Smoking,smoking cessation,and 7-year mortality in a cohort of Thai adults

Background

Smoking is a strong risk factor for mortality in both the developed and the developing world. However, there is still limited research to examine the impact of smoking cessation and mortality in middle-income Southeast Asian populations.

Methods

We use longitudinal data from a large Thai cohort of adult Open University students residing nationwide, linked with official death records to assess the association of smoking status and mortality risks during a 7-year follow-up. The log-rank test was used to evaluate the statistical probability of differential survival according to baseline smoking status. Multivariate hazard ratios (HR) were reported for smoking status and all-cause and cause-specific mortality.

Results

From 2005 baseline to 2012, current smokers were more likely to die than cohort members who ceased smoking and never smokers (1.9 vs 1.3 vs 0.6 %, p?<?0.05). The hazard of all-cause mortality increased with the daily amount of cigarette consumption among both current and former smokers. Cause of death analyses showed that current male smokers had a significantly increased risk of cardiovascular disease related mortality (HR 3.9 [95 % CI 1.8–8.1]). Former male smokers had a moderate increase in risk of dying from cardiovascular diseases compared to never smokers (HR 1.6 [95 % CI 0.7–3.4]). Current male smokers between 2005 and 2009 experienced highest subsequent mortality hazards during the period 2009–2012 compared to never smokers (HR 2.1 [95 % CI 1.4–3.4]). The higher risk of dying reduced if people quit smoking during the 2005–2009 follow-up period (HR 1.5 [95 % CI 0.7–3.3]). Risk for mortality fell even further among long-term quitters (HR 1.4 [95 % CI 0.9–2.2]).

Conclusion

Among a large nationwide cohort of Thai adults, current smokers were at a significantly and substantially higher risk of all-cause mortality, especially cardiovascular-related mortality. The higher risk of dying fell if people quit smoking and the risk for mortality was even lower among long-term quitters. Promotion of smoking cessation will contribute substantially to the reduction in avoidable mortality in Thailand.

     

Association between adiposity and disability in the Lc65+ cohort

Objectives

To examine the longitudinal association between body mass index (BMI) and waist circumference (WC) with mortality and incident disability in Lc65+ cohort.

Design

Population-based cohort of non-institutionalized adults with up to 8.9 years of follow-up.

Setting

City of Lausanne, Switzerland.

Participants

1,293 individuals aged 65 to 70 at baseline (58% women).

Measurements

BMI, WC and covariates were measured at baseline in 2004-2005. Vital status was obtained up to the 31st December 2013 and difficulty with basic activities of daily living (BADL) was reported in a self-administered questionnaire sent to participants every year. Main outcomes were total mortality and disability, defined as difficulty with BADL for ≥2 years or institutionalization. Cox regression was used with BMI/WC quintiles 2 as the reference.

Results

130 persons died over a median follow-up of 8.47 years (crude mortality rate, men: 16.5/1,000 person-years, women: 9.7/1,000 person-years). In Cox regression adjusted for age, sex, education, financial situation, smoking and involuntary weight loss (IWL) at baseline, mortality was significantly associated with neither BMI nor WC, but there were trends towards non-significant J-curves across both BMI and WC quintiles. Disability (231 cases) tended to increase monotonically across both BMI and WC quintiles and was significantly associated with BMI quintile 5 (HR=2.44, 95% CI [1.65-3.63]), and WC quintiles 4 (HR=1.81 [1.15-2.85]) and 5 (HR=2.58, [1.67-4.00]).

Conclusion

Almost half of the study population had a substantially increased HR of disability, as compared to the reference BMI/WC categories. This observation emphasizes the need for life-long strategies aimed at preventing excess weight, muscle loss and functional decline through adequate nutrition and regular physical activity, starting at early age and extending throughout life.

     

Effect of Body Weight,Waist Circumference and Their Changes on Mortality: A 10-Year Population-Based Study

Objectives

To investigate the effect of body weight, waist circumference and their changes on all-cause and cardiovascular mortality.

Design

A nationwide population-based cohort study

Participants

627 community-dwelling older adults.

Measurements

Participants were interviewed for demographic and anthropometric data collected. Blood were drawn for testing biochemistry data. Central obesity was defined as waist circumference is greater than 80 cm for women and 90 cm for men. Obesity, overweight, normal and underweight were defined as BMI ≥27 kg/m2, ≥24 kg/m2,18.5-24 kg/m2 and <18.5 kg/m2. Cox proportion hazard model was used to explore the impact of body weight and its change on mortality.

