Adherence to a Mediterranean Dietary Pattern and Functional Parameters: A Cross-Sectional Study in an Older Population

OBJECTIVES

In older adults, diet and physical activity are among the most important behaviours that influence health. The Mediterranean Dietary Pattern has been related to longevity and can benefit physical function in older adults. The present study aims to quantify the association of adherence to a Mediterranean Dietary Pattern with physical functioning through by handgrip strength, as well as, with sedentary behaviour based on sitting time, in a sample of older adults.

METHODS

A cross-sectional study was conducted in 1,491 older adults ≥ 65 years old. The adherence or non-adherence to a Mediterranean Dietary Pattern was assessed using the previously validated and translated 14 item questionnaire, the PREDIMED (Prevención com Dieta Mediterránea). Handgrip strength was measured with a Jamar Dynamometer. Sitting time per day was used as an indicator of sedentary behaviour. Multinomial logistic regressions were performed to quantify the association of adherence to a Mediterranean Dietary Pattern with handgrip strength and sitting time.

RESULTS

Compared to participants who adhered to a Mediterranean Dietary Pattern, those who did not adhere to this diet have a significantly higher adjusted odds ratio for low handgrip strength [adjusted odds ratio: 1.50; 95% confidence interval: 1.09-2.05], as well as for longer sitting time [adjusted odds ratio: 1.43; 95% confidence interval: 1.04-1.96].

CONCLUSION

In older adults, the non-adherence to a Mediterranean Dietary Pattern was associated with both lower values of handgrip strength and longer sitting time.

161 Increasing the dose of cloprostenol sodium reduced pregnancy losses but did not increase pregnancies per AI in lactating dairy cows

Incomplete luteolysis after last prostaglandin F2α (PGF2α) of Ovsynch in fertility programmes decreases the likelihood of pregnancy per AI (P/AI) in lactating dairy cows (Martins et al. 2011 J. Dairy Sci. 94, 2815-2824; https://doi.org/10.3168/jds.2010-3652). Two doses of PGF2α 24h apart increased the percentage of cows with complete luteolysis (Brusveen et al. 2009 J. Dairy Sci. 92, 1412-1422; https://doi.org/10.3168/jds.2008-1289). Increasing the dose of cloprostenol sodium (CLO) from 0.5 to 0.75mg enhanced luteolytic properties and increased P/AI (Giordano et al. 2013 Theriogenology 80, 773-783; https://doi.org/10.1016/j.theriogenology.2013.07.003). We hypothesised that a 1.0-mg dose of CLO would not have different P/AI compared with two 0.5-mg doses 24h apart but would have greater P/AI than a single dose (0.5mg) in a timed AI programme. We also hypothesised that dose of CLO would not affect pregnancy losses. The objective was to determine the effect of cloprostenol dose on P/AI and pregnancy losses in lactating dairy cows. Lactating dairy cows (n=944) were randomly assigned to three treatments of various CLO doses at final PGF2α of Ovsynch: single dose (0.5 mg; n=338), two doses 24h apart (0.5mg each; n=311), or double dose (1.0 mg; n=295). Cows were randomly assigned to treatments by parity, synchronisation status, and type of AI (Double-Ovsynch (n=546) for first AI or GGPG (GnRH-GnRH-PGF2α-GnRH; n=398) for second and third AI). Cows were classified as either synchronised or non-synchronised based on evaluation of follicle and corpora lutea (CL) development during synchronisation protocols using ultrasound. Synchronised cows were defined as having at least one Day 7 and Day 14 CL at time of treatment. About 72% of all cows were classified as synchronised. Synchrony was not different between treatments. Within-cow pregnancy-specific protein B levels on Days 17 and 24 post-AI were used to determine pregnancy at 24 days. Pregnancy was confirmed via ultrasonography 34 days post-AI. All binomial variables were analysed using chi-square with PROC FREQ in SAS (SAS Institute Inc.). There were no differences between treatments on P/AI on d 24 post-AI (55, 50, and 53% for 0.5mg, two doses of 0.5mg 24h apart, and 1.0mg, respectively; P=0.35). At 24 days post-AI, P/AI were greater in synchronised versus non-synchronised cows (57 vs. 42%; P<0.0001). Older cows (third parity or greater) had reduced P/AI (44%) compared with first-parity (60%) and second-parity (54%) cows at 24 days post-AI (P=0.0001). At 24 days post-AI, P/AI in cows inseminated following Double-Ovsynch were greater than those in cows that were resynchronised using GGPG (58 vs. 46%; P=0.0001). Pregnancy loss between 24 and 34 days post-AI was greater for cows receiving 0.5mg (single dose) versus two 0.5-mg doses 24h apart or 1.0mg (12, 6, and 5%, respectively; P=0.02). In summary, cows receiving a double dose (1.0mg) of CLO had similar P/AI to cows receiving two doses of 0.5mg 24h apart. Unexpectedly, P/AI at 24 days post-AI in cows from the single-dose group were not different from those of cows treated with a double dose and two doses 24h apart. Despite numerically higher P/AI, cows that received a single dose had greater pregnancy loss between 24 and 34 days post-AI. Further analyses of effects of treatment on luteal function assessed with colour Doppler may provide information about fertility outcomes.

