Influence of Dietary Patterns and Inflammatory Markers on Atherosclerosis Using Ankle Brachial Index as a Surrogate

OBJECTIVE

To examine the influence of various dietary patterns on ankle-brachial index (ABI) as a surrogate of atherosclerosis, taking into account serum levels of C-reactive protein (CRP) and factors that predispose to inflammation and/or endothelial damage (homocysteine) or may be protective (tryptophan, vitamin D), as well as age, gender, and lifestyle risk factors.

DESIGN

Cross sectional analysis.

SETTING

Cohort of 4000 men and women aged 65 years living in the community in Hong Kong SAR China.

MEASUREMENTS

Interviewer administered questionnaire that includes dietary intake estimation by the food frequency records (from which various dietary patterns can be characterized), socioeconomic status, smoking habit, alcohol consumption, physical activity. Clinical measurements include body weight and height, and ankle-brachial index using hand-held Doppler machine. Laboratory measurements include assays of serum 25 hydroxyvitamin D, CRP, homocysteine, and tryptophan using LC/MC methods.

RESULT

Compared with the lowest quintile of vitamin D level, higher quintile was associated with lower prevalence of ABI <0.9 in women only after multiple adjustments of covariates. In men the low score group of the vegetables-fruits dietary pattern was associated with increased odds of having ABI<0.9 after adjusting for all covariates (OR=16.51 (95% CI: 2.21, 123.26)). Similar findings apply to the low score group in the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay Diet) pattern (OR=2.6 (95% CI: 1.24, 5.42)). In women, ABI<0.9 was associated with low Dietary Quality Index (DQI) score (OR=2.05 (95% CI: 1.22, 3.43)), and low score group of snacks-drinks-milk products dietary pattern (OR=3.07 (95% CI: 1.05, 9.04)). No association was observed for the Mediterranean Dietary Pattern (MDS), Dietary Approaches to Stop Hypertension (DASH), Okinawan and "meat-fish" dietary patterns in either men or women.

CONCLUSION

We conclude that any dietary patterns emphasizing fruit and vegetable intake are associated with better vascular health using ABI as an indicator.

International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management

OBJECTIVES

Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR).

METHODS

To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process.

RECOMMENDATIONS

We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.

Decline and Peripheral Redistribution of Fat Mass in Old Age - A Four-Year Prospective Study in 3018 Older Community-Living Adults

BACKGROUND

It is widely recognized that fat will accumulate with ageing and is more prominent centrally. However, there were studies reported that fat might not gain either centrally or generally with ageing.

METHODS

The baseline, 2-year and 4-year total body fat mas, trunk fat mass and percentage fat mass, were measured by DXA in 3018 community-living Chinese older than 65 years. The respective 4-year trajectories of adiposity were analyzed by repeated measure ANOVA p-for-trend test.

RESULTS

There was a trend of increase in total body fat mass in men and a decreasing trend in women but neither reached statistical significance. However, there was a significant increase in percent fat mass in both genders. Fat mass was relatively stable in the 2 young-old groups but it declined in the oldest group, aged 75 years or above. (men, p=0.017; women, p<0.001). On the contrary, a corresponding rise of percent fat mass was observed, which was steeper in the 2 younger age groups but did not change in the oldest group. For trunk fat mass, there was a statistically significant decreasing trend in women (p < 0.001) but it remained static in men (p = 0.092). The fat mass in upper limbs of both genders did not change but for the lower limbs, there was a statistically significant increase in both men (p < 0.001) and women (p < 0.02).

CONCLUSION

Absolute total body fat mass does not accumulate in old age and in the contrary, in the oldest old group (75 years or above), it declined instead. With ageing, fat will redistribute from the central region to the lower limbs.

Variability in Repeated Blood Pressure Measurements as a Marker of Frailty

OBJECTIVES

Variation in repeated blood pressure measurements may represent a decline in homeostatic mechanisms in blood pressure regulation in response to various internal or external stressors, indicating a frail state. We tested this hypothesis by examining the association between variability in repeated blood pressure measurements (BPV) and frailty status, adjusting for other confounding factors.

DESIGN

A longitudinal cohort study.

SETTING

Community centres in all three regions of Hong Kong.

PARTICIPANTS

1156 community-living older adults aged 60 years and over participated in a community geriatric screening program with blood pressure measurements three times a week over one year. Participants were divided into three groups based on variability of repeated blood pressure measurements (low, medium, high) using machine learning methods.

MEASUREMENTS

Frailty status was assessed using the FRAIL scale. Logistic regression was used to examine cross sectional association between frailty status and BPV adjusting for confounding factors, and also frailty transition with BPV.

RESULTS

In multi-variate models adjusting for co-variates, high BPV was associated with frailty (OR 1.57; 95% CI 1.05-2.37) among all participants; however, this was only significant in women in subgroup analysis. Similar findings were observed when transition to a more frail state was examined over a twelve month period.

CONCLUSIONS

The findings of this study support the concept of physiological dysregulation underlying the frail state, and that BPV calculated using machine learning methods may be used as a biomarker of such dysregulation.

Moderate iodine deficiency among pregnant women in Hong Kong: revisit the problem after two decades

INTRODUCTION

A survey conducted during 2005 to 2007 by the Centre for Food Safety in Hong Kong suggested that only 5% of the local population had a sufficient dietary intake of iodine. The study, however, was limited as biochemical data (ie urinary iodine concentration) were lacking. Pregnant women are vulnerable to iodine deficiency because of their increased requirement. Recent studies have shown that iodine deficiency in early pregnancy is associated with poorer cognitive development in early childhood. This study reports the iodine status of women during early gestation at an obstetric unit in Hong Kong.