Results

The distribution of weight changes and mortality was right skewed, but U-shape of waist change for all-cause mortality was observed. Compared to normal BMI at baseline, the association between underweight (HR: 1.7, 95% CI: 0.7-4.0), overweight (HR:0.7, 95% CI:0.4-1.2) and obesity (HR:1.3,95% CI:0.8-2.3) showed insignificantly associated with all-cause mortality. The HR of those weight loss >5% (HR: 1.7, 95% CI: 1.1-2.8) and waist decrease >5% (HR: 1.7, 95% CI: 1.0-2.8) were higher than those of stable weight/waist +/- 5% over a 6-year period. Compared to those stable weight/waist, the mortality risk was similar in those of weight gain or waist increase (HR 0.7,95%CI: 0.4-1.5 and HR:0.9, 95%CI:0.4-1.6).

Conclusion

Weight loss and waist decrease were significantly associated with long-term mortality risk, a life-course approach for body weight management is needed to pursuit the most optimal health benefits for the middle-aged and older adults.

     

Association between dietary zinc intake and mortality among Chinese adults: findings from 10-year follow-up in the Jiangsu Nutrition Study

Purpose

Population studies of the association between zinc intake and mortality yield inconsistent findings. Using data from Jiangsu Nutrition Study, we aimed to assess the association between zinc intake and mortality among Chinese adults.

Methods

We prospectively studied 2832 adults aged 20 years and older with a mean follow-up of 9.8 years. At baseline, food intake was measured by 3-day weighed food record (WFR) between September and December in 2002. Death occurrence was assessed in 2012 during a household visit as well as by data linkage with the regional death registry. Hazard ratios (HRs) and 95% CI were calculated using competing risks regression (CVD and cancer mortality) and Cox proportional hazards analysis (all-cause mortality).

Results

During 27,742 person-years of follow-up, there were 184 deaths [63 cancer deaths and 70 cardiovascular disease (CVD) deaths]. Dietary zinc to energy ratio was positively associated with cancer and all-cause mortality. Across quartiles of the zinc to energy ratio from low to high, the HR (95% CI) for all-cause mortality was 1.00, 1.80 (95% CI 1.10–2.95), 1.55 (95% CI 0.96–2.50), and 1.85 (95% CI 1.11–3.07), respectively. Comparing the extreme quartiles of the zinc to energy ratio, the HR for cancer mortality was 2.28 (95% CI 1.03–5.04).

Conclusion

Zinc intake was positively related to all-cause mortality and cancer mortality.

     

Overweight and abdominal obesity association with all-cause and cardiovascular mortality in the elderly aged 80 and over: A cohort study

Objective

To evaluate the association between overweight and abdominal obesity with all-cause and cardiovascular mortality in the elderly aged 80 and over.

Design

A prospective cohort study.

Setting

A population-based study of community-dwelling very elderly adults in a city in southern Brazil.

Participants

236 very elderly adults, number that represents 85% of the population aged 80 and over living in the city in the period (mean age 83.4 ± 3.2).

Measurements

Overweight and abdominal obesity were assessed using recommended cut-off points for body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR). The association between these anthropometric measurements and all-cause and cardiovascular mortality were independently estimated by Cox proportional hazards model. Kaplan-Meier was used to assess survival time.

Results

Increased WC (>80cm F and >94cm M) and WHtR (>0.53 F and >0.52 M) were associated with lower all-cause mortality, but only WHtR remained associated even after controlling for residual confounding (HR 0.55 CI95% 0.36-0.84; p<0.001). Additionally increased WC was independently associated with lower mortality from cardiovascular diseases (HR 0.57 CI95% 0.34-0.95; p<0.030). BMI and WHR did not show significant independent association with mortality in the main analysis.

Conclusion

Greater abdominal fat accumulation, as estimated by WC and WHtR, presented an association with lower allcause and cardiovascular mortality in the elderly aged 80 and over, but not by BMI and WHR.

     

Is obesity a marker of robustness in vulnerable hospitalized aged populations? Prospective,multicenter cohort study of 1 306 acutely ill patients

Background

The “obesity paradox” is poorly understood in vulnerable older hospitalized populations.

