Sensory impairments and their associations with functional disability in a sample of the oldest-old

Purpose

Research focusing on the consequences of sensory impairments for the everyday competence of the oldest-old is emerging. The two main goals of this study were to document the prevalence of self-reported vision, hearing, and dual sensory impairment and to explore associations of these impairments with functional disability in near-centenarians and centenarians.

Methods

Centenarians and near-centenarians (N = 119; average age = 99) were recruited, with about 80 % living in the community. In-person interviews included self-ratings of vision and hearing impairment and functional disability conceptualized as having difficulties performing personal and instrumental activities of daily livings (PADLs and IADLs).

Results

Based on self-report ratings, 17 % of participants were classified as having a visual impairment only, 18 % as having a hearing impairment only, and 38 % with both a visual and hearing impairment (dual sensory impairment). Regression analyses demonstrated that having a vision impairment only and being dual sensory impaired were the strongest predictors of functional disability. They were associated with higher levels of functional disability over and above higher levels of depressive symptomatology, interference of health with desired activities, and living in a nursing home.

Conclusions

Sensory impairments—especially dual sensory impairment—are prevalent in the oldest-old. Having dual sensory impairment or a single visual impairment among other factors are strongly associated with less-optimal everyday functioning in the oldest-old.     

Plasma amino acid concentrations in healthy elderly men and women

Postabsorptive plasma concentrations of the large neutral amino acids (LNAAs) were measured in 74 elderly (age 71 +/- 8 y) and 138 young (age 26 +/- 5 y) healthy subjects. Plasma concentrations of valine, leucine, and isoleucine were significantly lower in young females than in young males. This gender-related difference was not observed among elderly subjects because aging was associated with a significant rise in plasma LNAAs in females but not in males. Multiple-regression analysis of plasma amino acid concentrations from female subjects revealed a significant and positive effect of age on plasma valine, leucine, isoleucine, phenylalanine, and tyrosine but not on plasma tryptophan or methionine. Tryptophan was the only amino acid to exhibit a significant response to age in males, consisting of a 14% decline in the elderly subjects. Percentile ranges are presented for young and elderly females and males for each of the amino acids.     

Plasma free amino acid concentrations in healthy Guatemalan adults and in patients with classic dengue

BACKGROUND: Plasma free amino acid patterns in health and disease have been reported. However, amino acid concentrations in adult populations in developing countries and in patients with dengue, as a model for an acute infectious viral disease endemic to the tropics, have not been reported. OBJECTIVE: The purpose of this study was to determine the amino acid profile in both healthy Guatemalan adults from different socioeconomic backgrounds and at 3 time points during the course of classic dengue. DESIGN: The study was carried out in Guatemala and included measurement of plasma free amino acids in 22 healthy control subjects (14 low income, 8 middle class) and 17 febrile patients. Measurements of amino acids were repeated within a 48-h interval in 20 of the healthy Guatemalans. In 9 patients with dengue, amino acids were assayed 3 times: on admission to a local hospital in the coastal plain of Guatemala, on hospital discharge, and 7 d after hospital discharge. RESULTS: Branched-chain amino acid concentrations in healthy adults and dengue patients in Guatemala were lower than normal values reported in the literature for healthy Swedish adults. With the exception of increased phenylalanine concentrations and an increased ratio of phenylalanine to tyrosine, all amino acids as well as the Fischer molar ratio were decreased in the acute phase of dengue. CONCLUSIONS: Healthy Guatemalans have different amino acid patterns than do Swedish subjects independent of socioeconomic status. The systemic viral disease dengue is associated with changes in the plasma free amino acid pattern, reflecting infection-related alterations in amino acid metabolism.     

