Physical stature decline and the health status of the elderly population in England

A systematic review of social connections as determinants of obesity: Longitudinal evidence limited to marital transitions

BACKGROUND

Social relationships impact health and may affect proximal determinants such as obesity. Our review examined empirical evidence of the impact of changes in social relationships on risk of obesity in aging adults, with attention to gender.

METHODS

We systematically searched Medline, EMBASE, Scopus, CINAHL, and ProQuest Dissertations and reference lists of relevant reviews and papers published up to November 2022. Longitudinal studies examining changes in marital status, living arrangement, social participation, and social networks and anthropometric changes or incident obesity were deemed eligible. Relevant data were extracted and synthesized narratively.

RESULTS

We identified 41,910 eligible titles, resulting in 252 full texts and 7 included studies. All studies were conducted in the United States and assessed marital transitions only; 3 studies included both women and men. Overall, compared with people who remain non-married, entering marriage leads to a significant increase in body mass index (BMI) for both genders. Conversely, transitioning out of marriage through widowhood or divorce leads to a decrease in weight (kg/lbs), waist circumference, and BMI for both genders. All seven studies were deemed to be of medium quality.

CONCLUSIONS

Our review revealed a paucity of prospective evidence on social connections as determinants of obesity among aging adults. There is limited evidence that marital transitions are associated with changes in anthropometric measurements in aging individuals, but no evidence on the effects of changes in living arrangements, social participation, and social networks on anthropometric measurements. More research attention to the social determinants of obesity is warranted.

Height & income: Labor returns of health in Mexico from 2000 to 2018

Investment in health has been proposed as a mechanism to promote upward social mobility. Previous analyses have reported inconsistent estimates of the returns to investment in health in Mexico based on different models for different years. We aim to estimate returns for Mexico using data from four time points Adult height and labor income are drawn from the periodical national health and nutrition surveys-a group of relatively standardized surveys-that are representative of individuals living in the country in 2000, 2006, 2012 & 2018. These surveys collect anthropometric measurements and information on individuals' labor income. We estimated Mincerian models separately for men and women using OLS, Heckman, instrumental variables, and Heckman with instrumental variables models. Our results indicate significant and positive returns to health for the four surveys, similar in magnitude across years for women and with variations for men. By 2018, returns to health were about 7.4% per additional centimeter in height for females and 9.3% for males. Investments in health and nutrition during childhood and adolescence that increase health capital-measured as adult height-may promote social mobility in Mexico and similar countries to the extent that these investments differentially increase health capital among the poor.

Association between Height-Changing Scores and Risk of Sarcopenia Estimated from Anthropometric Measurements in Older Adults: A Cross-Sectional Study

Anthropometric assessments are commonly used to diagnose sarcopenia in older adults. However, the ongoing exploration of novel approaches aims to improve the early detection of sarcopenia. This study investigated the association between the height-changing score (HCS) and the risk of sarcopenia defined by anthropometric measurements in 340 older adults (mean age: 66.2 years). The HCS derived from the difference in height and demi-span equivalent height (DEH) was used as an indicator of declining height in the older adults. Multivariate logistic regression analysis revealed a significant association between the HCS and the risk of sarcopenia in both male and female older adults (OR = 1.146, 95% CI [1.021, 1.286], p = 0.021). In addition, income, BMI, and nutritional status were significantly associated with the risk of sarcopenia (OR = -1.933, 95% CI [0.271, 0.986], p = 0.045; OR = -2.099, 95% CI [0.386, 0.587], p < 0.001; OR = -1.443, 95% CI [0.555, 0.866], p = 0.001, respectively). The white blood cell count, lymphocyte count, and HDL cholesterol were blood biomarkers significantly correlated with calf circumference. It can be suggested that the HCS acts as an indicator and screening tool for sarcopenia risk in older adults, highlighting the potential impact of decreased height on muscle mass loss. Encouraging nutritional support can help mitigate the risk of sarcopenia.

Genetic influence on within-person longitudinal change in anthropometric traits in the UK Biobank

The causes of temporal fluctuations in adult traits are poorly understood. Here, we investigate the genetic determinants of within-person trait variability of 8 repeatedly measured anthropometric traits in 50,117 individuals from the UK Biobank. We found that within-person (non-directional) variability had a SNP-based heritability of 2-5% for height, sitting height, body mass index (BMI) and weight (P ≤ 2.4 × 10-3). We also analysed longitudinal trait change and show a loss of both average height and weight beyond about 70 years of age. A variant tracking the Alzheimer's risk APOE- E 4 allele (rs429358) was significantly associated with weight loss ( β  = -0.047 kg per yr, s.e. 0.007, P = 2.2 × 10-11), and using 2-sample Mendelian Randomisation we detected a relationship consistent with causality between decreased lumbar spine bone mineral density and height loss (bxy = 0.011, s.e. 0.003, P = 3.5 × 10-4). Finally, population-level variance quantitative trait loci (vQTL) were consistent with within-person variability for several traits, indicating an overlap between trait variability assessed at the population or individual level. Our findings help elucidate the genetic influence on trait-change within an individual and highlight disease risks associated with these changes.

The role of education in health policy reform outcomes: evidence from Japan

This study analyzes the role of education in the outcomes of the reform of the Japanese annual health checkup program. In April 2008, the annual checkup was redesigned to address concerns about metabolic syndrome. As the checkup is mandatory only for salaried workers, their participation rate is significantly higher than other workers; thus, they were most affected by the reform. Using institutional information, a difference-in-differences estimation was conducted with salaried workers as the treatment group and self-employed workers as the control group. We found that the reform caused significant changes in health behaviors and outcomes only among university graduates who were at a relatively high risk of metabolic syndrome. This highly educated group increased their physical activity, brought energy intake close to an ideal level, and achieved significant weight loss and BMI reduction to levels that minimize all-cause mortality among middle-aged Japanese. A secondary analysis implies that the difference in cognitive functioning test scores may be a critical factor in explaining the heterogeneous responses to the reform, suggesting that thoroughly well-articulated recommendations for healthy behaviors are needed in order to improve reform uptake.

Does mandibular bone structure predict subsequent height loss? A longitudinal cohort study of women in Gothenburg, Sweden

BACKGROUND

Several risk factors for loss of height with increasing age have been identified.

OBJECTIVE

To investigate if mandibular bone structure predicts future height loss in middle-aged and elderly Swedish women.

DESIGN

Prospective cohort study with longitudinally measured heights, radiographical assessments of the cortical bone using Klemetti's Index (normal, moderate or severely eroded cortex) and classification of the trabecular bone using an index proposed by Lindh et al (sparse, mixed or dense trabeculation). No intervention was performed.

SETTING

Gothenburg, Sweden.

PARTICIPANTS

A population-based sample of 937 Swedish women born in 1914, 1922 and 1930 was recruited. At the baseline examination, the ages were 38, 46 and 54 years. All had undergone a dental examination with panoramic radiographs of the mandible, and a general examination including height measurements on at least two occasions.

MAIN OUTCOME MEASURE

Height loss was calculated over three periods 12-13 years (1968-1980, 1980-1992, 1992-2005).