A Bridge to Wellness: Gains from a health fair among fishermen in the Port of New Bedford, USA

Background

Globally, it has been noted that fishermen have a higher mortality from cardiovascular disease, cancer, and injury from work-related accidents when compared to the general population. A potential increase in unemployment in fishermen in New Bedford could result in a lower income level which relates to an increase in risk behaviors, less health screenings, and negative health behaviors. While there is a lack of health-related data among fishermen across the globe, there is little information regarding the health among fishermen, who are predominantly immigrants, in the US.

Objectives

The objectives include designing a health promotion fair to prepare nursing students with the skills to educate fishermen associated with nutrition, diabetes mellitus, cancer and hypertension as identified by key informants in the community.

Results

Students expressed gains in achieving nursing competencies related to collaboration, communication, and teaching/learning by designing a fair with stations related to the four health topics with posters and activities. Educational materials were available in both Portuguese and English to support this aggregate who expressed learning new knowledge. Networking among local fishing agencies, nursing students and the fishermen supported this project from start to finish.

Conclusions

Despite limited access to this vulnerable group, learning nursing competencies and increased fishermen’s knowledge were realized. Connecting students with vulnerable populations is an effective way to promote learning for both groups.

Key messages

Multiple gains are noted when nursing students are paired with vulnerable community aggregates. Learning to work in the community with local agencies and groups is an effective teaching/learning pedagogy.

Bridging Generations: Sharing stories from the past with the future

Background

As the immigration population continues to grow; little is known about this phenomenon from the immigrants’ perspective. In recent years, nurses have embraced narrative inquiry to better understand the human experience. When relaying their stories, vulnerable groups legitimize their behavior, share their emotional experiences, and amplify their voices that may have otherwise remained silent.

Objective

Eight elderly Portuguese women who immigrated to the United States (US) were interviewed about their experience of immigration by nursing students from Portugal and U.S., as part of a student exchange. The objective of this project was to better understand the impact of immigration through narrative inquiry.

Results

On average, the women lived in the US for approximately fifty years; immigrating in their early twenties. Most women arrived alone or accompanied by spouse and/or children. Their first memories were related to snow, and solitude of being in a new country. The participants attended classes to obtain documents or learn English. All worked in the textile industry; their greatest accomplishment was buying their own house. Challenges faced were related to language and difficult jobs. Overall, they had no regrets except in leaving family members behind. Their message to the students was that love and family are most important in the world. Students were able to realize emigration and immigration from their respective countries.

Conclusions

Rich descriptions provided an in-depth understanding of the details of the women’s experience. Student nurses gained valuable skills and knowledge to understand the impact of immigration among Portuguese women using narrative inquiry.

Key messages

The use of narrative inquiry proved to be a valuable method to interview Portuguese immigrant women. Every immigrant has a unique narrative to share that allowed for nursing student’s appreciation of the experience across generations.

Are hypohydrated older adults at increased risk of exhaustion?

BACKGROUND

Dehydration appears to affect muscle strength and weakness, although its influence on exhaustion remains unclear. The present study aimed to quantify the association between hydration status and exhaustion among older adults.

METHODS

A cluster sampling approach was used, representing Portuguese older adults (≥65 years) according to age, sex, education level and region within the Nutrition UP65 cross-sectional study. A 24-h urine sample was collected to estimate free water reserve (FWR), which was categorised into tertiles according to sex. Subjects with incomplete 24-h urine and renal disease were excluded. From a sample size of 1500 subjects, 1143 were eligible. Exhaustion was self-reported according to the Center for Epidemiologic Studies Depression Scale. A logistic regression model was conducted to evaluate the association between FWR and exhaustion. Odds ratios and the respective 95% confidence intervals were calculated by sex and age.

RESULTS

Free water reserve median (interquartile range) was 0.52 (0.68) L in women and 0.36 (0.77) L in men. Hypohydration affected 11.6% of women and 25.1% of men, whereas exhaustion was reported by 39.3% of women and 25.1% of men. After adjusting for confounders, women ≥80 years classified in the highest tertile of FWR showed a decreased risk of exhaustion (third tertile: odds ratio = 0.38; 95% confidence interval = 0.15-0.96) compared to women in the lowest FWR tertile. No such significant association was observed in women with <80 years and in men.

CONCLUSIONS

These results show an association between worse hydration status and exhaustion in older women, highlighting the need to implement further studies clarifying this association.

P2683Beneficial effects of red wine intake upon gut microbiota and parallel effects upon plasma metabolomics

Background

Evidence suggests that red wine (RW) components can influence favorably gut microbiota. However, Interactions of RW, gut microbiota and plasma metabolomics remain unclear.

