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Dietary patterns and risk of incident type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)
Abbreviated Abstract: OBJECTIVE: We characterized dietary patterns and their relation to incident type 2 diabetes in 5,011 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). RESEARCH DESIGN AND METHODS: White, black, Hispanic, and Chinese adults, aged 45-84 years and free of cardiovascular disease and diabetes, completed food frequency questionnaires at baseline (2000-2002). Incident type 2 diabetes was defined at three follow-up exams (2002-2003, 2004-2005, and 2005-2007) as fasting glucose >126 mg/dl, self-reported type 2 diabetes, or use of diabetes medication. Two types of dietary patterns were studied: four empirically derived (principal components analysis) and one author-defined (low-risk food pattern) as the weighted sum of whole grains, vegetables, nuts/seeds, low-fat dairy, coffee (positively weighted), red meat, processed meat, high-fat dairy, and soda (negatively weighted). CONCLUSIONS: Multiple food groups collectively influence type 2 diabetes risk beyond that of the individual food groups themselves.
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Nettleton JA, Steffen LM, Ni H, Liu K, Jacobs DR Jr. Diabetes Care. 2008 Sep;31(9):1777-82.
Polyunsaturated Fatty Acids Prevent Metabolic and Vascular Disorders
Long-chain (n-3) polyunsaturated fatty acids prevent metabolic and vascular disorders in fructose-fed rats
Abbreviated Abstract: The crossover relationship between cardiometabolic risk, in terms of insulin resistance and vascular dysfunction, and the fatty acid (FA) profile of insulin-sensitive tissues as well as the dietary FA impact has almost never been explored in the same experiment. In this study, the intake of alpha-linolenic acid (ALA) alone and/or with its higher metabolites, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) were evaluated in a nonobese, hypertriglyceridemic and insulin-resistant rat model, that exhibits the 2 main characteristics of metabolic syndrome. Insulin resistance was linked to a specific FA pattern in insulin-sensitive tissues, which probably involved modifications of Delta9, Delta6, and Delta5-desaturases. This pathological status was related to high cardiovascular risk as assessed by increases in systolic and diastolic blood pressures and particularly by the increase of pulse pressure, an index of vascular stiffness obtained from telemetry investigations. The (n-3) experimental diets prevented changes in the FA patterns in insulin-sensitive tissues, insulin resistance, and vascular dysfunction. This beneficial effect was large with an intake of long chain (n-3) PUFA (ALA+EPA+DHA) and to a lesser extent with dietary ALA alone.
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Robbez Masson V, Lucas A, Gueugneau AM, Macaire JP, Paul JL, Grynberg A, Rousseau D.
J Nutr. 2008 Oct; 138(10):1915-22.
High Intake of Vitamin C is Associated with Lower Bone Loss
High vitamin C intake is associated with lower 4-year bone loss in elderly men
Full Abstract: Vitamin C is essential for collagen formation and normal bone development. We evaluated associations of total, supplemental, and dietary vitamin C intake with bone mineral density (BMD) at the hip [femoral neck, trochanter], spine, and radial shaft and 4-y BMD change in elderly participants from the Framingham Osteoporosis Study. Energy-adjusted vitamin C intakes were estimated from the Willett FFQ in 1988-89. Mean BMD and 4-y BMD change was estimated, for men and women, by tertile/category of vitamin C intake, adjusting for covariates. We tested for interaction with smoking, calcium, and vitamin E intake. Among 334 men and 540 women, the mean age was 75 y and mean vitamin D intake was 8.25 mug/d (women) and 8.05 mug/d (men). We observed negative associations between total and supplemental vitamin C intake and trochanter-BMD among current male smokers (P-trend = 0.01). Among male nonsmokers, total vitamin C intake was positively associated with femoral neck BMD (P-trend = 0.04). Higher total vitamin C intake was associated with less femoral neck and trochanter-BMD loss in men with low calcium (all P-trend
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Sahni S, Hannan MT, Gagnon D, Blumberg J, Cupples LA, Kiel DP, Tucker KL. J Nutr. 2008 Oct; 138(10):1931-8.
Dark Chocolate and C-Reaction Protein
Regular consumption of dark chocolate is associated with low serum concentrations of C-reactive protein in a healthy Italian population
Abbreviated Abstract: Dark chocolate contains high concentrations of flavonoids and may have antiinflammatory properties. We evaluated the association of dark chocolate intake with serum C-reactive protein (CRP). The Moli-sani Project is an ongoing cohort study of men and women aged >/=35 y randomly recruited from the general population. By July 2007, 10,994 subjects had been enrolled. Of 4849 subjects apparently free of any chronic disease, 1317 subjects who declared having eaten any chocolate during the past year (mean age 53 +/- 12 y; 51% men) and 824 subjects who ate chocolate regularly in the form of dark chocolate only (50 +/- 10 y; 55% men) were selected. High sensitivity-CRP was measured by an immunoturbidimetric method. A J-shaped relationship between dark chocolate consumption and serum CRP was observed; consumers of up to 1 serving (20 g) of dark chocolate every 3 d had serum CRP concentrations that were significantly lower than nonconsumers or higher consumers. Our findings suggest that regular consumption of small doses of dark chocolate may reduce inflammation.
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di Giuseppe R, Di Castelnuovo A, Centritto F, Zito F, De Curtis A, Costanzo S, Vohnout B, Sieri S, Krogh V, Donati MB, de Gaetano G, Iacoviello L. J Nutr. 2008 Oct; 138(10):1939-45.
Calorie Restriction Minimizes Activation of Insulin Signals
Calorie restriction minimizes activation of insulin signaling in response to glucose: potential involvement of the growth hormone-insulin-like growth factor 1 axis
Abbreviated Abstract: Calorie restriction (CR) may modulate insulin signaling in response to energy intake through suppression of the growth hormone (GH)-IGF-1 axis. We investigated the glucose-stimulated serum insulin response and subsequent alterations in insulin receptor (IR), Akt, and FoxO1 in the rat liver and quadriceps femoris muscle (QFM). The phenotypic similarity of W-CR and Tg-AL rats suggest that CR minimizes activation of insulin signaling in response to energy intake mostly through the GH-IGF-1 axis.
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Hayashi H, Yamaza H, Komatsu T, Park S, Chiba T, Higami Y, Nagayasu T, Shimokawa I. Exp Gerontol. 2008 Sep;43(9):827-32.
Resveratrol-containing Nutraceutical Mixture Mimics Gene Expression of Caloric Restriction
Short-term consumption of a resveratrol-containing nutraceutical mixture mimics gene expression of long-term caloric restriction in mouse heart.
Full Abstract: An active area of aging research is focused on identifying compounds having the ability to mimic the effects of caloric restriction (CR). From 2 to 5 months of age, we fed male B6C3F(1) mice either a 40% CR diet, a control diet supplemented with a commercially available nutraceutical mixture (NCM) containing resveratrol, quercetin and inositol hexaphosphate, or a diet supplemented with an equivalent dose of chemical-grade resveratrol (RES; 1.25 mg resveratrol kg(-1) day(-1)) from 2 to 5 months of age. Cardiac gene expression profiles were generated for the three groups of treated mice and compared to age-matched control (CO) mice. All three treatments were associated with changes in several cytoskeletal maintenance pathways, suggesting that RES and NCM are able to mimic short-term CR. CR uniquely affected several immune function pathways while RES uniquely affected multiple stress response pathways. Pathway analysis revealed that NCM (but not CR or RES) regulated multiple metabolic pathways that were also changed by long-term CR, including glucose and lipid metabolism, oxidative phosphorylation and chromatin assembly. Examination of key genes and pathways affected by NCM suggests that Foxo1 is a critical upstream mediator of its actions.
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Barger JL, Kayo T, Pugh TD, Prolla TA, Weindruch R. Exp Gerontol. 2008 Sep; 43(9):859-66.
Relation of Framingham risk score to subclinical atherosclerosis evaluated across three arterial sites
Full Abstract: The Framingham risk score (FRS) is widely used in clinical practice to identify subjects at high risk for developing coronary heart disease. However, FRS may not accurately identify subjects at risk. We measured subclinical atherosclerosis in the coronary arteries and aorta with the presence of calcium and in the common carotid artery by intima-media thickness in 498 healthy subjects. The distribution of these subclinical atherosclerosis measures was evaluated across 3 strata of the FRS. Coronary arteries with the presence of calcium, aorta with the presence of calcium, and carotid artery by intima-media thickness were significantly independently associated with FRS. The FRS increased with the number of arterial sites with atherosclerosis; 69% of the subjects categorized in the low risk group (FRS <10%), 95% of the intermediate risk group (FRS 10% to 20%), and 100% of the high risk group (FRS >20%) had > or = 1 vascular imaging studies demonstrating subclinical atherosclerosis. In the low risk group, subjects with atherosclerosis had a longer history of lifetime smoking compared with those without atherosclerosis. In conclusion, subclinical atherosclerosis is prominent across the spectrum of FRS. Evaluation of subclinical atherosclerosis in different arterial sites in addition to FRS may be useful in targeting subjects for lifestyle and other interventions.
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Karim R, Hodis HN, Detrano R, Liu CR, Liu CH, Mack. Am J Cardiol. 2008 Oct 1; 102(7):825-30.
Effects of Hormone Replacement Therapy and Coffee
Insulin resistance in postmenopausal women: concurrent effects of hormone replacement therapy and coffee
Abbreviated Abstract: BACKGROUND: In postmenopausal women, an increase in insulin resistance is associated with an increased risk of diabetes, cardiovascular disease and breast cancer. Hormone replacement therapy (HRT) can reduce insulin resistance and coffee use is reported to decrease the incidence of diabetes. The aim of our study was to assess possible concurrent effects of HRT and espresso coffee intake on insulin resistance and on interdependent nutritional and clinical features. METHODS: A total of 478 healthy postmenopausal, non-diabetic women (aged 54.5 +/- 4.2 years) were studied: 360 had been on HRT for at least 2 years and 118 were not treated. Women on HRT show lower insulin resistance, but not lower prevalence of arterial hypertension. Coffee use is associated with a decrease in insulin resistance in non-obese women receiving HRT, but not in other subsets. CONCLUSIONS: The combination of coffee consumption and HRT could lower insulin resistance in postmenopausal women. In overweight women, greater insulin sensitivity is associated with intake of espresso coffee and not with HRT; in normal weight women, only HRT is associated with lower insulin resistance.