MAIN RESULTS

Mean annual height loss measures were 0.075 cm/year, 0.08 cm/year and 0.18 cm/year over the three observation intervals, corresponding to absolute decreases of 0.9 cm, 1.0 cm and 2.4 cm. Cortical erosion in 1968, 1980 and 1992 significantly predicted height loss 12 years later. Sparse trabeculation in 1968, 1980 and 1992 also predicted significant shrinkage over 12 or 13 years. Multivariable regression analyses adjusting for baseline covariates such as height, birth year, physical activity, smoking, body mass index and education yielded consistent findings except for cortical erosion 1968-1980.

CONCLUSION

Mandibular bone structure characteristics such as severe cortical erosion and sparse trabeculation may serve as early risk factors for height loss. Since most individuals visit their dentist at least every 2 years and radiographs are taken, a collaboration between dentists and physicians may open opportunities for predicting future risk of height loss.

Use of Mindex and Demiquet for assessing nutritional status in older adults

BACKGROUND

The Mini Nutritional Assessment (MNA) is a validated questionnaire that estimates nutritional status. Given that this questionnaire uses stature measurement, which are unreliable in older adults, Mindex and Demiquet are alternatives to BMI for assessing malnutrition risk. However, the correlation of Mindex and Demiquet values with MNA scores has not been investigated.

OBJECTIVES

This cross-sectional study examined the correlation of Mindex and Demiquet with nutritional status and blood parameters in older adults in Thailand.

METHODS

The correlation of Mindex and Demiquet with MNA scores and body mass index (BMI), as well as blood parameters, was evaluated. Sociodemographic characteristics, anthropometric measurements, and blood test results were collected from 347 participants aged 60 years and older (mean ± SD, 66.4 ± 5.3 years). Spearman's rank correlation coefficient and multiple logistic regression analyses were used in statistical analyses.

RESULTS

MNA scores were significantly correlated with Mindex (P < 0.001) and Demiquet (P = 0.001), and BMI was related to Mindex and Demiquet (P < 0.001). Low-density lipoprotein cholesterol (LDL-C) predicted MNA scores (P = 0.048) in males but not females.

CONCLUSIONS

Mindex and Demiquet values were positively correlated with MNA scores and BMI. In addition, LDL-C predicted MNA scores in male older adults.

Diurnal pattern of breaks in sedentary time and the physical function of older adults

BACKGROUND

The association of breaks in sedentary time with outcomes of physical function can vary according to the time of day. We examined the association of the diurnal pattern of breaks in sedentary time with physical function outcomes in older adults.

METHODS

A cross-sectional analysis was conducted among 115 older adults (≥60 years). The overall and time-specific breaks (morning: 06:00-12:00; afternoon: 12:00-18:00; evening: 18:00-24:00) in sedentary time were assessed using a triaxial accelerometer (Actigraph GT3X+). A break in sedentary time was defined as at least 1 min where the accelerometer registered ≥100 cpm following a sedentary period. Five physical function outcomes were assessed: handgrip strength (dynamometer), balance ability (single leg stance), gait speed (11-m walking), basic functional mobility (time up and go), and lower-limb strength (five times sit-to-stand). Generalized linear models were used to examine the associations of the overall and time-specific breaks in sedentary time with the physical function outcomes.

RESULTS

Participants showed an average of 69.4 breaks in sedentary time during the day. Less frequent breaks in the evening (19.3) were found than that in the morning (24.3) and the afternoon (25.3) (p < 0.05). Breaks in sedentary time during the day were associated with less time on gait speed in older adults (exp (β) = 0.92, 95% confidence interval [CI] 0.86-0.98; p < 0.01). Time-specific analysis showed that breaks in sedentary time were associated with less time on gait speed (exp (β) = 0.94, 95% CI 0.91-0.97; p < 0.01), basic functional mobility (exp (β) = 0.93, 95% CI 0.89-0.97; p < 0.01), and lower-limb strength (exp (β) = 0.92, 95% CI 0.87-0.97; p < 0.01) in the evening only.

CONCLUSION

A break in sedentary time, particularly during the evening, was associated with better lower extremity strength in older adults. Further strategies to interrupt sedentary time with frequent breaks, with an emphasis on evening hours, can be helpful to maintain and improve physical function in older adults.

Body mass index associates with amyotrophic lateral sclerosis survival and metabolomic profiles

INTRODUCTION/AIMS

Body mass index (BMI) is linked to amyotrophic lateral sclerosis (ALS) risk and prognosis, but additional research is needed. The aim of this study was to identify whether and when historical changes in BMI occurred in ALS participants, how these longer term trajectories associated with survival, and whether metabolomic profiles provided insight into potential mechanisms.

METHODS

ALS and control participants self-reported body height and weight 10 (reference) and 5 years earlier, and at study entry (diagnosis for ALS participants). Generalized estimating equations evaluated differences in BMI trajectories between cases and controls. ALS survival was evaluated by BMI trajectory group using accelerated failure time models. BMI trajectories and survival associations were explored using published metabolomic profiling and correlation networks.

RESULTS

Ten-year BMI trends differed between ALS and controls, with BMI loss in the 5 years before diagnosis despite BMI gains 10 to 5 years beforehand in both groups. An overall 10-year drop in BMI associated with a 27.1% decrease in ALS survival (P = .010). Metabolomic networks in ALS participants showed dysregulation in sphingomyelin, bile acid, and plasmalogen subpathways.

DISCUSSION

ALS participants lost weight in the 5-year period before enrollment. BMI trajectories had three distinct groups and the group with significant weight loss in the past 10 years had the worst survival. Participants with a high BMI and increase in weight in the 10 years before symptom onset also had shorter survival. Certain metabolomics profiles were associated with the BMI trajectories. Replicating these findings in prospective cohorts is warranted.

AnthropoAge, a novel approach to integrate body composition into the estimation of biological age

Aging is believed to occur across multiple domains, one of which is body composition; however, attempts to integrate it into biological age (BA) have been limited. Here, we consider the sex-dependent role of anthropometry for the prediction of 10-year all-cause mortality using data from 18,794 NHANES participants to generate and validate a new BA metric. Our data-driven approach pointed to sex-specific contributors for BA estimation: WHtR, arm and thigh circumferences for men; weight, WHtR, thigh circumference, subscapular and triceps skinfolds for women. We used these measurements to generate AnthropoAge, which predicted all-cause mortality (AUROC 0.876, 95%CI 0.864-0.887) and cause-specific mortality independently of ethnicity, sex, and comorbidities; AnthropoAge was a better predictor than PhenoAge for cerebrovascular, Alzheimer, and COPD mortality. A metric of age acceleration was also derived and used to assess sexual dimorphisms linked to accelerated aging, where women had an increase in overall body mass plus an important subcutaneous to visceral fat redistribution, and men displayed a marked decrease in fat and muscle mass. Finally, we showed that consideration of multiple BA metrics may identify unique aging trajectories with increased mortality (HR for multidomain acceleration 2.43, 95%CI 2.25-2.62) and comorbidity profiles. A simplified version of AnthropoAge (S-AnthropoAge) was generated using only BMI and WHtR, all results were preserved using this metric. In conclusion, AnthropoAge is a useful proxy of BA that captures cause-specific mortality and sex dimorphisms in body composition, and it could be used for future multidomain assessments of aging to better characterize the heterogeneity of this phenomenon.

