Accelerometer-assessed light-intensity physical activity and mortality among those with mobility limitations

Background

Emerging research demonstrates that light-intensity physical activity is favorably associated with numerous health outcomes among the general population, even independent of high-intensity physical activity.

Body mass index and mobility limitations: An analysis of middle-aged and older Black,Hispanic, and White women in the U.S.

IntroductionWhile the Body Mass Index (BMI) did not change significantly for men from 2005 to 2014 in the United States, women exhibited an upward linear trend. Hispanic and Black women, in particular, showed a dramatic increase. Therefore, the objective of this study was to examine the association between BMI and mobility limitations for non-institutionalised middle-aged and older Black, Hispanic, and White women.MethodsThe International Classification of Functioning, Disability, and Health model was applied to a sample of 2865 Black, 1846 Hispanic, and 9721 White women categorised as middle-aged and older (i.e., at least 50 years of age) from the 2010 and 2014 Rand Health and Retirement Study. A random effects ordered logit was employed.ResultsAfter accounting for personal/activity characteristics, the analyses revealed Black women with greater BMI were associated with a higher likelihood for mobility limitations with an odds ratio of 1.11 [1.06–1.16, 95% CI]. A significant association was also found for Hispanic women with an odds ratio of 1.16 [1.11–1.23, 95% CI] and White women with an odds ratio of 1.16 [1.13–1.19, 95% CI]. Even after accounting for the possibility of endogeneity, BMI remained robust.ConclusionHigher-levels of BMI were associated with an increased probability for mobility limitations for Black, Hispanic, and White middle-aged and older women. Those with a vigorous exercise regimen were less likely to be in this category across all ranges of BMI. These results are useful for prioritising minority health policy, particularly given the limited amount of existing research in this specific area.     

Transitions in mobility,ADLs, and IADLs among working-age Medicare beneficiaries

BackgroundDisability is a dynamic process where functional status may change over time. Examination of the Medicare population suggests that, for those over age 65, disability status will fluctuate in 30% of beneficiaries each year. Less is known about those under age 65. The dynamic nature of disability is of relevance since it has important implications for social policies related to disability.ObjectivesTo: 1) describe the characteristics of Medicare beneficiaries eligible due to disability; and 2) estimate the proportion of individuals with transitions in functional status over a one-year period stratified by baseline characteristics and diagnostic subgroups.MethodsWe used the Medicare Current Beneficiary Survey from 1995 to 2005 to examine transitions in mobility and daily activities among individuals who were eligible for Medicare coverage due to disability.ResultsFrom the standpoint of function in mobility and daily activities, the working-age Medicare population with disability is fairly stable. While 75%–90% of our sample reported no disability or stable disability from one year to the next, depending on the condition and disability metric, as many as 13–14% of individuals showed improvement or decline in their functional status.ConclusionsIn the working-age population with disability, a small percentage of individuals will improve or worsen from one year to the next. Since these transitions are associated with a variety of individual characteristics including health conditions, further research applied to larger samples is required to refine policy relevant models that might inform decisions related to ongoing eligibility for disability programs.     

Urban built environments and trajectories of mobility disability: Findings from a national sample of community-dwelling American adults (1986–2001)

As people age, they become more dependent on their local communities, especially when they are no longer able to drive. Uneven or discontinuous sidewalks, heavy traffic, and inaccessible public transportation, are just some of the built environment characteristics that can create barriers for outdoor mobility in later adulthood. A small body of literature has been investigating the role of the built environment on disability, but has been limited to cross-sectional analyses. The purpose of this paper is to further advance this area of research by examining the role of the built environment on long-term trajectories of mobility disability in a national sample of American adults (age 45+) followed over a 15-year period. Using multilevel logistic growth curve models with nationally representative data from the Americans' Changing Lives Study (1986–2001), we find that trajectories of mobility disability are steeper in older age groups. Women and those with lower education had a higher odds of mobility disability over time. The presence of just one chronic health condition doubled the odds of mobility disability at each of the four study waves. Among older adults (age 75+), living in neighborhoods characterized by more motorized travel was associated with an odds ratio for mobility disability that was 1.5 times higher in any given year than for older adults living in environments that were more pedestrian friendly. These results suggest that the built environment can exacerbate mobility difficulties for older adults. When considering ways to minimize disability as the population ages, simple changes in the built environment may be easier to implement than efforts to change risk factors at the individual level.     