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Catalano D, Trovato GM, Spadaro D, Martines GF, Garufi G, Tonzuso A, Grasso D, Sciacchitano SG. Climacteric. 2008 Oct;11(5):373-82.
Transdermal Estradiol May Reduce Oxidative Stress In Postmenopausal Women
Transdermal estradiol reduces F2alpha-isoprostane levels in postmenopausal women
Abbreviated Abstract: OBJECTIVE: F2alpha-isoprostanes are considered the most reliable index of in vivo oxidative stress. Given the implication of oxidative stress in the pathogenesis of atherosclerosis, we investigatedthe effects of hormone therapy on the plasma levels of F2alpha-isoprostanes. DESIGN: Sixty-one healthy postmenopausal women were treated in a randomized trial with estradiol either orally (2 mg/day, 28 women) or transdermally (50 mug/day, 33 women) for 4 weeks. Then women in each group were randomly assigned to oral progestogen, either micronized progesterone (300 mg/day) or medroxyprogesterone acetate (5 mg/day) for 2 additional weeks. RESULTS: A significant reduction in the levels of F2alpha-isoprostanes was detected only in women receiving transdermal estradiol, alone or in combination with medroxyprogesterone acetate. CONCLUSIONS: Transdermal estradiol alone or associated with medroxyprogesterone acetate decreased plasma levels of F2alpha-isoprostanes. These data elucidate additional details of the beneficial effect of estradiol on oxidative stress, a relevant mechanism in atherogenesis.
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Hermenegildo C, Oviedo PJ, Laguna A, García-Pérez MA, Tarín JJ, Cano A. Menopause. 2008 Jul-Aug;15(4 Pt 1):714-7.
Effects of Physical Exercises and Estrogen Therapy on Health-Related Quality of Life
A randomized, placebo-controlled trial of the effects of physical exercises and estrogen therapy on health-related quality of life in postmenopausal women
Abbreviated Abstract: OBJECTIVE: The purpose of this study was to evaluate the isolated and associated effects of estrogen therapy (estradiol valerate 1 mg/d orally) and physical exercise (moderate aerobic exercise, 3 h/wk) on health-related quality of life (HRQOL) and menopausal symptoms among women who had undergone hysterectomy. DESIGN: A 6-month, randomized, double-blind, placebo-controlled clinical trial with 44 postmenopausal women who had undergone hysterectomy. RESULTS: There was a decrease in symptoms in all groups, but only groups who performed physical exercise showed an increase in quality of life. Analysis of variance showed that changes in physical functioning (P = 0.001) and bodily pain (P = 0.012) scores over the 6-month period differed significantly between women who exercised and women who were sedentary, regardless of hormone therapy. Hormone therapy had no effect, and there was also no significant association between physical exercise and hormone therapy in HRQOL. CONCLUSIONS: Physical exercises can reduce menopausal symptoms and enhance HRQOL, independent of whether hormone therapy is taken.
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Moriyama CK, Oneda B, Bernardo FR, Cardoso CG Jr, Forjaz CL, Abrahao SB, Mion D Jr, Fonseca AM, Tinucci T. Menopause. 2008 Jul-Aug; 15(4 Pt 1):613-8.
Older Men with Low Serum Estradiol Have an Increased Risk of Fractures
Older men with low serum estradiol and high serum SHBG have an increased risk of fractures
Abbreviated Abstract: Osteoporosis-related fractures constitute a major health concern not only in women but also in men. To study the predictive role of serum sex steroids for fracture risk in men, serum sex steroids were analyzed by the specific gas chromatography-mass spectrometry technique at baseline in older men (n = 2639; mean, 75 yr of age) of the prospective population-based MrOS Sweden cohort. Fractures occurring after baseline were validated (average follow-up of 3.3 yr). The inverse relation between serum E2 and fracture risk was nonlinear with a strong relation <16 pg/ml for E2 and 0.3 pg/ml for fE2. In conclusion, older Swedish men with low serum E2 and high SHBG levels have an increased risk of fractures.
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Mellström D, Vandenput L, Mallmin H, Holmberg AH, Lorentzon M, Odén A, Johansson H, Orwoll ES, Labrie F, Karlsson MK, Ljunggren O, Ohlsson C. J Bone Miner Res. 2008 Oct;23(10):1552-60.
Risk Factors For the Onset of Menopausal Symptoms
Risk factors for onset of menopausal symptoms: results from a large cohort study
Full Abstract: OBJECTIVES: Menopause, the permanent cessation of ovarian activity, is part of normal aging, resulting in climacteric symptoms for most women, particularly in Western countries. The objective of the present study was to analyze risk factors for onset of menopausal symptoms. METHODS: Analyses were based on the 28,118 women participating in the French E3N cohort study who reached menopause between 1990 and 2000. Questionnaires were sent every 2 years, and specifically enquired about use of hormonal treatments, reproductive factors, smoking status, anthropometric measurements, dietary habits and personal medical history, including onset of menopausal symptoms. Hazard ratios were computed from multivariable Cox proportional hazard models with age as the time-scale. RESULTS: The risk of onset of menopausal symptoms was negatively associated with education level and with some hormonal and reproductive factors (usual duration of menstrual cycles, parity and current use of oral contraceptives). A decrease in risk was found in those with underweight, overweight and obesity, but only in post-menopause. The risk was positively associated with smoking and alcohol consumption; it was also positively related to certain frequent medical conditions (depression, migraine, benign thyroid disease, atopy), possibly due to underlying common mechanisms such as the influence of vaso-active substances. Among dietary factors, rapidly absorbed sugars and snacking were positively associated with the risk of onset of menopausal symptoms. CONCLUSIONS: Onset of menopausal symptoms seems to be affected by various reproductive, hormonal and environmental factors. Some of them are modifiable, which may allow suggesting recommendations.
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Sabia S, Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F. Maturitas. 2008 Jun 20; 60(2):108-21.
The Hot Flush Beliefs Scale
The Hot Flush Beliefs Scale: a tool for assessing thoughts and beliefs associated with the experience of menopausal hot flushes and night sweats
Full Abstract: OBJECTIVES: Approximately 15-20% of women experience their hot flushes and night sweats as problematic. There is some evidence that cognitive appraisals may help explain individual variation, and that cognitive behaviour therapy can alleviate related distress. This paper describes the development of the Hot Flush Beliefs Scale (HFBS), a questionnaire to assess women's appraisals, and reports on the reliability, validity and factor structure of the scale. METHODS: An initial pool of 63 items was generated from several sources: empirical literature, clinicians' views, and in-depth interviews, with the aim of reflecting common thoughts and beliefs about flushes and sweats. A total of 103 women, aged 41-64 years completed the initial measure. Principal components analysis and principal axis factoring were applied to the data, with both orthogonal and oblique rotation to determine the most coherent and interpretable solution. RESULTS: Exploratory factor analysis culminated in a 27-item measure comprising three dimensions: beliefs about self in social context; beliefs about coping with hot flushes; beliefs about coping with night sweats/sleep. The HFBS was internally consistent, with subscale alphas ranging from 0.78 to 0.93, and test-retest reliability 0.74-0.78. Validity was supported through correlations with other measures of mood and menopause beliefs. CONCLUSIONS: Preliminary analysis of the HFBS reveals it to be a psychometrically sound instrument. The HFBS has the benefit of being grounded in women's experiences and shows initial promise as a tool to aid further clinical and theoretical understanding of the impact of hot flushes and night sweats.
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Rendall MJ, Simonds LM, Hunter MS. Maturitas. 2008 Jun 20; 60(2):158-69.
Bone Turnover Marker Profile in Relation to the Menstrual Cycle of Premenopausal Healthy Women
Bone turnover marker profile in relation to the menstrual cycle of premenopausal healthy women
Full Abstract: OBJECTIVE: To explore the bone turnover marker profile during the menstrual cycle of premenopausal women. DESIGN: This was a noninterventional study. Levels of bone turnover markers, including serum C-terminal telopeptide of type I collagen (sCTX), bone-specific alkaline phosphatase, osteocalcin, procollagen type 1 N propeptide, and urinary N-terminal telopeptide of type I collagen, were measured in blood and urine samples during one menstrual cycle. Levels were expressed as raw test results and percent change from serum luteinizing hormone peak. Differences in mean levels of bone turnover markers between menstrual phases and subphases were examined. RESULTS: Fifty-five women comprised the per-protocol population. Mean sCTX values were 0.48 ng/mL during the follicular phase (FP), 0.47 ng/mL at serum luteinizing hormone peak, and 0.43 ng/mL during the luteal phase (LP). Additionally, the mean percent change from luteinizing hormone peak varied from +4.35% during the FP to -5.11% during the LP (P = 0.0014). Mean sCTX levels during the early and through mid FP were significantly higher than levels during the mid and late LP. The pattern for urinary N-terminal telopeptide of type I collagen was similar to that of sCTX but not statistically significant. There was a statistically significant tendency for procollagen type I N propeptide levels to be lower during the FP relative to the LP. Levels of osteocalcin and bone-specific alkaline phosphatase did not vary significantly during the menstrual cycle. CONCLUSIONS: Levels of some bone turnover markers varied during the menstrual cycle. A statistically significant change in sCTX (9.46%) occurred between the FP and LP of the menstrual cycle.
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Gass ML, Kagan R, Kohles JD, Martens MG. Menopause. 2008 Jul-Aug; 15(4 Pt 1):667-75.