Objectives

To prospectively analyze the impact of body mass index (BMI) and comorbidities on early (6-week), one- and two-year mortality.

Design

Prospective multicenter study with a two-year follow-up of old patients participating in the SAFES cohort study.

Settings

Nine university hospitals in France.

Participants

Patients aged 75 or older hospitalized in medical divisions through the emergency department.

Measurement

Inpatients’ characteristics were obtained through a comprehensive geriatric assessment of inpatients, conducted in the first week of hospitalization. All-cause mortalities at 6-week, one- and two-year were determined using bivariable and multivariable Cox proportional hazard model.

Results

The SAFES cohort included 1,306 patients, aged 85±6 years, with a majority of women (65%). One- and two-year mortality were inversely associated with BMI ≥30 kg/m2 while early mortality was not, and positively associated with age, burden of comorbidities, walking disorders, level of dependency and presence of a dementia syndrome. Survival rates between patients in low (< 18.0 kg/m2) and intermediate (18–24.9 and 25–29.9 kg/m2) BMI categories were not significant.

Conclusion

While our findings seem to confirm the reality of the “obesity paradox” in vulnerable older hospitalized population, the exact understanding of underlying mechanisms and even the truthfulness of this paradoxical relationship are still fraught with considerable methodological, epidemiological and metabolic challenges.     

Dietary total antioxidant capacity is inversely associated with all-cause and cardiovascular disease death of US adults

Purpose

Although evidence strongly supports that antioxidant-rich diets reduce risk of chronic disease and mortality, findings from the previous studies on the effect of individual antioxidants on mortality have been inconsistent. The aim of this study was to assess the relationship between dietary total antioxidant capacity (TAC) and all-cause and disease-specific mortality in a representative sample of the US population.

Methods

A total of 23,595 US adults aged 30 years and older in NHANES 1988–1994 and 1999–2004 were selected for this study. Dietary TAC was calculated from 1-day 24-h diet recall data at baseline and all-cause, cancer and cardiovascular disease (CVD) mortality was assessed through December 31, 2011.

Results

During a mean follow-up of 13 years, deaths from all-cause, cancer and CVD were 7157, 1578, and 2155, respectively. Using cause-specific Cox proportional hazards models, inverse associations and linear trends were observed between dietary TAC and all-cause mortality [highest quartile (Q4) versus Q1 ref. HR 0.78; 95% CI 0.71–0.86], cancer mortality (Q4 versus Q1 ref. HR 0.75; 95% CI 0.60–0.93), and CVD mortality (Q4 versus Q1 ref. HR 0.83; 95% CI 0.69–0.99), respectively, after adjusting for age, sex, ethnicity, and total energy intake. The inverse association and linear trend still remained between dietary TAC and all-cause mortality (Q4 versus Q1 ref. HR 0.79; 95% CI 0.71–0.87) and CVD mortality (Q4 versus Q1 ref. HR 0.74; 95% CI 0.61–0.89) when further adjusted for relevant covariates.

Conclusions

These findings support that antioxidant-rich diets are beneficial to reducing risk of death from all-cause and CVD.

     

MTHFR C677T genotype and cardiovascular risk in a general population without mandatory folic acid fortification

Purpose

Meta-analyses have suggested an effect of MTHFR C677T genotype (rs1801133), a proxy for blood total homocysteine, on cardiovascular disease (CVD) in populations with low population dietary folate. The aim was to examine the association and effect modification by serum folate and vitamin B12 levels between MTHFR and CVD-related outcomes in a general population with no mandatory folic acid fortification policy.

Methods

The study population included 13,748 adults retrieved from pooling of four population-based studies conducted in Denmark. MTHFR genotype, serum folate (measured in approximately 9,356 individuals), and serum vitamin B12 (9,215 individuals), hypertension, and dyslipidemia were measured at baseline, and participants were followed for a mean of 10.5–11.7 years in central registries for diagnoses of stroke (623 incidents), ischaemic heart disease (IHD) (835 incidents), and all-cause mortality (1,272 incidents).

