Physical Activity is Related to Fatty Liver Marker in Obese Youth,Independently of Central Obesity or Cardiorespiratory Fitness

Nonalcoholic fatty liver disease (NAFLD) is one of the most frequent complications associated with excess adiposity and has been identified as the leading cause of liver disease in pediatric populations worldwide. Because cardiorespiratory fitness (CRF) is related to physical activity (PA) levels, and increased PA plays a protective role against NAFLD risk factors, the aim of this study was to analyze the association between PA and a fatty liver marker (alanine aminotransferase - ALT) in obese children and adolescents, independently of central adiposity or CRF. 131 obese children (83 girls, 7-15 year-olds) involved in a PA promotion program comprised the sample. Measurements included anthropometric and body composition evaluations (DEXA), biological measurements (venipuncture), CRF (progressive treadmill test), PA (accelerometry), and maturational stage (Tanner criteria). The associations between ALT with PA intensities, central obesity, and CRF were calculated by three different models of linear regression, adjusted for potential confounders. Level of significance was set at 95%. RESULTS: ALT was negatively associated with MVPA (β = -0.305), and CRF (β = -0.426), and positively associated with central obesity (β=.468). After adjustment for central obesity the negative and statistically significant association between ALT with MVPA (β = -0.364) and CRF (β = -0.550) still persists while a positive and significantly correlation was shown between ALT and SB (β = 0.382). Additional adjustment for CRF (Model 3) showed significant associations for all the PA intensities analyzed including light activity. PA at different intensities is associated to a fatty liver marker in obese children and adolescents, independently of central adiposity or CRF.

Key points

• In a previous study our group observed that there might be a potential protective effect of cardiorespiratory fitness (CRF) against abnormal ALT values;
• Considering that CRF is related to physical activity (PA), and increased PA plays a protective role against fatty liver, we hypothesized that it might be an association between PA and fatty liver in obese youth, independently of central adiposity or CRF;
• No other study has investigated these associations in obese youth;
• Our findings stresses the fact that moderate-to-vigorous and light physical activities, as well as lower sedentary behavior, is associated with lower fatty liver marker, independent of the effect of potential mediators, such as central obesity or CRF.

Key words: Physical activity, fatty liver, obese youth, cardiorespiratory fitness, central obesity     

Breast Cancer in Older Women

Abstract: Breast cancer remains the most common malignancy and the leading cause of cancer death in women of all ages. The American Cancer Society has estimated that 180,200 women will develop breast cancer in the United States in 1997 and 43,900 will die from the disease (1). Age is an important variable affecting both breast cancer biology and management. The risk of developing breast cancer increases with age. Feuer et al., using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program, have estimated that the cumulative probability of developing invasive breast cancer from birth, which is less than 0.5% at the age of 40, increases approximately 20-fold for those women that reach the age of 95 years (2). As the duration of life continues to increase in the western world, the percentage of older women who have breast cancer will also increase. It is estimated that by the end of the 20th century more than 50% of all new cases of breast cancer will occur in women aged 65 years or older (3). Despite this high prevalence of disease, there is a great lack of definitive information about outcome from breast cancer in this segment of the population. Patients over the age of 65 years have frequently been excluded from large prospective randomized clinical trials, and as a consequence, no clear practice guidelines about the optimal management of these patients have been released. Many studies have indicated that elderly women with breast cancer are more likely to receive less aggressive treatment when compared to their younger counterparts (4–6). This lesser treatment has stemmed from several widely held assumptions: that older women (a) have less aggressive breast cancers, (b) have a greater likelihood of presenting with more advanced disease, (c) have a life expectancy so limited not to justify the use of standard treatment, and (d) are poor candidates for surgery more extensive than biopsy and for adjuvant treatments. Evidence to support these assumptions remains controversial. This article will provide an overview of available data on the main unresolved issues, including biology, screening, local treatment, and adjuvant therapy, and will try to indicate practice guidelines for the management of elderly women based on the current knowledge.     

Breast Cancer in Older Women

Abstract: This review addresses the management of breast cancer in women over 65 years of age. In 1995, approximately 50% of breast cancers will be diagnosed in this quickly growing segment of our population. Breast cancer screening and treatment modalities including surgery, radiation therapy, and chemotherapy are underutilized in the geriatric population. Several recent studies demonstrate that healthy older women, like younger women, benefit from screening and tolerate surgery, radiation therapy, and chemotherapy well. We will discuss current screening and treatment recommendations based on a review of pertinent literature.     