Identifying Meaningful Differences in Vasomotor Symptoms Among Menopausal Women
Identifying meaningful differences in vasomotor symptoms among menopausal women
Full Abstract: OBJECTIVE: First, to identify treatment satisfaction thresholds for interpreting treatment-related changes in vasomotor symptoms, and, second, to determine the doses of desvenlafaxine (DVS) (administeredas desvenlafaxine succinate) that effectively provide relief of vasomotor symptoms considered important by menopausal women. DESIGN: Efficacy and treatment satisfaction were assessed in 620 postmenopausal women with moderate to severe vasomotor symptoms participating in a double-blind, placebo-controlled trial and randomly assigned to placebo or 50, 100, 150, or 200 mg DVS. Number and severity of hot flushes and number of nighttime awakenings were recorded in daily diaries for 12 weeks of treatment. At week 12, responses to the Menopause Symptoms Treatment Satisfaction Questionnaire were compared with efficacy results. RESULTS: Greater percentages of participants in the DVS groups reported being "satisfied" or "extremely satisfied" with daytime and nighttime control of hot flushes compared with placebo. The treatment satisfaction threshold, defined as the difference between the average reduction in vasomotor symptoms for women who were "neutral" versus "satisfied," was 1.64 for moderate to severe hot flushes and 0.42 for nighttime awakenings. Statistically significant reductions with 100, 150, and 200 mg DVS exceeded treatment satisfaction threshold results for at least one of these thresholds, and results with 100 mg DVS compared with placebo exceeded both treatment satisfaction thresholds. CONCLUSIONS: Among menopausal women with moderate to severe vasomotor symptoms, the treatment satisfaction thresholds that were meaningful to participants were 1.64 fewer moderate to severe hot flushes per day and 0.42 fewer nighttime awakenings per night. A dose of 100 mg DVS met both of these important vasomotor symptom change thresholds.
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Wyrwich KW, Spratt DI, Gass M, Yu H, Bobula JD. Menopause. 2008 Jul-Aug;15(4 Pt 1):698-705.
Bone Mineral Density at Menopause Does not Predict Breast Cancer Incidence
Bone mineral density at menopause does not predict breast cancer incidence
Full Abstract: SUMMARY: In this prospective study in 2,137 perimenopausal and early postmenopausal women who were followed over a 13.1-year period of time, we observed no association between bone mineral density measured at the beginning of menopause and the subsequent risk of breast cancer. INTRODUCTION: This study aimed to investigate the relationship between BMD and the risk of breast cancer (BC) in young postmenopausal women. METHODS: As part of a clinical research program, 2,137 women who were perimenopausal or within their 5 first postmenopausal years were scanned between 1988-1990 and reviewed on average 13.1 years after their initial examination. Ninety-eight incident BC cases were recorded throughout the follow-up. RESULTS: Women with incident BC significantly differed from those who had never had BC with regard to age at menarche, age of birth of 1st child, familial history of BC and postmenopausal hormone therapy (PHT) use. There was no significant difference between the two groups for baseline DXA of the spine. There was a trend for BC cases for having lower femoral neck BMD compared to women without BC. However, women with low BMD were more likely to have taken PHT by the end of the study. In Cox multivariate analyses the relationship between BC risk and femoral neck BMD no longer existed. CONCLUSIONS: There was no relationship between BMD measured within the first postmenopausal years and the risk of BC, which makes unlikely the possibility of using BMD as a predictor factor for BC in early postmenopausal women.
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Trémollieres FA, Pouillès JM, Laparra J, Ribot C. Osteoporos Int. 2008 Oct;19(10):1497-504.
Association between parental history of type 2 diabetes and glycemic control in urban African Americans
Abbreviated Abstract: OBJECTIVE: The purpose of this study was to examine the association between parental history of type 2 diabetes and glycemic control among diabetic urban African Americans. RESEARCH DESIGN AND METHODS: Study participants included 359 African Americans with type 2 diabetes. Participants underwent an interview-administrated questionnaire that asked about family history, sociodemographics, clinical characteristics, and knowledge and perception of adequate glycemic control. Regression analysis was used to determine the association between parental history of diabetes and glycemic control, as measured by A1C. CONCLUSIONS: From these results, we conclude that among the urban African American participants who were aware of their parental history of diabetes, a positive parental history was associated with worse glycemic control, partly due to longer duration of diabetes. Parental history did not appear to be associated with better knowledge or perception of adequate glycemic control.
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Gong L, Kao WH, Brancati FL, Batts-Turner M, Gary TL. Diabetes Care. 2008 Sep; 31(9):1773-6.
The Relationship of Reduced Nerve Function and Diabetes with Physical Performance
The relationship of reduced peripheral nerve function and diabetes with physical performance in older white and black adults: the Health, Aging, and Body Composition (Health ABC) study
Abbreviated Abstract: OBJECTIVE: Poor peripheral nerve function is prevalent in diabetes and older populations, and it has great potential to contribute to poor physical performance. RESEARCH DESIGN AND METHODS: Cross-sectional analyses were done for the Health, Aging, and Body Composition (Health ABC) Study participants (n = 2,364; 48% men; 38% black; aged 73-82 years). Sensory and motor peripheral nerve function in legs/feet was assessed by 10- and 1.4-g monofilament perception, vibration detection, and peroneal motor nerve conduction amplitude and velocity. CONCLUSIONS: Poor peripheral nerve function accounts for a portion of worse physical performance in diabetes and may be directly associated with physical performance in older diabetic and nondiabetic adults. The impact of peripheral nerve function on incident disability should be evaluated in older adults.
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Strotmeyer ES, de Rekeneire N, Schwartz AV, Faulkner KA, Resnick HE, Goodpaster BH, Shorr RI, Vinik AI, Harris TB, Newman AB. Diabetes Care. 2008 Sep; 31(9):1767-72.
The Decline in Early Mortality in Men and Women with Type 2 Diabetes
Explaining the decline in early mortality in men and women with type 2 diabetes: a population-based cohort study
Abbreviated Abstract: OBJECTIVE: The purpose of this study was to test the hypothesis that changing utilization of lipid-lowering, antihypertensive, and oral hypoglycemic drugs may be associated with trends in all-cause mortality in men and women with type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a cohort study in 197 general practices in the U.K. General Practice Research Database including 48,579 subjects with type 2 diabetes first diagnosed between 1996 and 2006. Measures included all-cause mortality and prescription of hypoglycemic, lipid-lowering, and antihypertensive drugs. CONCLUSIONS: Widespread implementation of more effective prescribing to control lipids, blood glucose, and blood pressure may have contributed to recent declines in early mortality in men and women with type 2 diabetes.
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Charlton J, Latinovic R, Gulliford MC. Diabetes Care. 2008 Sep;31(9):1761-6.
Differences in treadmill exercise tolerance parameters between patients with partial and advanced interatrial depolarization abnormality
Full Abstract: Advanced interatrial block (aIAB) is considerably much less common than partial interatrial block (pIAB), occuring in <2% of the elderly hospitalized population. Less is, therefore, known of the true clinical burden of aIAB, particularly in relation to graded exercise. Therefore, 12 patients with aIAB and 30 patients with pIAB who performed a baseline exercise tolerance test and had a repeat test performed > or = 2 years later were included in the study. Exercise tolerance, echocardiographic findings, and major adverse cardiovascular events were compared. Left atrial size progressed at a significantly faster rate in those with aIAB. In addition, Duke Prognostic Treadmill scores were significantly lower on follow-up in those patients with aIAB. Overall, patients with aIAB had significantly greater left atrial size (48.3 +/- 9 vs 42.8 +/- 4 mm, p < 0.01) and significantly lower Duke Prognostic Treadmill scores than those with pIAB (-0.2 +/- 5 vs 4.1 +/- 4, p < 0.05). There were, however, no significant differences in the occurence of major adverse cardiovascular events. In conclusion, left atrial size progressed at a significantly faster rate but Duke Prognostic Treadmill scores were significantly lower in those with aIAB compared with patients with pIAB after > or = 2 years of follow-up. Further study is required to determine whether patients with aIAB require follow-up echocardiography and/or exercise tolerance tests for optimal risk stratification.
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Raja A, Ariyarajah V, Fernandes J, Apiyasawat S, Khadem A, Barac I, Spodick DH. Am J Cardiol. 2008 Oct 1;102(7):866-70.
Impact of Genetics on Low Bone Mass in Adults
Impact of genetics on low bone mass in adults
Full Abstract: Low bone mass in adults is a major risk factor for low-impact fractures and is considered of complex origin because of interaction of environmental and genetic factors, each with modest effect. The objective was to assess the relative impact of genetics and environment and quantify the risk in relatives of osteopenic individuals. We studied 440 Icelandic nuclear families with 869 first-degree relatives of both sexes. Index cases (male or female) had BMD in the lumbar spine or hip >1.5 SD less than sex-matched controls. Heritability of BMD was estimated by maximum likelihood method, and variance component analysis was used to partition the genetic and environmental effects. Relative risk of low BMD (< -1 SD) in first-degree relatives was estimated, and heritable decrement in BMD was calculated compared with controls. Heritability was estimated as 0.61-0.66. Relative risk among first-degree relatives was 2.28, and the yield of screening was as high as 36%. The genetic influence was consistent with one or a few genes with considerable effect in addition to multiple genes each with a small effect. The genetic deficit in BMD was already present before 35 yr of age and equaled bone loss during 8-30 yr after menopause. We confirmed that genetics are more important than environment to low bone mass in adults. Our results are consistent with a few underlying genes with considerable effect. The prevalence among first-degree relatives of both sexes is common, suggesting that screening them should be cost effective and informative to elucidate the underlying genetics.
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Sigurdsson G, Halldorsson BV, Styrkarsdottir U, Kristjansson K, Stefansson K. J Bone Miner Res. 2008 Oct;23(10):1584-90.