Plasma amino acid concentrations in patients with acute myelogenous leukemia

Changes in plasma-free amino acid (PFAA) concentrations in the presence of solid tumors have been widely described. Conversely, the PFAA profile in patients with acute leukemias is less well defined. The aim of the present study was to clarify whether the PFAA profile is altered in patients with acute myeloid leukemia (AML), whether the profile differs from the PFAA profile of solid tumors, and whether it may predict outcome of AML. Fasting PFAA were measured in 40 untreated, normally nourished patients with AML (17 males, 23 females), ages 22-78 y, with white blood cell (WBC) counts ranging from 1.08 to 276.5 x 10(3)/cm2, and in 24 healthy volunteers. Plasma concentrations (mu mol/L, mean +/- SE) of glutamic acid (GLU), free tryptophan (FTRP), ornithine (ORN), and glycine (GLY) were significantly higher in AML (GLU: 90.2 +/- 6.1 versus 37 +/- 8; FTRP: 7.0 +/- 0.6 versus 4.8 +/- 0.3, P < 0.005; ORN: 108.7 +/- 5.8 versus 78 +/- 6, P < 0.001; GLY: 295.0 +/- 14.8 versus 239 +/- 9, P < 0.01), whereas serine (SER), methionine (MET), and taurine (TAU) were significantly lower in AML than in controls (SER: 109.0 +/- 5.8 versus 130 +/- 4, P < 0.03; MET: 25.5 +/- 1.3 versus 33 +/- 3, P < 0.03; TAU: 46.5 +/- 3.5 versus 81 +/- 2, P < 0.001), and tended to be even lower in patients who had not responded to chemotherapy or had relapsed within 18 mo of enrollment. Such changes were unrelated to age, sex, and WBC count. Changes in PFAA that occur in AML are only in part similar to those observed in solid tumors. The reduction of TAU appears to be a typical feature of AML and might be secondary to the deficiency of its precursors SER and MET. Further studies are under way aimed at clarifying whether PFAA might predict prognosis in AML, whether PFAA is normalized by remission induction, and if its correction may be of any benefit for patients with hematologic malignancies.     

Plasma and erythrocyte amino acid concentrations in anorexia nervosa

Plasma and erythrocyte amino acid concentrations in seven female patients in the acute stage of anorexia nervosa were compared with values in the same subjects after refeeding, and with normal controls. We also compared these values with literature values from patients with protein-calorie malnutrition and prolonged starvation in an attempt to identify a biological indicator of severity and prognosis. Our data indicate: (1) Routine laboratory analyses that reflect protein status do not differentiate normal subjects from patients with anorexia nervosa. (2) The plasma aminogram in the acute stage of anorexia nervosa differs from normal, and differs from values reported for both protein malnutrition and prolonged starvation. (3) The Whitehead ratio clearly separates the acutely ill anorectic state from the treated state and from normal controls. (4) Both erythrocyte and plasma amino acid concentrations differ from normal in anorexia nervosa, but changes in erythrocyte concentrations are more obvious. (5) Erythrocyte glycine concentrations are unique, in that values were persistently elevated at all stages of illness in anorexia nervosa. (6) Erythrocyte-to-plasma amino acid ratios do not provide a biological index of severity and prognosis for patients with anorexia nervosa, in contrast to data reported for individuals with protein malnutrition.     

Plasma amino acid concentrations in premature infants: effect of sampling site

Amino acid concentrations in plasma obtained from infants by heel puncture differ from those in venous plasma primarily because of skin contamination but data from the two sites might agree more closely in premature infants because of their poorly developed sweat glands. To evaluate the importance of sampling site, amino acids were analyzed by a sensitive high-performance liquid chromatographic method in plasma obtained both by heel puncture and venipuncture in 14 premature infants. Histidine, tryptophan, alanine, aspartic acid, glycine, and serine were higher in capillary plasma. Tryptophan and glycine levels in capillary plasma correlated strongly with those in venous plasma. An additional wash with soap and water done in five infants did not eradicate the differences. Thus the lack of agreement between data from the two sites may be due to factors other than contamination.     

Comparison of serum concentrations of trace elements in healthy free-living and hospitalized oldest-old

PURPOSE: The aim of this study was to examine differences in concentration of trace elements in serum between healthy free-living and hospitalized oldest-old people aged > or = 85 years. SUBJECTS AND METHODS: Subjects were 33 healthy free-living oldest-olds (18 men, 15 women, aged 85-91 years, mean age: 87.3 +/- 1.7 years) selected at annual health examination and 40 hospitalized oldest-olds (14 men, 26 women, aged 85-92 years, mean age: 87.8 +/- 2.2 years). The serum concentrations of managanese (Mn), zinc (Zn), copper (Cu), iron (Fe), calcium (Ca), magnesium (Mg) and phosphorus (P) (microgram/ml) were measured using atomic absorption spectrophotometry and colorimetric method. Differences between groups for serum concentration of trace elements were assessed with the Wilcoxon rank sum test. Spearman's rank correlation coefficients were calculated with reference to clinical examination data in the two groups. RESULTS: 1) The concentrations of Ca, Mg, P and Zn were significantly higher in the healthy free-living than in the hospitalized, especially in the P and Zn case. The Cu/Zn ratio was significantly lower in the healthy free-living. 2) The Zn concentration was positively correlated with the Ca concentration, and the P concentration with the total cholesterol level in both groups. Zn was one of the elements demonstrating good correlations with other parameter. Especially in the healthy free-living, the Zn concentration was high positively associated with the Fe concentration. CONCLUSION: These results suggest that the serum concentrations of trace elements in the healthy free-living are higher than in the hospitalized oldest-old, especially in the P and Zn case.     