METHODS

Healthy pregnant women with no history of hyperemesis gravidarum were enrolled into a study when they first made a booking in an antenatal clinic of a public hospital to investigate their iodine status during early pregnancy. All subjects were asked to collect their morning urine for measurement of iodine and creatinine levels. Daily dietary intake of iodine was assessed in a subgroup of participants by structured interview using a standard food frequency questionnaire.

RESULTS

A total of 600 pregnant women were enrolled at a median of 7.0 weeks of gestation. The median urinary iodine concentration and urinary iodine-to-creatinine ratio were 100 μg/L and 98 μg/g, respectively; 429 (71.5%) participants had iodine insufficiency according to the World Health Organization classification. Daily dietary intake of iodine was assessed in 146 participants. The median daily intake of iodine was 69.5 μg and 122 (83.6%) participants had an intake below the 250 μg recommended during pregnancy by the World Health Organization.

CONCLUSIONS

Local pregnant women continue to have an inadequate dietary intake of iodine and remain iodine-deficient.

Deficiency of aminopeptidase P1 causes behavioral hyperactivity, cognitive deficits, and hippocampal neurodegeneration

Metabolic diseases affect various organs including the brain. Accumulation or depletion of substrates frequently leads to brain injury and dysfunction. Deficiency of aminopeptidase P1, a cytosolic proline-specific peptidase encoded by the Xpnpep1 gene, causes an inborn error of metabolism (IEM) characterized by peptiduria in humans. We previously reported that knockout of aminopeptidase P1 in mice causes neurodevelopmental disorders and peptiduria. However, little is known about the pathophysiological role of aminopeptidase P1 in the brain. Here, we show that loss of aminopeptidase P1 causes behavioral and neurological deficits in mice. Mice deficient in aminopeptidase P1 (Xpnpep1^-/- ) display abnormally enhanced locomotor activities in both the home cage and open-field box. The aminopeptidase P1 deficiency in mice also resulted in severe impairments in novel-object recognition, the Morris water maze task, and contextual, but not cued, fear memory. These behavioral dysfunctions were accompanied by epileptiform electroencephalogram activity and neurodegeneration in the hippocampus. However, mice with a heterozygous mutation for aminopeptidase P1 (Xpnpep1^+/- ) exhibited normal behaviors and brain structure. These results suggest that loss of aminopeptidase P1 leads to behavioral, cognitive and neurological deficits. This study may provide insight into new pathogenic mechanisms for brain dysfunction related to IEMs.

Diabetes incidence and prevalence in Hong Kong, China during 2006-2014

AIMS

To estimate recent secular changes in the incidence and prevalence of diabetes and pre-diabetes among Hong Kong Chinese adults, and thus show possible future trends for developing mainland China.

METHODS

Based on a complete census of the public sector health records of 6.4 million people from 2006 to 2014, diabetes cases were ascertained using different methods including the World Health Organization (WHO) 2011 guidelines (HbA_1c , fasting plasma glucose and glucose tolerance test), American Diabetes Association (ADA) 2015 guidelines (plus random plasma glucose), and additionally recorded diagnosis codes and medication dispensation. Pre-diabetes was defined using ADA 2015 guidelines.

RESULTS

We identified 697 201 people with diabetes (54.2% were incident cases); and 1 229 731 people with diabetes or pre-diabetes. In 2014, the overall incidence of diabetes was 9.46 per 1000 person-years [95% confidence interval (CI): 9.38 to 9.54], and overall prevalence was 10.29% (95% CI: 10.27% to 10.32%). Incidence of diabetes decreased significantly from 2007 to 2014 (quadratic trend, P < 0.001). From 2006 to 2014, the prevalence of diabetes increased significantly in both sexes and across all age groups (quadratic trend, P < 0.001). The overall incidence of pre-diabetes in 2014 was 18.88 per 1000 person-years (95% CI: 18.76 to 18.99), and the overall prevalence of pre-diabetes was 8.90% (95% CI: 8.87% to 8.92%).

CONCLUSIONS

Similar to other developed western and Asian populations, diabetes (and pre-diabetes) incidence in Hong Kong Chinese appeared to have stabilized and there have been small declines during the period of observation. Ageing and survivorship will likely drive a continued increase in the prevalence of diabetes and pre-diabetes, albeit with a decelerating growth rate if past trends persist.

Evaluation of the effect of energy conservation techniques in the performance of activity of daily living tasks

Objective: To determine whether energy conservation techniques during common activity of daily living tasks actually result in lower energy expenditure, and to document subjective comments regarding any differences in the perceived level of effort.

Design: Descriptive study comparing energy expenditure in three tasks with and without energy conservation techniques, taking into account the effect of age.

Setting: Occupational therapy department of a rehabilitation hospital in Hong Kong.

Subjects: One hundred and eight subjects (30 < 60 years; 78 ≥ 60 years) were recruited from staff and members of an elderly social centre in the community.

Measurements: Energy expenditure was measured using a portable indirect calorimetry system for three tasks (shopping, washing clothes and hanging laundry) with and without energy conservation techniques. Dyspnoea, fatigue and perceived exertion were measured using visual analogue scales.

Results: Reduction in energy expenditure using energy conservation techniques for shopping and hanging laundry was documented in younger subjects only (O2 consumption fell from 13.89&plusmn;3.7 to 12.29&plusmn;3.8 mL/min per kg for shopping, P < 0.001 and 5.9&plusmn;1.2 to 5.0&plusmn;1.2 mL/min per kg, P < 0.001 for hanging laundry), although the older subjects experienced less perceived exertion with the energy conservation techniques. For washing clothes, no reduction in energy expenditure was observed in either age groups.

Conclusion: Measurable benefits were observed with use of labour-saving equipment and avoidance of overhead reaching in younger subjects only.