Results

The MTHFR genotype (TT vs. CC/CT) was not associated with hypertension [OR (95 % CI) 1.09 (0.95–1.25)], dyslipidemia [OR (95 % CI) 0.97 (0.84–1.11)], stroke [HR (95 % CI) 0.92 (0.69–1.23)], and all-cause mortality [HR (95 % CI) 0.94 (0.77–1.14)], either overall, or in participants with low serum folate or B12 status (P values for interactions 0.15–0.94). Individuals with the MTHFR TT genotype had a higher risk of IHD (HR (95 % CI) 1.38 (1.11–1.71)), but this association was not modified by folate status (P value for interaction 0.45).

Conclusions

Our results do not support a causal relationship between homocysteine and CVD. However, we cannot exclude a direct causal effect of MTHFR C677T genotype on IHD.     

Nutritional risk,nutritional status and incident disability in older adults. The FRADEA Study

Objectives

To analyze if body mass index (BMI) and waist circumference (WC) as measures of nutritional status, and the Mini Nutritional Assessment Short Form (MNA-SF) as a nutritional risk measure are associated with increased risk of incident disability in basic activities of daily living (BADL) in a population based cohort of Spanish older adults.

Design

Concurrent cohort study.

Setting

Albacete City, Spain.

Participants

678 subjects over age 70 from the FRADEA Study (Frailty and Dependence in Albacete).

Measurements

BMI, WC and MNA-SF were recorded at the basal visit of the FRADEA Study. Incident disability in BADL was defined as loss of the ability to perform bathing, grooming, dressing, toilet use, or feeding from basal to follow-up visit, using the Barthel index. The association between nutritional status and nutritional risk with incident BADL disability was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, basal function, comorbidity, cognitive decline, depression risk and frailty status.

Results

Each point less of MNA-SF (OR 1.17, 95%CI 1.04–1.31) and MNA-SF<14 (OR 2.33, 95%CI 1.39–3.89), but not MNA-SF<12 (OR 1.47, 95%CI 0.89–2.42) had a greater adjusted risk of incident disability in BADL. Neither BMI (OR 1.02, 95%CI 0.97–1.06) nor WC (OR 1.01, 95%CI 0.99–1.03) were associated. Weight loss (OR 1.75, 95%CI 1.08–2.83) and mobility impairment (OR 3.35, 95%CI 1.67–6.73) remained as adjusted predictors of incident BADL disability, while anorexia almost reached the significance (OR 1.65, 95%CI 0.94–2.87).

Conclusion

Nutritional risk measured with the MNA-SF is associated with incident disability in BADL in older adults, while nutritional status measured with BMI or WC is not.     

Mercury in serum predicts low risk of death and myocardial infarction in Gothenburg women

Purpose

Markers of mercury (Hg) exposure have shown both positive and negative associations with cardiovascular disease (CVD). We assessed the association between serum Hg (S–Hg) and risk of cardiovascular disease in a prospective population-based cohort, with attention to the roles of dental health and fish consumption.

Methods

Total mortality, as well as morbidity and mortality from acute myocardial infarction (AMI) and stroke, was followed up for 32 years in 1,391 women (initially age 38–60), in relation to S–Hg at baseline, using Cox regression models. Potential confounders (age, socioeconomic status, serum lipids, alcohol consumption, dental health, smoking, hypertension, waist-hip ratio, and diabetes) and other covariates (e.g., fish consumption) were also considered.

Results

Hazard ratios (HR) adjusted only for age showed strong inverse associations between baseline S–Hg and total mortality [highest quartile: hazard ratio (HR) 0.76; 95% confidence interval (CI) 0.59–0.97], incident AMI (HR 0.56; CI 0.34–0.93), and fatal AMI (HR 0.31; CI 0.15–0.66). Adjustment for potential confounding factors, especially dental health, had a strong impact on the risk estimates, and after adjustment, only the reduced risk of fatal AMI remained statistically significant.

Conclusions

There was a strong inverse association between Hg exposure and CVD. Likely, reasons are confounding with good dental health (also correlated with the number of amalgam fillings in these age groups) and/or fish consumption. The results suggest potential effects of dental health and/or fish consumption on CVD that deserve attention in preventive medicine.     

Association of surrogate and direct measures of adiposity with risk of metabolic syndrome in rural Chinese women

Background

Most studies linking obesity and metabolic syndrome (MS) have used body mass index (BMI) and waist circumference (WC) to measure obesity. While BMI is correlated with direct measures of total and central adiposity, it is influenced by lean body and bone mass. We hypothesize that direct measures of adiposity may help develop further insight into the link between obesity and MS, thus more accurately identifying individuals at high risk for MS.