成年居民每日膳食盐摄入量与肥胖关系

目的 探讨成人膳食盐摄入量与肥胖关系。方法 于2013年4月采用多阶段整群随机抽样方法抽取徐州市≥18岁常住人口30 572人进行调查。结果 30 572名成年居民平均膳食盐摄入量（14.53±11.04）g/d,超重率为32.17%（9 834/30 572）,肥胖率为7.09%（2 169/30 572）,中心性肥胖率为45.58%（13 934/30 572）;校正潜在的混杂因素后,膳食盐摄入量对肥胖和中心性肥胖的OR值（95%CI）分别为1.467（1.267~1.698）、1.155（1.080~1.234）。结论 膳食盐摄入量与肥胖的发生有关联。降低膳食盐摄入量有助于减少肥胖的发生,对居民进行低盐饮食相关健康教育刻不容缓。     

Association between physical activity and mental disorders among adults in the United States

BACKGROUND: The objective of this study was to determine the association between regular physical activity and mental disorders among adults in the United States. METHODS: Multiple logistic regression analyses were used to compare the prevalence of mental disorders among those who did and did not report regular physical activity using data from the National Comorbidity Survey (n = 8098), a nationally representative sample of adults ages 15-54 in the United States. CONCLUSIONS: Slightly over one-half of adults reported regular physical activity (60.3%). Regular physical activity was associated with a significantly decreased prevalence of current major depression and anxiety disorders, but was not significantly associated with other affective, substance use, or psychotic disorders. The association between regular physical activity and lower prevalence of current major depression (OR = 0.75 (0.6,0.94)), panic attacks (OR = 0.73 (0.56, 0.96)), social phobia (OR = 0.65 (0.53, 0.8)), specific phobia (OR = 0.78 (0.63, 0.97)), and agoraphobia (OR = 0.64 (0.43, 0.94)) persisted after adjusting for differences in sociodemographic characteristics, self-reported physical disorders, and comorbid mental disorders. Self-reported frequency of physical activity also showed a dose-response relation with current mental disorders. DISCUSSION: These data document a negative association between regular physical activity and depressive and anxiety disorders among adults in the U.S. population. Future research that investigates the mechanism of this association using longitudinal data to examine the link between physical activity and incident and recurrent mental disorders across the lifespan is needed.     

Psychological and behavioral responses during the COVID-19 pandemic among individuals with mobility and/or self-care disabilities

BackgroundThe lockdowns during the COVID-19 pandemic created major obstacles for individuals with disabilities to obtain support in their daily living.ObjectivesThis study was to examine the psychological and behavioral responses of US individuals with mobility and/or self-care disabilities during the pandemic.MethodsFrom a nationally representative longitudinal survey (n = 6403) administered during the pandemic, individuals were classified at baseline as having no mobility/self-care disability (ADL = 0, n = 4975), mobility or self-care disability (ADL = 1, n = 1061), and both mobility and self-care disabilities (ADL = 2, n = 367). Weighted mean of baseline mental distress scores (PHQ4), psychological risk factors (loneliness, stress, perceived COVID risk), resilience, and coping were compared among these groups. Random effects models were employed to assess the effects of disability and disability-moderated effects of risk factors on mental distress.ResultsAt baseline, mental distress increased with greater ADL disabilities (Mean[95%CI] = 1.88[1.77, 1.98], 2.54[2.29, 2.79], and 3.55[3.01, 4.08] for ADL = 0, 1, and 2, respectively, p < .0001). Loneliness, stress, and perceived risk increased with ADL disabilities, but resilience and social coping decreased with it (p's < 0.0001). In the random-effects models, greater ADL disabilities, higher psychological risks, and use of cannabis and other recreational drugs were associated with greater mental distress. Greater ADL disabilities augmented the detrimental effects of risk factors on mental health, but resilience protected mental health both independently and through a buffering effect on its risk factors across all groups.ConclusionIndividuals with mobility and/or self-care disability tend to have poorer mental health and are differentially more affected by its risk factors. Mental health professionals should address these modifiable factors in interventions.     

Association between dietary patterns and the risk of metabolic syndrome among Lebanese adults

Purpose

The main objective of this study was to evaluate the association between dietary patterns and the metabolic syndrome (MetS) and its metabolic abnormalities among Lebanese adults, using data from a national nutrition survey.

Methods

A cross-sectional analysis involving adults aged ≥18 years (n = 323) with no prior history of chronic diseases was conducted. Participants completed a brief sociodemographic and 61-item food frequency questionnaire. Anthropometric measurements and fasting blood samples were also obtained. The International Diabetes Federation criteria were used to classify study participants with the metabolic syndrome. Dietary patterns were identified by factor analysis. Multivariate logistic regression analysis was used to evaluate the associations of extracted patterns with MetS and its metabolic abnormalities.