Do brachycephaly and nose size predict the severity of obstructive sleep apnea (OSA)? A sample-based geometric morphometric analysis of craniofacial variation in relation to OSA syndrome and the role of confounding factors

Obstructive sleep apnea is a common disorder that leads to sleep fragmentation and is potentially bidirectionally related to a variety of comorbidities, including an increased risk of heart failure and stroke. It is often considered a consequence of anatomical abnormalities, especially in the head and neck, but its pathophysiology is likely to be multifactorial in origin. With geometric morphometrics, and a large sample of adults from the Study for Health in Pomerania, we explore the association of craniofacial morphology to the apnea-hypopnea index used as an estimate of obstructive sleep apnea severity. We show that craniofacial size and asymmetry, an aspect of morphological variation seldom analysed in obstructive sleep apnea research, are both uncorrelated to apnea-hypopnea index. In contrast, as in previous analyses, we find evidence that brachycephaly and larger nasal proportions might be associated to obstructive sleep apnea severity. However, this correlational signal is weak and completely disappears when age-related shape variation is statistically controlled for. Our findings suggest that previous work might need to be re-evaluated, and urge researchers to take into account the role of confounders to avoid potentially spurious findings in association studies.

Comparison of body fat percentage assessments by bioelectrical impedance analysis, anthropometrical prediction equations, and dual-energy X-ray absorptiometry in older women

Background

Individuals with high body fat have a higher risk of mortality. Numerous anthropometric-based predictive equations are available for body composition assessments; furthermore, bioelectrical impedance analysis (BIA) estimates are available. However, in older adults, the validity of body fat estimates requires further investigation.

Objective

To assess the agreement between percentage body fat (BF%) estimates by BIA and five predictive equations based on anthropometric characteristics using dual X-ray absorptiometry (DXA) as reference method. A secondary objective was to identify whether excluding short-stature women improves the agreement of BF% estimates in a group of community-dwelling, older Mexican women.

Methods

A concordance analysis of BF% was performed. A total of 121 older women participated in the study. Anthropometric information, BIA, and DXA body composition estimates were obtained. Five equations using anthropometric data were evaluated in order to determine body fat percentage (BF%) using DXA as reference method. Paired t-test comparisons and standard error of estimates (SEE) were obtained. The Bland-Altman plot with 95% limits of agreement and the concordance correlation coefficient (CCC) were used to evaluate the BF% prediction equations and BIA estimates.

Results

The mean age of the study participants was 73.7 (±5.8) years old. BIA and the anthropometric based equations examined showed mean significant differences when tested in the entire sample. For the taller women (height > 145 cm), no significant difference in the paired comparison was found between DXA and BIA of BF% estimates. The mean BF% was 40.3 (±4.8) and 40.7 (±6.2) for DXA and BIA, respectively. The concordance between methods was good (CCC 0.814), (SEE 2.62). Also, in the taller women subset, the Woolcott equation using waist-to-height ratio presented no significant difference in the paired comparison; however, the error of the estimates was high (SEE 3.37) and the concordance was moderate (CCC 0.693).

Conclusion

This study found that BIA yielded good results in the estimation of BF% among women with heights over 145 cm. Also, in this group, the Woolcott predictive equation based on waist circumference and height ratio showed no significant differences compared to DXA in the paired comparison; however, the large error of estimates observed may limit its application. In older women, short stature may impact the validity of the body fat percentage estimates of anthropometric-based predictive equations.

Height and nigral neuron density in Parkinson's disease

Background

The dopaminergic system modulates growth hormone secretion and previous results have suggested a link between short stature and an increased risk of Parkinson’s disease (PD).

Methods

In 36 Lewy body spectrum disease (LBD) cases (PD = 22) and 19 controls, nigral TH-positive neuron densities were measured postmortem from midbrain sections and corrected with the Abercrombie method. Body measurements were collected from autopsies or patient records. Our aim was to investigate the possible relationship between height and the density of neurons in the substantia nigra pars compacta (SNc).

Results

SNc neuron density (n/mm²) had an inverse association with height, (R² = 0.317, p < 0.0001) in patients. The association was not explained by weight, age, sex, brain weight, medication, or disease motor severity. The association was also separately observed in patients with PD (n = 22), but not in subjects who died without diagnosed neurological diseases.

Conclusions

Individual adult height may be connected to nigral neuron numbers in patients with LBDs, including PD.

Getting a Grip on Secular Changes: Age-Period-Cohort Modeling of Grip Strength in the English Longitudinal Study of Ageing

BACKGROUND

Grip strength is a popular and valuable measure in studies of physical functional capabilities in old age. The influence of historical trends and differential period-specific exposures can complicate the interpretation of biomarkers of aging and health and requires careful analysis and interpretation of aging, birth cohort, and period effects. This study evaluates the effects of aging, period, and cohort on grip strength in a population of adults and older adults.

METHODS

We use more than 27 000 observations for individuals at least 50 years of age, born in approximately 1910-1960, from the English Longitudinal Study of Ageing to examine a variety of multilevel and cross-classified modeling approaches to evaluate age, period, and cohort effects. Our results extended Hierarchical Age-Period-Cohort modeling and compared our results with a set of 9 submodels with explicit assumptions to determine the most reliable modeling approach.

RESULTS

Findings suggest grip strength is primarily related to age, with minimal evidence of either period and/or cohort effects. Each year's increase in a person's age was associated with a 0.40-kg decrease in grip strength, though this decline differs by gender.

CONCLUSIONS

We conclude that as the population ages, grip strength declines at a systematic and predictable rate equal to -0.40 kg per year (approximately -0.50 kg for men and -0.30 kg for women) in residents of England aged 50 and older. Age effects were predominant and most consistent across methodologies. While there was some evidence for cohort effects, such effects were minimal and therefore indicative that grip strength is a consistent physiological biomarker of aging.

Secular Difference in Body Mass Index From 2014 to 2020 in Chinese Older Adults: A Time-Series Cross-Sectional Study

Background

Body mass index (BMI) is the most widely used parameter to assess the body weight status. Both the increase of BMI (overweight and obesity) and decrease of BMI (underweight) has been associated with high risk of adverse outcome, such as stroke, disability, and even death. However, recent data on secular differences in BMI in the Chinese aged population are limited. The present study provides robust new evidence about the evolving epidemic of obesity among aged adults in China.

Objective

Evaluating secular difference in BMI in a group of Chinese older adults.

Materials and Methods

We analyzed 7 continuous survey years (2014–2020), including 50,192 Chinese aged participants (25,505 men and 24,687 women, aged 71.9 ± 6.1 years, age range: 65–99 years). Information on sex, age, height, and body weight, was collected based on medical history. Participants were classified into four groups: underweight (BMI &lt; 18.5 kg/m2), normal weight (18.5 kg/m2 ≤ BMI &lt; 25 kg/m2), overweight (25 kg/m2 ≤ BMI &lt; 30 kg/m2), and obesity (BMI ≥ 30 kg/m2). Linear regressions were used to assess the secular difference in BMI. Sex and age differences were also evaluated by stratified analyses.