The Developmental Origins of Sarcopenia
The developmental origins of sarcopenia: using peripheral quantitative computed tomography to assess muscle size in older people
Full Abstract: BACKGROUND: A number of studies have shown strong graded positive relationships between size at birth, grip strength, and estimates of muscle mass in older people. However no studies to date have included direct measures of muscle size. METHODS: We studied 313 men and 318 women born in Hertfordshire, United Kingdom between 1931 and 1939 who were still resident there and had historical records of growth in early life. Information on lifestyle was collected, and participants underwent peripheral quantitative computed tomography to directly measure forearm and calf muscle size. RESULTS: Birth weight was positively related to forearm muscle area in the men (r = 0.24, p <.0001) and women (r = 0.17, p =.003). There were similar but weaker associations between birth weight and calf muscle area in the men (r = 0.13, p =.03) and in the women (r = 0.17, p =.004). These relationships were all attenuated by adjustment for adult size. CONCLUSION: We present first evidence that directly measured muscle size in older men and women is associated with size at birth. This may reflect tracking of muscle size and is important because it suggests that benefit may be gained from taking a life course approach both to understanding the etiology of sarcopenia and to developing effective interventions.
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Sayer AA, Dennison EM, Syddall HE, Jameson K, Martin HJ, Cooper C. J Gerontol A Biol Sci Med Sci. 2008 Aug;63(8):835-40.
Moderate Impact Exercise on Skeletal Integrity in Master Athletes
The effect of moderate impact exercise on skeletal integrity in master athletes
Abbreviated Abstract: SUMMARY: We measured bone mineral density (BMD) in senior athletes competing in running and swimming events and compared results to those of sedentary controls. Total body BMD was greatest among runners suggesting that moderate impact activities continue to play a role in maintaining skeletal integrity with age. INTRODUCTION: The role of moderate impact exercise in maintaining skeletal integrity as we age remains unclear. METHODS: To determine the effect of moderate impact exercise on skeletal integrity in the elderly, we recruited master athletes, including 44 runners (moderate impact exercise) and 43 swimmers, competing in the 2005 National Senior Olympic Games and 87 non-athletes, all over the age of 65 years. CONCLUSION: These findings suggest that moderate impact exercise contributes to skeletal integrity in older age.
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Velez NF, Zhang A, Stone B, Perera S, Miller M, Greenspan SL. Osteoporos Int. 2008 Oct;19(10):1457-64.
Screening for Osteoporosis in Men: A Clinical Practice Guideline from the American College of Physicians
Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians
Abbreviated Abstract: The American College of Physicians developed this guideline to present the available evidence on risk factors and screening tests for osteoporosis in men. RECOMMENDATION 1: The American College of Physicians recommends that clinicians periodically perform individualized assessment of risk factors for osteoporosis in older men (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 2: The American College of Physicians recommends that clinicians obtain dual-energy x-ray absorptiometry for men who are at increased risk for osteoporosis and are candidates for drug therapy (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 3: The American College of Physicians recommends further research to evaluate osteoporosis screening tests in men.
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Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK. Ann Intern Med. 2008 May 6;148(9):680-4.
Cognitive Decline During Aging
Role of neuroendocrine pathways in cognitive decline during aging
Full Abstract: The pineal and pituitary-adrenocortical secretions play an important role in adaptive responses of the organism acting as coordinating signals for both several biological rhythms and multiple neuroendocrine and metabolic functions. The more relevant neuroendocrine changes occurring with ageing affect the secretion of melatonin and of corticosteroids. These changes may be clearly appreciated by the study of their circadian rhythmicity. The circadian profile of plasma melatonin was clearly flattened in elderly subjects and even more in old individuals with dementia. Indeed, the impairment of melatonin signal occurring in aging was related either to age itself or to the cognitive performances of subjects. The biosynthetic dissociation between glucocorticoids and androgen secretion is responsible for the selective impairment of androgens, such as DHEA and DHEA-S, by comparison to cortisol. Due to the opposite effects of the two kinds of corticosteroids either in the periphery and in the CNS, the imbalance between glucocorticoids and androgens, well demonstrated by the evaluation of the cortisol/DHEA-S molar ratio, may be responsible for the occurrence in the CNS of a more neurotoxic steroidal milieu, already present in clinically healthy elderly subjects and especially in patients with dementia. The effects of that steroidal milieu are more prominent at the level of the hippocampal-limbic structure, involved both in the modulation of endocrine structures, such as the HPA axis, and in the control of cognitive, behavioral and affective functions.
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Ferrari E, Magri F. Ageing Res Rev. 2008 Jul; 7(3):225-33.
The Importance of Daytime Movement
Cognition in Older Women: The Importance of Daytime Movement
Abbreviated Abstract: OBJECTIVES: To determine whether an objective measure of daytime movement is associated with better cognitive function in women in their 80s. SETTING: A study of health and aging. PARTICIPANTS: Two thousand seven hundred thirty-six older women without evidence of dementia. MEASUREMENTS: Daytime movement was assessed using actigraphy, which involved wearing a watch-like device that objectively quantified accelerometer motion over a mean of 3.0+/-0.8 days. Cognitive function was measured using the Trail-Making Test, Part B (Trails B) and the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as performing 1.5 standard deviations (SDs) worse than the mean on a given test. CONCLUSION: Daytime movement as measured objectively using actigraphy was associated with better cognitive function and lower odds of cognitive impairment in women in their 80s. Additional studies are needed to clarify the direction of the association and to explore potential mechanisms.
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Barnes DE, Blackwell T, Stone KL, Goldman SE, Hillier T, Yaffe K; for the Study of Osteoporotic Fractures. J Am Geriatr Soc. 2008 Jul 24.
Self-reported Distress After Cognitive Testing in Patients
Self-reported distress after cognitive testing in patients with Alzheimer's disease
Abbreviated Abstract: BACKGROUND: The prevalence and degree of self-reported distress that patients with Alzheimer's disease (AD) experience after cognitive testing remain unknown. It is also unknown whether this level of distress is at all related to specific patient factors, test performance, or awareness of test performance. METHODS: In 154 mild-to-moderate AD patients and 62 cognitively intact patients, we measured self-reported distress, on a five-point Likert scale, after 45 minutes of cognitive testing. Using multivariate logistic regression, we then examined whether demographic factors, level of education, depressive symptoms, cognitive performance, perceived test difficulty, and perceived test performance compared to 10 years ago were predictive of self-reported distress. CONCLUSION: Cognitive tasks provoke more distress in patients with mild-to-moderate AD compared with persons who do not have dementia. Predictors of distress are more closely related to patient awareness about test difficulty and performance, rather than actual test performance.
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Lai JM, Hawkins KA, Gross CP, Karlawish JH. J Gerontol A Biol Sci Med Sci. 2008 Aug; 63(8):855-9.
Frailty in Older Mexican-American and European-American Adults: Is There an Ethnic Disparity?
Full Abstract: Because conventional frailty screening criteria have been standardized in predominantly European-American (EA) cohorts, applying them to ethnically diverse populations may result in inaccurate estimation of frailty prevalence in ethnic minorities. The objective of this study was to determine whether use of ethnic-specific criteria (EC) to characterize frailty in a bi-ethnic cohort results in significant differences in frailty prevalence when compared with the prevalence obtained using conventional criteria (CC). Data were from a random sample of community-dwelling Mexican Americans (MAs) (n=394) and EAs (n=355) aged 65 to 80 who participated in the baseline examination of the San Antonio Longitudinal Study of Aging. Frailty was defined as three or more of five characteristics: slow walking speed, weak grip strength, low energy expenditure, self-reported exhaustion, and weight loss. For CC, walking speed was standardized to height and sex, grip strength was standardized to body mass index and sex, and energy expenditure was standardized to sex using the pooled sample. For EC, these criteria were applied within each ethnic group. Frailty prevalence in MAs and EAs was compared using chi-square statistic. Using CC, a higher proportion of MAs than EAs were frail (11.3% vs 7.0%, P=.045). Using EC, there was no difference in frailty prevalence between MAs and EAs (9.9% in both ethnic groups). The application of conventional frailty screening criteria in a bi-ethnic cohort results in a higher prevalence of frailty in MAs than in EAs. In determining whether there are ethnic disparities in frailty, future studies should carefully consider whether CC or EC should be applied.
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Espinoza SE, Hazuda HP. J Am Geriatr Soc. 2008 Jul 24.
Patient Ethnicity and the Identification of Anxiety in Elderly
Patient Ethnicity and the Identification of Anxiety in Elderly Primary Care Patients
Full Abstract: OBJECTIVES: To examine the role of ethnicity and primary care physician (PCP) identification of anxiety in older adults. DESIGN: A cross-sectional survey conducted between 2001 and 2003. SETTING: Primary care offices in the Baltimore, Maryland, area. PARTICIPANTS: A sample of 330 adults aged 65 and older from Maryland primary care practices with complete information on psychological status and physician assessments. MEASUREMENTS: PCPs were asked to rate anxiety on a Likert scale. Patient interviews included measures of psychological status and patient use of psychotropic medications. RESULTS: Older black patients were less likely than older white patients to be identified as anxious (unadjusted odds ratio (OR)=0.34, 95% confidence interval (CI)=0.18-0.64) and less likely to be taking psychotropic medications (unadjusted OR=0.40, 95% CI=0.20-0.81). In multivariate models that controlled for potentially influential characteristics including depression and anxiety symptoms, the association between identification (OR=0.30, 95% CI=0.15-0.61) with patient ethnicity remained significantly unchanged. CONCLUSION: PCPs were less likely to identify older black Americans as anxious than white patients. An understanding of the role of ethnicity in the identification of anxiety is important for the screening and management of anxiety in elderly people.
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Kim YA, Morales KH, Bogner HR. J Am Geriatr Soc. 2008 Aug 5.
About the Kronos Longevity Research Institute
Kronos Longevity Research Institute (KLRI), a not-for-profit 501(c)(3) organization, is a leader in developing new modes of prevention and treatment to enhance human longevity. KLRI is the only independent research institute devoted exclusively to translating basic discoveries in the process of aging into useful tools, improved medical care and healthier lives. KLRI's research is conducted by its own highly regarded scientists and through collaboration with some of the nation's leading medical research centers. Because KLRI conducts pioneering research in an area of science that is poorly understood, KLRI offers the potential to make seminal contributions that benefit not only the growing population of older Americans, but people everywhere and generations to follow. For more information about KLRI, visit our website at www.kronosinstitute.org.
