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Volkert D, Delzenne N, Demirkan K, Schneider S, Abbasoglu O, Bahat G, Barazzoni R, Bauer J, Cuerda C, de van der Schueren M, Doganay M, Halil M, Lehtisalo J, Piccoli GB, Rolland Y, Sengul Aycicek G, Visser M, Wickramasinghe K, Wirth R, Wunderle C, Zanetti M, Cederholm T. Nutrition for the older adult - Current concepts. Report from an ESPEN symposium. Clin Nutr 2024; 43:1815-1824. [PMID: 38970937 DOI: 10.1016/j.clnu.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND & AIMS In view of the global demographic shift, a scientific symposium was organised by the European Society for Clinical Nutrition and Metabolism (ESPEN) to address nutrition-related challenges of the older population and provide an overview of the current state of knowledge. METHODS Eighteen nutrition-related issues of the ageing global society were presented by international experts during the symposium and summarised in this report. RESULTS Anorexia of ageing, dysphagia, malnutrition, frailty, sarcopenia, sarcopenic obesity, and the metabolic syndrome were highlighted as major nutrition-related geriatric syndromes. Great progress has been made in recent years through standardised definitions of some but not all syndromes. Regarding malnutrition, the GLIM approach has shown to be suitable also in older adults, justifying its continuous implementation. For anorexia of ageing, a consensus definition is still required. Intervention approaches should be integrated and person-centered with the aim of optimizing intrinsic capacity and maintaining functional capacity. Landmark studies like EFFORT and FINGER have impressively documented the potential of individualised and multifactorial interventions for functional and health benefits. Combining nutritional intervention with physical training seems particularly important whereas restrictive diets and drug treatment should generally be used with caution because of undesirable risks. Obesity management in older adults should take into account the risk of promoting sarcopenia. CONCLUSIONS In the future, even more individualised approaches like precision nutrition may enable better nutritional care. Meanwhile all stakeholders should focus on a better implementation of currently available strategies and work closely together to improve nutritional care for older adults.
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Affiliation(s)
- D Volkert
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany.
| | - N Delzenne
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Brussels, Belgium.
| | - K Demirkan
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hacettepe University, Ankara, Turkiye.
| | - S Schneider
- Gastroenterology and Nutrition, CHU de Nice, Université Côte d'Azur, Nice, France.
| | - O Abbasoglu
- Department of Clinical Nutrition, Hacettepe University, Ankara, Turkiye.
| | - G Bahat
- Department of Internal Medicine, Division of Geriatrics, Medical Faculty, Istanbul University, Istanbul, Turkiye.
| | - R Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Italy.
| | - J Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Germany.
| | - C Cuerda
- Department of Medicine, Universidad Complutense, Nutrition Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - M de van der Schueren
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, The Netherlands; Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands.
| | - M Doganay
- Department of Surgery and Surgical Oncology, University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkiye.
| | - M Halil
- Department of Internal Medicine, Division of Geriatrics, Medical Faculty, Hacettepe University, Ankara, Turkiye.
| | - J Lehtisalo
- Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - G B Piccoli
- Nephrologie, Centre Hospitalier Le Mans, Le Mans, France.
| | - Y Rolland
- IHU HealthAge, Centre Hospitalo-Universitaire de Toulouse, France; Centre for Epidemiology and Research in POPulation Health, CERPOP UMR 1295, Toulouse, France.
| | | | - M Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - K Wickramasinghe
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark.
| | - R Wirth
- Department of Geriatric Medicine, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.
| | - C Wunderle
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
| | - M Zanetti
- Geriatric Clinic, Department of Medical Sciences, University of Trieste, Italy.
| | - T Cederholm
- Department of Clinical Nutrition & Metabolism, Uppsala University and Theme Inflammation & Aging, Karolinska University Hospital, Stockholm, Sweden.
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2
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de Souza M, da Silva Rocha G, de Souza Sampaio E, de Oliveira Garcia Rodrigues P, Vieira R, Souza Gomes A, Pereira de Brito T. Metabolic Syndrome and Positive Frailty Screening: A Cross-Sectional Study with Community-Dwelling Older Adults. JAR LIFE 2024; 13:82-87. [PMID: 38817671 PMCID: PMC11137116 DOI: 10.14283/jarlife.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024]
Abstract
Background Metabolic Syndrome is a set of disorders that characterized by the association of three or more risk factors, like the obesity central, dyslipidemia, borderline blood pressure, hyperglycemia, and the increase of triglycerides. However, these factors also can be associated with pathophysiology of frailty. Objectives verifying whether the metabolic syndrome is associated to the positive frailty screening in the older people. Design Cross-sectional study. Participants: 443 older people living in Rio Branco, Brazil. Setting Data collection was carried out in two stages: a personal interview and blood collection. Measurements The diagnosis of metabolic syndrome was based on the criteria of the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. The frailty screening was performed using subjective questions validated in a previous study. Descriptive statistics and multinomial logistic regression were used for data analyses. Results There was a predominance of female older people (69.07%), aged between 60 and 79 years (87.13%), with an income greater than or equal to one minimum wage (72.09%), no cognitive decline (75.94%) and depressive symptoms (63.31%), independent for BADL (86.46%) and dependent for IADL (51.69%). From the total sample, 56.88% of the older people were identified as frail, 34.09% pre-frail and 9.03% non frail. The prevalence of metabolic syndrome was 51.69%. After adjusting by the independent variables, an association between metabolic syndrome and pre-frailty was observed, and older people with metabolic syndrome were more likely to be prefrail (RRR=2.36; 95%CI=1.08-5.18). Conclusion The metabolic syndrome was associated to the increase chance of screening for prefrailty in the older people evaluated, which reinforces the needy to establish preventive measures in relation to the metabolic syndrome to avoid frailty in the older people.
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Affiliation(s)
- M.C.B. de Souza
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - G. da Silva Rocha
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - E. de Souza Sampaio
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
| | | | - R.A. Vieira
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - A.F. Souza Gomes
- Institute of Motricity Sciences, Federal University of Alfenas, Alfenas, Brazil
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3
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Mishra M, Wu J, Kane AE, Howlett SE. The intersection of frailty and metabolism. Cell Metab 2024; 36:893-911. [PMID: 38614092 PMCID: PMC11123589 DOI: 10.1016/j.cmet.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/15/2024]
Abstract
On average, aging is associated with unfavorable changes in cellular metabolism, which are the processes involved in the storage and expenditure of energy. However, metabolic dysregulation may not occur to the same extent in all older individuals as people age at different rates. Those who are aging rapidly are at increased risk of adverse health outcomes and are said to be "frail." Here, we explore the links between frailty and metabolism, including metabolic contributors and consequences of frailty. We examine how metabolic diseases may modify the degree of frailty in old age and suggest that frailty may predispose toward metabolic disease. Metabolic interventions that can mitigate the degree of frailty in people are reviewed. New treatment strategies developed in animal models that are poised for translation to humans are also considered. We suggest that maintaining a youthful metabolism into older age may be protective against frailty.
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Affiliation(s)
- Manish Mishra
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Judy Wu
- Institute for Systems Biology, Seattle, WA, USA
| | - Alice E Kane
- Institute for Systems Biology, Seattle, WA, USA; Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada; Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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4
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Zhou Q, Zhou L, Chen X, Chen Q, Hao L. Composite dietary antioxidant index is associated with reduced prevalence of metabolic syndrome but not mortality in metabolic syndrome: Results from NHANES 2001-2018. Prev Med Rep 2024; 41:102704. [PMID: 38576515 PMCID: PMC10992715 DOI: 10.1016/j.pmedr.2024.102704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
The relationship between the composite dietary antioxidant index (CDAI), a comprehensive measure of individual dietary antioxidants, and the prevalence and mortality of metabolic syndrome (MetS) remains unknown. We aimed to explore these relationships in the National Health and Nutrition Examination Survey (NHANES). We explored these relationships using two independent cohorts. First, we addressed CDAI and the prevalence of MetS in the general population; second, we explored the association between CDAI and mortality in patients with MetS by following NHANES 2001-2018 participants through December 31, 2019. In addition, restricted cubic spline (RCS), stratified analysis, and sensitivity analysis were used for further interpretation. We included 24,514 participants aged 20-85 years, in which the prevalence of MetS was 27.61 %. CDAI was negatively and dose-responsively associated with the prevalence of MetS, however it was not associated with mortality in patients with MetS. In addition, CDAI was associated with a reduced prevalence of certain components of MetS, including dyslipidemia and central obesity. RCS showed a linear correlation between CDAI and MetS and the above components. Stratified analyses indicated that alcohol consumption was a significant influence of CDAI-MetS and that socioeconomic status and lifestyle specificity existed. Sensitivity analysis confirmed the stability of the results. CDAI was protective against the development of MetS in the general population, but not against mortality in patients with MetS. Clinicians need to develop individualized prevention strategies to reduce the development of MetS by modifying CDAI.
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Affiliation(s)
- Qing Zhou
- Central Laboratory, The People’s Hospital of Baoan Shenzhen, Shenzhen, China
| | - Lijun Zhou
- Department of Urology, The People’s Hospital of Baoan Shenzhen, Shenzhen, China
| | - Xi Chen
- Central Laboratory, The People’s Hospital of Baoan Shenzhen, Shenzhen, China
| | - Qiuyan Chen
- Science and Education Department, Shenzhen Baoan Shiyan People’s Hospital, Shenzhen, China
| | - Lu Hao
- Science and Education Department, Shenzhen Baoan Shiyan People’s Hospital, Shenzhen, China
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5
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Ler P, Ploner A, Finkel D, Reynolds CA, Zhan Y, Jylhävä J, Dahl Aslan AK, Karlsson IK. Interplay of body mass index and metabolic syndrome: association with physiological age from midlife to late-life. GeroScience 2024; 46:2605-2617. [PMID: 38102440 PMCID: PMC10828240 DOI: 10.1007/s11357-023-01032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Obesity and metabolic syndrome (MetS) share common pathophysiological characteristics with aging. To better understand their interplay, we examined how body mass index (BMI) and MetS jointly associate with physiological age, and if the associations changed from midlife to late-life. We used longitudinal data from 1,825 Swedish twins. Physiological age was measured as frailty index (FI) and functional aging index (FAI) and modeled independently in linear mixed-effects models adjusted for chronological age, sex, education, and smoking. We assessed curvilinear associations of BMI and chronological age with physiological age, and interactions between BMI, MetS, and chronological age. We found a significant three-way interaction between BMI, MetS, and chronological age on FI (p-interaction = 0·006), not FAI. Consequently, we stratified FI analyses by age: < 65, 65-85, and ≥ 85 years, and modeled FAI across ages. Except for FI at ages ≥ 85, BMI had U-shaped associations with FI and FAI, where BMI around 26-28 kg/m2 was associated with the lowest physiological age. MetS was associated with higher FI and FAI, except for FI at ages < 65, and modified the BMI-FI association at ages 65-85 (p-interaction = 0·02), whereby the association between higher BMI levels and FI was stronger in individuals with MetS. Age modified the MetS-FI association in ages ≥ 85, such that it was stronger at higher ages (p-interaction = 0·01). Low BMI, high BMI, and metabolic syndrome were associated with higher physiological age, contributing to overall health status among older individuals and potentially accelerating aging.
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Affiliation(s)
- Peggy Ler
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Solna, 171 65, Stockholm, Sweden.
| | - Alexander Ploner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Solna, 171 65, Stockholm, Sweden
| | - Deborah Finkel
- Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA
- Institute of Gerontology, Jönköping University, Jönköping, Sweden
| | - Chandra A Reynolds
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, Colorado, USA
| | - Yiqiang Zhan
- School of Public Health, Sun Yat-Sen University, Shenzhen Campus, Shenzhen, Guandong, China
| | - Juulia Jylhävä
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Solna, 171 65, Stockholm, Sweden
- Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, University of Tampere, Tampere, Finland
| | | | - Ida K Karlsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Solna, 171 65, Stockholm, Sweden
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6
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Atabieke F, Li XJ, Aierken A, Li J, Zhang Y, Aizezi Y, Gao HL, Zhang ZQ. Association between frailty and hepatic fibrosis in NAFLD among middle-aged and older adults: results from NHANES 2017-2020. Front Public Health 2024; 12:1330221. [PMID: 38389936 PMCID: PMC10883311 DOI: 10.3389/fpubh.2024.1330221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Background Although previous studies found that frailty is prevalent in NAFLD patients with advanced liver fibrosis and cirrhosis, studies examining the relationship are spare. Aim Our study aspires to investigate the potential correlation between the Frailty Index (FI) and hepatic fibrosis among middle-aged and older adults with NAFLD. Methods Data from the 2017-2020.03 National Health and Nutrition Examination Survey (NHANES) were utilized for this study, with a final of 2,383 participants aged 50 years and older included. The quantification of frailty was executed employing a 49-item frailty index. The recognition of hepatic steatosis and fibrosis was accomplished through the utilization of the controlling attenuation parameter (CAP) and transient elastography (TE). The relationship between the FI and hepatic fibrosis were investigated employing univariable and multivariable-adjusted logistic regression analyses. A subgroup analysis was conducted, dividing the subjects based on gender, Body Mass Index (BMI), and the presence of hyperlipidemia. Results The findings demonstrated a positive correlation between the FI and significant hepatic fibrosis in NAFLD, even after using multivariate logistic regression models adjusting for potential confounding factors (OR = 1.022, 95% CI, 1.004-1.041) and in tertiles (Q3vs Q1: OR = 2.004, 95% CI, 1.162-3.455). In the subgroup analysis, the correlation was more statistically significant in male (OR = 1.046, 95% CI, 1.022-1.071), under/normal weight (OR = 1.077, 95% CI, 1.009-1.150), overweight (OR = 1.040, 95% CI, 1.010-1.071), and subjects without hyperlipidemia (OR = 1.054, 95% CI, 1.012-1.097). The area under the Receiver Operating Characteristic (ROC) curve for the FI in assessing the existence of substantial fibrosis in NAFLD was 0.612 (95% CI, 0.596-0.628). Conclusion This study demonstrated a positive correlation between significant hepatic fibrosis and frailty, particularly among males aged 50 years and older, who were non-obese and did not have hyperlipidemia with NAFLD. Additional studies are required to further validate these findings.