Plasma amino acid concentrations in geriatric control and hip-fracture patients.

Changes in plasma amino acids, 24-h nitrogen balances, and resting metabolic expenditures (RMEs) were measured in 10 geriatric patients (aged 70-92 y) with hip fracture 1 d after surgical fixation during both a 24-h fasting state and while receiving total peripheral parenteral nutrition (TPPN) for 24 h at 1.5 g amino acids.kg-1.d-1 and 29-30 kcal.kg-1.d-1 and compared with 19 healthy volunteer subjects (aged 70-84 y). RME and 24-h urinary nitrogen losses were also elevated in the trauma patients during both fasting and TPPN. Positive nitrogen balances were evident in both groups during TPPN. Plasma total amino acid concentration was significantly lower in the trauma patients because of lower plasma concentrations of the nonessential amino acids. Phenylalanine and methionine concentrations were significantly higher and lysine lower in the trauma group. In addition, evaluation of the essential amino acid ratios after fasting and TPPN reveal that there are no limiting amino acids during TPPN.     

Testosterone concentrations in women aged 25-50 years: associations with lifestyle, body composition, and ovarian status

While there is substantial evidence of the importance of endogenous and exogenous estrogen in reproductive health and chronic disease, there is little consideration of androgens in women's health. In the Michigan Bone Health Study (1992-1995), the authors examined the correlates of testosterone concentrations in pre- and perimenopausal women (i.e., age, menopausal status, body composition, and lifestyle behaviors) in a population-based longitudinal study including three annual examinations among 611 women aged 25-50 years identified through a census in a midwestern community. Current smokers had the highest testosterone concentrations with decreasing values in former and nonsmokers (p = 0.0001). Body composition measures (body mass index, body fat (%), weight (kg), lean body mass (kg), and fat mass (kg)) were significantly and positively associated with total testosterone concentrations in a dose-response manner. Hysterectomy with oophorectomy was associated with significantly lower testosterone concentrations. Alcohol consumption, physical activity, and dietary macronutrient intake were not associated with testosterone concentrations. This is one of the first studies to examine correlates of serum testosterone concentrations in anticipation of the growing interest in the role of androgens in women's health. The greater circulating levels of testosterone in obese women and smokers suggest that testosterone concentrations should be considered in the natural history of disease conditions where obesity and smoking are risk factors, including cardiovascular disease.     

Effect of a high-protein, very-low-calorie diet on body composition and anthropometric parameters of obese middle-aged women

Effects of a very-low-calorie (420 kcal/day), high-protein diet (70 g/day) and realimentation on weight and body composition of 15 obese, middle-aged women were examined in a 4-6 mo study. Mean weight loss was 20.5 kg (1.1 kg/wk). Fat accounted for 83% and lean body mass (LBM) for 17% of total body weight loss. Multiple regression equations estimated from anthropometric measures were developed to predict the body density of obese individuals both before and after weight loss. Best predictors of body density in obese women before and after weight loss were circumference measurements in the trunk area. Nine previously published population specific and generalized equations for predicting body fat in women were not strongly enough correlated with body fat values obtained by densitometry in this study to be of use clinically.     

Fetal programming of body composition: relation between birth weight and body composition measured with dual-energy X-ray absorptiometry and anthropometric methods in older Englishmen

BACKGROUND: Reduced fetal growth is associated with differences in body composition in adult life that may predispose to cardiovascular disease and diabetes. Most published data are based on simple anthropometric measures, which incompletely describe body composition. OBJECTIVE: The objective was to assess body composition and fat distribution by using dual-energy X-ray absorptiometry (DXA). DESIGN: This was a case-control study of 64-72-y-old white men (n = 32) with a low (mean: 2.76 kg) or high (mean: 4.23 kg) birth weight. RESULTS: Compared with the high-birth-weight group, after adjustment for weight and height, the low-birth-weight group had a higher percentage body fat (29.31% compared with 25.33%; P = 0.029) and fat mass (P = 0.039) but a lower fat-free soft tissue (56.32 compared with 59.22 kg; P = 0.024), muscle mass (27.25 compared with 29.22 kg; P = 0.022), and muscle-to-fat ratio. Low birth weight was also associated with a higher trunk-to-limb fat ratio after control for total fat mass (1.42 compared with 1.16; P = 0.005) or percentage body fat (P = 0.041). The same body mass index predicted a greater percentage body fat (P = 0.019) in the low- than in the high-birth-weight group, and the same ratio of trunk-to-limb skinfold thickness (or waist-to-hip ratio) predicted a higher trunk-to-limb fat ratio (P < 0.01). CONCLUSION: Lifelong differences in adult body composition and fat distribution between the low- and high-birth-weight groups are consistent with programming in early life. The use of BMI to predict percentage body fat and the use of the trunk-to-limb skinfold thickness ratio (and waist-to-hip ratio) to predict the trunk-to-limb fat ratio measured by DXA can be misleading when low- and high-birth-weight groups are compared.     