Volume 3 - 2008
Topics
Nutrition
Diabetes
Caloric Restriction
Exercise and Physiology
Cardiovascular
Cognitive
Hormones
Other
Nutrition
Multiple Food Groups Influence DiabetesDietary patterns and risk of incident type 2 diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)
Abbreviated Abstract: OBJECTIVE: We characterized dietary patterns and their relation to incident type 2 diabetes in 5,011 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). RESEARCH DESIGN AND METHODS: White, black, Hispanic, and Chinese adults, aged 45-84 years and free of cardiovascular disease and diabetes, completed food frequency questionnaires at baseline (2000-2002). Incident type 2 diabetes was defined at three follow-up exams (2002-2003, 2004-2005, and 2005-2007) as fasting glucose >126 mg/dl, self-reported type 2 diabetes, or use of diabetes medication. Two types of dietary patterns were studied: four empirically derived (principal components analysis) and one author-defined (low-risk food pattern) as the weighted sum of whole grains, vegetables, nuts/seeds, low-fat dairy, coffee (positively weighted), red meat, processed meat, high-fat dairy, and soda (negatively weighted). CONCLUSIONS: Multiple food groups collectively influence type 2 diabetes risk beyond that of the individual food groups themselves.
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Nettleton JA, Steffen LM, Ni H, Liu K, Jacobs DR Jr. Diabetes Care. 2008 Sep;31(9):1777-82.
Polyunsaturated Fatty Acids Prevent Metabolic and Vascular Disorders
Long-chain (n-3) polyunsaturated fatty acids prevent metabolic and vascular disorders in fructose-fed rats
Abbreviated Abstract: The crossover relationship between cardiometabolic risk, in terms of insulin resistance and vascular dysfunction, and the fatty acid (FA) profile of insulin-sensitive tissues as well as the dietary FA impact has almost never been explored in the same experiment. In this study, the intake of alpha-linolenic acid (ALA) alone and/or with its higher metabolites, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) were evaluated in a nonobese, hypertriglyceridemic and insulin-resistant rat model, that exhibits the 2 main characteristics of metabolic syndrome. Insulin resistance was linked to a specific FA pattern in insulin-sensitive tissues, which probably involved modifications of Delta9, Delta6, and Delta5-desaturases. This pathological status was related to high cardiovascular risk as assessed by increases in systolic and diastolic blood pressures and particularly by the increase of pulse pressure, an index of vascular stiffness obtained from telemetry investigations. The (n-3) experimental diets prevented changes in the FA patterns in insulin-sensitive tissues, insulin resistance, and vascular dysfunction. This beneficial effect was large with an intake of long chain (n-3) PUFA (ALA+EPA+DHA) and to a lesser extent with dietary ALA alone.
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Robbez Masson V, Lucas A, Gueugneau AM, Macaire JP, Paul JL, Grynberg A, Rousseau D.
J Nutr. 2008 Oct; 138(10):1915-22.
High Intake of Vitamin C is Associated with Lower Bone Loss
High vitamin C intake is associated with lower 4-year bone loss in elderly men
Full Abstract: Vitamin C is essential for collagen formation and normal bone development. We evaluated associations of total, supplemental, and dietary vitamin C intake with bone mineral density (BMD) at the hip [femoral neck, trochanter], spine, and radial shaft and 4-y BMD change in elderly participants from the Framingham Osteoporosis Study. Energy-adjusted vitamin C intakes were estimated from the Willett FFQ in 1988-89. Mean BMD and 4-y BMD change was estimated, for men and women, by tertile/category of vitamin C intake, adjusting for covariates. We tested for interaction with smoking, calcium, and vitamin E intake. Among 334 men and 540 women, the mean age was 75 y and mean vitamin D intake was 8.25 mug/d (women) and 8.05 mug/d (men). We observed negative associations between total and supplemental vitamin C intake and trochanter-BMD among current male smokers (P-trend = 0.01). Among male nonsmokers, total vitamin C intake was positively associated with femoral neck BMD (P-trend = 0.04). Higher total vitamin C intake was associated with less femoral neck and trochanter-BMD loss in men with low calcium (all P-trend
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Sahni S, Hannan MT, Gagnon D, Blumberg J, Cupples LA, Kiel DP, Tucker KL. J Nutr. 2008 Oct; 138(10):1931-8.
Dark Chocolate and C-Reaction Protein
Regular consumption of dark chocolate is associated with low serum concentrations of C-reactive protein in a healthy Italian population
Abbreviated Abstract: Dark chocolate contains high concentrations of flavonoids and may have antiinflammatory properties. We evaluated the association of dark chocolate intake with serum C-reactive protein (CRP). The Moli-sani Project is an ongoing cohort study of men and women aged >/=35 y randomly recruited from the general population. By July 2007, 10,994 subjects had been enrolled. Of 4849 subjects apparently free of any chronic disease, 1317 subjects who declared having eaten any chocolate during the past year (mean age 53 +/- 12 y; 51% men) and 824 subjects who ate chocolate regularly in the form of dark chocolate only (50 +/- 10 y; 55% men) were selected. High sensitivity-CRP was measured by an immunoturbidimetric method. A J-shaped relationship between dark chocolate consumption and serum CRP was observed; consumers of up to 1 serving (20 g) of dark chocolate every 3 d had serum CRP concentrations that were significantly lower than nonconsumers or higher consumers. Our findings suggest that regular consumption of small doses of dark chocolate may reduce inflammation.
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di Giuseppe R, Di Castelnuovo A, Centritto F, Zito F, De Curtis A, Costanzo S, Vohnout B, Sieri S, Krogh V, Donati MB, de Gaetano G, Iacoviello L. J Nutr. 2008 Oct; 138(10):1939-45.
CALORIC RESTRICTION
Calorie Restriction Minimizes Activation of Insulin Signals
Calorie restriction minimizes activation of insulin signaling in response to glucose: potential involvement of the growth hormone-insulin-like growth factor 1 axis
Abbreviated Abstract: Calorie restriction (CR) may modulate insulin signaling in response to energy intake through suppression of the growth hormone (GH)-IGF-1 axis. We investigated the glucose-stimulated serum insulin response and subsequent alterations in insulin receptor (IR), Akt, and FoxO1 in the rat liver and quadriceps femoris muscle (QFM). The phenotypic similarity of W-CR and Tg-AL rats suggest that CR minimizes activation of insulin signaling in response to energy intake mostly through the GH-IGF-1 axis.
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Hayashi H, Yamaza H, Komatsu T, Park S, Chiba T, Higami Y, Nagayasu T, Shimokawa I. Exp Gerontol. 2008 Sep;43(9):827-32.
Resveratrol-containing Nutraceutical Mixture Mimics Gene Expression of Caloric Restriction
Short-term consumption of a resveratrol-containing nutraceutical mixture mimics gene expression of long-term caloric restriction in mouse heart.
Full Abstract: An active area of aging research is focused on identifying compounds having the ability to mimic the effects of caloric restriction (CR). From 2 to 5 months of age, we fed male B6C3F(1) mice either a 40% CR diet, a control diet supplemented with a commercially available nutraceutical mixture (NCM) containing resveratrol, quercetin and inositol hexaphosphate, or a diet supplemented with an equivalent dose of chemical-grade resveratrol (RES; 1.25 mg resveratrol kg(-1) day(-1)) from 2 to 5 months of age. Cardiac gene expression profiles were generated for the three groups of treated mice and compared to age-matched control (CO) mice. All three treatments were associated with changes in several cytoskeletal maintenance pathways, suggesting that RES and NCM are able to mimic short-term CR. CR uniquely affected several immune function pathways while RES uniquely affected multiple stress response pathways. Pathway analysis revealed that NCM (but not CR or RES) regulated multiple metabolic pathways that were also changed by long-term CR, including glucose and lipid metabolism, oxidative phosphorylation and chromatin assembly. Examination of key genes and pathways affected by NCM suggests that Foxo1 is a critical upstream mediator of its actions.
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Barger JL, Kayo T, Pugh TD, Prolla TA, Weindruch R. Exp Gerontol. 2008 Sep; 43(9):859-66.
CARDIOVASCULAR
Subclinical Atherosclerosis EvaluatedRelation of Framingham risk score to subclinical atherosclerosis evaluated across three arterial sites
Full Abstract: The Framingham risk score (FRS) is widely used in clinical practice to identify subjects at high risk for developing coronary heart disease. However, FRS may not accurately identify subjects at risk. We measured subclinical atherosclerosis in the coronary arteries and aorta with the presence of calcium and in the common carotid artery by intima-media thickness in 498 healthy subjects. The distribution of these subclinical atherosclerosis measures was evaluated across 3 strata of the FRS. Coronary arteries with the presence of calcium, aorta with the presence of calcium, and carotid artery by intima-media thickness were significantly independently associated with FRS. The FRS increased with the number of arterial sites with atherosclerosis; 69% of the subjects categorized in the low risk group (FRS <10%), 95% of the intermediate risk group (FRS 10% to 20%), and 100% of the high risk group (FRS >20%) had > or = 1 vascular imaging studies demonstrating subclinical atherosclerosis. In the low risk group, subjects with atherosclerosis had a longer history of lifetime smoking compared with those without atherosclerosis. In conclusion, subclinical atherosclerosis is prominent across the spectrum of FRS. Evaluation of subclinical atherosclerosis in different arterial sites in addition to FRS may be useful in targeting subjects for lifestyle and other interventions.
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Karim R, Hodis HN, Detrano R, Liu CR, Liu CH, Mack. Am J Cardiol. 2008 Oct 1; 102(7):825-30.
