertension, diabetes, stroke, cataract, cancer, respiratory disease, and low back pain). Respondents who reported having two or more of these diseases were identified as having multimorbidity. Multivariate logistic regression analysis was used to examine if physical performance (grip strength and walking speed) and self-rated health were independently associated with multimorbidity after adjusting for potential confounders (e.g., demographic, physiological, and lifestyle-related variables).ResultsThe responses of 2525 participants who responded to the survey by themselves (i.e., without proxies) were analyzed (response rate: 57.9%). Among the chronic diseases examined, hypertension had the highest prevalence (44.1%), followed by low back pain (25.7%) and cataract (24.7%). Approximately 44.4% of the respondents had multimorbidity. The regression analysis revealed that multimorbidity was significantly associated with both poor grip strength (P = 0.006) and self-rated health (P < 0.001), but not with walking speed (P = 0.479).ConclusionsMultimorbidity is prevalent in older Japanese adults, and poor grip strength and self-rated health were independently and significantly associated with multimorbidity. Health assessments that include these indicators may provide insight into the health status patterns of older adults with multimorbidity and inform the development of health management strategies.     

Association between deterioration in muscle strength and peripheral neuropathy in people with diabetes

AimsDiabetic peripheral neuropathy (DPN) is a major risk factor for sarcopenia or frailty in older patients with diabetes. In this study, we investigated the association between DPN and muscle strength in type 2 diabetes.MethodsDPN was assessed using the Michigan Neuropathy Screening Instrument Questionnaire (MNSI-Q) and Physical Examination (MNSI-PE) in 230 subjects with type 2 diabetes. Handgrip strength (HGS) was measured using an electronic grip strength dynamometer.ResultsThe prevalence of DPN was 26.4% in men and 34.7% in women. HGS was significantly lower in men with DPN compared with men without DPN (27.0 ± 9.4 vs. 29.7 ± 8.4 kg, p = 0.036). This effect was not seen in women. In men, multivariate regression analysis showed that HGS was negatively associated with the MNSI-Q (β = ?1.200, p = 0.003) and MNSI-PE scores (β = ?0.937, p = 0.046) and resulted in an abnormal 10-gram monofilament test score (β = ?10.895, p < 0.001). However, HGS was not significantly associated with neuropathy in women.ConclusionsMuscle strength was lower in men with DPN than in those without DPN. Assessment of muscle function may have clinical implications in the prevention of sarcopenia and frailty in men with DPN.     

Handgrip Strength Predicts Persistent Walking Recovery After Hip Fracture Surgery

Background

In older people, hip fractures often lead to disability and death. We evaluated handgrip strength, an objective measure of physical function for bedridden patients, as a predictor of walking recovery in the year after fracture surgery.

Methods

This multicenter prospective cohort study included 504 patients, aged 70 years or more, who were admitted to the hospital for hip fracture surgery and were formerly able to walk independently. A multidimensional geriatric evaluation that included a physical examination, Short Portable Mental Status Questionnaire, Geriatric Depression Scale, Charlson Index, Basic Activities of Daily Living, and grip strength was administered at the time of admission. Follow-ups were performed every 3 months for 1 year after surgery to assess functional status and survival. The walking recovery probability was evaluated using multivariable logistic regression models.

Results

The mean age of the participants was 85.3 ± 5.5 years, and 76.1% of the participants were women. The mean grip strength was greater in men (β: 6.6 ± 0.62, P < .001) and was directly related to the Short Portable Mental Status Questionnaire results (P < .001), Basic Activities of Daily Living results (P < .001), serum vitamin D levels (P = .03), and time before surgery (P < .001), whereas it was inversely related to age (P < .001), Geriatric Depression Scale score (P < .001), and Charlson Index (P < .001). After adjusting for confounders, the grip strength was directly associated with the probability of both incident and persistent walking recovery (odds ratio highest tertile vs lowest tertile, 2.84, confidence interval, 1.76-4.59 and 2.79, confidence interval, 1.35-5.79, respectively).

Conclusions

In older patients with hip fractures, early grip strength evaluation might provide important prognostic information regarding the patient's future functional trajectory.     

Total and regional bone mineral density are associated with cellular health in older men and women

ObjectiveThis study aimed to investigate the relationship between crude bioimpedance variables with bone mineral density (BMD) in older adults.MethodOne hundred eighty-four older men and women (≥ 60 years old) composed the sample. BMD (whole-body) was measured through dual-energy X-ray absorptiometry. Bioimpedance spectroscopy was used to estimate whole-body resistance and reactance as well as to calculate the phase angle (PhA) and fat-free mass (FFM). Age, gender, body mass, FFM, height, calcium intake, vitamin D intake, number of fractures, number of diseases, and number of medications were included as covariates in the regression analyses.ResultsBMD fractions were significantly (P < 0.01) associated with PhA (femur: r = 0.524; neck: r = 0.450; and forearm: r = 0.437). Independently of age, body mass, FFM, calcium intake, vitamin D, number of diseases, fratures and medications, PhA remains a significant explanator of the variability of total (β = 0.22; P < 0.001), femur (β = 0.10; P = 0.018), and neck BMD (β = 0.07; P = 0.05) for men, and total (β = 0.08; P = 0.002), femur (β = 0.06; P = 0.005), neck (β = 0.04; P = 0.03), and forearm BMD (β = 0.05; P = 0.004) for women.ConclusionOur results suggest that a higher PhA is associated with BMD in older men and women fractions regardless of relevant covariates highlighting the biological meaning of this simple and crude bioimpedance-based measure in the elderly population.     