The clinical significance of body composition and anthropometric evaluation in athletes

Body composition and anthropometric assessment provide the sports physician with useful information on the health state of the athlete and with some necessary elements to plan specific training loads in the most appropriate way. In practice, the chemical composition of an athlete’s body (especially those who carry out 1–2 daily workouts) is always in a physiologic condition that we can define as “dynamic” (concentration of electrolytes, hydration state and relationship between intra-and extra-cellular water, stages of growth of muscle mass and/or reduction of fat mass, etc.), with the exception of few times of year, such as the short resting break before resuming training. As a consequence, a real “baseline” (or “stationary”) physiological state, allowing to detect the parameters of body composition under the same conditions several times during the year, is only rarely achieved. In this paper, we wanted to review the most interesting parameters and methods for the evaluation of athletes’ body composition, and underline their potential applications, possible advantages, theoretical and practical limitations.     

Impact of community lifestyle intervention on anthropometric parameters and body composition among overweight and obese women: findings from the MyBFF@home study

Background

The prevalence of overweight and obesity among Malaysian women remained high over the past three decades. Collaboration with existing community at-risk may be feasible for wide-scale prevention of overweight and obesity in the country. The aims of this study were to examine the impact of community-based lifestyle intervention among overweight and obese women on their anthropometric and body composition changes as compared to the usual care group.

Methods

This was a quasi-experimental study conducted in low-cost flats in Kuala Lumpur, Malaysia. A total of 255 overweight and obesity individuals aged between 18 to 59 years old were assigned to either the lifestyle intervention group (n?=?169) or the usual care group (n?=?146) over a period of 6 months. Individuals in the intervention group received 6 individual lifestyle counselling comprised of physical activity, diet counselling and self-monitoring components aimed to achieve at least 5% weight loss while individuals in the usual care group obtained six sessions of health care seminars from health care providers. These individuals were then followed-up for another 6 months without any intervention as part of maintenance period.

Results

An intention-to-treat analysis of between-groups at 6-month of intervention (β, 95% CI) revealed greater changes in weight among intervention individuals’ (??1.09 kg vs. -0.99; p?<?0.018) as compared to the control group. These changes were not sustained during the maintenance phase (between 6 and 12 months). Overall significant improvement at 12th month was found for visceral fat (??0.78 vs. -0.64; p-value?=?0.017), although no significant changes between groups were detected either during intervention or maintenance phase (p?>?0.05). Individuals in the intervention group showed a significant increase for skeletal muscle mass (0.13 kg) than those individuals in the control group (??0.37 kg), p?=?0.033, throughout the study period.

Conclusion

This study provides evidence that an overweight and obesity prevention program can be implemented in a community setting, with some reduction of several anthropometric and body composition parameters.

     

Plasma amino acid concentrations and amino acid ratios in normal adults and adults heterozygous for phenylketonuria ingesting a hamburger and milk shake meal

Plasma amino acid concentrations were measured and selected amino acid ratios were calculated in 12 normal adults and 12 adults heterozygous for phenylketonuria (PKU) ingesting a hamburger and milk shake meal providing 1 g protein/kg body wt. Plasma concentrations of all amino acids increased significantly over baseline after meal ingestion in both groups, reaching the highest mean values 3-5 h after meal ingestion. Plasma phenylalanine concentrations were significantly higher in heterozygous than in normal subjects both before and at all times after meal ingestion. The absolute increase in plasma phenylalanine concentration over baseline and the area under the plasma phenylalanine concentration-time curve were approximately twice as large in heterozygous as in normal subjects. However, the molar ratio of the plasma phenylalanine concentration to the sum of the plasma concentrations of the other large neutral amino acids did not increase significantly over baseline, but rather decreased.