Aim of the study

We examined how surrogate and direct measures of adiposity were associated with MS risk and if direct adiposity measures enhanced BMI and WC identification of MS risk.

Methods

3,734 Chinese female twins aged 20–39 years were studied. Percent body fat (%BF) and proportion of trunk fat to total BF (%TF) were assessed by DEXA. Graphic plots and generalized estimating equations were used to examine the associations of adiposity measures with MS and its components. Concordance of adiposity measures and MS abnormalities between monozygotic (MZ) and dizygotic (DZ) twin pairs were compared.

Results

The prevalence of MS increased for high BMI (≥23 kg/m²), %BF (≥32), WC (≥80 cm), and (to a lesser degree) %TF (≥50). Below those thresholds, the prevalence of MS was low (0–5.3%). %TF was independently associated with higher risk of MS and its components even after adjusting for BMI and WC. As a result, among women with normal BMI and WC, high %TF was associated with 1.3–2.0-fold elevated risk of MS components. In contrast, women with high BMI but normal WC and %TF neither have significantly increased risk of MS, nor for any component other than high BP. MZ twins showed higher concordance for MS and its components than DZ twins.

Conclusions

In this lean Chinese rural female sample, BMI ≥ 23 and WC ≥ 80 were associated with a markedly increased risk of MS, which was further enhanced by elevated %TF. Even in women with a normal BMI and WC, %TF was independently associated with MS and its components. Twin analysis findings suggest that adiposity measurements and MS risk are influenced by genetics.     

Association between body mass index and mortality among institutionalized elderly adults in Japan

Background

The purpose of this study is to assess the association between body mass index (BMI) and mortality among nursing home residents in Japan.

Methods

A one-year prospective cohort study was conducted with 8,510 elderly individuals across 140 nursing homes. Baseline measurements included age, sex, height, weight, BMI, activities of daily living (ADL) (Barthel Index), and degree of dementia. Information regarding dates of discharge and mortality were also obtained to calculate person-years. Cox’s proportional hazards model was used to estimate hazard ratios.

Results

Mean age and BMI were 84.3 [standard deviation (SD) 8.1] years and 20.6 (SD 3.8) kg/m², respectively. Hazard ratios of mortality adjusted for sex, age, ADL, degree of dementia, and type of home were 2.4 [95 % confidence interval (CI): 1.9–3.1] for the 1st quintile of BMI (<17.3 kg/m²), 1.7 (95 % CI: 1.3–2.3) for the 2nd quintile (17.3–19.2 kg/m²), 1.5 (95 % CI: 1.2–2.0) for the 3rd quintile (19.3–21.1 kg/m²), and 1.2 (95 % CI: 0.9–1.6) for the 4th quintile (21.2–23.5 kg/m²) (P for trend <0.001), compared with the reference 5th quintile (23.6≤ kg/m²).

Conclusions

There was a clear inverse dose-dependent relationship between BMI and mortality. Future studies should be conducted to determine the effects of nutritional intervention on mortality in institutionalized elderly adults.     

Vitamin/mineral supplementation and cancer, cardiovascular, and all-cause mortality in a German prospective cohort (EPIC-Heidelberg)

Purpose

To prospectively evaluate the association of vitamin/mineral supplementation with cancer, cardiovascular, and all-cause mortality.

Methods

In the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC-Heidelberg), which was recruited in 1994–1998, 23,943 participants without pre-existing cancer and myocardial infarction/stroke at baseline were included in the analyses. Vitamin/mineral supplementation was assessed at baseline and during follow-up. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

After an average follow-up time of 11?years, 1,101 deaths were documented (cancer deaths?=?513 and cardiovascular deaths?=?264). After adjustment for potential confounders, neither any vitamin/mineral supplementation nor multivitamin supplementation at baseline was statistically significantly associated with cancer, cardiovascular, or all-cause mortality. However, baseline users of antioxidant vitamin supplements had a significantly reduced risk of cancer mortality (HR: 0.52; 95% CI: 0.28, 0.97) and all-cause mortality (HR: 0.58; 95% CI: 0.38, 0.88). In comparison with never users, baseline non-users who started taking vitamin/mineral supplements during follow-up had significantly increased risks of cancer mortality (HR: 1.74; 95% CI: 1.09, 2.77) and all-cause mortality (HR: 1.58; 95% CI: 1.17, 2.14).