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Affiliation(s)
- Falide Atabieke
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Xiu-Juan Li
- Department of Pathophysiology, School of Basic Medical Sciences Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Ailikamu Aierken
- Xinjiang Medical University School of Clinical Medicine, Children's Hospital of the Autonomous Region, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Jian Li
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yu Zhang
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Yierzhati Aizezi
- Center of Critical Care Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Hong-Liang Gao
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
| | - Zhi-Qiang Zhang
- The Second Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang Uygur Autonomous Region, China
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7
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Skubiszewska A, Broczek K, Maruniak-Chudek I, Oledzka G, Jonas MI, Puzianowska-Kuznicka M, Mossakowska M. Frailty and Survivability of Polish Caucasian Nonagenarians and Centenarians. Geriatrics (Basel) 2024; 9:14. [PMID: 38247989 PMCID: PMC10801576 DOI: 10.3390/geriatrics9010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Frailty is a major geriatric problem leading to an increased risk of disability and death. Prevention, identification, and treatment of frailty are important challenges in gerontology and public health. The study aimed to estimate the prevalence of the frailty phenotype (FP) among the oldest-old Polish Caucasians and investigate the relationship between the FP and mortality. Baseline data were collected from 289 long-lived individuals, including 87 centenarians and 202 subjects aged 94-99. Mortality was obtained from population registers over the following 5 years. Sixty percent of subjects were classified as frail, 33% as prefrail, and 7% as robust. Frailty was more common in women than men and among centenarians than nonagenarians. During the 5-year observation period, 92.6% of the frail women and all frail men died, while mortality rates were lower among prefrail, 78.8% and 66.7%, and robust individuals, 60% and 54.5%, respectively. In the survival analysis, frailty was the strongest negative risk factor: HR = 0.328 (95% CI: 0.200-0.539). The inability to perform handgrip strength measurement was an additional predictor of short survival. In conclusion, the FP is prevalent in nonagenarians and centenarians and correlates with lower survivability. Future studies should address differences between unavoidable age-associated frailty and reversible disability in long-lived individuals.
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Affiliation(s)
- Agnieszka Skubiszewska
- Department of Medical Biology, Medical University of Warsaw, 00-575 Warsaw, Poland
- Study on Ageing and Longevity, International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland
| | - Katarzyna Broczek
- Mazovia Branch, Polish Society of Gerontology, 01-826 Warsaw, Poland
| | | | - Gabriela Oledzka
- Department of Medical Biology, Medical University of Warsaw, 00-575 Warsaw, Poland
| | - Marta Izabela Jonas
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
| | - Monika Puzianowska-Kuznicka
- Department of Human Epigenetics, Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland
- Department of Geriatrics and Gerontology, Medical Centre of Postgraduate Education, 01-826 Warsaw, Poland
| | - Malgorzata Mossakowska
- Study on Ageing and Longevity, International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland
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8
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Musazzi L, Carini G, Barbieri SS, Maggi S, Veronese N, Popoli M, Barbon A, Ieraci A. Phenotypic Frailty Assessment in SAMP8 Mice: Sex Differences and Potential Role of miRNAs as Peripheral Biomarkers. J Gerontol A Biol Sci Med Sci 2023; 78:1935-1943. [PMID: 37422721 DOI: 10.1093/gerona/glad160] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Indexed: 07/10/2023] Open
Abstract
Frailty is a geriatric syndrome characterized by age-related decline in physiological reserves and functions in multiple organ systems, including the musculoskeletal, neuroendocrine/metabolic, and immune systems. Animal models are essential to study the biological basis of aging and potential ways to delay the onset of age-related phenotypes. Unfortunately, validated animal models of frailty are still lacking in preclinical research. The senescence-accelerated prone-8 (SAMP8) mouse strain exhibits early cognitive loss that mimics the deterioration of learning and memory in the elderly and is widely used as a model of aging and neurodegenerative diseases. Here, we examined the frailty phenotype, which includes body weight, strength, endurance, activity, and slow walking speed, in male and female SAMP8 and senescence-accelerated mouse resistant (SAMR1) mice at 6- and 9-months of age. We found that the prevalence of frailty was higher in SAMP8 mice compared with SAMR1 mice, regardless of sex. The overall percentage of prefrail and frail mice was similar in male and female SAMP8 mice, although the percentage of frail mice was slightly higher in males than in females. In addition, we found sex- and frailty-specific changes in selected miRNAs blood levels. In particular, the levels of miR-34a-5p and miR-331-3p were higher in both prefrail and frail mice, whereas miR-26b-5p was increased only in frail mice compared with robust mice. Finally, levels of miR-331-3p were also increased in whole blood from a small group of frail patients. Overall, these results suggest that SAMP8 mice may be a useful mouse model for identifying potential biomarkers and studying biological mechanisms of frailty.
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Affiliation(s)
- Laura Musazzi
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giulia Carini
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Silvia S Barbieri
- Unit of Brain-Heart Axis: Cellular and Molecular Mechanisms, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Stefania Maggi
- Aging Branch, Neuroscience Institute, National Research Council, Padua, Italy
| | - Nicola Veronese
- Geriatrics Section, Department of Medicine, University of Palermo, Palermo, Italy
| | - Maurizio Popoli
- Department of Pharmaceutical Sciences, University of Milano, Milano, Italy
| | - Alessandro Barbon
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Alessandro Ieraci
- Department of Pharmaceutical Sciences, University of Milano, Milano, Italy
- Department of Theoretical and Applied Sciences, eCampus University, Novedrate, Italy
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9
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Gomes MFP, de Moura EDOC, Cardoso NM, da Silva GA, Dos Santos ACC, de Souza FS, Estadella D, Lambertucci RH, Lago JHG, Medeiros A. Supplementation with okra combined or not with exercise training is able to protect the heart of animals with metabolic syndrome. Sci Rep 2023; 13:1468. [PMID: 36702820 PMCID: PMC9879946 DOI: 10.1038/s41598-023-28072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 01/12/2023] [Indexed: 01/27/2023] Open
Abstract
The metabolic syndrome (MetS) is a clinical manifestation strongly associated with cardiovascular disease, the main cause of death worldwide. In view of this scenario, many therapeutic proposals have appeared in order to optimize the treatment of individuals with MetS, including the practice of exercise training (ET) and the consumption of okra (O). The aim of the present study was to evaluate the effect of O consumption and/or ET in animals with MetS. In all, 32 male Zucker rats (fa/fa) at 10 weeks old were randomly distributed into four groups of 8 animals each: MetS, MetS+O, MetS+ET and MetS+ET+O, and 8 lean Zucker rats (fa/ +) comprised the control group. Okra was administered by orogastric gavage 2x/day (morning and night, 100 mg/kg), 5 days/week, for 6 weeks. The ET was performed on a treadmill 1x/day (afternoon), 5 days/week, 60 min/day, in an intensity of 70% of maximal capacity, for the same days of O treatment. It was found that, O consumption alone was able to promote improved insulin sensitivity (MetS 93.93 ± 8.54 mg/dL vs. MetS+O 69.95 ± 18.7 mg/dL, p ≤ 0.05, d = 1.65, CI = 50.32 -89.58, triglyceride reduction (MetS 492.9 ± 97.8 mg/dL vs. MetS+O 334.9 ± 98.0 mg/dL, p ≤ 0.05, d = 1.61, CI = 193.2-398.7). In addition, it promoted a reduction in systolic blood pressure (MetS 149.0 ± 9.3 mmHg vs. MetS+O 132.0 ± 11.4 mmHg, p ≤ 0.05, d = 1.63, CI = 120-140), prevented an increase in cardiac collagen (MetS 12.60 ± 2.08% vs. MetS+O 7.52 ± 0.77%, p ≤ 0.05, d = 3.24, CI = 6.56-8.49). When associated with ET, the results were similar. Thus, we conclude that O consumption combined or not with aerobic ET can have a protective effect on the cardiac tissue of rats with MetS.
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Affiliation(s)
- Moisés Felipe Pereira Gomes
- Department of Bioscience, Universidade Federal de São Paulo (UNIFESP), R. Silva Jardim, 136 - Vila Matias, Santos, SP, 11015-020, Brazil.
- Center for Applied Social Sciences and Health, Universidade Católica de Santos (Unisantos), Av. Conselheiro Nébias, 300, Vila Matias, Santos, SP, 11015-002, Brazil.
| | | | - Naiara Magalhães Cardoso
- Department of Bioscience, Universidade Federal de São Paulo (UNIFESP), R. Silva Jardim, 136 - Vila Matias, Santos, SP, 11015-020, Brazil
| | - Graziele Aparecida da Silva
- Department of Bioscience, Universidade Federal de São Paulo (UNIFESP), R. Silva Jardim, 136 - Vila Matias, Santos, SP, 11015-020, Brazil
| | - Ana Carolina Cardoso Dos Santos
- Department of Bioscience, Universidade Federal de São Paulo (UNIFESP), R. Silva Jardim, 136 - Vila Matias, Santos, SP, 11015-020, Brazil
| | - Fernanda Samantha de Souza
- Institute of Environmental, Chemical and Pharmaceutical Sciences, Universidade Federal de São Paulo (UNIFESP), Rua Prof. Artur Riedel, n° 275, Eldorado, Diadema, SP, 09972-270, Brazil
| | - Débora Estadella
- Department of Bioscience, Universidade Federal de São Paulo (UNIFESP), R. Silva Jardim, 136 - Vila Matias, Santos, SP, 11015-020, Brazil
| | - Rafael Herling Lambertucci
- Department of Bioscience, Universidade Federal de São Paulo (UNIFESP), R. Silva Jardim, 136 - Vila Matias, Santos, SP, 11015-020, Brazil
| | - João Henrique Ghilardi Lago
- Center of Natural and Human Sciences, Universidade Federal Do ABC, Av. Dos Estados, 500, Bangú, Santo André, SP, 09210-580, Brazil
| | - Alessandra Medeiros
- Department of Bioscience, Universidade Federal de São Paulo (UNIFESP), R. Silva Jardim, 136 - Vila Matias, Santos, SP, 11015-020, Brazil
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10
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Saifuddin Ekram ARM, Espinoza SE, Ernst ME, Ryan J, Beilin L, Stocks NP, Ward SA, McNeil JJ, Shah RC, Woods RL. The Association between Metabolic Syndrome, Frailty and Disability-Free Survival in Healthy Community-dwelling Older Adults. J Nutr Health Aging 2023; 27:1-9. [PMID: 36651481 PMCID: PMC10061371 DOI: 10.1007/s12603-022-1860-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine the association between metabolic syndrome (MetS) and frailty, and determine whether co-existent MetS and frailty affect disability-free survival (DFS), assessed through a composite of death, dementia or physical disability. DESIGN Longitudinal study. SETTING AND PARTICIPANTS Community-dwelling older adults from Australia and the United States (n=18,264) from "ASPirin in Reducing Events in the Elderly" (ASPREE) study. MEASUREMENTS MetS was defined according to American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (2018). A modified Fried phenotype and a deficit accumulation Frailty Index (FI) were used to assess frailty. Association between MetS and frailty was examined using multinomial logistic regression. Cox regression was used to analyze the association between MetS, frailty and DFS over a median follow-up of 4.7 years. RESULTS Among 18,264 participants, 49.9% met the criteria for MetS at baseline. Participants with Mets were more likely to be pre-frail [Relative Risk Ratio (RRR): 1.22; 95%Confidence Interval (CI): 1.14, 1.30)] or frail (RRR: 1.66; 95%CI: 1.32, 2.08) than those without MetS. MetS alone did not shorten DFS while pre-frailty or frailty alone did [Hazard Ratio (HR): 1.68; 95%CI: 1.45, 1.94; HR: 2.65; 95%CI:1.92, 3.66, respectively]. Co-existent MetS with pre-frailty/frailty did not change the risk of shortened DFS. CONCLUSIONS MetS was associated with pre-frailty or frailty in community-dwelling older individuals. Pre-frailty or frailty increased the risk of reduced DFS but presence of MetS did not change this risk. Assessment of frailty may be more important than MetS in predicting survival free of dementia or physical disability.