HORMONES
Effects of Hormone Replacement Therapy and Coffee
Insulin resistance in postmenopausal women: concurrent effects of hormone replacement therapy and coffee
Abbreviated Abstract: BACKGROUND: In postmenopausal women, an increase in insulin resistance is associated with an increased risk of diabetes, cardiovascular disease and breast cancer. Hormone replacement therapy (HRT) can reduce insulin resistance and coffee use is reported to decrease the incidence of diabetes. The aim of our study was to assess possible concurrent effects of HRT and espresso coffee intake on insulin resistance and on interdependent nutritional and clinical features. METHODS: A total of 478 healthy postmenopausal, non-diabetic women (aged 54.5 +/- 4.2 years) were studied: 360 had been on HRT for at least 2 years and 118 were not treated. Women on HRT show lower insulin resistance, but not lower prevalence of arterial hypertension. Coffee use is associated with a decrease in insulin resistance in non-obese women receiving HRT, but not in other subsets. CONCLUSIONS: The combination of coffee consumption and HRT could lower insulin resistance in postmenopausal women. In overweight women, greater insulin sensitivity is associated with intake of espresso coffee and not with HRT; in normal weight women, only HRT is associated with lower insulin resistance.
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Catalano D, Trovato GM, Spadaro D, Martines GF, Garufi G, Tonzuso A, Grasso D, Sciacchitano SG. Climacteric. 2008 Oct;11(5):373-82.
Transdermal Estradiol May Reduce Oxidative Stress In Postmenopausal Women
Transdermal estradiol reduces F2alpha-isoprostane levels in postmenopausal women
Abbreviated Abstract: OBJECTIVE: F2alpha-isoprostanes are considered the most reliable index of in vivo oxidative stress. Given the implication of oxidative stress in the pathogenesis of atherosclerosis, we investigatedthe effects of hormone therapy on the plasma levels of F2alpha-isoprostanes. DESIGN: Sixty-one healthy postmenopausal women were treated in a randomized trial with estradiol either orally (2 mg/day, 28 women) or transdermally (50 mug/day, 33 women) for 4 weeks. Then women in each group were randomly assigned to oral progestogen, either micronized progesterone (300 mg/day) or medroxyprogesterone acetate (5 mg/day) for 2 additional weeks. RESULTS: A significant reduction in the levels of F2alpha-isoprostanes was detected only in women receiving transdermal estradiol, alone or in combination with medroxyprogesterone acetate. CONCLUSIONS: Transdermal estradiol alone or associated with medroxyprogesterone acetate decreased plasma levels of F2alpha-isoprostanes. These data elucidate additional details of the beneficial effect of estradiol on oxidative stress, a relevant mechanism in atherogenesis.
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Hermenegildo C, Oviedo PJ, Laguna A, García-Pérez MA, Tarín JJ, Cano A. Menopause. 2008 Jul-Aug;15(4 Pt 1):714-7.
Effects of Physical Exercises and Estrogen Therapy on Health-Related Quality of Life
A randomized, placebo-controlled trial of the effects of physical exercises and estrogen therapy on health-related quality of life in postmenopausal women
Abbreviated Abstract: OBJECTIVE: The purpose of this study was to evaluate the isolated and associated effects of estrogen therapy (estradiol valerate 1 mg/d orally) and physical exercise (moderate aerobic exercise, 3 h/wk) on health-related quality of life (HRQOL) and menopausal symptoms among women who had undergone hysterectomy. DESIGN: A 6-month, randomized, double-blind, placebo-controlled clinical trial with 44 postmenopausal women who had undergone hysterectomy. RESULTS: There was a decrease in symptoms in all groups, but only groups who performed physical exercise showed an increase in quality of life. Analysis of variance showed that changes in physical functioning (P = 0.001) and bodily pain (P = 0.012) scores over the 6-month period differed significantly between women who exercised and women who were sedentary, regardless of hormone therapy. Hormone therapy had no effect, and there was also no significant association between physical exercise and hormone therapy in HRQOL. CONCLUSIONS: Physical exercises can reduce menopausal symptoms and enhance HRQOL, independent of whether hormone therapy is taken.
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Moriyama CK, Oneda B, Bernardo FR, Cardoso CG Jr, Forjaz CL, Abrahao SB, Mion D Jr, Fonseca AM, Tinucci T. Menopause. 2008 Jul-Aug; 15(4 Pt 1):613-8.
Older Men with Low Serum Estradiol Have an Increased Risk of Fractures
Older men with low serum estradiol and high serum SHBG have an increased risk of fractures
Abbreviated Abstract: Osteoporosis-related fractures constitute a major health concern not only in women but also in men. To study the predictive role of serum sex steroids for fracture risk in men, serum sex steroids were analyzed by the specific gas chromatography-mass spectrometry technique at baseline in older men (n = 2639; mean, 75 yr of age) of the prospective population-based MrOS Sweden cohort. Fractures occurring after baseline were validated (average follow-up of 3.3 yr). The inverse relation between serum E2 and fracture risk was nonlinear with a strong relation <16 pg/ml for E2 and 0.3 pg/ml for fE2. In conclusion, older Swedish men with low serum E2 and high SHBG levels have an increased risk of fractures.
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Mellström D, Vandenput L, Mallmin H, Holmberg AH, Lorentzon M, Odén A, Johansson H, Orwoll ES, Labrie F, Karlsson MK, Ljunggren O, Ohlsson C. J Bone Miner Res. 2008 Oct;23(10):1552-60.
Risk Factors For the Onset of Menopausal Symptoms
Risk factors for onset of menopausal symptoms: results from a large cohort study
Full Abstract: OBJECTIVES: Menopause, the permanent cessation of ovarian activity, is part of normal aging, resulting in climacteric symptoms for most women, particularly in Western countries. The objective of the present study was to analyze risk factors for onset of menopausal symptoms. METHODS: Analyses were based on the 28,118 women participating in the French E3N cohort study who reached menopause between 1990 and 2000. Questionnaires were sent every 2 years, and specifically enquired about use of hormonal treatments, reproductive factors, smoking status, anthropometric measurements, dietary habits and personal medical history, including onset of menopausal symptoms. Hazard ratios were computed from multivariable Cox proportional hazard models with age as the time-scale. RESULTS: The risk of onset of menopausal symptoms was negatively associated with education level and with some hormonal and reproductive factors (usual duration of menstrual cycles, parity and current use of oral contraceptives). A decrease in risk was found in those with underweight, overweight and obesity, but only in post-menopause. The risk was positively associated with smoking and alcohol consumption; it was also positively related to certain frequent medical conditions (depression, migraine, benign thyroid disease, atopy), possibly due to underlying common mechanisms such as the influence of vaso-active substances. Among dietary factors, rapidly absorbed sugars and snacking were positively associated with the risk of onset of menopausal symptoms. CONCLUSIONS: Onset of menopausal symptoms seems to be affected by various reproductive, hormonal and environmental factors. Some of them are modifiable, which may allow suggesting recommendations.
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Sabia S, Fournier A, Mesrine S, Boutron-Ruault MC, Clavel-Chapelon F. Maturitas. 2008 Jun 20; 60(2):108-21.
The Hot Flush Beliefs Scale
The Hot Flush Beliefs Scale: a tool for assessing thoughts and beliefs associated with the experience of menopausal hot flushes and night sweats
Full Abstract: OBJECTIVES: Approximately 15-20% of women experience their hot flushes and night sweats as problematic. There is some evidence that cognitive appraisals may help explain individual variation, and that cognitive behaviour therapy can alleviate related distress. This paper describes the development of the Hot Flush Beliefs Scale (HFBS), a questionnaire to assess women's appraisals, and reports on the reliability, validity and factor structure of the scale. METHODS: An initial pool of 63 items was generated from several sources: empirical literature, clinicians' views, and in-depth interviews, with the aim of reflecting common thoughts and beliefs about flushes and sweats. A total of 103 women, aged 41-64 years completed the initial measure. Principal components analysis and principal axis factoring were applied to the data, with both orthogonal and oblique rotation to determine the most coherent and interpretable solution. RESULTS: Exploratory factor analysis culminated in a 27-item measure comprising three dimensions: beliefs about self in social context; beliefs about coping with hot flushes; beliefs about coping with night sweats/sleep. The HFBS was internally consistent, with subscale alphas ranging from 0.78 to 0.93, and test-retest reliability 0.74-0.78. Validity was supported through correlations with other measures of mood and menopause beliefs. CONCLUSIONS: Preliminary analysis of the HFBS reveals it to be a psychometrically sound instrument. The HFBS has the benefit of being grounded in women's experiences and shows initial promise as a tool to aid further clinical and theoretical understanding of the impact of hot flushes and night sweats.
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Rendall MJ, Simonds LM, Hunter MS. Maturitas. 2008 Jun 20; 60(2):158-69.
Bone Turnover Marker Profile in Relation to the Menstrual Cycle of Premenopausal Healthy Women
Bone turnover marker profile in relation to the menstrual cycle of premenopausal healthy women
Full Abstract: OBJECTIVE: To explore the bone turnover marker profile during the menstrual cycle of premenopausal women. DESIGN: This was a noninterventional study. Levels of bone turnover markers, including serum C-terminal telopeptide of type I collagen (sCTX), bone-specific alkaline phosphatase, osteocalcin, procollagen type 1 N propeptide, and urinary N-terminal telopeptide of type I collagen, were measured in blood and urine samples during one menstrual cycle. Levels were expressed as raw test results and percent change from serum luteinizing hormone peak. Differences in mean levels of bone turnover markers between menstrual phases and subphases were examined. RESULTS: Fifty-five women comprised the per-protocol population. Mean sCTX values were 0.48 ng/mL during the follicular phase (FP), 0.47 ng/mL at serum luteinizing hormone peak, and 0.43 ng/mL during the luteal phase (LP). Additionally, the mean percent change from luteinizing hormone peak varied from +4.35% during the FP to -5.11% during the LP (P = 0.0014). Mean sCTX levels during the early and through mid FP were significantly higher than levels during the mid and late LP. The pattern for urinary N-terminal telopeptide of type I collagen was similar to that of sCTX but not statistically significant. There was a statistically significant tendency for procollagen type I N propeptide levels to be lower during the FP relative to the LP. Levels of osteocalcin and bone-specific alkaline phosphatase did not vary significantly during the menstrual cycle. CONCLUSIONS: Levels of some bone turnover markers varied during the menstrual cycle. A statistically significant change in sCTX (9.46%) occurred between the FP and LP of the menstrual cycle.
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Gass ML, Kagan R, Kohles JD, Martens MG. Menopause. 2008 Jul-Aug; 15(4 Pt 1):667-75.