Results

From 2014 to 2020, age-adjusted mean BMI increased by 0.3 kg/m2 (95% CI: 0.1, 0.5 kg/m2) in men, and 0.5 kg/m2 (95% CI: 0.2, 0.7 kg/m2) in women. Age-standardized prevalence of underweight decreased from 3.0 to 2.3% in men, and from 3.0 to 2.1% in women. Age-standardized prevalence of overweight increased in both men (from 40.1 to 41.7%) and women (from 37.8 to 39.8%), and so as obesity (men: from 4.1 to 6.1%; women: from 5.8 to 8.7%).

Conclusion

Our results confirmed that BMI gradually increased from 2014 to 2020. The age-adjusted mean BMI increased by 0.3 kg/m2 in older men, and 0.5 kg/m2 in older women. The age- and sex-standardized prevalence of overweight and obesity significantly increased, especially in 70–79-year age group, while the prevalence of underweight decreased. The combination of a balanced-diet and physical exercise is needed to maintain optimal BMI range for the aged population.

Anthropometric Equations to Determine Maximum Height in Adults ≥ 60 Years: A Systematic Review

Although it is common to measure bone lengths for study, methodological errors in data measurement and processing often invalidate their clinical and scientific usefulness. This manuscript reviews the validity of several published equations used to determine the maximum height in older adults, since height is an anthropometric parameter widely employed in health sciences. A systematic review of original articles published in the English, Spanish, or Portuguese languages was performed in PubMed, ScienceDirect, EBSCO, Springer Link, and two institutional publisher integrators (UACJ and CONRICYT). The search terms were included in the metasearch engines in a combined way and text form using the Boolean connectors AND and OR {(Determination OR Estimation OR Equation) AND Height AND (Elderly OR "Older adults")}. Eleven manuscripts were selected from 1935 records identified through database searching after applying the following criteria: (1) original articles that designed and validated equations for the determination of height by anthropometric methods in adults 60 years of age and older and (2) manuscripts that presented robust evidence of validation of the proposed regression models. The validity of the reported linear regression models was assessed throughout a manuscript review process called multi-objective optimization that considered the collection of the models, the prediction errors, and the adjustment values (i.e., R², standard error of estimation, and pure error). A total of 64 equations were designed and validated in 45,449 participants (57.1% women) from four continents: America (85.3%, with 46 equations), Asia (8.1%, with 10), Europe (4.6%, with 7), and Africa (2.0%, with 1); the Hispanic American ethnic group was the most numerous in participants and equations (69.0%, with 28). Due to various omissions and methodological errors, this study did not find any valid and reliable equations to assess the maximum height in older adults by anthropometric methods. It is proposed to adjust allometric mathematical models that can be interpreted in the light of ontogenetic processes.

The reliability of adult self-reported height: The role of interviewers

Surveys serve as an important source of information on key anthropometric characteristics such as body height or weight in the population. Such data are often obtained by directly asking respondents to report those values. Numerous studies have examined measurement errors in this context by comparing reported to measured values. However, little is known on the role of interviewers on the prevalence of irregularities in anthropometric survey data. In this study, we explore such interviewer effects in two ways. First, we use data from the US National Health and Nutrition Examination Survey and the UK Household Longitudinal Study to evaluate whether differences between reported and measured values are clustered within interviewers. Second, we investigate changes in adult self-reported height over survey waves in two German large-scale panel surveys. Here, we exploit that height should be constant over time for the majority of adult age groups. In both analyses, we use multilevel location-scale models to identify interviewers who enhance reporting errors and interviewers for whom unlikely height changes over waves occur frequently. Our results reveal that interviewers can play a prominent role in differences between reported and measured height values and changes in reported height over survey waves. We further provide an analysis of the consequences of height misreporting on substantive regression coefficients where we especially focus on the role of interviewers who reinforce reporting errors and unlikely height changes.

Relationship between height and hypertension among women in India: Evidence from the fourth round of National Family Health Survey

BACKGROUND AND AIMS

Hypertension (HTN) is associated with significant morbidity and mortality, especially among women. Literature suggests an association between height and hypertension. We did this study to ascertain an association between hypertension and height and explore their determinants among Indian women of reproductive age group (15-49 years).

METHODS

We did a secondary data analysis of the National Family Health Survey-4 (2015-16) and included 5,36,093 women between 20 and 49 years. Blood pressure and height were measured using the standard procedures. Weighted analysis was done to depict the association between the two variables.

RESULTS

Overall prevalence of HTN was 13.49%. We observed an inverse association between height and mean blood pressure of the women, and shorter women had a higher prevalence of HTN. The height of women was found to be associated with lower systolic blood pressure but not with diastolic blood pressure. Women's height depicted significant associations with age and other socio-economic and geographical parameters. Prevalence of HTN depicted a significant association with height and across other subgroups stratified by these parameters.

CONCLUSION

We observed a positive association between the systolic BP and the height of the female. Height is one of the most convenient forms of identifying target groups that should not be missed during screening women for NCDs, especially during pregnancy to prevent premature morbidity and mortality. We recommend disseminating this concept to our primary health care workers, who are also the point of first contact for early screening and halt the burden of disease.

Sex, Age and Stature Affects Neck Biomechanical Responses in Frontal and Rear Impacts Assessed Using Finite Element Head and Neck Models

The increased incidence of injury demonstrated in epidemiological data for the elderly population, and females compared to males, has not been fully understood in the context of the biomechanical response to impact. A contributing factor to these differences in injury risk could be the variation in geometry between young and aged persons and between males and females. In this study, a new methodology, coupling a CAD and a repositioning software, was developed to reposture an existing Finite element neck while retaining a high level of mesh quality. A 5th percentile female aged neck model (F05_75YO) and a 50th percentile male aged neck model (M50_75YO) were developed from existing young (F05_26YO and M50_26YO) neck models (Global Human Body Models Consortium v5.1). The aged neck models included an increased cervical lordosis and an increase in the facet joint angles, as reported in the literature. The young and the aged models were simulated in frontal (2, 8, and 15 g) and rear (3, 7, and 10 g) impacts. The responses were compared using head and relative facet joint kinematics, and nominal intervertebral disc shear strain. In general, the aged models predicted higher tissue deformations, although the head kinematics were similar for all models. In the frontal impact, only the M50_75YO model predicted hard tissue failure, attributed to the combined effect of the more anteriorly located head with age, when compared to the M50_26YO, and greater neck length relative to the female models. In the rear impacts, the F05_75YO model predicted higher relative facet joint shear compared to the F05_26YO, and higher relative facet joint rotation and nominal intervertebral disc strain compared to the M50_75YO. When comparing the male models, the relative facet joint kinematics predicted by the M50_26YO and M50_75YO were similar. The contrast in response between the male and female models in the rear impacts was attributed to the higher lordosis and facet angle in females compared to males. Epidemiological data reported that females were more likely to sustain Whiplash Associated Disorders in rear impacts compared to males, and that injury risk increases with age, in agreement with the findings in the present study. This study demonstrated that, although the increased lordosis and facet angle did not affect the head kinematics, changes at the tissue level were considerable (e.g., 26% higher relative facet shear in the female neck compared to the male, for rear impact) and relatable to the epidemiology. Future work will investigate tissue damage and failure through the incorporation of aged material properties and muscle activation.