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Affiliation(s)
- A R M Saifuddin Ekram
- Dr. A R M Saifuddin Ekram, Senior Clinical Research Consultant (ASPREE), SPHPM, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia. Mobile phone: +61449031659, E-mail:
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11
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Liu X, Tou NX, Gao Q, Gwee X, Wee SL, Ng TP. Frailty and risk of cardiovascular disease and mortality. PLoS One 2022; 17:e0272527. [PMID: 36121826 PMCID: PMC9484650 DOI: 10.1371/journal.pone.0272527] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background Prospective cohort studies suggest that frailty is associated with an increased risk of incident cardiovascular disease (CVD) morbidity and mortality, but their mechanistic and developmental relations are not fully understood. We investigated whether frailty predicted an increased risk of incident nonfatal and fatal CVD among community-dwelling older adults. Methods A population cohort of 5015 participants aged 55 years and above free of CVD at baseline was followed for up to 10 years. Pre-frailty and frailty were defined as the presence of 1–2 and 3–5 modified Fried criteria (unintentional weight loss, weakness, slow gait speed, exhaustion, and low physical activity), incident CVD events as newly diagnosed registered cases of myocardial infarction (MI), stroke, and CVD-related mortality (ICD 9: 390 to 459 or ICD-10: I00 to I99). Covariate measures included traditional cardio-metabolic and vascular risk factors, medication therapies, Geriatric Depression Scale (GDS), Mini-Mental State Exam (MMSE), and blood biomarkers (haemoglobin, albumin, white blood cell counts and creatinine). Results Pre-frailty and frailty were significantly associated with elevated HR = 1.26 (95%CI: 1.02–1.56) and HR = 1.54 (95%CI:1.00–2.35) of overall CVD, adjusted for cardio-metabolic and vascular risk factors and medication therapies, but not after adjustment for GDS depression and MMSE cognitive impairment. The HR of association between frailty status and both CVD mortality and overall mortality, however, remained significantly elevated after full adjustment for depression, cognitive and blood biomarkers. Conclusion Frailty was associated with increased risk of CVD morbidity and especially mortality, mediated in parts by traditional cardio-metabolic and vascular risk factors, and co-morbid depression and associated cognitive impairment and chronic inflammation. Given that pre-frailty and frailty are reversible by multi-domain lifestyle and health interventions, there is potential benefits in reducing cardiovascular diseases burden and mortality from interventions targeting pre-frailty and early frailty population.
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Affiliation(s)
- Xiao Liu
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Nien Xiang Tou
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Qi Gao
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xinyi Gwee
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shiou Liang Wee
- Geriatric Education and Research Institute, Singapore, Singapore
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute, Singapore, Singapore
- Gerontology Research Programme, Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail:
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12
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Jiang X, Xu X, Ding L, Lu J, Zhu H, Zhao K, Zhu S, Xu Q. The association between metabolic syndrome and presence of frailty: a systematic review and meta-analysis. Eur Geriatr Med 2022; 13:1047-1056. [PMID: 36036343 DOI: 10.1007/s41999-022-00688-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Frailty represents a progressive deterioration in multi-system of the body and could increase vulnerability to stressors. Recently, several studies found that metabolic syndrome was significantly associated with frailty and emphasized its role in assessing and preventing frailty. However, these conclusions are controversial. We conducted this systematic review and meta-analysis to evaluate the association between metabolic syndrome and frailty. METHODS Databases including Pubmed, Embase, Web of Science, CINAHL Complete, China National Knowledge Infrastructure (CNKI) and Wanfang Data Knowledge Service Platform were searched for studies on the association between metabolic syndrome and frailty, from inception to 17th June 2022. Two researchers independently screened the literature, extracted the data and evaluated the quality. Stata/SE 15.0 software was used to perform the statistical analysis. RESULTS Eleven studies were included in this review and eight studies were included in the meta-analysis, involving one prospective cohort studies and ten cross-sectional studies with 12,640 participants. The pooled results indicated that metabolic syndrome was significantly associated with frailty (OR = 1.82, 95% CI = 1.46-2.27) with a low heterogeneity (I2 = 32.1%), and there were significant associations between MetS and weakness (OR = 1.35, 95% CI = 1.15-1.58, I2 = 0.0%), slow gait speed (OR = 1.80, 95% CI = 1.51-2.14, I2 = 93.4%), weight loss (OR = 1.77, 95% CI = 1.36-2.29, I2 = 0.0%) and decreased physical activity (OR = 1.87, 95% CI = 1.49-2.35, I2 = 39.7%). CONCLUSIONS The findings of this systematic review and meta-analysis suggested that metabolic syndrome could be significantly associated with the presence of frailly. Future studies need to further consider the effects of measurement tools, age and specific disease status in this association. Furthermore, the casual relationship between them is to be determined.
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Affiliation(s)
- Xiaoman Jiang
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Xinyi Xu
- Faculty of Health, Queensland University of Technology, Brisbane, 4702, Australia
| | - Lingyu Ding
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Jinling Lu
- Department of Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 211166, China
| | - Hanfei Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Kang Zhao
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Shuqin Zhu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China
| | - Qin Xu
- School of Nursing, Nanjing Medical University, Nanjing, 211166, China.
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13
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The Relationship between Metabolic Syndrome and Frailty in Older People: A Systematic Review and Meta-Analysis. Geriatrics (Basel) 2022; 7:geriatrics7040076. [PMID: 35893323 PMCID: PMC9330874 DOI: 10.3390/geriatrics7040076] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: Both metabolic syndrome (MetS) and frailty are associated with increased all-cause mortality, yet the complex interplay between these two conditions has not adequately been elucidated. We aim to analyse the relationship between MetS and frailty through a systematic review of the literature with meta-analyses. Methods: A literature search was conducted via MEDLINE and EMBASE. Studies were included if validated frameworks for defining frailty and MetS (presence of at least 3 out of the five constitutive components: abdominal obesity, high fasting blood glucose, hypertension, hypertriglyceridaemia, and low high-density lipoprotein level) were utilised, in addition to the inclusion of participants aged 60 or older. Results: Eleven studies were included, all observational. All were in community-dwelling older people, 9 cross-sectional and 2 longitudinal. Most of the studies used Fried’s frailty phenotype. The prevalence of frailty ranged from 0.9% to 14.8% in population-based studies and 35.6% in the outpatient clinic setting. The prevalence of MetS was also higher in the outpatient clinic setting at 47.5%, compared to 17.5–41.0% in the community-dwelling populations. The meta-analysis of 11 studies showed that MetS was associated with an increased risk of frailty (pooled OR 1.73, 95% CI, 1.41–2.13). Conclusion: This systematic review and meta-analysis suggest that frailty was more prevalent in older people with MetS compared to older people without MetS. The study findings suggest the importance of frailty screening in older people with MetS and a distinct role of managing MetS in preventing frailty in older people.
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14
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Riquelme-Gallego B, García-Molina L, Cano-Ibáñez N, Andújar-Vera F, González-Salvatierra S, García-Fontana C, Bueno-Cavanillas A, Muñoz-Torres M, García-Fontana B. Undercarboxylated Osteocalcin: A Promising Target for Early Diagnosis of Cardiovascular and Glycemic Disorders in Patients with Metabolic Syndrome: A Pilot Study. Nutrients 2022; 14:nu14142991. [PMID: 35889946 PMCID: PMC9321347 DOI: 10.3390/nu14142991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/13/2022] [Accepted: 07/16/2022] [Indexed: 12/04/2022] Open
Abstract
Lifestyle changes are causing an exponential increase in the prevalence of obesity and metabolic syndrome (MetS) worldwide. The most frequent complications of these are the development of diabetes (T2D) and cardiovascular disease (CVD). Accurate tools are needed to classify the cardiovascular risk (CVR) in the MetS population. In recent years, numerous biomarkers of bone metabolism have been associated with CVR. The aim of this study was to determine the levels of undercarboxylated osteocalcin (ucOC) in a cohort of patients with MetS and to analyse its association with MetS parameters and CVR as well as with T2D prevalence. A longitudinal study was conducted in which a MetS population was followed for one year. Weight change, adherence to the Mediterranean diet (MedDiet), ucOC levels, MetS parameters and CVR were analysed and CVR was calculated using different scores. Our results showed a decrease of CVR associated with a better adherence to the MetDiet resulting in higher HDL-C and ucOC levels though the improvement of MetS risk factors. This bone protein appeared as a potential biomarker to classify CVR in the MetS population, especially for MetS patients without prevalent T2D. Furthermore, ucOC serum levels could be good predictors of T2D prevalence.
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Affiliation(s)
- Blanca Riquelme-Gallego
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (B.R.-G.); (L.G.-M.); (N.C.-I.); (A.B.-C.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain;
| | - Laura García-Molina
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (B.R.-G.); (L.G.-M.); (N.C.-I.); (A.B.-C.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain;
| | - Naomi Cano-Ibáñez
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (B.R.-G.); (L.G.-M.); (N.C.-I.); (A.B.-C.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Francisco Andújar-Vera
- Department of Computer Science and Artificial Intelligence, University of Granada, 18071 Granada, Spain;
- Andalusian Research Institute in Data Science and Computational Intelligence (DaSCI Institute), 18014 Granada, Spain
| | - Sheila González-Salvatierra
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain;
- Department of Medicine, University of Granada, 18016 Granada, Spain
| | - Cristina García-Fontana
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain;
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- Correspondence: (C.G.-F.); (M.M.-T.); (B.G.-F.); Tel.: +34-958023460 (C.G.-F.); +34-958246124 (M.M.-T.); +34-958023460 (B.G.-F.)
| | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain; (B.R.-G.); (L.G.-M.); (N.C.-I.); (A.B.-C.)
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain;
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Manuel Muñoz-Torres
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain;
- Department of Medicine, University of Granada, 18016 Granada, Spain
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- Correspondence: (C.G.-F.); (M.M.-T.); (B.G.-F.); Tel.: +34-958023460 (C.G.-F.); +34-958246124 (M.M.-T.); +34-958023460 (B.G.-F.)
| | - Beatriz García-Fontana
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18014 Granada, Spain;
- CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Endocrinology and Nutrition Unit, University Hospital Clínico San Cecilio, 18016 Granada, Spain
- Correspondence: (C.G.-F.); (M.M.-T.); (B.G.-F.); Tel.: +34-958023460 (C.G.-F.); +34-958246124 (M.M.-T.); +34-958023460 (B.G.-F.)
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15
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Nakhla M, Eakin CM, Mandelbaum A, Karlan B, Benharash P, Salani R, Cohen JG. Frailty is independently associated with worse outcomes and increased resource utilization following endometrial cancer surgery. Int J Gynecol Cancer 2022; 32:ijgc-2022-003484. [PMID: 35725031 PMCID: PMC9763544 DOI: 10.1136/ijgc-2022-003484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Frailty has been associated with poorer surgical outcomes and is a critical factor in procedural risk assessment. The objective of this study is to assess the impact of frailty on surgical outcomes in patients with endometrial cancer. METHODS Patients undergoing inpatient gynecologic surgery for endometrial cancer were identified using the 2005-2017 Nationwide Inpatient Sample database. The Johns Hopkins Adjusted Clinical Groups frailty-defining diagnosis indicator was used to designate frailty. Multivariate regression models were used to assess the association of frailty with postoperative outcomes and resource use. RESULTS Of 339 846 patients, 2.9% (9868) were considered frail. After adjusting for patient and hospital characteristics, frailty was associated with a four-fold increase in inpatient mortality (adjusted OR (aOR) 4.1; p<0.001), non-home discharge (aOR 5.2; p<0.001), as well as increased respiratory (aOR 2.6; p<0.001), neurologic (aOR 3.3; p<0.001), renal (aOR 2.0; p<0.001), and infectious (aOR 3.2; p<0.001) complications. While frail patients exhibited increased mortality with age, the rate of mortality in this cohort decreased significantly over time. Compared with non-frail counterparts, frail patients had longer lengths of stay (7.6 vs 3.4 days; p<0.001) and increased hospitalization costs with surgical admission ($25 093 vs $13 405; p<0.001). CONCLUSIONS Frailty is independently associated with worse surgical outcomes, including increased mortality and resource use, in women undergoing surgery for endometrial cancer. Though in recent years there have been improvements in mortality in the frail population, further efforts to mitigate the impact of frailty should be explored.