Identifying Meaningful Differences in Vasomotor Symptoms Among Menopausal Women
Identifying meaningful differences in vasomotor symptoms among menopausal women
Full Abstract: OBJECTIVE: First, to identify treatment satisfaction thresholds for interpreting treatment-related changes in vasomotor symptoms, and, second, to determine the doses of desvenlafaxine (DVS) (administeredas desvenlafaxine succinate) that effectively provide relief of vasomotor symptoms considered important by menopausal women. DESIGN: Efficacy and treatment satisfaction were assessed in 620 postmenopausal women with moderate to severe vasomotor symptoms participating in a double-blind, placebo-controlled trial and randomly assigned to placebo or 50, 100, 150, or 200 mg DVS. Number and severity of hot flushes and number of nighttime awakenings were recorded in daily diaries for 12 weeks of treatment. At week 12, responses to the Menopause Symptoms Treatment Satisfaction Questionnaire were compared with efficacy results. RESULTS: Greater percentages of participants in the DVS groups reported being "satisfied" or "extremely satisfied" with daytime and nighttime control of hot flushes compared with placebo. The treatment satisfaction threshold, defined as the difference between the average reduction in vasomotor symptoms for women who were "neutral" versus "satisfied," was 1.64 for moderate to severe hot flushes and 0.42 for nighttime awakenings. Statistically significant reductions with 100, 150, and 200 mg DVS exceeded treatment satisfaction threshold results for at least one of these thresholds, and results with 100 mg DVS compared with placebo exceeded both treatment satisfaction thresholds. CONCLUSIONS: Among menopausal women with moderate to severe vasomotor symptoms, the treatment satisfaction thresholds that were meaningful to participants were 1.64 fewer moderate to severe hot flushes per day and 0.42 fewer nighttime awakenings per night. A dose of 100 mg DVS met both of these important vasomotor symptom change thresholds.
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Wyrwich KW, Spratt DI, Gass M, Yu H, Bobula JD. Menopause. 2008 Jul-Aug;15(4 Pt 1):698-705.
Bone Mineral Density at Menopause Does not Predict Breast Cancer Incidence
Bone mineral density at menopause does not predict breast cancer incidence
Full Abstract: SUMMARY: In this prospective study in 2,137 perimenopausal and early postmenopausal women who were followed over a 13.1-year period of time, we observed no association between bone mineral density measured at the beginning of menopause and the subsequent risk of breast cancer. INTRODUCTION: This study aimed to investigate the relationship between BMD and the risk of breast cancer (BC) in young postmenopausal women. METHODS: As part of a clinical research program, 2,137 women who were perimenopausal or within their 5 first postmenopausal years were scanned between 1988-1990 and reviewed on average 13.1 years after their initial examination. Ninety-eight incident BC cases were recorded throughout the follow-up. RESULTS: Women with incident BC significantly differed from those who had never had BC with regard to age at menarche, age of birth of 1st child, familial history of BC and postmenopausal hormone therapy (PHT) use. There was no significant difference between the two groups for baseline DXA of the spine. There was a trend for BC cases for having lower femoral neck BMD compared to women without BC. However, women with low BMD were more likely to have taken PHT by the end of the study. In Cox multivariate analyses the relationship between BC risk and femoral neck BMD no longer existed. CONCLUSIONS: There was no relationship between BMD measured within the first postmenopausal years and the risk of BC, which makes unlikely the possibility of using BMD as a predictor factor for BC in early postmenopausal women.
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Trémollieres FA, Pouillès JM, Laparra J, Ribot C. Osteoporos Int. 2008 Oct;19(10):1497-504.
DIABETES
Type 2 Diabetes and Glycemic Control in African AmericansAssociation between parental history of type 2 diabetes and glycemic control in urban African Americans
Abbreviated Abstract: OBJECTIVE: The purpose of this study was to examine the association between parental history of type 2 diabetes and glycemic control among diabetic urban African Americans. RESEARCH DESIGN AND METHODS: Study participants included 359 African Americans with type 2 diabetes. Participants underwent an interview-administrated questionnaire that asked about family history, sociodemographics, clinical characteristics, and knowledge and perception of adequate glycemic control. Regression analysis was used to determine the association between parental history of diabetes and glycemic control, as measured by A1C. CONCLUSIONS: From these results, we conclude that among the urban African American participants who were aware of their parental history of diabetes, a positive parental history was associated with worse glycemic control, partly due to longer duration of diabetes. Parental history did not appear to be associated with better knowledge or perception of adequate glycemic control.
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Gong L, Kao WH, Brancati FL, Batts-Turner M, Gary TL. Diabetes Care. 2008 Sep; 31(9):1773-6.
The Relationship of Reduced Nerve Function and Diabetes with Physical Performance
The relationship of reduced peripheral nerve function and diabetes with physical performance in older white and black adults: the Health, Aging, and Body Composition (Health ABC) study
Abbreviated Abstract: OBJECTIVE: Poor peripheral nerve function is prevalent in diabetes and older populations, and it has great potential to contribute to poor physical performance. RESEARCH DESIGN AND METHODS: Cross-sectional analyses were done for the Health, Aging, and Body Composition (Health ABC) Study participants (n = 2,364; 48% men; 38% black; aged 73-82 years). Sensory and motor peripheral nerve function in legs/feet was assessed by 10- and 1.4-g monofilament perception, vibration detection, and peroneal motor nerve conduction amplitude and velocity. CONCLUSIONS: Poor peripheral nerve function accounts for a portion of worse physical performance in diabetes and may be directly associated with physical performance in older diabetic and nondiabetic adults. The impact of peripheral nerve function on incident disability should be evaluated in older adults.
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Strotmeyer ES, de Rekeneire N, Schwartz AV, Faulkner KA, Resnick HE, Goodpaster BH, Shorr RI, Vinik AI, Harris TB, Newman AB. Diabetes Care. 2008 Sep; 31(9):1767-72.
The Decline in Early Mortality in Men and Women with Type 2 Diabetes
Explaining the decline in early mortality in men and women with type 2 diabetes: a population-based cohort study
Abbreviated Abstract: OBJECTIVE: The purpose of this study was to test the hypothesis that changing utilization of lipid-lowering, antihypertensive, and oral hypoglycemic drugs may be associated with trends in all-cause mortality in men and women with type 2 diabetes. RESEARCH DESIGN AND METHODS: This was a cohort study in 197 general practices in the U.K. General Practice Research Database including 48,579 subjects with type 2 diabetes first diagnosed between 1996 and 2006. Measures included all-cause mortality and prescription of hypoglycemic, lipid-lowering, and antihypertensive drugs. CONCLUSIONS: Widespread implementation of more effective prescribing to control lipids, blood glucose, and blood pressure may have contributed to recent declines in early mortality in men and women with type 2 diabetes.
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Charlton J, Latinovic R, Gulliford MC. Diabetes Care. 2008 Sep;31(9):1761-6.
EXERCISE AND PHYSIOLOGY
Differences in Treadmill Exercise ToleranceDifferences in treadmill exercise tolerance parameters between patients with partial and advanced interatrial depolarization abnormality
Full Abstract: Advanced interatrial block (aIAB) is considerably much less common than partial interatrial block (pIAB), occuring in <2% of the elderly hospitalized population. Less is, therefore, known of the true clinical burden of aIAB, particularly in relation to graded exercise. Therefore, 12 patients with aIAB and 30 patients with pIAB who performed a baseline exercise tolerance test and had a repeat test performed > or = 2 years later were included in the study. Exercise tolerance, echocardiographic findings, and major adverse cardiovascular events were compared. Left atrial size progressed at a significantly faster rate in those with aIAB. In addition, Duke Prognostic Treadmill scores were significantly lower on follow-up in those patients with aIAB. Overall, patients with aIAB had significantly greater left atrial size (48.3 +/- 9 vs 42.8 +/- 4 mm, p < 0.01) and significantly lower Duke Prognostic Treadmill scores than those with pIAB (-0.2 +/- 5 vs 4.1 +/- 4, p < 0.05). There were, however, no significant differences in the occurence of major adverse cardiovascular events. In conclusion, left atrial size progressed at a significantly faster rate but Duke Prognostic Treadmill scores were significantly lower in those with aIAB compared with patients with pIAB after > or = 2 years of follow-up. Further study is required to determine whether patients with aIAB require follow-up echocardiography and/or exercise tolerance tests for optimal risk stratification.
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Raja A, Ariyarajah V, Fernandes J, Apiyasawat S, Khadem A, Barac I, Spodick DH. Am J Cardiol. 2008 Oct 1;102(7):866-70.
Impact of Genetics on Low Bone Mass in Adults
Impact of genetics on low bone mass in adults
Full Abstract: Low bone mass in adults is a major risk factor for low-impact fractures and is considered of complex origin because of interaction of environmental and genetic factors, each with modest effect. The objective was to assess the relative impact of genetics and environment and quantify the risk in relatives of osteopenic individuals. We studied 440 Icelandic nuclear families with 869 first-degree relatives of both sexes. Index cases (male or female) had BMD in the lumbar spine or hip >1.5 SD less than sex-matched controls. Heritability of BMD was estimated by maximum likelihood method, and variance component analysis was used to partition the genetic and environmental effects. Relative risk of low BMD (< -1 SD) in first-degree relatives was estimated, and heritable decrement in BMD was calculated compared with controls. Heritability was estimated as 0.61-0.66. Relative risk among first-degree relatives was 2.28, and the yield of screening was as high as 36%. The genetic influence was consistent with one or a few genes with considerable effect in addition to multiple genes each with a small effect. The genetic deficit in BMD was already present before 35 yr of age and equaled bone loss during 8-30 yr after menopause. We confirmed that genetics are more important than environment to low bone mass in adults. Our results are consistent with a few underlying genes with considerable effect. The prevalence among first-degree relatives of both sexes is common, suggesting that screening them should be cost effective and informative to elucidate the underlying genetics.
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Sigurdsson G, Halldorsson BV, Styrkarsdottir U, Kristjansson K, Stefansson K. J Bone Miner Res. 2008 Oct;23(10):1584-90.