Conclusions

Based on limited numbers of users and cases, this cohort study suggests that supplementation of antioxidant vitamins might possibly reduce cancer and all-cause mortality. The significantly increased risks of cancer and all-cause mortality among baseline non-users who started taking supplements during follow-up may suggest a “sick-user effect,” which researchers should be cautious of in future observational studies.     

Dyspnea: A strong independent factor for long-term mortality in the elderly

Objective

To determine the association between dyspnea at entry into the PAQUID cohort and 13-year mortality, taking into consideration BMI and other mortality-related factors.

Methods: Design

Longitudinal study.

Setting

In Dordogne and Gironde, South Western France.

Subjects

A total of 3646 French community dwellers aged 65 years old and over from the PAQUID study were included. Main outcome measures: dyspnea measured on 5-grades scale, mortality measured over 13 years of follow-up. Adjustment variables: age, gender, BMI (kg/m²), antecedent of ischemic heart disease, antecedent of stroke, hypertension, smoking history and diabetes.

Results

The study sample included 3646 subjects out of whom 54.11% died at 13 years of follow-up, 57.3% of participants were women and mean age was 75.3 (SD 6.8) years. Univariate analysis showed that dyspnea was associated with 13-year mortality. Death occurred in 45.6% of non-dyspneic subjects, 51.8% in those with level 1 of dyspnea, 65.6% in level 2 and 80.6% in level 3 and 4 (P<10^?4). The median survival was at 13.26 (SD 0.20) years for level-0 of dyspnea, 12.33 (SD 0.31) years for level-1 of dyspnea, 9.28 (SD 0.44) years for level-2 and 6.43 (SD 0.45) years for level-3 and 4 (P=10^?3). In the multivariate analysis, the risk of mortality for level1 compared to level-0 was HR=1.13 (CI95%=[1.01–1.26]); this risk increases to HR=1.42 (CI95%=[1.25–1.63]) for level-2 and to HR=1.90 (CI95%=[1.61–2.25]) for level-3 and 4.

Conclusion

These findings suggest that the relationship between long-term mortality and dyspnea is strong, consistent and independent of other covariates in the elderly.     

Moderate alcohol consumption predicts long-term mortality in elderly subjects with chronic heart failure

Objective

Moderate alcohol consumption is related to a reduction of mortality. However, this phenomenon is not well established in the elderly, especially in the presence of chronic heart failure (CHF). The aim of the study was to verify the effect of moderate alcohol consumption on 12-year mortality in elderly community-dwelling with and without CHF.

Settings

community-dwelling from 5 regions of Italy.

Participants

A cohort of 1332 subjects aged 65 and older.

Measurement

Mortality after 12-year follow-up in elderly subjects (≥65 years old) with and without CHF was studied. Moderate alcohol consumption was considered ≤250 ml/day (drinkers).

Results

In the absence of CHF (n=947), mortality was 42.2% in drinkers vs. 53.7% in non-drinker elderly subjects (p=0.021). In contrast, in the presence of CHF (n=117), mortality was 86.5% in drinkers vs. 69.7% in non-drinker elderly subjects (p=0.004). Accordingly, Cox regression analysis shows that a moderate alcohol consumption is protective of mortality in the absence (HR=0.79; CI 95% 0.66–0.95; p<0.01) but it is predictive of mortality in the presence of CHF (HR=1.29; CI 95% 1.05–1.97; p<0.05).

Conclusions

Our data demonstrates that moderate alcohol consumption is associated with an increased long-term mortality risk in the elderly in the presence of CHF.     

Under-reporting of energy intake in elderly Australian women is associated with a higher body mass index

Objectives

Identify the extent of under-reporting of energy intake and the characteristics associated with implausible intakes in elderly women.

Design

Dietary intake was assessed using a 3-day weighed food record. Protein intake was validated by 24-hour urinary nitrogen. To examine under-reporting, participants were grouped according to their energy intake and compared to the Goldberg cut-off equation. Logistic regression was performed to assess the influence of body mass index (BMI) and social-demographic factors on under-reporting.

Setting

Community dwelling elderly women from Perth, Western Australia.

Participants

217 elderly women aged 70–80 years.