Effect of Different Rest Intervals,Between Sets,on Muscle Performance During Leg Press Exercise,in Trained Older Women

The purpose of this study was to assess the effect of different rest intervals (RI) between sets on number of repetitions, sustainability of repetitions, and total volume during a leg press exercise. Seventeen resistance-trained older women (68.0 ± 5.9 years, 71. 2 ± 11.7 kg, 1.58 ± 0.07 m) participated in the study. All participants performed three sets to voluntary exhaustion, with loads that corresponded to 15 maximum repetitions, in two experimental sessions (that ranged from 48 to 72 hours apart). In each session, one of two RI (one-minute: RI-1 and three minute: RI-3) was tested, employing a randomized and counterbalanced design. For both RI, significant reductions (p < 0.05) were observed in the number of repetitions and sustainability of repetitions, from the first to the second and third sets. Differences (p < 0.05) between the RI also were observed in the two final sets. The total volume for the RI-3 session was statistically higher (29.4%, p < 0.05) as compared to the RI-1 session. The length of the RI between sets influenced the number of repetitions, sustainability of repetitions, and total volume. The longer RI should be used, therefore, when the goal of training is to increase the total volume.

Key points

• This study examined the influence of rest intervals, between sets, on muscle performance during leg press exercise, in trained older women.
• When multiple sets were performed to voluntary exhaustion, neither short and long rest interval (1 and 3 minutes, respectively) promoted the sustainability of repetitions in subsequent sets.
• A longer rest interval seems to be necessary for a higher number of repetitions in subsequent sets, and with increase in time of tension and total volume.

Key words: Aging, muscle fatigue, muscle endurance, recovery.     

Cardiorespiratory Fitness and Health-Related Quality of Life in Bariatric Surgery Patients

Health-related quality of life (HRQOL) is impaired in severely obese individuals presenting for bariatric surgery. Little is known about the relationship between cardiorespiratory fitness (CRF) and HRQOL in these individuals. We hypothesized that better HRQOL would be reported by those with higher CRF. In 326 gastric bypass patients (mean BMI = 46.5 ± 7.0; mean age = 40.9 ± 10.1; 83.4% female), pre-surgical CRF was quantified as duration (minutes) of a submaximal treadmill test to 80% of age-predicted maximal heart rate (MHR). Patients completed both a general measure of HRQOL [the Medical Outcome Short Form 36 (SF-36)] and a weight-specific measure of HRQOL [Impact of Weight on Quality of Life—Lite]. Mean HRQOL scores were examined, controlling for age, gender, and BMI. Mean treadmill duration was 9.9 ± 3.1 min, and percent age-predicted MHR was 81.2 ± 3.0%. Higher cardiorespiratory fitness tended to be associated with better physical and weight-specific HRQOL. Adjustment for differences in gender, age, and BMI attenuated the significance of associations between fitness and physical measures from the SF-36, whereas adjustment eliminated significance of associations between fitness and weight-specific HRQOL in most cases. Results suggest that CRF confers some HRQOL benefits in severely obese adults, though these benefits may largely be explained by differences in age, gender, and BMI.     

Management of Overactive Bladder in Older Women

Purpose of review:

This review will highlight our current understanding of age-related changes in bladder function and propose important clinical considerations in the management of overactive bladder (OAB) specific to older women.

Recent findings:

Frailty, functional and cognitive impairment, multimorbidity, polypharmacy, estrogen deficiency, and remaining life expectancy are important clinical factors to consider and may impact OAB symptom management in older women. Third-line therapies, particularly PTNS, may be preferable over second-line therapy in some cases.

Summary:

Due to the complexity within this population, the standard treatment algorithms may not be applicable, thus a broader, more holistic focus is recommended when managing OAB in older women.

     

Effects of Chair-Based,Low–Load Elastic Band Resistance Training on Functional Fitness and Metabolic Biomarkers in Older Women