Results

Out of 323 participants, 112 (34.6%) were classified as having MetS. Three dietary patterns were identified: “Fast Food/Dessert,” “Traditional Lebanese,” and “High Protein.” Compared with participants in the lowest quintile of the Fast Food/Dessert pattern, those in the highest quintile had significantly higher odds for MetS (OR, 3.13; 95% CI: 1.36–7.22) and hyperglycemia (OR, 3.81; 95% CI: 159–9.14). Subjects with the highest intake of the High Protein pattern had an increased risk for hypertension (OR, 2.98; 95% CI: 1.26–7.02). The Traditional Lebanese pattern showed no association with MetS or its components.

Conclusions

The findings of this study demonstrate a positive association of the Fast Food/Dessert pattern with MetS and hyperglycemia among Lebanese adults. These results may guide the development of improved preventive nutrition interventions in this adult population.     

Declines in coronary heart disease incidence and mortality among middle-aged adults with and without diabetes

PurposeThe purpose of the study was to investigate secular changes in coronary heart disease (CHD) incidence and mortality among adults with and without diabetes and to determine the effect of increased lipid-lowering medication use and reductions in low-density lipoprotein cholesterol (LDL-C) levels on these changes.MethodsWe analyzed data on participants aged 45 to 64 years from the Atherosclerosis Risk in Communities Study in 1987–1996 (early period) and the Reasons for Geographic and Racial Differences in Stroke Study in 2003–2009 (late period). Hazard ratios (HRs) for the association of diabetes and period with incident CHD and CHD mortality were obtained after adjustment for sociodemographics cardiovascular risk factors, lipid-lowering medication use, and LDL-C.ResultsAfter multivariable adjustment, diabetes was associated with an increased CHD risk during the early (HR = 1.99, 95% confidence interval = 1.59–2.49) and late (HR = 2.39, 95% confidence interval = 1.69–3.35) periods. CHD incidence and mortality declined between the early and late periods for individuals with and without diabetes. Increased use of lipid-lowering medication and lower LDL-C explained 33.6% and 27.2% of the decline in CHD incidence and CHD mortality, respectively, for those with diabetes.ConclusionsAlthough rates have declined, diabetes remains associated with an increased risk of CHD incidence and mortality, highlighting the need for continuing diabetes prevention and cardiovascular risk factor management.     

Association between race/ethnicity and disability status and receipt of vaccines among older adults in Florida

Background

Individuals living with a disability or are a member of a certain racial/ethnic group may be at heightened risk for not receiving important vaccinations.

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.     

Lessons learned from a blended telephone/e-health platform for caregivers in promoting physical activity and nutrition in children with a mobility disability

BackgroundChildren with physical disabilities report higher rates of sedentary lifestyle and unhealthy dietary patterns than non-disabled peers. These behaviors can increase comorbidities, caregiver burden, and healthcare costs. Innovative interventions are needed to assist caregivers of children with physical disabilities improve health behaviors.Objective/Hypothesis: The purpose of this pilot study was to test the usability and preliminary efficacy of an e-health and telecoaching intervention compared to telecoaching alone.MethodsParent/child dyads (n = 65) were randomized into either the e-health and telephone group (e-HT) or the telephone only group (TO). All participants received regular calls from a telecoach, and the e-HT group received access to a website with personalized weekly goals for diet and physical activity, and access to resources to meet these goals. At the conclusion of the intervention, participants in the e-HT group were asked to complete a semi-structured interview to discuss the usability of the e-health platform.ResultsFifty of the 65 randomized dyads (77%) completed all baseline measures and had at least one intervention call. Forty families (80% of those that started the intervention) completed the study (50% spina bifida, 24% mobility limitation, diagnosis not reported). Age of the children ranged from 6 to 17 years old. Both groups had high adherence to scheduled phone calls (e-HT (n = 17): 81%, TO (n = 23): 86%); however no significant differences in dietary intake or physical activity were seen within or between groups. Primary themes to emerge from qualitative interviewers were: the platform should target children rather than parents, parents valued the calls more than the website, and schools need to be involved in interventions.ConclusionsE-health interventions are a promising way to promote healthy behaviors in children with physical disability, but technology must be balanced with ease of use for parents while also engaging the child.     

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.