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Affiliation(s)
- Morcos Nakhla
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Cortney M Eakin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Ava Mandelbaum
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Beth Karlan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Ritu Salani
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Joshua G Cohen
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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16
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Perazza LR, Brown-Borg HM, Thompson LV. Physiological Systems in Promoting Frailty. Compr Physiol 2022; 12:3575-3620. [PMID: 35578945 DOI: 10.1002/cphy.c210034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Frailty is a complex syndrome affecting a growing sector of the global population as medical developments have advanced human mortality rates across the world. Our current understanding of frailty is derived from studies conducted in the laboratory as well as the clinic, which have generated largely phenotypic information. Far fewer studies have uncovered biological underpinnings driving the onset and progression of frailty, but the stage is set to advance the field with preclinical and clinical assessment tools, multiomics approaches together with physiological and biochemical methodologies. In this article, we provide comprehensive coverage of topics regarding frailty assessment, preclinical models, interventions, and challenges as well as clinical frameworks and prevalence. We also identify central biological mechanisms that may be at play including mitochondrial dysfunction, epigenetic alterations, and oxidative stress that in turn, affect metabolism, stress responses, and endocrine and neuromuscular systems. We review the role of metabolic syndrome, insulin resistance and visceral obesity, focusing on glucose homeostasis, adenosine monophosphate-activated protein kinase (AMPK), mammalian target of rapamycin (mTOR), and nicotinamide adenine dinucleotide (NAD+ ) as critical players influencing the age-related loss of health. We further focus on how immunometabolic dysfunction associates with oxidative stress in promoting sarcopenia, a key contributor to slowness, weakness, and fatigue. We explore the biological mechanisms involved in stem cell exhaustion that affect regeneration and may contribute to the frailty-associated decline in resilience and adaptation to stress. Together, an overview of the interplay of aging biology with genetic, lifestyle, and environmental factors that contribute to frailty, as well as potential therapeutic targets to lower risk and slow the progression of ongoing disease is covered. © 2022 American Physiological Society. Compr Physiol 12:1-46, 2022.
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Affiliation(s)
- Laís R Perazza
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
| | - Holly M Brown-Borg
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - LaDora V Thompson
- Department of Physical Therapy and Athletic Training, Boston University, Boston, Massachusetts, USA
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17
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Ler P, Li X, Hassing LB, Reynolds CA, Finkel D, Karlsson IK, Dahl Aslan AK. Independent and joint effects of body mass index and metabolic health in mid- and late-life on all-cause mortality: a cohort study from the Swedish Twin Registry with a mean follow-up of 13 Years. BMC Public Health 2022; 22:718. [PMID: 35410261 PMCID: PMC9004188 DOI: 10.1186/s12889-022-13082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is robust evidence that in midlife, higher body mass index (BMI) and metabolic syndrome (MetS), which often co-exist, are associated with increased mortality risk. However, late-life findings are inconclusive, and few studies have examined how metabolic health status (MHS) affects the BMI-mortality association in different age categories. We, therefore, aimed to investigate how mid- and late-life BMI and MHS interact to affect the risk of mortality. METHODS This cohort study included 12,467 participants from the Swedish Twin Registry, with height, weight, and MHS measures from 1958-2008 and mortality data linked through 2020. We applied Cox proportional hazard regression with age as a timescale to examine how BMI categories (normal weight, overweight, obesity) and MHS (identification of MetS determined by presence/absence of hypertension, hyperglycemia, low HDL, hypertriglyceridemia), independently and in interaction, are associated with the risk of all-cause mortality. Models were adjusted for sex, education, smoking, and cardiovascular disease. RESULTS The midlife group included 6,252 participants with a mean age of 59.6 years (range = 44.9-65.0) and 44.1% women. The late-life group included 6,215 participants with mean age 73.1 years (65.1-95.3) and 46.6% women. In independent effect models, metabolically unhealthy status in midlife increased mortality risks by 31% [hazard ratio 1.31; 95% confidence interval 1.12-1.53] and in late-life, by 18% (1.18;1.10-1.26) relative to metabolically healthy individuals. Midlife obesity increased the mortality risks by 30% (1.30;1.06-1.60) and late-life obesity by 15% (1.15; 1.04-1.27) relative to normal weight. In joint models, the BMI estimates were attenuated while those of MHS were less affected. Models including BMI-MHS categories revealed that, compared to metabolically healthy normal weight, the metabolically unhealthy obesity group had increased mortality risks by 53% (1.53;1.19-1.96) in midlife, and across all BMI categories in late-life (normal weight 1.12; 1.01-1.25, overweight 1.10;1.01-1.21, obesity 1.31;1.15-1.49). Mortality risk was decreased by 9% (0.91; 0.83-0.99) among those with metabolically healthy overweight in late-life. CONCLUSIONS MHS strongly influenced the BMI-mortality association, such that individuals who were metabolically healthy with overweight or obesity in mid- or late-life did not carry excess risks of mortality. Being metabolically unhealthy had a higher risk of mortality independent of their BMI.
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Affiliation(s)
- Peggy Ler
- Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.
| | - Xia Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Linda B Hassing
- Department of Psychology and Centre for Ageing and Health, University of Gothenburg, Gothenburg, Sweden
| | - Chandra A Reynolds
- Department of Psychology, University of California - Riverside, Riverside, CA, USA
| | - Deborah Finkel
- Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Psychology, Indiana University Southeast, New Albany, Indiana, USA
| | - Ida K Karlsson
- Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna K Dahl Aslan
- Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Health Sciences, University of Skövde, Skövde, Sweden
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18
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Manusov EG, Gomez De Ziegler C, Diego VP, Munoz-Monaco G, Williams-Blangero S. Frailty Index in the Colonias on the US-Mexico Border: A Special Report. Front Med (Lausanne) 2021; 8:650259. [PMID: 34485319 PMCID: PMC8416248 DOI: 10.3389/fmed.2021.650259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
Frailty is the age-related decline in well-being. The Frailty index (FI) measures the accumulation of health deficits and reflects biopsychosocial and cultural determinants of well-being. Frailty is measured as a static phenotype or as a Frailty Index comprising a ratio of suffered health deficits and total deficits. We report a Frailty Index calculated from routinely measured clinical variables gathered from residents of two Colonias (neighborhoods) in South Texas. A Colonia is a predominantly Hispanic, economically distressed, unincorporated neighborhood. We analyzed retrospective data from 894 patients that live in two Colonias located on the Texas-Mexico border. We calculated the FI with seven physiological variables, PHQ-9 score, and the 11 domain-specific Duke Profile scores, for a total of 19 possible health deficits. FI against age separately in males (n = 272) and females (n = 622) was regressed. Females had a significantly higher starting frailty, and males had a significantly greater change rate with age. FI against age for Cameron Park Colonia and Indian Hills Colonia was regressed. We calculated a significantly higher starting FI in Indian Hills and a significantly greater change rate in Cameron Park residents. Frailty's contributors are complex, especially in neighborhoods of poverty, immigration, low education level, and high prevalence of chronic disease. We report baseline Frailty Index data from two Colonias in South Texas and the clinical and research implications.
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Affiliation(s)
- Eron G Manusov
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Carolina Gomez De Ziegler
- Knapp Family Medicine Residency Program, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Vincent P Diego
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Gerardo Munoz-Monaco
- Knapp Family Medicine Residency Program, University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Sarah Williams-Blangero
- Department of Human Genetics, School of Medicine, University of Texas Rio Grande Valley, Edinburg, TX, United States.,South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX, United States
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Chen LH, Wu LW. Association between serum lactate dehydrogenase and frailty among individuals with metabolic syndrome. PLoS One 2021; 16:e0256315. [PMID: 34478437 PMCID: PMC8415577 DOI: 10.1371/journal.pone.0256315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/03/2021] [Indexed: 01/10/2023] Open
Abstract
While metabolic syndrome (MetS) is associated with frailty, the correlation of serum lactate dehydrogenase (sLDH) and frailty with MetS remain uncertain. To investigate the relationship between sLDH and frail components in the US with MetS. A total of 4,066 participants aged 40-90 years were assessed from the database of the third National Health and Nutrition Examination Survey, 1988-1994. The participants were classified into MetS and non-MetS groups. Multivariate logistic regression analysis with four models were performed to assess the odds ratio (OR) of the divided tertiles of sLDH levels with frailty, and frail components including slow walking (SW), weakness, exhaustion, low physical activity (LPA), and low body weight (LBW). Higher sLDH levels were positively associated with frailty in the MetS group (p = 0.024) but not in non-MetS group (p = 0.102). After covariate adjustments, the OR of frailty in the upper two tertiles compared to the lowest tertile and revealed statistical significance (p < 0.05). Frail components of SW, weakness, exhaustion, and LPA were associated with higher sLDH (p < 0.05) except for LBW in MetS and non-MetS groups. The results demonstrated the strong association of higher sLDH levels and frailty among US individuals with MetS.
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Affiliation(s)
- Li-Hsiang Chen
- Division of Family Medicine, Department of Family and Community Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Li-Wei Wu
- Division of Family Medicine, Department of Family and Community Medicine, Tri-Service General Hospital; and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Division of Geriatric Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, Taipei, Taiwan, Republic of China
- Health Management Center, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, Republic of China
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Calcaterra V, Cena H, Ruggieri A, Zuccotti G, De Silvestri A, Bonalumi G, Pelizzo G. Metabolically Unhealthy Phenotype: A Key Factor in Determining "Pediatric" Frailty. Pediatr Rep 2021; 13:340-346. [PMID: 34287378 PMCID: PMC8293425 DOI: 10.3390/pediatric13030042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/03/2021] [Accepted: 06/29/2021] [Indexed: 11/16/2022] Open
Abstract
Frailty (FI) and metabolic syndrome (MS) are each associated with adverse health outcomes. A relationship between FI and MS has previously been described in adults. We considered the prevalence of a metabolically unhealthy phenotype (MUP) in malnourished children with neurological impairment and in subjects with obesity in comparison to a group of elderly individuals at risk of FI, and we did so in order to define the potential similarities that may underline the risk of FI in specific children. We considered 50 undernourished (defined as having a body mass index of BMI ≤ 2, standard deviation score, SDS, according to World Health Organization) disabled children; 50 children with obesity (BMI ≥ 2 SDS); 50 children who were a normal weight (-1 SDS ≤ BMI ≤ +1 SDS); 21 patients who were >75 years old. MUP was defined as the presence of at least one of the following risk factors: hypertension, hyperglycemia or diabetes, hypercholesterolemia, and hypertriglyceridemia. In children with a disability and obesity, a higher prevalence (p < 0.001) and risk (disability OR 54.88, obesity OR 13.37) of MUP was noted compared to children of a normal weight. Compared to elderly patients, the prevalence of MUP did not differ in disabled children. On the contrary, MUP was lower in children with obesity (p < 0.001) and in pediatric subjects of a normal weight (p < 0.01). MS might play a key role in "pediatric" frailty. The extremities of the aging process and malnutrition are likely key factors in the development of FI. A multidisciplinary approach to FI may represent an important milestone for pediatric care.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy;
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20154 Milano, Italy;
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy
| | - Annamaria Ruggieri
- Vascular Surgery Unit, Istituto di Cura Città di Pavia, 27100 Pavia, Italy; (A.R.); (G.B.)
| | - Gianvincenzo Zuccotti
- Pediatric Unit, “V. Buzzi” Children’s Hospital, 20154 Milano, Italy;
- Department of Biomedical and Clinical Science “L. Sacco”, University of Milano, 20154 Milano, Italy
| | - Annalisa De Silvestri
- Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
| | - Gianni Bonalumi
- Vascular Surgery Unit, Istituto di Cura Città di Pavia, 27100 Pavia, Italy; (A.R.); (G.B.)
| | - Gloria Pelizzo
- Clinical Epidemiology & Biometry, IRCCS Policlinico San Matteo Foundation, 27100 Pavia, Italy;
- Pediatric Surgery Unit, “V. Buzzi” Children’s Hospital, 20154 Milano, Italy
- Correspondence:
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Rodríguez-Mañas L, Angulo J, Carnicero JA, El Assar M, García-García FJ, Sinclair AJ. Dual effects of insulin resistance on mortality and function in non-diabetic older adults: findings from the Toledo Study of Healthy Aging. GeroScience 2021; 44:1095-1108. [PMID: 34075557 DOI: 10.1007/s11357-021-00384-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/13/2021] [Indexed: 01/23/2023] Open
Abstract
Insulin signalling declines with increasing age and impacts skeletal muscle function and longevity in animal models. Our aim was to assess the relationships between insulin resistance (IR) and frailty and mortality in a unique community-dwelling cohort of older people. 991 non-diabetic subjects from the Toledo Study of Healthy Ageing (TSHA) cohort were included. IR was estimated by the homeostasis model assessment index (HOMA-IR) at baseline while frailty was determined by frailty phenotype (FP) and Frailty Trait Scale (FTS) at baseline and after 5-year follow-up. Deaths were also determined. Multivariate regression models were used to analyze the effects of HOMA-IR on outcomes. Age, gender, BMI, education level, cardio- and cerebro-vascular disease, glomerular filtration rate, and disability were included as potential confounding variables in progressive adjustment models. IR determined as increasing log HOMA-IR was inversely associated with risk of mortality. The association remained significant for all adjustment models (HR: 0.64-0.69). When we analyzed survival curves, the higher the HOMA-IR tertile, the lower the mortality rate (highest vs lowest tertile, p = 0.0082). In contrast, IR increased the risk of incident frailty determined by FP (OR 1.81 [1.14-2.87]) as well as deterioration of frailty status determined by worsening in FTS score (OR 1.28 [1.01-1.63]) at 5-year follow-up. In non-diabetic older subjects, IR significantly increases the risk for frailty and functional decline but decreased the risk of death at 5-year follow-up. This finding raises the need of assessing the effect of biomarkers on different outcomes before establishing their role as biomarkers of aging.