The Developmental Origins of Sarcopenia
The developmental origins of sarcopenia: using peripheral quantitative computed tomography to assess muscle size in older people
Full Abstract: BACKGROUND: A number of studies have shown strong graded positive relationships between size at birth, grip strength, and estimates of muscle mass in older people. However no studies to date have included direct measures of muscle size. METHODS: We studied 313 men and 318 women born in Hertfordshire, United Kingdom between 1931 and 1939 who were still resident there and had historical records of growth in early life. Information on lifestyle was collected, and participants underwent peripheral quantitative computed tomography to directly measure forearm and calf muscle size. RESULTS: Birth weight was positively related to forearm muscle area in the men (r = 0.24, p <.0001) and women (r = 0.17, p =.003). There were similar but weaker associations between birth weight and calf muscle area in the men (r = 0.13, p =.03) and in the women (r = 0.17, p =.004). These relationships were all attenuated by adjustment for adult size. CONCLUSION: We present first evidence that directly measured muscle size in older men and women is associated with size at birth. This may reflect tracking of muscle size and is important because it suggests that benefit may be gained from taking a life course approach both to understanding the etiology of sarcopenia and to developing effective interventions.
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Sayer AA, Dennison EM, Syddall HE, Jameson K, Martin HJ, Cooper C. J Gerontol A Biol Sci Med Sci. 2008 Aug;63(8):835-40.
Moderate Impact Exercise on Skeletal Integrity in Master Athletes
The effect of moderate impact exercise on skeletal integrity in master athletes
Abbreviated Abstract: SUMMARY: We measured bone mineral density (BMD) in senior athletes competing in running and swimming events and compared results to those of sedentary controls. Total body BMD was greatest among runners suggesting that moderate impact activities continue to play a role in maintaining skeletal integrity with age. INTRODUCTION: The role of moderate impact exercise in maintaining skeletal integrity as we age remains unclear. METHODS: To determine the effect of moderate impact exercise on skeletal integrity in the elderly, we recruited master athletes, including 44 runners (moderate impact exercise) and 43 swimmers, competing in the 2005 National Senior Olympic Games and 87 non-athletes, all over the age of 65 years. CONCLUSION: These findings suggest that moderate impact exercise contributes to skeletal integrity in older age.
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Velez NF, Zhang A, Stone B, Perera S, Miller M, Greenspan SL. Osteoporos Int. 2008 Oct;19(10):1457-64.
Screening for Osteoporosis in Men: A Clinical Practice Guideline from the American College of Physicians
Screening for osteoporosis in men: a clinical practice guideline from the American College of Physicians
Abbreviated Abstract: The American College of Physicians developed this guideline to present the available evidence on risk factors and screening tests for osteoporosis in men. RECOMMENDATION 1: The American College of Physicians recommends that clinicians periodically perform individualized assessment of risk factors for osteoporosis in older men (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 2: The American College of Physicians recommends that clinicians obtain dual-energy x-ray absorptiometry for men who are at increased risk for osteoporosis and are candidates for drug therapy (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 3: The American College of Physicians recommends further research to evaluate osteoporosis screening tests in men.
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Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK. Ann Intern Med. 2008 May 6;148(9):680-4.
COGNITIVE
Cognitive Decline During Aging
Role of neuroendocrine pathways in cognitive decline during aging
Full Abstract: The pineal and pituitary-adrenocortical secretions play an important role in adaptive responses of the organism acting as coordinating signals for both several biological rhythms and multiple neuroendocrine and metabolic functions. The more relevant neuroendocrine changes occurring with ageing affect the secretion of melatonin and of corticosteroids. These changes may be clearly appreciated by the study of their circadian rhythmicity. The circadian profile of plasma melatonin was clearly flattened in elderly subjects and even more in old individuals with dementia. Indeed, the impairment of melatonin signal occurring in aging was related either to age itself or to the cognitive performances of subjects. The biosynthetic dissociation between glucocorticoids and androgen secretion is responsible for the selective impairment of androgens, such as DHEA and DHEA-S, by comparison to cortisol. Due to the opposite effects of the two kinds of corticosteroids either in the periphery and in the CNS, the imbalance between glucocorticoids and androgens, well demonstrated by the evaluation of the cortisol/DHEA-S molar ratio, may be responsible for the occurrence in the CNS of a more neurotoxic steroidal milieu, already present in clinically healthy elderly subjects and especially in patients with dementia. The effects of that steroidal milieu are more prominent at the level of the hippocampal-limbic structure, involved both in the modulation of endocrine structures, such as the HPA axis, and in the control of cognitive, behavioral and affective functions.
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Ferrari E, Magri F. Ageing Res Rev. 2008 Jul; 7(3):225-33.
The Importance of Daytime Movement
Cognition in Older Women: The Importance of Daytime Movement
Abbreviated Abstract: OBJECTIVES: To determine whether an objective measure of daytime movement is associated with better cognitive function in women in their 80s. SETTING: A study of health and aging. PARTICIPANTS: Two thousand seven hundred thirty-six older women without evidence of dementia. MEASUREMENTS: Daytime movement was assessed using actigraphy, which involved wearing a watch-like device that objectively quantified accelerometer motion over a mean of 3.0+/-0.8 days. Cognitive function was measured using the Trail-Making Test, Part B (Trails B) and the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as performing 1.5 standard deviations (SDs) worse than the mean on a given test. CONCLUSION: Daytime movement as measured objectively using actigraphy was associated with better cognitive function and lower odds of cognitive impairment in women in their 80s. Additional studies are needed to clarify the direction of the association and to explore potential mechanisms.
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Barnes DE, Blackwell T, Stone KL, Goldman SE, Hillier T, Yaffe K; for the Study of Osteoporotic Fractures. J Am Geriatr Soc. 2008 Jul 24.
Self-reported Distress After Cognitive Testing in Patients
Self-reported distress after cognitive testing in patients with Alzheimer's disease
Abbreviated Abstract: BACKGROUND: The prevalence and degree of self-reported distress that patients with Alzheimer's disease (AD) experience after cognitive testing remain unknown. It is also unknown whether this level of distress is at all related to specific patient factors, test performance, or awareness of test performance. METHODS: In 154 mild-to-moderate AD patients and 62 cognitively intact patients, we measured self-reported distress, on a five-point Likert scale, after 45 minutes of cognitive testing. Using multivariate logistic regression, we then examined whether demographic factors, level of education, depressive symptoms, cognitive performance, perceived test difficulty, and perceived test performance compared to 10 years ago were predictive of self-reported distress. CONCLUSION: Cognitive tasks provoke more distress in patients with mild-to-moderate AD compared with persons who do not have dementia. Predictors of distress are more closely related to patient awareness about test difficulty and performance, rather than actual test performance.
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Lai JM, Hawkins KA, Gross CP, Karlawish JH. J Gerontol A Biol Sci Med Sci. 2008 Aug; 63(8):855-9.
OTHER
Frailty in Older Mexican-American and European-American AdultsFrailty in Older Mexican-American and European-American Adults: Is There an Ethnic Disparity?
Full Abstract: Because conventional frailty screening criteria have been standardized in predominantly European-American (EA) cohorts, applying them to ethnically diverse populations may result in inaccurate estimation of frailty prevalence in ethnic minorities. The objective of this study was to determine whether use of ethnic-specific criteria (EC) to characterize frailty in a bi-ethnic cohort results in significant differences in frailty prevalence when compared with the prevalence obtained using conventional criteria (CC). Data were from a random sample of community-dwelling Mexican Americans (MAs) (n=394) and EAs (n=355) aged 65 to 80 who participated in the baseline examination of the San Antonio Longitudinal Study of Aging. Frailty was defined as three or more of five characteristics: slow walking speed, weak grip strength, low energy expenditure, self-reported exhaustion, and weight loss. For CC, walking speed was standardized to height and sex, grip strength was standardized to body mass index and sex, and energy expenditure was standardized to sex using the pooled sample. For EC, these criteria were applied within each ethnic group. Frailty prevalence in MAs and EAs was compared using chi-square statistic. Using CC, a higher proportion of MAs than EAs were frail (11.3% vs 7.0%, P=.045). Using EC, there was no difference in frailty prevalence between MAs and EAs (9.9% in both ethnic groups). The application of conventional frailty screening criteria in a bi-ethnic cohort results in a higher prevalence of frailty in MAs than in EAs. In determining whether there are ethnic disparities in frailty, future studies should carefully consider whether CC or EC should be applied.
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Espinoza SE, Hazuda HP. J Am Geriatr Soc. 2008 Jul 24.
Patient Ethnicity and the Identification of Anxiety in Elderly
Patient Ethnicity and the Identification of Anxiety in Elderly Primary Care Patients
Full Abstract: OBJECTIVES: To examine the role of ethnicity and primary care physician (PCP) identification of anxiety in older adults. DESIGN: A cross-sectional survey conducted between 2001 and 2003. SETTING: Primary care offices in the Baltimore, Maryland, area. PARTICIPANTS: A sample of 330 adults aged 65 and older from Maryland primary care practices with complete information on psychological status and physician assessments. MEASUREMENTS: PCPs were asked to rate anxiety on a Likert scale. Patient interviews included measures of psychological status and patient use of psychotropic medications. RESULTS: Older black patients were less likely than older white patients to be identified as anxious (unadjusted odds ratio (OR)=0.34, 95% confidence interval (CI)=0.18-0.64) and less likely to be taking psychotropic medications (unadjusted OR=0.40, 95% CI=0.20-0.81). In multivariate models that controlled for potentially influential characteristics including depression and anxiety symptoms, the association between identification (OR=0.30, 95% CI=0.15-0.61) with patient ethnicity remained significantly unchanged. CONCLUSION: PCPs were less likely to identify older black Americans as anxious than white patients. An understanding of the role of ethnicity in the identification of anxiety is important for the screening and management of anxiety in elderly people.
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Kim YA, Morales KH, Bogner HR. J Am Geriatr Soc. 2008 Aug 5.
About the Kronos Longevity Research Institute
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