Purpose

The goal of this study was to assess the effects upon gut microbiota and plasma metabolomic profile of short-term, moderate RW intake in patients (pts) with documented coronary artery disease (CAD)

Methods

Forty-two males aged 60.4±5.4 years (SD) with documented CAD by angiography underwent a randomized, crossover, controlled, interventional trial. They were assigned to either RW treatment or abstinence from any alcoholic beverage, as control. Each treatment was preceded by a 2-week washout period. During the RW intervention, subjects ingested 250 ml of RW per day/ 5 days a week/ 3 weeks. Fasting blood samples and fecal samples were collected 4 times, after washout and at the end of each 3-week intervention. Gut microbiota was analysed by 16 S rRNA gene sequences and plasma metabolomics was performed by Ultrahigh Performance Liquid Chromatography-Tandem Mass Spectroscopy. Twenty pts chosen randomly had their global metabolic profiles examined at all visits. Diet was carefully controlled and quantified by a 3 day/week questionnaire at beginning and end of the study. Prebiotics, probiotics were not allowed during the study. Patients in need for antibiotic therapy were not included.

Results

In the RW period compared to abstinence, fecal metagenomic revealed a decrease in abundance of Collinsella, a bacterial genus correlated with atherosclerosis; an increase in Eubacterium, genus related to fiber digestion and bile acid metabolism; and a significant increase in alpha diversity (p<0.05 for all). In plasma, trimethylamine N-oxide (TMAO), fell non-significantly post RW consumption. HDL and resveratrol increased after RW consumption (p<0.05). Plasma metabolomic analysis of 20 pts revealed microbiome related changes associated with RW consumption: decreased levels of phenylalanine, benzoate, tyrosine and tryptophan; lower levels of primary bile acids (BA) cholate, taurocholate, and also secondary BA deoxycholate and lithocholate sulfate. In parallel, RW elevated androgenic steroids and decreased beta oxidation (p<0.05 for all). Simultaneously total energy, proteins, carbohydrates and fat components of the diet did not change significantly.

Conclusions

Moderate RW ingestion augmented microbiota diversity, increased the proportion of putative anti-atherosclerotic bacteria and influenced plasma metabolomics. RW influenced energy metabolism through gut microbiota related plasma changes in amino acids, nucleotide profile, bile acids, androgenic steroids and beta-oxidation. These findings furnish some novel insight into mechanisms whereby RW may mitigate atherosclerosis.

Acknowledgement/Funding

FAPESP (Fundacao de Amparo à Pesquisa do Estado de Sao Paulo), IBRAVIN (Instituto Brasileiro do Vinho), Banco Bradesco SA

P184511 years of transcatheter aortic valve implantation in a single centre and outcomes for all 1004 patient cases completed

Background

Long-term outcome data after TAVI is of key importance as indications have extended from high risk patients to intermediate risk alongside contemporary study of low risk patients.

Purpose

We report our complete 11 y experience of TAVI.

Methods

All patients (n=1004) treated with TAVI in our institution between Feb 2008 & Nov 2018 were included. Data was collected prospectively and all death certificates were reviewed. Independent predictors of mortality were determined by multivariable cox proportional hazard modelling. Annular sizing was performed via echocardiography +/or angiography until Aug 2012 after which time cardiac CT was used.

Results

Patients were 53% female & had mean age 81.9±6.6 y, logistic EuroScore 18.5%. 89% were NYHA >2, and 26.7% had a left ventricular ejection fraction (LVEF) of <50%. TAVI was performed for severe degenerative aortic valve disease (93.5%), while valve-in-valve (2.4%) bicuspid (2.1%) & rheumatic (2%) made up the remainder. Self-expanding valves were implanted in 73% cases. 98% cases were performed under local anaesthesia. A percutaneous transfemoral approach was used in 92% cases. For the first 6 y 19% procedures were performed for urgent inpatients, rising to 42% over the last 5 y. The mean time to discharge was 5.5 d, overall, & 60% cases were discharged within 72 h in the last 5 y. Mortality, for those at risk, was 3.2%, 12.8%, 53% & 88% at 30 d, 1 y, 5 y & 10 y. The median time to death was 2.6 y. Non-cardiac death accounted for 62% deaths, with sepsis being the main cause (55%). The main cause of cardiac death was heart failure (HF (53%)). Independent clinical predictors of death were increased age, atrial fibrillation, pulmonary disease & LVEF <50%. Use of a 2nd generation valve was associated with better survival at 5 y (p<0.001).

30 d new permanent pacemaker and stroke incidence were 13.7% and 2% respectively. 30 d readmission occurred in 13% patients. Independent clinical predictors of 1 y HF (7%) readmission were NYHA Class >2 and LVEF <50%. Endocarditis was seen in 1.6% during a mean follow-up 2,593 patient y. Mean aortic gradients at 1 y, 5 y & 10 y were 9.7mmHg, 8.4mmHg & 10.53mmHg. One patient had severe trans-aortic regurgitation during the follow-up. A 2nd TAVI procedure was performed in 5 patients with clinically significant paravalvular regurgitation, all within 30 d.

Figure 1. A. Survival. B. Predictors death

Conclusion

This comprehensive evaluation of all patients treated with this innovative technology provides reassurance regarding the long-term clinical efficacy of TAVI & gives insight into the evolution of our programme with time.