Results

Under-reporters had a higher physical activity level (p<0.001) compared with acceptable-reporters. The under-reporters also had a higher body weight (p=0.006), body mass index (BMI) (p=0.001), waist (p=0.011), hip circumference (p<0.001), whole body fat mass (p<0.001) and percentage body fat (p<0.001) than acceptable-reporters. Under-reporters had a significantly lower intakes of protein, fat, carbohydrate and alcohol (p<0.001) and fewer reported food items, compared with acceptable reporters. However, 24-hour urinary nitrogen was only marginally different between the two groups (p=0.053). Participants with a higher BMI were more likely to under-report their energy intake (BMI=25–29.9: odds ratio=2.98[95% CI=1.46–6.09]; BMI≥30: 5.84[2.41–14.14]).

Conclusion

Under-reporting energy intake in elderly women was associated with a higher BMI, body fat and higher self-reported physical activity levels. A higher BMI (≥25) appears to be most significant factor in determining if elderly women will underreport their food intake and may be related to body image. These results have implications for undertaking surveys of food intake in elderly women.     

Association between weight change and mortality in community living older people followed for up to 14 years. The Hordaland Health Study (HUSK)

Objectives

To study the importance of weight change with regard to mortality in older people.

Design

Prospective cohort study.

Participants

The cohort includes participants in the Hordaland Health Study, Norway, 1997-99 (N=2935, age 71-74 years) who had previously participated in a survey in 1992-93.

Measurements

Participants with weight measured at both surveys were followed for mortality through 2012. Cox proportional hazards models were used to calculate risk of death according to changes in weight. Hazard ratios (HR) with 95% confidence intervals (CIs) for people with stable weight (±<5% weight change) were compared to people who lost (≥5%) or gained (≥5%) weight. Cox regression with penalized spline was used to evaluate the association between weight change (in kg) and mortality. Analyses were adjusted for age, sex, physical activity, smoking, diabetes, hypertension, and previous myocardial infarction or stroke. Participants with cancer were excluded.

Results

Compared to those with stable weight, participants who lost ≥5% weight had an increased mortality risk (HR 1.59 [95% CI: 1.35-1.89]) while the group with weight gain ≥5% did not (HR 1.07 [95% CI 0.90-1.28]). Penalized spline identified those who lost more than about three kg or gained more than about 12 kg as having increased risk of death.

Conclusion

Even a minor weight loss of ≥5% or >3 kg were significantly associated with increased risk of mortality. Thus, weight should be routinely measured in older adults.

     

Dairy intake in relation to cardiovascular disease mortality and all-cause mortality: the Hoorn Study

Purpose

Existing data from prospective cohort studies on dairy consumption and cardiovascular diseases are inconsistent. Even though the association between total dairy and cardiovascular diseases has been studied before, little is known about the effect of different types of dairy products on cardiovascular diseases (CVD). The objective of this study was to examine the relationship between (type of) dairy intake and CVD mortality and all-cause mortality in a Dutch population.

Methods

We examined the relationship between dairy intake and CVD mortality and all-cause mortality in 1956 participants of the Hoorn Study (aged 50–75 years), free of CVD at baseline. Hazard ratios with 95 % CIs were obtained for CVD mortality and all-cause mortality per standard deviation (SD) of the mean increase in dairy intake, with adjustment for age, sex, BMI, smoking, education, total energy intake, alcohol consumption, physical activity, and dietary intakes.

Results

During 12.4 years of follow-up, 403 participants died, of whom 116 had a fatal CVD event. Overall dairy intake was not associated with CVD mortality or all-cause mortality. Each SD increase in high-fat dairy intake was associated with a 32 % higher risk of CVD mortality (95 % CI; 7–61 %).

Conclusion

In this prospective cohort study, the intake of high-fat dairy products was associated with an increased risk of CVD mortality.     

Self-Assessed Kyphosis and Chewing Disorders Predict Disability and Mortality in Community-Dwelling Older Adults

Objective

It is clear that each trend of kyphosis with increased age and the ability to eat firm foods with the back teeth (chewing ability) has a strong influence on both the physical and mental condition of older people. Thus, this study aimed to examine whether the combination of kyphosis and chewing disorders was associated with mortality or the need for care under the new long-term care insurance (LTCI) service requirement, over 3 years in community-dwelling older Japanese adults.