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Affiliation(s)
- Leocadio Rodríguez-Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain.
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain.
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
- Division of Geriatric Medicine, Hospital Universitario de Getafe, Ctra de Toledo km 12,500, 28905, Getafe, Spain.
| | - Javier Angulo
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José A Carnicero
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariam El Assar
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alan J Sinclair
- Foundation for Diabetes Research in Older People (fDROP) and King's College London, London, UK
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Li Q, Chen X, Han B. Effect Modification by Sex of the Hemoglobin Concentration on Frailty Risk in Hospitalized Older Patients. Clin Interv Aging 2021; 16:687-696. [PMID: 33911857 PMCID: PMC8075178 DOI: 10.2147/cia.s298672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hemoglobin concentration differs by sex, possibly affecting any association between hemoglobin and frailty. This study aimed to evaluate the potential interaction effect of hemoglobin and sex on frailty in Chinese older inpatients. Methods A cross-sectional study was conducted between February 2015 and November 2017 in a tertiary hospital. Frailty was defined by the Fried phenotype. Hemoglobin concentration was measured with a standard procedure. Covariates included demographics, clinical characteristics, and serum biomarkers. Logistic regression was applied to examine the association between hemoglobin concentration and frailty. The relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP), and synergy index (SI) were used to evaluate the additive interaction. Results A total of 619 older inpatients [mean age 69.26±7.44 years; 334 men, 285 women] were included. The mean hemoglobin concentration was significantly lower in the elderly who were frail (11.9 g/L in frail versus 13.1g/L in non-frail; p<0.001). In the multivariable regression models, lower hemoglobin in patients was significantly associated with frailty (adjusted odds ratio (OR) = 2.51, 95% CI:1.37, 4.60). The stratified analyses indicated that lower hemoglobin was associated with frailty among older inpatients with different characteristics. Female inpatients with lower hemoglobin had the highest risk of frailty (adjusted OR=6.43, 95%: 2.38, 17.3); there were interactions between hemoglobin and sex on the development of frailty (RERI=4.30, 95% CI=−1.41, 10.01; AP=0.67, 95% CI=0.37, 0.97;SI=4.80, 95% CI=1.22, 18.84). Conclusions and Implications Our study provided evidence that sex and lower hemoglobin have an interaction effect on frailty; it is suggested that clinicians may consider sex-specific strategies for the elderly to conform the concept of precision medicine.
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Affiliation(s)
- Qiuping Li
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xi Chen
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Binru Han
- Department of Nursing, Xuanwu Hospital, Capital Medical University, Beijing, People's Republic of China
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Spiers GF, Kunonga TP, Hall A, Beyer F, Boulton E, Parker S, Bower P, Craig D, Todd C, Hanratty B. Measuring frailty in younger populations: a rapid review of evidence. BMJ Open 2021; 11:e047051. [PMID: 33753447 PMCID: PMC7986767 DOI: 10.1136/bmjopen-2020-047051] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/11/2021] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Frailty is typically assessed in older populations. Identifying frailty in adults aged under 60 years may also have value, if it supports the delivery of timely care. We sought to identify how frailty is measured in younger populations, including evidence of the impact on patient outcomes and care. DESIGN A rapid review of primary studies was conducted. DATA SOURCES Four databases, three sources of grey literature and reference lists of systematic reviews were searched in March 2020. ELIGIBILITY CRITERIA Eligible studies measured frailty in populations aged under 60 years using experimental or observational designs, published after 2000 in English. DATA EXTRACTION AND SYNTHESIS Records were screened against review criteria. Study data were extracted with 20% of records checked for accuracy by a second researcher. Data were synthesised using a narrative approach. RESULTS We identified 268 studies that measured frailty in samples that included people aged under 60 years. Of these, 85 studies reported evidence about measure validity. No measures were identified that were designed and validated to identify frailty exclusively in younger groups. However, in populations that included people aged over and under 60 years, cumulative deficit frailty indices, phenotype measures, the FRAIL Scale, the Liver Frailty Index and the Short Physical Performance Battery all demonstrated predictive validity for mortality and/or hospital admission. Evidence of criterion validity was rare. The extent to which measures possess validity across the younger adult age (18-59 years) spectrum was unclear. There was no evidence about the impact of measuring frailty in younger populations on patient outcomes and care. CONCLUSIONS Limited evidence suggests that frailty measures have predictive validity in younger populations. Further research is needed to clarify the validity of measures across the adult age spectrum, and explore the utility of measuring frailty in younger groups.
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Affiliation(s)
- Gemma F Spiers
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tafadzwa Patience Kunonga
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Hall
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fiona Beyer
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Boulton
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stuart Parker
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Peter Bower
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dawn Craig
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Barbara Hanratty
- National Institute for Health Research (NIHR) Older People and Frailty Policy Research Unit, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Simpson FR, Pajewski NM, Nicklas B, Kritchevsky S, Bertoni A, Ingram F, Ojeranti D, Espeland MA. Impact of Multidomain Lifestyle Intervention on Frailty Through the Lens of Deficit Accumulation in Adults with Type 2 Diabetes Mellitus. J Gerontol A Biol Sci Med Sci 2021; 75:1921-1927. [PMID: 31559418 DOI: 10.1093/gerona/glz197] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Type 2 diabetes and obesity increase the accumulation of health deficits and may accelerate biological aging. Multidomain lifestyle interventions may mitigate against this. METHODS Within a large, randomized clinical trial of intensive lifestyle intervention including caloric restriction, increased physical activity, dietary counseling, and risk factor monitoring compared with diabetes support and education, we examined the accumulation of health deficits across 8 years. We used two complementary frailty indices (FIs) based on deficit accumulation, one modeled on work in the Systolic Blood Pressure Intervention Trial and the other including additional deficits related to obesity and type 2 diabetes mellitus. Differences between intervention groups and their consistency among subgroups were assessed with re-randomization tests. RESULTS Data from 4,859 adults (45-76 years at baseline, 59% female) were analyzed. Random assignment to intensive lifestyle intervention was associated with lower FI scores throughout follow-up as captured by areas under curves traced by longitudinal means (p ≤ .001), over which time mean (SE) differences between intervention groups averaged 5.8% (0.9%) and 5.4% (0.9%) for the two indices. At year 8, the percentage of participants classified as frail (FI > 0.21) was lower among intensive lifestyle intervention (39.8% and 54.5%) compared with diabetes support and education (42.7% and 60.9%) for both FIs (both p < .001). Intervention benefits were relatively greater for participants who were older, not obese, and without history of cardiovascular disease at baseline. CONCLUSIONS Eight years of multidomain lifestyle intervention create a buffer against the accumulation of age-related health deficits in overweight or obese adults with type 2 diabetes.ClinicalTrials.gov Identifier: NCT00017953.
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Affiliation(s)
- Felicia R Simpson
- Department of Mathematics, Winston-Salem State University, North Carolina
| | | | - Barbara Nicklas
- Department of Internal Medicine, Winston-Salem, North Carolina
| | | | - Alain Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Frank Ingram
- Department of Mathematics, Winston-Salem State University, North Carolina
| | - Daniel Ojeranti
- Department of Mathematics, Winston-Salem State University, North Carolina
| | - Mark A Espeland
- Department of Mathematics, Winston-Salem State University, North Carolina.,Department of Biostatistics and Data Science, Winston-Salem, North Carolina
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Castellana F, Lampignano L, Bortone I, Zupo R, Lozupone M, Griseta C, Daniele A, De Pergola G, Giannelli G, Sardone R, Panza F. Physical Frailty, Multimorbidity, and All-Cause Mortality in an Older Population From Southern Italy: Results from the Salus in Apulia Study. J Am Med Dir Assoc 2021; 22:598-605. [PMID: 33493467 DOI: 10.1016/j.jamda.2020.12.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/11/2020] [Accepted: 12/13/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVES We first estimated the prevalence of physical frailty in older subjects from the population-based Salus in Apulia Study (Apulia, Southern Italy), and its impact on all-cause mortality. Second, we explored the relationship between multimorbidity and physical frailty. DESIGN Cross-sectional and longitudinal analyses from a population-based study. SETTING AND PARTICIPANTS We analyzed data from the Salus in Apulia study, a population-based sample of 1929 subjects aged 65 years and older. METHODS These older participants underwent clinical, physical, and laboratory assessments. Physical frailty was operationalized using slightly modified Fried criteria. Multimorbidity status was defined as the co-presence of 2 or more chronic conditions. RESULTS The overall prevalence of physical frailty in this older population from Southern Italy was 14.8% [95% confidence interval (CI): 13.26-16.49]. Physical frailty subjects were significantly older (P < .01), had a lower educational level (P < .01), increased executive dysfunction (P < .01), higher serum levels interleukin-6 (P < .01), and white blood cells (P = .01). Multimorbidity status (P < .01), diabetes mellitus (P = .05), peripheral age-related hearing loss (P < .01), cognitive impairment (P < .01), chronic obstructive pulmonary disease (P = .02), and metabolic syndrome (P = .02) were also directly related to physical frailty. Apathy increased according to the severity of physical frailty status (P = .02). There was a significant increased risk of all-cause mortality for physical frailty subjects (hazard ratio: 1.48; 95% CI: 1.03-2.12, adjusted for age and sex) during the observation from the date of enrollment to the date of death (mean ± SD: 55.70 ± 22.19 months, median: 54 months). CONCLUSIONS AND IMPLICATIONS Frailty is the consequence of the contributory action of the aging process and some chronic diseases that hasten some of the changes concurrent with aging.
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Affiliation(s)
- Fabio Castellana
- Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Luisa Lampignano
- Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Ilaria Bortone
- Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Roberta Zupo
- Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Chiara Griseta
- Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Antonio Daniele
- Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy; Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni De Pergola
- Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
| | - Rodolfo Sardone
- Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Francesco Panza
- Healthy Aging Phenotypes Research Unit - "Salus in Apulia Study" - National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy.
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Chen MZ, Wong MWK, Lim JY, Merchant RA. Frailty and Quality of Life in Older Adults with Metabolic Syndrome - Findings from the Healthy Older People Everyday (HOPE) Study. J Nutr Health Aging 2021; 25:637-644. [PMID: 33949631 DOI: 10.1007/s12603-021-1609-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Metabolic syndrome (MetS) and frailty are both associated with increased morbidity and mortality. Frailty is associated with reduced quality of life (QoL) but association of QoL with MetS have produced mixed results suggesting that other factors such as disease burden, obesity and depression may have a more significant influence. We aim to investigate the demographics of frail participants with MetS, and relationship between frailty and QoL in MetS. METHODS Cross-sectional population study involving 292 older adults ≥ 65 years with MetS. MetS was defined using the Modified ATP III for Asians which requires the presence of 3 or more of the following 5 components 1) waist circumference ≥ 90cm for males or ≥ 80cm for females, 2) TG ≥ 150mg/dL, 3) HDLc < 40mg/dL in males or < 50mg/dL in females, 4) blood pressure ≥ 130/85mmHg or use of anti-hypertensive medication, and 5) fasting plasma glucose ≥ 100mg/dL or use of pharmacological treatment for diabetes mellitus. Data were collected on demographics, frailty (FRAIL), QoL (Euroqol-5D), perceived health, functional status, cognition, Timed-Up-and-Go (TUG), and hand-grip strength (HGS). RESULTS 40.4% of the participants were pre-frail (MetSprefrail) and 7.2% were frail (MetSfrail). MetSfrail were significantly older, had lower education level, higher polypharmacy burden and higher prevalence of diabetes. The prevalence of at least 1 activity of daily living impairment was 4 times higher, and depression 9 times higher than their robust counterparts. MetSfrail also had longer TUG, higher prevalence of poor grip strength and poor perceived health. After adjusting for age, gender and education, MetSfrail was significantly associated with much higher odds of EQ-5D moderate to extreme problems with mobility (Odds Ratio (OR) =10.99, CI 2.62-46.14), usual activities (OR=37.82, CI 3.77-379.04) and pain (OR=10.79, CI 3.18-36.62). EQ-5D Index Value and Perceived Health improved by 0.1 (Mean Difference (MD) =0.07, CI 0.04-0.10) and 6.0 (MD=6.01, CI 3.29-8.73) respectively as frailty status improved. CONCLUSION Frailty in MetS is associated with depression, polypharmacy, greater functional impairment, poorer QoL and perceived health. Frailty screening and personalized management is crucial in MetS as frailty may be a mediator for negative outcomes in MetS, and frailty may be reversible.