Risk factors,surgical complications and graft survival in liver transplant recipients with early allograft dysfunction

Background: Early allograft dysfunction(EAD) is a severe complication after liver transplantation. The associated risk factors and complications have re-gained recent interest. This study investigated risk factors, survival and complications associated with EAD in a large liver transplant center in Latin America. Methods: Retrospective, unicenter, cohort, based on data from adult patients undergoing first deceaseddonor liver transplant from January 2009 to December 2013. EAD was defined by one or more of the following:(i) bilirubin ≥10 mg/d L on postoperative day 7;(ii) international normalized ratio ≥1.6 on postoperative day 7, and(iii) alanine aminotransferase or aspartate aminotransferase 20 0 0 IU/L within the first seven days after transplant. Results: A total of 602 patients were included; of these 34.2% developed EAD. Donor risk factors were male( P = 0.007), age between 50 and 59 years( P = 0.034), overweight( P = 0.028) or grade I obesity( P = 0.012), sodium 157 mmol/L( P = 0.002) and grade IV ischemia/reperfusion injury( P = 0.002). Cold ischemia time ≥10 h( P = 0.008) and warm ischemia time ≥40 min( P = 0.013) were the surgical factors. Male( P 0.001) was the only recipient protective factor. Compared with the non-EAD group, patients with EAD were submitted to more reoperations(24.3% vs. 13.4%, P = 0.001) and had higher graft loss rates(37.9% vs. 21.2%, P 0.001), with similar patient survival rates( P = 0.238). Conclusions: EAD risk factors are related to donor, surgical procedure and recipient. Donor risk factors for EAD were male, age between 50 and 59 years, donor overweight or grade I obesity, sodium 157 mmol/L and grade IV ischemia/reperfusion injury. Cold ischemia time ≥10 h and warm ischemia time ≥40 min were the surgical risk factors. Male was the only recipient protective factor. Patients with EAD had higher reoperations and graft loss rates.     

Grip strength as a predictor of disease severity in hospitalized COVID-19 patients

BackgroundGrip strength is one of the main components for the physical functioning in sarcopenia and physical frailty.ObjectivesTo explore the role of grip strength measurement at admission for predicting disease severity in COVID-19.MethodsDemographic data, smoking status, comorbidities, COVID-19 related symptoms, grip strength, laboratory and computed tomography (CT) findings at admission were all noted. Using a Smedley hand dynamometer, the maximum grip strength value (kg) after three measurements on the dominant side was recorded. Low grip strength was defined as two standard deviations below the gender-specific peak mean value of the healthy young adults (<32 kg for males, <19 kg for females). Patients were categorized into three groups according to clinical and CT findings. Severe illness group had pneumonia with a respiratory rate >30/min, oxygen saturation ≤90%, or extensive lung involvement in CT. Moderate illness group had pneumonia with CT score ≤11. Mild illness group had normal CT findings.ResultsThe study population included 312 patients (140 F, 172 M). The distribution of mild, moderate and severe disease groups were 36.9%, 51.0% and 12.2%, respectively. Cough, fever, dyspnea, hypertension, obesity, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) were most frequent, and C-reactive protein (CRP), ferritin, D-dimer, and neutrophil levels were highest in the severe group (all p<.05). Absolute grip strength values were lowest and the frequency of having low grip strength were highest in the severe group (both p<.01). Since we found that the significant differences were stemming from the severe group, we combined the mild and moderate group as non-severe, and compared severe vs. non-severe groups with binary logistic regression analyses. When age, gender, body mass index, smoking status, presence of comorbidities and low grip strength, and abnormal laboratory findings were taken into analyses; age (odds ratio [OR]: 1.054 [95% confidence interval (CI): 1.020-1.089]), obesity (OR: 2.822 [95% CI: 1.143-6.966]), COPD (OR: 5.699 [95 %CI: 1.231-26.383]), CRP level (OR: 1.023 [95% CI: 1.010-1.036]) and low grip strength (OR: 3.047 [95% CI: 1.146-8.103]) were observed to be independent predictors for severe COVID-19 disease (all p<.05).ConclusionsIn addition to the well-known independent risk factors (i.e. age, obesity, COPD, and CRP level), low grip strength independently increased (about three times) the severity of COVID-19.     

The effects of exercise and milk-fat globule membrane (MFGM) on walking parameters in community-dwelling elderly Japanese women with declines in walking ability: A randomized placebo controlled trial

ObjectiveTo investigate the effects of exercise and milk fat globule membrane (MFGM) supplementation on walking ability and walking parameters in community-dwelling elderly Japanese women with declined walking ability.MethodsA randomized placebo controlled trial was performed on 126 elderly community-dwelling women over 79 years old. Participants were randomly assigned to one of four three-month interventions: exercise and MFGM (Ex + MFGM), exercise and placebo (Ex + P), MFGM, and placebo interventions. The exercise intervention group performed one-hour progressive exercise classes twice a week. The MFGM supplementation included ingesting 1 g of MFGM per day. Medical history, physical function measurements included grip strength, knee extension strength, walking speed, as well as walking parameters, and blood components were analyzed.ResultsSignificant group × time interactions were observed in usual walking speed, stride, and foot progression angle between the groups. Walking speed improved in both exercise groups (P < 0.001). Similarly, stride significantly increased in the exercise groups compared to the MFGM and placebo groups (P < 0.001). Foot progression angle decreased in the exercise groups (P = 0.023) but not in MFGM or placebo groups. Participants with decreased or unchanged walking speed had significantly lower knee extension strength at baseline (P = 0.016), and a higher prevalence of knee OA (P = 0.033, P = 0.010, respectively).ConclusionThe exercise interventions alone or combined with nutrition were effective in improving walking speed as well as other walking parameters. Improvement in stride and foot progression angle may have contributed to the increase in walking speed. However, augmented effects of MFGM with exercise could not be confirmed.