Reliability and Validity of an Ultrasonic Device for Measuring Height in Adults

BACKGROUND

The ultrasonic stadiometer was originally developed as a device to measure and monitor children's height. However, an ultrasonic stadiometer (InLab S50; InBody Co., Seoul, Korea) was used to measure adults' height in the 2018 Korea Community Health Survey (KCHS). This study was conducted to assess the reliability and validity of the InLab S50 in adults.

METHODS

The study subjects were 120 adults (reliability test, n=20; validity test, n=100) who had visited a health screening center. The intra- and inter-rater reliabilities of InLab S50 were assessed using the intraclass correlation coefficient (ICC). The agreement between InLab S50 and an automatic stadiometer (HM-201; Fanics, Busan, Korea) was assessed using Pearson's correlation coefficient and Bland-Altman analysis.

RESULTS

The intra- and inter-rater reliabilities of the InLab S50 were excellent (ICC=0.9999 and 0.9998, respectively). The correlation coefficient of the height measured by the two measurement devices was very high (r=0.996). The difference (Δheight [HM-201-InLab S50]) was -0.15±0.78 cm (95% limit of agreement [LOA], -1.69 to 1.38). After excluding the values outside 95% LOA, the difference was further reduced to -0.05±0.59 cm (95% LOA, -1.20 to 1.10).

CONCLUSION

This study showed that the InLab S50 is a reliable and valid device for the measurement of adults' height. Therefore, we think that InLab S50 could be used to measure adults' height in household health surveys such as the KCHS.

Anthropometry as a readily accessible health assessment of older adults

Anthropometry (derived from the Greek Anthropos: human, and metron: measure) refers to the systematic collection, and measurement of the physical characteristics of the human body, primarily body weight, body size, and shape. Anthropometric values are closely related to genetic factors, environmental characteristics, social, and cultural conditions, lifestyle, functional status, and health. Anthropometric measurements can be used to assess risk of malnutrition, obesity, muscle wasting, increased fat mass, and maldistribution of adipose tissue. Potential modifiable factors include circumferences, skinfolds, and body weight. While are height, and the bone diameters are non-modifiable. Kinanthropometry is the study of size, shape, proportionality, composition, biological maturation, and body function, in order to understand the process of growth, exercise, sports performance, and nutrition. Aging of the population, which is associated with increased risk of chronic disease, and disability, is one of the most important demographic changes facing many countries. Anthropometric indicators are simple, portable, non-invasive, inexpensive, and easily applied measurements that can be readily applied in geriatric populations to guide preventative measures, and medical interventions in older adults.

Association of life course socioeconomic status and adult height with cognitive functioning of older adults in India and China

BACKGROUND

Cognitive functioning is an important measure of intrinsic capacity. In this study, we examine the association of life course socioeconomic status (SES) and height with cognitive functioning among older adults (50+) in India and China. The age pattern of cognitive functioning with measures of life course socioeconomic status has also been examined.

METHODS

Cross-sectional comparative analysis was conducted using the WHO's Study on global AGEing and adult health (SAGE) data for India and China. Multilevel mixed-effect linear regression analysis was used to examine the association of life course socioeconomic status and adult height with cognitive functioning.

RESULTS

In both India and China, parental education as a measure of childhood socioeconomic status was positively associated with cognitive functioning. The association between adult socioeconomic status and cognitive functioning was positive and significant. Height was significantly and positively associated with improved cognitive functioning of older adults in India and China. Furthermore, the age-related decline in cognitive functioning score was higher among older adults whose parents had no schooling, particularly in China. The cognitive functioning score with age was much lower among less-educated older adults than those with higher levels of education in China. Wealthier older adults in India had higher cognitive functioning in middle ages, however, wealth differences narrowed with age.

CONCLUSIONS

The results of this study suggest a significant association of lifetime socioeconomic status and cumulative net nutrition on later-life cognitive functioning in middle-income settings.

Impact of Height Estimation on Tidal Volume Calculation for Protective Ventilation-A Prospective Observational Study

Objectives

The current standard of care to deliver invasive mechanical ventilation support is the protective ventilation approach. One pillar of this approach is the limitation of tidal volume to less than 6 mL/Kg of predicted body weight. Predicted body weight is calculated from patient's height. Yet, little is known about the potential impact of errors arising from visual height estimation, a common practice, to calculate tidal volumes. The aim of this study was to evaluate that impact on tidal volume calculation to use during protective ventilation.

Design

Prospective observational study.

Setting

An eight-bed polyvalent ICU.

Patients

Adult patients (≥ 18 yr).

Interventions

None.

Measurements and Main Results

Tidal volumes were calculated from visual height estimates made by physicians, nurses, and patients themselves and compared with tidal volumes calculated from measured heights. Comparisons were made using the paired t test. Modified Bland-Altman plots were used to assess agreement between height estimates and measurements. One-hundred patients were recruited. Regardless of the height estimator, all the mean tidal volumes would be greater than 6 mL/Kg predicted body weight (all p < 0.001). Additionally, tidal volumes would be greater than or equal to 6.5 mL/Kg predicted body weight in 18% of patients' estimates, 25% of physicians' estimates, and 30% of nurses' estimates. Patients with lower stature (< 165 cm), older age, and surgical typology of admission were at increased risk of being ventilated with tidal volumes above protective threshold.

Conclusions

The clinical benefit of the protective ventilation strategy can be offset by using visual height estimates to calculate tidal volumes. Additionally, this approach can be harmful and potentially increase mortality by exposing patients to tidal volumes greater than or equal to 6.5 mL/Kg predicted body weight. In the interest of patient safety, every ICU patient should have his or her height accurately measured.

The gender gap in the biological living standard in Spain. A study based on the heights of an elite migration to Mexico, 1840-1930

This paper examines the evolution of the statures of Spanish male and female migrants who entered Mexico between the mid-nineteenth and the mid-twentieth century. Using the information contained in the National Registry of Foreigners created by the Mexican government, the paper also estimates the evolution of the gap between male and female migrants' heights. The inclusion of women and their heights in the registry allows the estimation of both male and female heights and the analysis of their evolution for a group of comparable individuals. The results show that Spanish migrants to Mexico grew taller between 1840 and 1930, and also reveal their character as a highly qualified group, with heights similar to those of the Latin-American elites and considerably higher than the statures of those who remained in Spain. In the long term, the differences between men and women decreased from more than 10 cm in the cohorts born in the mid-nineteenth century, to around 8-9 centimetres in the early twentieth century, coinciding with a period of profound economic and social transformations.