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Affiliation(s)
- M Z Chen
- Associate Professor Reshma A Merchant, Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore 119228, , Telephone number: +65 6779 5555
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Schultz MB, Kane AE, Mitchell SJ, MacArthur MR, Warner E, Vogel DS, Mitchell JR, Howlett SE, Bonkowski MS, Sinclair DA. Age and life expectancy clocks based on machine learning analysis of mouse frailty. Nat Commun 2020; 11:4618. [PMID: 32934233 PMCID: PMC7492249 DOI: 10.1038/s41467-020-18446-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 08/16/2020] [Indexed: 12/15/2022] Open
Abstract
The identification of genes and interventions that slow or reverse aging is hampered by the lack of non-invasive metrics that can predict the life expectancy of pre-clinical models. Frailty Indices (FIs) in mice are composite measures of health that are cost-effective and non-invasive, but whether they can accurately predict health and lifespan is not known. Here, mouse FIs are scored longitudinally until death and machine learning is employed to develop two clocks. A random forest regression is trained on FI components for chronological age to generate the FRIGHT (Frailty Inferred Geriatric Health Timeline) clock, a strong predictor of chronological age. A second model is trained on remaining lifespan to generate the AFRAID (Analysis of Frailty and Death) clock, which accurately predicts life expectancy and the efficacy of a lifespan-extending intervention up to a year in advance. Adoption of these clocks should accelerate the identification of longevity genes and aging interventions.
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Affiliation(s)
- Michael B Schultz
- Blavatnik Institute, Department of Genetics, Paul F. Glenn Center for Biology of Aging Research at Harvard Medical School, Boston, MA, USA
| | - Alice E Kane
- Blavatnik Institute, Department of Genetics, Paul F. Glenn Center for Biology of Aging Research at Harvard Medical School, Boston, MA, USA
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sarah J Mitchell
- Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michael R MacArthur
- Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elisa Warner
- Department of Computational Medicine & Bioinformatics, University of Michigan, Ann Arbor, MI, USA
| | - David S Vogel
- Voloridge Investment Management, LLC and VoLo Foundation, Jupiter, FL, USA
| | - James R Mitchell
- Department of Genetics and Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Susan E Howlett
- Departments of Pharmacology and Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada
| | - Michael S Bonkowski
- Blavatnik Institute, Department of Genetics, Paul F. Glenn Center for Biology of Aging Research at Harvard Medical School, Boston, MA, USA
- Department of Dermatology, The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - David A Sinclair
- Blavatnik Institute, Department of Genetics, Paul F. Glenn Center for Biology of Aging Research at Harvard Medical School, Boston, MA, USA.
- Department of Pharmacology, School of Medical Sciences, The University of New South Wales, Sydney, NSW, Australia.
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Angulo J, El Assar M, Álvarez-Bustos A, Rodríguez-Mañas L. Physical activity and exercise: Strategies to manage frailty. Redox Biol 2020; 35:101513. [PMID: 32234291 PMCID: PMC7284931 DOI: 10.1016/j.redox.2020.101513] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/25/2022] Open
Abstract
Frailty, a consequence of the interaction of the aging process and certain chronic diseases, compromises functional outcomes in the elderly and substantially increases their risk for developing disabilities and other adverse outcomes. Frailty follows from the combination of several impaired physiological mechanisms affecting multiple organs and systems. And, though frailty and sarcopenia are related, they are two different conditions. Thus, strategies to preserve or improve functional status should consider systemic function in addition to muscle conditioning. Physical activity/exercise is considered one of the main strategies to counteract frailty-related physical impairment in the elderly. Exercise reduces age-related oxidative damage and chronic inflammation, increases autophagy, and improves mitochondrial function, myokine profile, insulin-like growth factor-1 (IGF-1) signaling pathway, and insulin sensitivity. Exercise interventions target resistance (strength and power), aerobic, balance, and flexibility work. Each type improves different aspects of physical functioning, though they could be combined according to need and prescribed as a multicomponent intervention. Therefore, exercise intervention programs should be prescribed based on an individual's physical functioning and adapted to the ensuing response.
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Affiliation(s)
- Javier Angulo
- Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariam El Assar
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Fundación para la Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | | | - Leocadio Rodríguez-Mañas
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain.
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McMillan JM, Gill MJ, Power C, Fujiwara E, Hogan DB, Rubin LH. Comorbidities in Older Persons with Controlled HIV Infection: Correlations with Frailty Index Subtypes. AIDS Patient Care STDS 2020; 34:284-294. [PMID: 32639207 DOI: 10.1089/apc.2020.0051] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Frailty is prevalent in persons with human immunodeficiency virus (PWH), but factors predisposing older PWH to frailty remain uncertain. We examined factors associated with frailty and determined whether there were multiple frailty subtypes in older adults with controlled HIV infection. This was a cross-sectional outpatient study in an urban HIV clinic. Twenty-nine clinical indicators were extracted from medical records to compute a Frailty Index (FI) for 389 older (age 50+) PWH (range = 50-93; mean = 61.1, standard deviation = 7.2; 85% men) receiving HIV treatment in Calgary, Canada. We used regressions to identify factors associated with FI values. Latent class analysis was used to identify FI subtypes. Age, employment status, and duration of known HIV infection were the strongest predictors of FI (p's < 0.05). Four FI subtypes were identified. Subtype 1 (severe metabolic dysfunction+polypharmacy) had the highest mean FI (0.30). Subtype 2 (less severe metabolic dysfunction+polypharmacy) and Subtype 3 (lung and liver dysfunction+polypharmacy) had lower but equivalent mean FIs (0.20 for each). Subtype 4 (least severe metabolic dysfunction) had the lowest mean FI (0.13; p's < 0.001). Sociodemographic and behavioral characteristics differed among the subtypes. Individuals with Subtype 1 were older and more frequently unemployed/retired, whereas those with Subtype 3 were more likely to smoke, use crack/cocaine, have heavy alcohol use, and live in temporary/unstable housing. The clinical presentation of frailty in older PWH is heterogeneous. The metabolic syndrome, hepatitis C virus coinfection, cirrhosis, lung disease, and polypharmacy were associated with frailty as were unemployment/retirement, unstable housing, and substance use.
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Affiliation(s)
- Jacqueline M. McMillan
- Section of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Canada
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael John Gill
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Christopher Power
- Southern Alberta Clinic, Calgary, Canada
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Esther Fujiwara
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - David B. Hogan
- Section of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Canada
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Leah H. Rubin
- Department of Neurology and Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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30
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Jayanama K, Theou O, Godin J, Cahill L, Rockwood K. Association of fatty acid consumption with frailty and mortality among middle-aged and older adults. Nutrition 2020; 70:110610. [DOI: 10.1016/j.nut.2019.110610] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/17/2019] [Accepted: 09/23/2019] [Indexed: 02/09/2023]
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Methionine restriction delays aging-related urogenital diseases in male Fischer 344 rats. GeroScience 2019; 42:287-297. [PMID: 31728897 DOI: 10.1007/s11357-019-00129-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 10/21/2019] [Indexed: 01/11/2023] Open
Abstract
Dietary methionine restriction (MR) has been found to enhance longevity across many species. We hypothesized that MR might enhance longevity in part by delaying or inhibiting age-related disease processes. To this end, male Fischer 344 rats were fed control (CF, 0.86% methionine) or MR (0.17% methionine) diets throughout their life until sacrifice at approximately 30 months of age, and histopathology was performed to identify the incidence and progression of two important aging-related pathologies, namely, chronic progressive nephropathy (CPN) and testicular tumorigenesis. Although kidney pathology was observed in 87% CF rats and CPN in 62% of CF animals, no evidence of kidney disease was observed in MR rats. Consistent with the absence of renal pathology, urinary albumin levels were lower in the MR group compared to controls throughout the study, with over a six-fold difference between the groups at 30 months of age. Biomarkers associated with renal disease, namely, clusterin, cystatin C, and β-2 microglobulin, were reduced following 18 months of MR. A reduction in testicular tumor incidence from 88% in CF to 22% in MR rats was also observed. These results suggest that MR may lead to metabolic and cellular changes providing protection against age-related diseases.
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Chao CT, Lee YH, Li CM, Han DS, Huang JW, Huang KC. Advanced Age and Chronic Kidney Disease Modify the Association Between Metabolic Syndrome and Frailty Among Community-Dwelling Elderly. Rejuvenation Res 2019; 23:333-340. [PMID: 31423906 DOI: 10.1089/rej.2019.2202] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Metabolic syndrome (MetS) predisposes older adults to the development of frailty. However, previous studies have not explored factors that may influence the association between MetS and the risk of frailty in this population. Community-dwelling older adults (≥65 years of age) were prospectively identified and enrolled between 2013 and 2016. MetS and frailty were defined based on the American Association of Clinical Endocrinologists and Study of Osteoporotic Fractures criteria, respectively. Multiple logistic regression with frailty/prefrailty as the dependent variable was used to examine the relationship between MetS and frailty/prefrailty, supplemented by subgroup analyses of the influence of aging and chronic kidney disease (CKD). Among 2862 elderly (73.4 ± 6.7 years), 17.5% and 17.3%, respectively, had MetS and frailty/prefrailty, among whom 74 (2.6%) and 420 (14.7%) had frailty and prefrailty. The presence of MetS (odds ratio [OR] 2.53, p < 0.001), higher age (OR 1.05, p < 0.001), and CKD (OR 1.42, p = 0.006) were associated with a significantly higher risk of frailty/prefrailty. Furthermore, among those ≥80 years of age, the association between MetS and frailty/prefrailty disappeared (p = 0.329). Among those with CKD, the presence of MetS was significantly associated with a progressively higher risk of frailty/prefrailty (for stage 3 or higher and for stage 3b or higher, OR 6.4 and 12.4, p < 0.001 and = 0.009, respectively). In conclusion, aging and CKD modified the association between MetS and frailty. These findings may assist in devising case-specific care plans for elderly with MetS by refocusing our attention on those at high risk of developing frailty/prefrailty.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Chia-Ming Li
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
| | - Jenq-Wen Huang
- Nephrology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Ching Huang
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei, Taiwan.,Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei, Taiwan
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Fernandez E, Ross C, Liang H, Javors M, Tardif S, Salmon AB. Evaluation of the pharmacokinetics of metformin and acarbose in the common marmoset. PATHOBIOLOGY OF AGING & AGE RELATED DISEASES 2019; 9:1657756. [PMID: 31497263 PMCID: PMC6719263 DOI: 10.1080/20010001.2019.1657756] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 08/15/2019] [Indexed: 12/31/2022]
Abstract
Metformin has beneficial effects on several age-related diseases (e.g., diabetes, obesity, cancer) and extends lifespan in nematodes and mice. Acarbose, an FDA-approved agent for treating type 2 diabetes, prevents breakdown of complex carbohydrates. Both compounds have been suggested as potential anti-aging interventions and acarbose has been shown to extend mouse longevity by the Intervention Testing Program (ITP). One potential next step is to assess the effect of these interventions on healthspan and lifespan in non-human primates. The common marmoset (Callithrix jacchus) is a small new world monkey with a relatively short life span and small size, both valuable for the translation potential of this nonhuman primate species for the study of aging and chronic disease. However, the dosing and assessment of potential side effects of either metformin or acarbose in this species have yet to be assessed. This study evaluated the pharmacokinetics of two dosage levels each of metformin or acarbose (given separately) in two small groups of young marmosets (n = 5/group) treated for 24 h to define the pharmacokinetics of each drug. The ability to rapidly and reliably dose socially housed marmosets with an oral form of acarbose or metformin that is well tolerated indicates that this species is a reliable model for testing acarbose and metformin in a safe and efficient way in a long-term intervention.