     

The relationship between organizational policies and practices and work limitations among hospital patient care workers

Objective

We examined relationships between organizational policies and practices (OPPs) (safety practices, ergonomic practices, and people‐oriented culture) and work limitations in a sample of hospital workers.

Methods

We used the 6‐item Work Limitations Questionnaire (WLQ) to assess workers’ perceptions of health‐related work limitations. Self‐reported OPPs and the WLQ were collected from workers in Boston, Massachusetts (n = 1277). We conducted random‐intercept multi‐level logistic regression models for each OPP using stepwise selection of covariates.

Results

As the unit‐average ergonomic practice score increased by one, the odds of a worker reporting work limitations decreased by approximately 39% (P‐value = 0.018), adjusted for job title, age, and body mass index. A similar relationship existed for people‐oriented culture (P‐value = 0.038). The association between safety practices and work limitations was similar, but not statistically significant.

Conclusions

This study demonstrated the importance of workplace OPPs. OPPs that promote positive and supportive environments and that foster improvements in ergonomics may help reduce work limitations.

     

Association between sleep quality and physical functioning in adults with Down syndrome: A brief report

BackgroundSleep quality is associated with physical functioning in adults, but this has not been examined in those with Down syndrome (DS). High body mass index (BMI) and accelerated aging, both common in adults with DS, may alter the relationship between sleep quality and physical functioning in this population.ObjectiveTo examine sleep quality indicators and its association with physical functioning in adults with DS, and whether associations are altered by BMI and age.MethodsParticipants were 15 adults with DS (8 women; age 29 ± 14 years). We evaluated sleep quality over seven days with wrist-worn accelerometers and physical functioning with the timed-up-and-go (TUG) and 6-min walk (6 MW) tests. We examined the associations between sleep quality and physical functioning variables using Spearman's rho.ResultsSleep quality indicators were: total sleep time 407 ± 54 min; latency 26.8 ± 21 min; efficiency 73.9 ± 12 %; wake after sleep onset 122.8 ± 65.2 min; number of awakenings 21.0 ± 6.2; and average length of awakenings 6.1 ± 3 min. Total sleep time and average length of awakenings were significantly associated with 6 MW distances (rho = 0.58 and ?0.69; p < 0.05, respectively). After controlling for age and BMI, 6 MW distance was significantly associated with total sleep time, latency, efficiency, and average length of awakenings (rho = 0.56, ?0.73, 0.60, and ?0.87; p < 0.05, respectively). TUG was significantly associated with total time in bed (rho = 0.71); p < 0.05).ConclusionsSleep quality indicators are associated with walking performance in adults with DS. Age and BMI strengthen the relationship between sleep quality and physical functioning.     

Accelerometer determined sedentary behavior and dietary quality among US adults

ObjectiveScant evidence exists pertaining to objectively measured sedentary time and dietary quality among adults. Therefore, we examined the relationships between sedentary time, physical activity, and dietary quality.MethodsCross-sectional analyses of a 4,910 US adults from two cycles (2003–2006) of the National Health and Nutrition Examination Survey. The primary independent variables were sedentary time and physical activity (continuous and categorical), while the outcomes were overall dietary quality (Healthy Eating Index (HEI) 2010), fruit and vegetable scores, and empty caloric intake (kcal).ResultsMultivariable analyses revealed that a 1 min increase in daily sedentary behavior was associated with a 0.2 kcal decrease in empty calories (− 0.18, 95% CI = − 0.34, − 0.03); however, sedentary time was not significantly related to overall dietary quality (HEI) and fruit and vegetable intake. In comparison, a 1 min increase in daily moderate-to-vigorous intensity physical activity was related to a 0.1 higher HEI score (0.08, 95% CI = 0.04, 0.11), a 0.01 higher fruit score (0.01, 95% CI = 0.01, 0.02), and conversely a 1.3 kcal decrease in empty calories (− 1.35, 95% CI = − 2.01, − 0.69). In addition, meeting physical activity guidelines was associated with a 2.8 point higher HEI score (2.82, 95% CI = 1.40, 4.25), a 0.5 point higher fruit score (0.51, 95% CI = 0.31–0.71), and 37.4 fewer empty calories (− 37.43, 95% CI = − 64.86, − 9.10).ConclusionsPhysical activity is significantly related to better overall dietary quality, while sedentary behavior is not. Findings suggest the need to promote physical activity and encourage adherence to dietary guidelines jointly, whereas sedentary behavior and overall dietary quality might need to be targeted independently.