Height and quality of life among older adults (50+) in India: a cross-sectional study

Adult height is a summary measure of health and net nutrition in early childhood. This study examines the association between height and quality-of-life outcomes in older adults (50+) in India. Cross-sectional data from Wave 1 of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) conducted in 2007 were analysed. The association between height and quality of life was assessed using bivariate and multivariate logistic and linear regression models. The mean WHO quality-of-life score (WHO-QoL) increased from 45.2 among the older adults in the lowest height quintile to 53.2 for those in the highest height quintile. However, the prevalence of self-rated poor quality of life declined from 16.4% in the lowest height quintile to 6.1% in the highest height quintile. In the fully adjusted regression model, height was found to be positively associated with quality-of-life outcomes among both men and women, independent of socioeconomic and physical health confounders. The association was particularly strong for women. Women in the highest height quintile had a 2.65 point higher WHO-QoL score than those in the lowest height quintile. Similarly, the likelihood of reporting a poor quality of life was lower among women in the highest height quintile. Furthermore, measures of economic status, handgrip strength, cognitive ability and poor self-rated health were significantly associated with WHO-QoL and self-rated poor quality of life. Overall, this study revealed a significant association between height and quality of life among older adults in India, suggesting a significant role of childhood circumstances in quality of life in later life.

Changes in Added Sugar Intake and Body Weight in a Cohort of Older Australians: A Secondary Analysis of the Blue Mountains Eye Study

Background: The evidence regarding the association between added sugar (AS) intake and obesity remains inconsistent. The aim of this study was to investigate the association between changes in the percentage of energy intake from AS (EAS%) and changes in body weight in a cohort study of older Australians during 15 years of follow-up. In addition, associations were assessed according to whether EAS% intake was provided from beverage or non-beverage sources. Methods: Data were analyzed from the participants of the Blue Mountains Eye Study Cohort. Dietary data were collected at baseline (1992-94) and three five-yearly intervals using a 145-item food frequency questionnaire. Participants' body weight was measured at each time point. Five-yearly changes in EAS% intake and body weight were calculated (n = 1,713 at baseline). A generalized estimating equation (GEE) model was used to examine the relationship between the overall five-yearly changes in EAS% intake and body weight, adjusted for dietary and lifestyle variables. Results: In each time interval, the EAS% intake decreased by ~5% in the lowest quartile (Q1) and increased by ~5% in the highest quartile (Q4). The mean (SD) body weight change in Q1 and Q4 were 1.24 (8.10) kg and 1.57 (7.50) kg (first time interval), 0.08 (6.86) kg and -0.19 (5.63) kg (second time interval), and -1.22 (5.16) kg and -0.37 (5.47) kg (third time interval), respectively. In GEE analyses, the overall five-yearly change in EAS% intake was not significantly associated with body weight change (P trend = 0.837). Furthermore, no significant associations were observed between changes in EAS% intake from either beverage or non-beverage sources and changes in body weight (P trend for beverage sources = 0.621 and P trend for non-beverage sources = 0.626). Conclusion: The findings of this older Australian cohort do not support the association between changes in EAS% intake and body weight, regardless of AS food sources (beverage or non-beverage).

Economic development in Puerto Rico after US annexation: Anthropometric evidence

This paper considers economic development in Puerto Rico following its annexation by the United States in 1898, a watershed moment in the history of the island and the pinnacle of American imperialism in Latin America. Drawing on data from three surveys, I show that male height in Puerto Rico increased at more than twice the average rate for Latin America and the Caribbean between 1890 and 1940. I also show that Puerto Ricans at mid-century were among the tallest Latin Americans outside of Argentina and Uruguay. The evidence supports the conclusion that conditions improved substantially after US annexation, in contrast to the prevailing view in the literature.

Trends in BMI among elderly Japanese population: findings from 1973 to 2016 Japan National Health and Nutrition Survey

OBJECTIVE

To examine 44-year trends in height, weight and BMI, and the prevalence of overweight/obesity and underweight in the elderly Japanese population because Japan, the country with the longest life expectancy, has the highest ageing population.

DESIGN

Using the nationally representative cumulative data from the Japan National Health and Nutrition Survey 1973-2016, sex-specific and age-adjusted mean height, weight and BMI, and the prevalence of overweight/obesity and underweight were calculated for each year. Trend analyses were performed using the Joinpoint Regression Program. Next, changes in height, weight and BMI, and the prevalence of overweight/obesity and underweight were estimated for each age group (65-69, 70-79 and >80 years) according to the birth year groups.

SETTING

Japan.

PARTICIPANTS

Individuals aged ≥65 years with complete data on height and body weight measurements (N 94 508).

RESULTS

Trends in average height and weight increased over the four decades in both men and women. The prevalence of overweight/obesity dramatically increased and nearly tripled in men, accompanied with significantly decreased underweight prevalence. Furthermore, the increasing trend in average BMI and overweight/obesity prevalence in women reached a peak in 2002 and showed a decreasing trend thereafter, while a downward trend in underweight prevalence showed a gradual increase in women since 2003.

CONCLUSIONS

Trends in height, weight and BMI among the elderly population should continue to be closely monitored in parallel with the effects of dietary changes, energy intake and physical activity (step counts).

Height shrinkage, health and mortality among older adults: Evidence from Indonesia

In this paper, we analyze the correlates of height shrinkage and the association of height shrinkage and late-life health among mid-aged and older adults from the Indonesian Family Life Survey. We first document the extent of height shrinkage based on measured height over 17 years. Height shrinkage is higher among older age groups, taller individuals, and women. Socioeconomic and initial health correlates of shrinkage are found to be different for men and women. Higher education, marital status, household consumption, urban birth and poor self-reported health in adulthood and childhood are found to be significant correlates for men. Ethnicity, working in the agricultural sector and availability of local health infrastructure are key correlates of height shrinkage for women. Height shrinkage of 1 cm is associated with a 0.02 s.d. decrease in cognition scores for Indonesian men and a 0.01 s.d. decrease for women, and 4% increase in index of mobility difficulties for both men and women. Extreme height loss, defined as height loss greater than 3 cm is associated with 8-10 percent lower lung function and grip strength among both men and women. Extreme height loss among Indonesian older women is also associated with a 7-percentage-point increase in the likelihood of death in the most recent wave. Our results emphasize the importance of taking into account age related height loss as a significant covariate for health and mortality of older adults, independent of baseline height and health.

Educational level and its relationship with body height and popliteal height in Chilean male workers

A secular trend in body height has been experienced in many nations and populations, hypothesized to be the result of better living conditions. Educational level has been shown to be closely associated with body height. This study examined the changes in body height and popliteal height in a group of adult Chilean male workers by age cohort and the relationship of these with educational level. The body heights and popliteal heights of 1404 male workers from the Valparaíso and Metropolitan regions of Chile were measured in 2016. The sample was grouped by level of education (primary, secondary, technical and university) and age (21-30, 31-40 and 41-50 years). Robust ANOVA and post-hoc analyses using a one-step modified M-estimation of location were conducted based on bootstrap resampling. Both body height and popliteal height increased from the older to the younger age cohort. The largest increase was from the 41-50 to the 21-30 group, with a 1.1% increase in body height and 1.7% increase in popliteal height. When educational level was introduced into the analysis there was a marked increase in both body height and popliteal height for each cohort, but only in primary- and secondary-educated workers. Despite showing an overall increase in body height and popliteal height, younger workers with the highest levels of education showed fewer differences between them than did older workers with less education. The differences were larger in the older than in the younger cohorts. Similarly, this trend was less clear in workers with higher levels of education (technical and university), probably because of a dilution effect caused by increased access to higher education by workers in the lower income quintiles.