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Affiliation(s)
- Elizabeth Fernandez
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA.,Geriatric Research, Education and Clinical Center, South Texas Veteran's Health Care System, San Antonio.,Department of Pharmacology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Corinna Ross
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA.,Department of Arts & Sciences, Texas A&M-San Antonio, San Antonio, TX, USA
| | - Hanyu Liang
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA.,Geriatric Research, Education and Clinical Center, South Texas Veteran's Health Care System, San Antonio
| | - Martin Javors
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA.,Department of Pharmacology, University of Texas Health Science Center, San Antonio, TX, USA.,Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Suzette Tardif
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA.,Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
| | - Adam B Salmon
- Barshop Institute for Longevity and Aging Studies, University of Texas Health Science Center, San Antonio, TX, USA.,Geriatric Research, Education and Clinical Center, South Texas Veteran's Health Care System, San Antonio.,Department of Molecular Medicine, University of Texas Health Science Center, San Antonio, TX, USA
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34
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Heinze-Milne S, Banga S, Howlett S. Frailty Assessment in Animal Models. Gerontology 2019; 65:610-619. [DOI: 10.1159/000501333] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/05/2019] [Indexed: 11/19/2022] Open
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35
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Age-related deficit accumulation and the diseases of ageing. Mech Ageing Dev 2019; 180:107-116. [DOI: 10.1016/j.mad.2019.04.005] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/10/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022]
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Seldeen KL, Redae YZ, Thiyagarajan R, Berman RN, Leiker MM, Troen BR. High intensity interval training improves physical performance in aged female mice: A comparison of mouse frailty assessment tools. Mech Ageing Dev 2019; 180:49-62. [PMID: 30951786 PMCID: PMC9841971 DOI: 10.1016/j.mad.2019.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/22/2019] [Accepted: 04/01/2019] [Indexed: 01/19/2023]
Abstract
Frailty syndrome increases the risk for disability and mortality, and is a major health concern amidst the geriatric shift in the population. High intensity interval training (HIIT), which couples bursts of vigorous activity interspersed with active recovery intervals, shows promise for the treatment of frailty. Here we compare and contrast five Fried physical phenotype and one deficit accumulation based mouse frailty assessment tools for identifying the impacts of HIIT on frailty and predicting functional capacity, underlying pathology, and survival in aged female mice. Our data reveal a 10-minute HIIT regimen administered 3-days-a-week for 8-weeks increased treadmill endurance, gait speed and maintained grip strength. One frailty tool identified a benefit of HIIT for frailty, but many were trending suggesting HIIT was beneficial for physical performance in these mice, but the 8-week timeframe may have been insufficient to induce frailty benefits. Finally, most frailty tools distinguished between surviving or non-surviving mice, whereas half correlated with functional capacity measured by nest building ability, and none correlated with underlying pathology. In summary, this study supports the ongoing development of mouse assessment tools as useful instruments for frailty research.
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Affiliation(s)
- Kenneth Ladd Seldeen
- Corresponding author at: 875 Ellicott Street, CTRC Room 8030A, Buffalo, NY 14203, USA. (K.L. Seldeen)
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Washington SL, Porten SP, Quanstrom K, Jin C, Bridge M, Finlayson E, Walter LC, Suskind AM. The Association Between Race and Frailty in Older Adults Presenting to a Nononcologic Urology Practice. Urology 2019; 127:19-23. [PMID: 30822479 PMCID: PMC6495603 DOI: 10.1016/j.urology.2019.02.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/08/2019] [Accepted: 02/21/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To explore whether there is an association between nonwhite race and frailty among older adults presenting to an academic nononcologic urology practice. MATERIALS AND METHODS This is a prospective study of individuals ages ≥65years presenting to a nononcologic urology practice between December 2015 and November 2016. All individuals had a Timed Up and Go Test (TUGT, where a slower TUGT time of ≥15 seconds is suggestive of frailty. TUGT times, race (white vs nonwhite), and other clinical data were extracted from the electronic medical record using direct queries. Multivariable logistic regression was used to identify the association between race and slower TUGT times while adjusting for age, gender, number of medications, body mass index, and number of urologic diagnoses. RESULTS Among the 1715 individuals in our cohort, 33.9% were of nonwhite race and 15.3% had TUGT ≥15 seconds. A higher percentage of nonwhite individuals had TUGT times ≥15 seconds compared to white individuals (23.6% vs 11.1%, P <.01). TUGT times ≥15 seconds were significantly associated with nonwhite race after adjusting for clinical factors (adjusted odds ratio 2.5, 95% confidence interval 1.8-3.3). CONCLUSION Among older adults presenting to an academic nononcologic urology practice, nonwhite race was associated with increased odds of frailty. A greater understanding of the relationship between race and frailty is needed to better address the needs of this vulnerable population.
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Affiliation(s)
| | - Sima P Porten
- Department of Urology, University of California, San Francisco, CA
| | | | - Chengshi Jin
- Department of Urology, University of California, San Francisco, CA
| | - Mark Bridge
- Department of Urology, University of California, San Francisco, CA
| | - Emily Finlayson
- Department of General Surgery, University of California, San Francisco, CA
| | - Louise C Walter
- Division of Geriatrics, University of California, San Francisco, CA; San Francisco VA Medical Center, San Francisco, CA
| | - Anne M Suskind
- Department of Urology, University of California, San Francisco, CA
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Abstract
PURPOSE OF REVIEW Older adults often live with chronic disease including diabetes and its complications. In this review, we examine the complexity and heterogeneity of older adults with diabetes and chronic kidney disease, explore the nuances in their diabetes-related monitoring, and discuss their best diabetes management. RECENT FINDINGS Although there remains an overall lack of studies in older adults with diabetes and chronic kidney disease, recent reports have highlighted their vulnerabilities. These individuals face an increased risk of cognitive impairment and dementia, frailty, dysglycemia, polypharmacy, declining kidney function, and acute kidney injury. Their diabetes management should focus upon safer antihyperglycemic medications, close monitoring, and care individualization. Older adults with diabetes and chronic kidney disease are a complex population who requires careful diabetes management and monitoring. Research efforts might focus on improving the care and outcomes of these patients.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology, Western University, London, Ontario, Canada.
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
- St. Joseph's Health Care London, London, Ontario, Canada.
- Institute for Clinical Evaluative Sciences, Ontario, Canada.
- Lawson Health Research Institute, London, Ontario, Canada.
| | - Niamh O'Regan
- St. Joseph's Health Care London, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Jinnie J Rhee
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, CA, USA
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Gomes CS, Pirkle CM, Barbosa JFS, Vafaei A, Câmara SMA, Guerra RO. Age at First Birth, Parity and History of Hysterectomy Are Associated to Frailty Status: Cross-Sectional Analysis from the International Mobility in Aging Study -Imias. J Cross Cult Gerontol 2018; 33:337-354. [DOI: 10.1007/s10823-018-9360-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Jayanama K, Theou O, Blodgett JM, Cahill L, Rockwood K. Frailty, nutrition-related parameters, and mortality across the adult age spectrum. BMC Med 2018; 16:188. [PMID: 30360759 PMCID: PMC6202862 DOI: 10.1186/s12916-018-1176-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/19/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nutritional status and individual nutrients have been associated with frailty in older adults. The extent to which these associations hold in younger people, by type of malnutrition or grades of frailty, is unclear. Our objectives were to (1) evaluate the relationship between individual nutrition-related parameters and frailty, (2) investigate the association between individual nutrition-related parameters and mortality across frailty levels, and (3) examine whether combining nutrition-related parameters in an index predicts mortality risk across frailty levels. METHODS This observational study assembled 9030 participants aged ≥ 20 years from the 2003-2006 cohorts of the National Health and Nutrition Examination Survey who had complete frailty data. A 36-item frailty index (FI) was constructed excluding items related to nutritional status. We examined 62 nutrition-related parameters with established cut points: 34 nutrient intake items, 5 anthropometric measurements, and 23 relevant blood tests. The 41 nutrition-related parameters which were associated with frailty were combined into a nutrition index (NI). All-cause mortality data until 2011 were identified from death certificates. RESULTS All 5 anthropometric measurements, 21/23 blood tests, and 19/34 nutrient intake items were significantly related to frailty. Although most nutrition-related parameters were directly related to frailty, high alcohol consumption and high levels of serum alpha-carotene, beta-carotene, beta-cryptoxanthin, total cholesterol, and LDL-c were associated with lower frailty scores. Only low vitamin D was associated with increased mortality risk across all frailty levels. Seventeen nutrition-related parameters were associated with mortality in the 0.1-0.2 FI group, 11 in the 0.2-0.3 group, and 16 in the > 0.3 group. Overall, 393 (5.8%) of the participants had an NI score less than 0.1 (abnormality in ≤ 4 of the 41 parameters examined). Higher levels of NI were associated with higher mortality risk after adjusting for frailty and other covariates (HR per 0.1: 1.19 [95%CI 1.133-1.257]). CONCLUSIONS Most nutrition-related parameters were correlated to frailty, but only low vitamin D was associated with higher risk for mortality across levels of frailty. As has been observed with other age-related phenomena, even though many nutrition-related parameters were not significantly associated with mortality individually, when combined in an index, they strongly predicted mortality risk.
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Affiliation(s)
- Kulapong Jayanama
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Olga Theou
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Health Care of the Elderly, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | | | - Leah Cahill
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kenneth Rockwood
- Centre for Health Care of the Elderly, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada. .,Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Camp Hill Veterans' Memorial Bldg., 5955 Veterans' Memorial Lane, Halifax, Nova Scotia, B3H 2E1, Canada.
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Sills AM, Artavia JM, DeRosa BD, Ross CN, Salmon AB. Long-term treatment with the mTOR inhibitor rapamycin has minor effect on clinical laboratory markers in middle-aged marmosets. Am J Primatol 2018; 81:e22927. [PMID: 30311681 DOI: 10.1002/ajp.22927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 09/20/2018] [Accepted: 09/23/2018] [Indexed: 11/06/2022]
Abstract
Interventions to extend lifespan and improve health with increasing age would have significant impact on a growing aged population. There are now several pharmaceutical interventions that extend lifespan in laboratory rodent models with rapamycin, an inhibitor of mechanistic target of rapamycin (mTOR) being the most well studied. In this study, we report on the hematological effects in a cohort of middle-aged common marmosets (Callithrix jacchus) that were enrolled in a study to test the effects of daily rapamycin treatment on aging in this species. In addition, we assessed whether sex was a significant factor in either baseline assessment or as an interaction with rapamycin treatment. Among our cohort at baseline, we found few differences in either basic morphology or hematological markers of blood cell counts, metabolism or inflammation between male and female marmosets. After dosing with rapamycin, surprisingly we found trough blood concentrations of rapamycin were significantly lower in female compared to male marmosets. Despite this pharmacological difference, both sexes had only minor changes in cellular blood counts after 9 months of rapamycin. These data then suggest that the potential clinical hematological side effects of rapamycin are not likely outcomes of long-term rapamycin in relatively healthy, middle-aged marmosets.
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Affiliation(s)
- Aubrey M Sills
- The Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas
| | - Joselyn M Artavia
- The Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas
| | - Brian D DeRosa
- The Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas
| | - Corinna N Ross
- The Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas.,Department of Science and Mathematics, Texas A&M University at San Antonio, San Antonio, Texas
| | - Adam B Salmon
- The Sam and Ann Barshop Institute for Longevity and Aging Studies, UT Health San Antonio, San Antonio, Texas.,Department of Molecular Medicine, UT Health San Antonio, San Antonio, Texas.,Geriatric Research, Education and Clinical Center, South Texas Veterans Healthcare System, San Antonio, Texas
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42
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Rivera-Almaraz A, Manrique-Espinoza B, Ávila-Funes JA, Chatterji S, Naidoo N, Kowal P, Salinas-Rodríguez A. Disability, quality of life and all-cause mortality in older Mexican adults: association with multimorbidity and frailty. BMC Geriatr 2018; 18:236. [PMID: 30286727 PMCID: PMC6172837 DOI: 10.1186/s12877-018-0928-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/24/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Multimorbidity and frailty are relevant conditions among older adult population. There is growing evidence about their association with poor health outcomes like disability, worst quality of life, and death. Nonetheless, the independent associations of both conditions have been studied, and few evidence exists about an interaction between them. Our aims were to assess the association of frailty and multimorbidity with the disability, quality of life and all-cause mortality as well as to analyze a potential interaction between these conditions. METHODS Analytical samples included 1410 respondents for disability and quality of life, and 1792 for mortality. We performed a longitudinal analysis with older Mexican adults aged 50, using data collected from the WHO's Study on global AGEing and Adult Health Waves 1 and 2. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), and quality of life using the WHOQOL (WHO Quality of Life) instrument. All-cause mortality was determined by reviewing death certificates. Associations of frailty and multimorbidity with disability, quality of life and mortality were estimated using linear regression and Cox proportional hazards models. RESULTS Multimorbidity assessed through three patterns (cardiopulmonary, vascular-metabolic, and mental-musculoskeletal) was associated with the three outcomes in this study. Cardiopulmonary and mental-musculoskeletal patterns increased the WHODAS mean score (β = 5.05; p < 0.01 and β = 5.10; p < 0.01, respectively) and decreased WHOQOL score (β = - 1.81; p < 0.01 and β = - 2.99; p < 0.01, respectively). Vascular-metabolic was associated with mortality (HR = 1.47; p = 0.04), disability (β = 3.27; p < 0.01) and quality of life (β = - 1.30; p = 0.02). Frailty was associated with mortality (pre-frail: HR = 1.48; p = 0.02 and frail: HR = 1.68; p = 0.03), disability (pre-frail: β = 5.02; p < 0.01; frail: β = 13.29; p < 0.01) and quality of life (pre-frail: β = - 2.23; p < 0.01; frail: β = - 4.38; p < 0.01). Interaction terms of frailty and multimorbidity were not statistically significant. CONCLUSIONS Multimorbidity and frailty are important predictors of poor health outcomes. These results highlight the importance of carrying out health promotion and prevention actions as well as specific interventions aimed at older adults who suffer from multimorbidity and frailty, in such a way that deleterious effects on health can be avoided.