Strength training can improve myriad health parameters in elderly cohorts. Although potentially more appropriate for the elderly, low-load resistance training protocols have been less investigated. We aimed to examine the effects of 12 weeks of chair-based, low-load resistance training with elastic band (EBT) on functional fitness and metabolic biomarkers in older women. One hundred sixty-eight women were allocated randomly to an elastic band resistance training (EBT, n = 86, 75.7 ± 8.9 years, 71.3 ± 12.2 kg) or a control group (CON, n = 82, 74.5 ± 8.2years, 70.6 ± 12.0 kg). RT protocol consisted of periodized chair-based, low-load whole-body resistance exercises (2 sets, 12-15 repetitions, 40-60% of one repetition maximum-1RM) using an elastic band, twice weekly for 12 weeks. The resistance training program was generally designed to maintain internal load over time, provided with increasing intensity using various elastic bands (Thera-Band). Functional fitness (30-s Chair Stand,30-s Arm Curl, 2-min Step Test, Chair Sit-and-Reach, Back Scratch, 8-Foot Up-and-Go, Handgrip Strength) and metabolic markers (Fasting blood glucose, triglycerides, total cholesterol, high (HDL) and low (LDL) density lipoprotein) were measured before and after the training period. To detect pre/post intervention changes and between group- differences 2x2 repeated measures ANOVA was applied. Significant improvements over time for all fitness variables for EBT comparing to CON were obtained (F = 12.78, p < 0.05 for 30-s Chair Stand; F = 14.04, p < 0.05 for 30-s Arm Curl; F = 5.18, p < 0.05 for 2-min Step Test; F = 10.90, p < 0.05 for Chair Sit-and-Reach; F = 16.57, p < 0.05 for Back Scratch; F = 11.79, p < 0.05 for 8-foot Up-and-Go; and F = 29.25, p < 0.05 for Handgrip Strength). In addition, significant improvements over time for all but one (triglycerides) biomarkers for EBT comparing to CON were obtained (F = 7.30, p < 0.05 for blood sugar levels; F = 13.36, p < 0.05 for total cholesterol; F = 8.61, p < 0.05 for HDL; and F = 11.53, p < 0.05 for LDL). Furthermore, the participants’ adherence to training sessions of over 90% was reported. In conclusion, 12 weeks of EBT is safe and beneficial for improving health-related fitness and metabolic biomarkers in older women and seems to be viable model to ensure a high training adherence rate.Key points

• EBT lead to a significant improvement in glucose, total cholesterol, HDL and LDL in older women.
• EBT lead to a significant increase in cardiorespiratory fitness, handgrip strength, lower- body strength and flexibility, upper-body strength and flexibility and agility in older women.
• EBT seems to be viable model to ensure high training adherence rate.

Key words: Aging, lipoproteins, low-intensity strength training, physical function     

Intervertebral T-Score Differences in Younger and Older Women

The T-score discordance among skeletal sites is an important aspect of dual-energy X-ray absorptiometry (DXA) measurements. In the spine, large T-score differences between vertebrae are frequently seen in elderly patients owing to degenerative disease. However, it is unclear how often such differences occur in younger adults with healthy spines.The T-scores for individual lumbar vertebrae were compared for 2391 female singletons (18–79 yr) recruited to the Twins UK Adult Twin Register. Women were divided into 6 age bands and 5 bands by body weight, respectively, and the T-score differences between the pairs of vertebrae were examined using correlation coefficients and the standard error of the estimate (SEE) from linear regression analysis.Correlations between the T-scores for adjacent lumbar vertebrae were r = 0.92 decreasing to r = 0.79 between L1 and L4. When plotted as a function of age, r-values were constant for the 5 younger age bands, but decreased in the oldest group. In contrast, the T-score SEE values increased progressively with age from 0.4 to 0.5 for the younger groups to 0.7 for the oldest. Similar trends were seen when women were divided according to body weight. Both increasing age and higher body weight were statistically significantly associated with a higher T-score SEE.The incidence of large T-score differences between vertebrae varies with age and body weight, but is common even among younger women. Clinically significant T-score differences can occur in the absence of osteoarthritis, and visual assessment of spine DXA scans for evidence of degenerative disease is advised before vertebrae are omitted from scan analyses.     

Stroke Volume Response to Liver Graft Reperfusion Stress in Cirrhotic Patients

Introduction

In patients with advanced cirrhosis, stressful stimuli may reveal a silent reduced cardiac performance. During liver transplantation (LT), graft reperfusion strongly stresses the heart and may unmask latent myocardial dysfunction.

Aim

The objective of this study was to assess heart response to acutely increased preload after liver graft reperfusion and correlate this response with preoperative data and outcome.

Methods

Preoperative clinical, echocardiographic, and hemodynamic data, and patient outcome were retrospectively recorded for 235 liver recipients who had no known cardiac disease. Myocardial dysfunction was defined as less than 10 % increase of stroke volume after graft reperfusion (non-responder).

Results

We found 84 (35.7 %) non-responder patients. The non-responders showed higher Model for end-stage liver disease scores (p = 0.046), left atrial diameter (LAD) (p = 0.040), hepatic vein pressure gradient (p = 0.055), and hyperdynamic state than responders. The percentages of patients with hyponatremia (p = 0.048) and alcohol etiology (p = 0.025) were also higher among non-responders. Independent predictors of inadequate cardiac response in the multivariate analysis were low preoperative systemic vascular resistance (SVRI) [odds ratio (OR) 3.09, 95 % CI 1.15–4.82; p = 0.027] and enlargement of LAD (OR 2.08, 95 % CI 1.49–2.74; p = 0.044). Non-response was associated with higher rates of early cardiovascular events [hazard ratio (HR) 2.84, 95 % CI 1.09–4.22; p = 0.039] and higher length of intensive care unit stay (p = 0.038). No differences were found in 1-year survival rates.