Have Swiss adult males and females stopped growing taller? Evidence from the population-based nutrition survey menuCH, 2014/2015

Data from the National Nutrition Survey for adults (menuCH) allow for the assessment of recent trends in measured height by year of birth for adult men and women from a population-based sample. The aim of the present study was to test if - similarly to conscripts and schoolchildren - the Swiss adult population stopped growing taller in recent birth cohorts, and if so, when the change occurred. We found that - when self-reported - height was overestimated on average by about 1 cm in both men and women, with an increasing tendency with older age and with shorter height. Average measured height increased by 4.5-5.0 cm for adult men and women between the birth years 1937-1949 and 1990-1995. However, this increase was not linear, and starting with the 1970s birth years, average height plateaued on a level of about 178 cm for men and 166 cm for women. Being born outside of Switzerland or adjustment for potential shrinkage with increasing age did not change this temporal pattern. We also found shorter average height among participants from the Italian part of Switzerland and those with lower educational level. It remains unclear if the phenomenon of stabilisation affects all subgroups of the Swiss population. Future studies should combine a larger number of population-based surveys to enhance the sample size, for example, for people with a migration background or with different educational levels. Continuing growth monitoring needs to be performed to assess if environmental and demographic changes with an impact on body growth (adverse trends in nutrition, increasing social inequality in health, ethnic composition of the population) positively or negatively influence future trends in average height.

The Role of Physical Frailty Independent Components on Increased Disabilities in Institutionalized Older Women

The purpose of this study was to identify the independent components of physical frailty that most influence disability indicators in institutionalized older women. A cross-sectional study with 319 participants (81.96±7.89 years old) was performed. Disability was assessed through dynamic and static balance tests, activities of daily life and falls risk screen. Fried physical frailty protocol was used to access physical frailty. The frail subgroup displayed the weakest results for all disability indicators (p < 0.05). Regression analysis showed that in the two models tested, low physical activity levels and slowness were the physical frailty independent components that better associated with the disability indicators. More studies with larger samples will help to better understand the independent relationship of each physical frailty component with disability outcomes and assist to design a co-adjuvant treatment to reverse physical frailty.

Estimating the height of elderly nursing home residents: Which equation to use?

Estimating equations can be used when measuring the height of elderly persons is not possible. However, such methods are not always applicable; therefore, it is necessary to consider several aspects, such as sex, age, and ethnicity of the studied population to generate these equations. This study aimed to compare and validate methods of estimating the height of the Brazilian elderly nursing home residents. An accuracy study was conducted with 168 elderly persons. A total of 23 equations were quantitatively evaluated by plotting the differences in means, the Student's t-test for paired samples, the coefficient of determination (R2), the root-mean-square error (RMSE), the interclass correlation coefficient (ICC), and by graphic analysis of the residuals. A significance value of p <0.05 was adopted. An equation was considered applicable when it had R2 >0.7, the lowest RMSE among the equations evaluated, ICC >0.7, and a confidence interval of 95%, with the smallest difference between the upper and lower limits. A greater mean height was noted among younger elderly persons and elderly men compared to up to 80 years and women elderly. Quantitative analysis revealed that equation for Puerto Ricans, using knee height and age, was the most applicable for the overall population (ICC = 0.802). The same equation was applicable for the elderly Brazilian male participants (ICC = 0.838) and for those aged 60-69 years (ICC = 0.895). None of the equations used were applicable for the height estimation of elderly women or individuals aged 70 years or more.

Education modifies the relationship between height and cognitive function in a cross-sectional population-based study of older adults in Rural South Africa

We aimed to estimate the relationship between height (a measure of early-life cumulative net nutrition) and later-life cognitive function among older rural South African adults, and whether education modified this relationship. Data were from baseline in-person interviews with 5059 adults ≥ 40 years in the population-based "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI) study in Agincourt sub-district, South Africa, in 2015. Linear regression was used to estimate the relationship between height quintile and latent cognitive function z-score (representing episodic memory, time orientation, and numeracy), with adjustment for life course covariates and a height-by-education interaction. Mean (SD) height was 162.7 (8.9) cm. Nearly half the sample had no formal education (46%; 2307/5059). Mean age- and sex-adjusted cognitive z-scores increased from - 0.68 (95% CI: - 0.76 to - 0.61) in those with no education in the shortest height quintile to 0.62 (95% CI: 0.52-0.71) in those with at least 8 years of education in the tallest height quintile. There was a linear height disparity in cognitive z-scores for those with no formal education (adjusted β = 0.10; 95% CI: 0.08-0.13 per height quintile), but no height disparity in cognitive z-scores in those with any level of education. Short stature is associated with poor cognitive function and may be a risk factor for cognitive impairment among older adults living in rural South Africa. The height disparity in cognitive function was negated for older adults who had any level of education.

The role of the cell-matrix interface in aging and its interaction with the renin-angiotensin system in the aged vasculature

The extracellular matrix (ECM) is an intricate network that provides structural and anchoring support to cells in order to stabilize cell morphology and tissue architecture. The ECM also controls many aspects of the cell's dynamic behavior and fate through its ongoing, bidirectional interaction with cells. These interactions between the cell and components of the surrounding ECM are implicated in several biological processes, including development and adult tissue repair in response to injury, throughout the lifespan of multiple species. The present review gives an overview of the growing evidence that cell-matrix interactions play a pivotal role in the aging process. The focus of the first part of the article is on recent studies using cell-derived decellularized ECM, which strongly suggest that age-related changes in the ECM induce cellular senescence, a well-recognized hallmark of aging. This is followed by a review of findings from genetic studies indicating that changes in genes involved in cell-ECM adhesion and matrix-mediated intracellular signaling cascades affect longevity. Finally, mention is made of novel data proposing an intricate interplay between cell-matrix interactions and the renin-angiotensin system that may have a significant impact on mammalian arterial stiffness with age.

Socioeconomic patterns of underweight and its association with self-rated health, cognition and quality of life among older adults in India

BACKGROUND

Underweight defined as body mass index (BMI) < 18.5 is associated with negative health and quality of life outcomes including mortality. Yet, little is known about the socioeconomic differentials in underweight and its association with health and well-being among older adults in India. This study examined the socioeconomic differentials in underweight among respondents aged ≥50 in India. Consequently, three outcomes of the association of underweight were studied. These are poor self-rated health, cognition and quality of life.

METHODS

Cross-sectional data on 6,372 older adults derived from the first wave of the WHO's Study on global AGEing and adult health (SAGE), a nationally representative survey conducted in six states of India during 2007-8, were used. Bivariate and multivariate regression analyses were applied to fulfil the objectives.

RESULTS

The overall prevalence of underweight was 38 percent in the study population. Further, socioeconomic status showed a significant and negative association with underweight. The association of underweight with poor self-rated health (OR = 1.60; p < .001), cognition (β = -0.95; p < .001) and quality of life (β = -1.90; p < .001) were remained statistically significant after adjusting for age, sex, place of residence, marital status, years of schooling, wealth quintile, sleep problems, chronic diseases, low back pain and state/province.