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Affiliation(s)
- Ana Rivera-Almaraz
- National Institute of Public Health, Avenida Universidad #655, Colonia Santa María Ahuacatitlán, ZC, 62100 Cuernavaca, Morelos Mexico
| | - Betty Manrique-Espinoza
- National Institute of Public Health, Avenida Universidad #655, Colonia Santa María Ahuacatitlán, ZC, 62100 Cuernavaca, Morelos Mexico
| | - José Alberto Ávila-Funes
- Department of Geriatrics, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Somnath Chatterji
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Nirmala Naidoo
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
| | - Paul Kowal
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland
- University of Newcastle Research Centre on Gender, Health and Ageing, Newcastle, Australia
- Chiang Mai University Research Institute for Health Sciences, Chiang Mai, Thailand
| | - Aarón Salinas-Rodríguez
- National Institute of Public Health, Avenida Universidad #655, Colonia Santa María Ahuacatitlán, ZC, 62100 Cuernavaca, Morelos Mexico
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Kaeberlein M. How healthy is the healthspan concept? GeroScience 2018; 40:361-364. [PMID: 30084059 DOI: 10.1007/s11357-018-0036-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Matt Kaeberlein
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, 98195, USA.
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Csipo T, Fulop GA, Lipecz A, Tarantini S, Kiss T, Balasubramanian P, Csiszar A, Ungvari Z, Yabluchanskiy A. Short-term weight loss reverses obesity-induced microvascular endothelial dysfunction. GeroScience 2018; 40:10.1007/s11357-018-0028-9. [PMID: 29916025 PMCID: PMC6060194 DOI: 10.1007/s11357-018-0028-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/06/2018] [Indexed: 12/30/2022] Open
Abstract
Obesity is one of the major risk factors for cardiovascular diseases and its prevalence is increasing in all age groups, with the biggest impact observed in middle-aged and older adults. A critical mechanism by which obesity promotes vascular pathologies in these patients involves impairment of endothelial function. While endothelial dysfunction in large vessels promotes atherogenesis, obesity-induced microvascular endothelial dysfunction impairs organ perfusion and thereby is causally related to the pathogenesis of ischemic heart disease, chronic kidney disease, intermittent claudication, exercise intolerance, and exacerbates cognitive decline in aging. Reduction of weight via calorie-based diet and exercise in animal models of obesity results in significant improvement of endothelial function both in large vessels and in the microcirculation, primarily due to attenuation of oxidative stress and inflammation. Clinical data on the protective effects of weight loss on endothelial function is limited to studies of flow-mediated dilation assessed in brachial arteries. Currently, there is no guideline on testing the effects of different weight management strategies on microvascular endothelial function in obese patients. Here, we provide proof-of-concept that weight loss-induced improvement of microvascular endothelial function can be reliably assessed in the setting of a geriatric outpatient clinic using a fast, reproducible, non-invasive method: laser speckle contrast imaging-based measurement of endothelium-dependent microvascular responses during post-occlusive reactive hyperemia tests. Our study also provides initial evidence that short-term weight loss induced by consumption of a low-carbohydrate low-calorie diet can reverse microvascular endothelial dysfunction associated with obesity.
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Affiliation(s)
- Tamas Csipo
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gabor A Fulop
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Agnes Lipecz
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Department of Ophthalmology, Josa Andras Hospital, Nyiregyhaza, Hungary
| | - Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
| | - Tamas Kiss
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
| | - Priya Balasubramanian
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
- Department of Pulmonology, Semmelweis University, Budapest, Hungary
| | - Andriy Yabluchanskiy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1315, Oklahoma City, OK, 73104, USA.
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46
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Ju SY, Lee JY, Kim DH. Association of metabolic syndrome and its components with all-cause and cardiovascular mortality in the elderly: A meta-analysis of prospective cohort studies. Medicine (Baltimore) 2017; 96:e8491. [PMID: 29137039 PMCID: PMC5690732 DOI: 10.1097/md.0000000000008491] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There is increasing evidence regarding the relationship between metabolic syndrome and mortality. However, previous research examining metabolic syndrome and mortality in older populations has produced mixed results. In addition, there is a clear need to identify and manage individual components of metabolic syndrome to decrease cardiovascular disease (CVD) mortality. In this meta-analysis, we searched the MEDLINE databases using PubMed, Cochrane Library, and EMBASE databases. Based on 20 prospective cohort studies, metabolic syndrome was associated with a higher risk of all-cause mortality [relative risk (RR), 1.23; 95% confidence interval (CI), 1.15-1.32; I = 55.9%] and CVD mortality (RR, 1.24; 95% CI, 1.11-1.39; I = 58.1%). The risk estimates of all-cause mortality for single components of metabolic syndrome were significant for higher values of waist circumference or body mass index (RR, 0.94; 95% CI, 0.88-1.00), higher values of blood glucose (RR, 1.19; 95% CI, 1.05-1.34), and lower values of high-density lipoprotein (HDL) cholesterol (RR, 1.11; 95% CI, 1.02-1.21). In the elderly population, metabolic syndrome was associated with an increased risk of all-cause and CVD mortality. Among the individual components of metabolic syndrome, increased blood glucose and HDL cholesterol levels were significantly associated with increased mortality. However, older obese or overweight individuals may have a decreased mortality risk. Thus, the findings of the current meta-analysis raise questions about the utility of the definition of metabolic syndrome in predicting all-cause mortality and CVD mortality in the elderly population.
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Affiliation(s)
- Sang-Yhun Ju
- Department of Family Medicine, College of Medicine, Yeouido St. Mary's Hospital, the Catholic University of Korea
| | - June-Young Lee
- Department of Biostatistics, Korea University College of Medicine
| | - Do-Hoon Kim
- Department of Family Medicine, Korea University Ansan Hospital, Ansan-Si Gyeonggi, Republic of Korea
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Abstract
Busy primary care providers are in the frontline and see the bulk of older adults with diabetes. This vulnerable population is more prone to diabetic complications and hypoglycemia. In contrast to the younger patients with diabetes, lifestyle interventions are even more effective in older adults while the target A1c levels may need to be more relaxed for frail individuals. Geriatric syndromes can adversely affect diabetes care. A team with experts in different fields who understand the needs of older adults is essential for the adequate quality care of the whole individual with diabetes.
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Affiliation(s)
- Rangaraj Gopalraj
- Department of Family & Geriatric Medicine, University of Louisville, 1941 Bishop Lane, Suite 900, Louisville, KY 40218, USA.
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Csiszar A, Tarantini S, Fülöp GA, Kiss T, Valcarcel-Ares MN, Galvan V, Ungvari Z, Yabluchanskiy A. Hypertension impairs neurovascular coupling and promotes microvascular injury: role in exacerbation of Alzheimer's disease. GeroScience 2017; 39:359-372. [PMID: 28853030 PMCID: PMC5636770 DOI: 10.1007/s11357-017-9991-9] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/26/2017] [Indexed: 12/13/2022] Open
Abstract
Hypertension in the elderly substantially increases both the risk of vascular cognitive impairment (VCI) and Alzheimer's disease (AD); however, the underlying mechanisms are not completely understood. This review discusses the effects of hypertension on structural and functional integrity of cerebral microcirculation, including hypertension-induced alterations in neurovascular coupling responses, cellular and molecular mechanisms involved in microvascular damage (capillary rarefaction, blood-brain barrier disruption), and the genesis of cerebral microhemorrhages and their potential role in exacerbation of cognitive decline associated with AD. Understanding and targeting the hypertension-induced cerebromicrovascular alterations that are involved in the onset and progression of AD and contribute to cognitive impairment are expected to have a major role in preserving brain health in high-risk older individuals.
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Affiliation(s)
- Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gábor A Fülöp
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Division of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamas Kiss
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - M Noa Valcarcel-Ares
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Veronica Galvan
- Department of Cellular and Integrative Physiology, Barshop Institute for Longevity and Aging Studies University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Andriy Yabluchanskiy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Tarantini S, Fulop GA, Kiss T, Farkas E, Zölei-Szénási D, Galvan V, Toth P, Csiszar A, Ungvari Z, Yabluchanskiy A. Demonstration of impaired neurovascular coupling responses in TG2576 mouse model of Alzheimer's disease using functional laser speckle contrast imaging. GeroScience 2017; 39:465-473. [PMID: 28578467 PMCID: PMC5636768 DOI: 10.1007/s11357-017-9980-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 05/23/2017] [Indexed: 01/28/2023] Open
Abstract
Increasing evidence from epidemiological, clinical, and experimental studies indicates that cerebromicrovascular dysfunction and microcirculatory damage play critical roles in the pathogenesis of many types of dementia in the elderly, including both vascular cognitive impairment (VCI) and Alzheimer's disease. Vascular contributions to cognitive impairment and dementia (VCID) include impairment of neurovascular coupling responses/functional hyperemia ("neurovascular uncoupling"). Due to the growing interest in understanding and pharmacologically targeting pathophysiological mechanisms of VCID, there is an increasing need for sensitive, easy-to-establish methods to assess neurovascular coupling responses. Laser speckle contrast imaging (LSCI) is a technique that allows rapid and minimally invasive visualization of changes in regional cerebromicrovascular blood perfusion. This type of imaging technique combines high resolution and speed to provide great spatiotemporal accuracy to measure moment-to-moment changes in cerebral blood flow induced by neuronal activation. Here, we provide detailed protocols for the successful measurement in neurovascular coupling responses in anesthetized mice equipped with a thinned-skull cranial window using LSCI. This method can be used to evaluate the effects of anti-aging or anti-AD treatments on cerebromicrovascular health.
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Affiliation(s)
- Stefano Tarantini
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma, OK, 73104, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Gabor A Fulop
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma, OK, 73104, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Tamas Kiss
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma, OK, 73104, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
- Faculty of Medicine & Faculty of Science and Informatics, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Eszter Farkas
- Faculty of Medicine & Faculty of Science and Informatics, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Dániel Zölei-Szénási
- Faculty of Medicine & Faculty of Science and Informatics, Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Veronica Galvan
- Department of Cellular and Integrative Physiology, Barshop Institute for Longevity and Aging Studies University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Peter Toth
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma, OK, 73104, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
- Department of Neurosurgery, University of Pecs, Pecs, Hungary
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma, OK, 73104, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma, OK, 73104, USA
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Andriy Yabluchanskiy
- Reynolds Oklahoma Center on Aging, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma, OK, 73104, USA.
- Translational Geroscience Laboratory, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA.
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Hypertension-induced synapse loss and impairment in synaptic plasticity in the mouse hippocampus mimics the aging phenotype: implications for the pathogenesis of vascular cognitive impairment. GeroScience 2017; 39:385-406. [PMID: 28664509 DOI: 10.1007/s11357-017-9981-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 05/30/2017] [Indexed: 12/22/2022] Open
Abstract
Strong epidemiological and experimental evidence indicates that hypertension has detrimental effects on the cerebral microcirculation and thereby promotes accelerated brain aging. Hypertension is an independent risk factor for both vascular cognitive impairment (VCI) and Alzheimer's disease (AD). However, the pathophysiological link between hypertension-induced cerebromicrovascular injury (e.g., blood-brain barrier disruption, increased microvascular oxidative stress, and inflammation) and cognitive decline remains elusive. The present study was designed to characterize neuronal functional and morphological alterations induced by chronic hypertension and compare them to those induced by aging. To achieve that goal, we induced hypertension in young C57BL/6 mice by chronic (4 weeks) infusion of angiotensin II. We found that long-term potentiation (LTP) of performant path synapses following high-frequency stimulation of afferent fibers was decreased in hippocampal slices obtained from hypertensive mice, mimicking the aging phenotype. Hypertension and advanced age were associated with comparable decline in synaptic density in the stratum radiatum of the mouse hippocampus. Hypertension, similar to aging, was associated with changes in mRNA expression of several genes involved in regulation of neuronal function, including down-regulation of Bdnf, Homer1, and Dlg4, which may have a role in impaired synaptic plasticity. Collectively, hypertension impairs synaptic plasticity, reduces synaptic density, and promotes dysregulation of genes involved in synaptic function in the mouse hippocampus mimicking the aging phenotype. These hypertension-induced neuronal alterations may impair establishment of memories in the hippocampus and contribute to the pathogenesis and clinical manifestation of both vascular cognitive impairment (VCI) and Alzheimer's disease (AD).
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