Conclusions

Latent cardiac dysfunction among LT recipients, considered to be abnormal stroke volume response to unclamping of portal vein, is very prevalent. SVRI and LAD were independent predictors of inadequate responses. This condition deserves special attention since it may aggravate the early postoperative course of LT.     

Abdominal Aortic Calcification Detected on Lateral Spine Images From a Bone Densitometer Predicts Incident Myocardial Infarction or Stroke in Older Women

Among a cohort of elderly women, abdominal aortic calcification scored on baseline lateral spine densitometric images intended for vertebral fracture assessment was associated with subsequent myocardial infarction or stroke over a median 4‐yr period, independent of clinical cardiovascular disease risk factors. Introduction: Cardiovascular disease (CVD) risk among older women is not adequately captured by traditional CVD risk factors. Lateral spine images obtained on bone densitometers for vertebral fracture assessment (VFA) can detect abdominal aortic calcification (AAC), an important marker of subclinical CVD. Our objective was to estimate the association between AAC scored on VFA images and subsequent myocardial infarction (MI) or stroke in elderly women. Materials and Methods: Among participants in a randomized controlled trial (women; age >75 yr) of clodronate versus placebo, those who sustained an MI or stroke during the median 4‐yr follow‐up study period were selected as cases (n = 408), and 408 controls were randomly selected from the remainder of the parent study population. Baseline VFA images were scored for AAC with a previously validated 24‐point scale and a newer, simpler 8‐point scale. Results: The OR of incident MI or stroke for those in the middle and top tertiles, respectively, compared with the bottom tertile of AAC score were 1.14 (95% CI, 0.79–1.66) and 1.74 (95% CI, 1.19–2.56) for the 24‐point scale and 1.42 (95% CI, 0.98–2.05) and 1.77 (95% CI, 1.22–2.55) for the 8‐point scale, adjusted for age, high‐density lipoprotein and low‐density lipoprotein cholesterol, triglycerides, blood pressure, smoking, renal function, health status, and baseline diagnoses of diabetes mellitus, hypertension, angina, and prior stroke. Conclusions: AAC scored on VFA images is independently associated with incident MI or stroke. Because bone densitometry is indicated for all women ≥65 yr of age, VFA imaging offers an opportunity to capture this CVD risk factor in postmenopausal women undergoing bone densitometry at very little additional cost.     

Daily Physical Activity and Physical Fitness in 11-to 15-year-old Trained and Untrained Turkish Boys

The aims of this study were to assess levels and patterns of physical activity (PA) in relation to age and regular sport activity, and to examine its relationship to physical fitness in trained and untrained boys. One hundred forty-seven 11-to 15- year-old boys (73 trained and 74 untrained) participated in this study. Trained boys, comprised of 26 soccer, 25 handball and 22 volleyball players, had been training regularly for at least one year. The intensity, duration and frequency of PA were assessed from four complete days of heart rate monitoring with 15-seconds sampling intervals. Aerobic fitness was assessed by determining peakVO₂ with a portable breath-by-breath gas analyzer (Cosmed K4b²) and the running speeds at fixed lactate concentrations during an incremental running test. Anaerobic fitness was evalu-ated with the Wingate Anaerobic Test. Skinfold thicknesses from eight sites and Tanner stages of pubic hair were also obtained. Based on 15-s heart rate data, instead of continuous activity, multiple short bouts of moderate and vigorous PA, lasting up to one minute, were characteristic of daily PA patterns of both trained and untrained boys. PA levels of trained boys were higher than untrained boys (p < 0.01) and the levels of PA decreased with age and maturation in both groups (p < 0.05). Daily PA variables were related to body fatness in both groups (p < 0.05), but the relationships were not consistent in the trained group. Daily PA variables were also related to aerobic fitness in the untrained group (p < 0.05) and these relationships were somewhat better with vigorous PA, whereas in the trained group, none of the PA variables were related to any of the aerobic fitness indices (p > 0.05). No relationship was observed between PA variables and anaerobic fitness in either group (p> 0.05). It seems that such relationships may somewhat depend on the fitness level of the subjects.

Key points

• PA levels of trained boys were higher than untrained boys and the levels of PA decreased with age and maturation in both groups.
• Based on the 15-s HR data, instead of continuous activity, multiple short bouts of moderate and vigorous PA, lasting up to one minute, were characteristic of daily PA patterns of both trained and untrained boys.
• Daily PA variables were related to aerobic fitness in the untrained group and these relationships were somewhat better with vigorous PA (>70% HRR), whereas in the trained group, none of the PA variables were related to any of the aerobic fitness indices.
• Neither peak nor mean power values were related to any of the daily PA variables in both trained and untrained groups.

Key words: Physical activity, training, aerobic and anaerobic fitness, body fatness, children