CONCLUSION

The results indicated significant socioeconomic differentials in underweight and its association with poor self-rated health, cognition and quality of life outcomes. Interventions focussing on underweight older adults are important to enhance the overall wellbeing of the growing older population in India.

Agreement between renal prescribing references and determination of prescribing appropriateness in hospitalized patients with chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) is a risk factor for adverse drug events. The clinical significance of discordance between renal prescribing references is unknown.

AIM

We determined the prevalence of potentially inappropriate prescribing (PIP) in CKD, measured agreement between two prescribing references, and assessed potential for harm consequent to PIP.

DESIGN

Single-centre observational study.

METHODS

A random sample of hospitalized patients with CKD were grouped according to baseline CKD stage (3, 4, or 5). Prescriptions requiring caution in CKD were referenced against the Renal Drug Handbook (RDH) and British National Formulary (BNF) to identify PIP (non-compliance with recommendations). Inter-reference agreement was measured using percentage agreement and Kappa coefficient. Potential for harm consequent to PIP was assessed by physicians and pharmacists using a validated scale. One-year mortality was compared between patients with or without PIP during admission.

RESULTS

Among 119 patients (median age 73 years, 50% male), 136 cases of PIP were identified in 78 (65.5%) patients. PIP prevalence, per patient, was 64.7% using the BNF and 28.6% using the RDH (fair agreement, Kappa 0.33, P <  0.001). The majority (63.2%) of PIP cases detected exclusively by the BNF carried minimal or no potential for harm. PIP was not significantly associated with one-year mortality (34.7% vs. 21.1%, P = 0.14).

CONCLUSIONS

PIP was common in hospitalized patients with CKD. Substantial discordance between renal prescribing references was apparent. The development of universally-adopted, evidence-based, prescribing guidelines for CKD might optimize medications safety in this vulnerable group.

[General and abdominal obesity among the elderly from Southern Brazil: results of the HOW ARE YOU DOING? (COMO VAI?) study]

This is a cross-sectional population-based study aimed to measure the prevalence and to identify associated factors with the occurrence of general and abdominal obesity among the elderly living in the urban area of Pelotas, State of Rio Grande do Sul. The process of cluster sampling was conducted in two stages. Overall obesity was defined by Body Mass Index (BMI) from measurements of weight and height estimated by knee height. Obesity was considered when BMI was ≥ 30 kg/m2. Abdominal obesity was evaluated by waist circumference, being considered obese when it was > 102 cm for men and > 88 cm for women. The crude and adjusted analyses were performed using Poisson regression. The prevalence of obesity was 29.9% (CI95%: 27.5-32.4) and abdominal obesity, 50.4% (CI95%: 47.8-53.1). After adjustment, the prevalence of both outcomes were higher in women, non-smokers, hypertensives and diabetics and lower in the physically active in their leisure time. Age was inversely associated with general and abdominal obesity. Reducing obesity in this population depends on the planning of health policies actively encourage physical activity, keeping in mind the limitations and health conditions of the elderly.

Estimation of Skeletal Muscle Mass and Visceral Adipose Tissue Volume by a Single Magnetic Resonance Imaging Slice in Healthy Elderly Adults

BACKGROUND

Assessing skeletal muscle (SM) and visceral adipose tissue (VAT) by a single MRI slice at lumbar vertebra (L) 3 can replace whole-body MRI in young and middle-aged adults. However, this technique has not been proven in older adults.

OBJECTIVE

The aim of this analysis was to reinvestigate the best estimate for SM and VAT in an independent population of healthy elderly people.

METHODS

SM and VAT were assessed by whole-body MRI in 84 subjects ≥60 y [45 men; mean ± SD age: 68.4 ± 5.4 y, mean ± SD body mass index (in kg/m²): 25.5 ± 3.5]. SM and VAT areas of 9 slices at the lumbar spine were analyzed. The best estimate was investigated by Pearson correlations. Total volumes (in liters) were predicted by the area at lumbar vertebra 3 (A_L3). Besides Bland-Altman analysis, linear regressions were performed to explain the variance of the bias by age, height, and percentage of fat mass (%FM). In a mixed population (healthy elderly plus reference population), linear regression with total SM and VAT volume as dependent variables and A_L3, age, and height as independent variables was applied.

RESULTS

When comparing the correlation coefficients between the tissue areas and total volumes, L3 was identified as the best estimate (r range: 0.71-0.94; all P < 0.05). However, Bland-Altman analysis showed a positive SM bias in men (mean ± SD: -1.0% ± 9.0%; P < 0.05) and a negative SM bias in women (mean ± SD: 3.7% ± 9.6%; P < 0.05). Contrary to SM, no significant bias was observed for VAT. In the elderly, stepwise linear regression showed height as a predictor for SM bias (R² = 0.21, SEE = 2.07 L; P < 0.05) and %FM and age as predictors of the nonsignificant VAT bias (R² = 0.26, SEE = 0.22L, P < 0.05), in men only. In the mixed population, A_L3 and height were predictors for total SM, and A_L3 for total VAT, independent of sex.

CONCLUSIONS

A_L3 was confirmed as the best estimate for SM and VAT volumes in healthy elderly adults. Contrary to VAT, there is a bias for SM, and height has to be added to the algorithm.

Adult height, nutrition, and population health

In this review, the potential causes and consequences of adult height, a measure of cumulative net nutrition, in modern populations are summarized. The mechanisms linking adult height and health are examined, with a focus on the role of potential confounders. Evidence across studies indicates that short adult height (reflecting growth retardation) in low- and middle-income countries is driven by environmental conditions, especially net nutrition during early years. Some of the associations of height with health and social outcomes potentially reflect the association between these environmental factors and such outcomes. These conditions are manifested in the substantial differences in adult height that exist between and within countries and over time. This review suggests that adult height is a useful marker of variation in cumulative net nutrition, biological deprivation, and standard of living between and within populations and should be routinely measured. Linkages between adult height and health, within and across generations, suggest that adult height may be a potential tool for monitoring health conditions and that programs focused on offspring outcomes may consider maternal height as a potentially important influence.

The dynamics of health and its determinants among the elderly in developing countries

This paper examines the persistence of bad health among the elderly, and attempts to identify its determinants. We are particularly interested in the role of recent past bad health. Using a panel data set from Indonesia Family Life Survey (IFLS), several health measures such as poor general health status (poor GHS), hypertension, and low body mass index (low BMI) are examined. We find that for all health measures, recent past bad health has a small impact on current bad health once conditioning on individual fixed effects. For instance, in the case of poor GHS, the elderly with poor GHS in the recent past are only 4% points more likely to have poor GHS in the subsequent period compared to their counterparts.

Comparing the Relationship Between Stature and Later Life Health in Six Low and Middle Income Countries

This paper examines the relationship between stature and later life health in 6 emerging economies, each of which are expected to experience significant increases in the mean age of their populations over the coming decades. Using data from the WHO Study on Global Ageing and Adult Health (SAGE) and pilot data from the Longitudinal Ageing Study in India (LASI), I show that various measures of health are associated with height, a commonly used proxy for childhood environment. In the pooled sample, an additional 10cm increase in height is associated with between a 2 and 3 percentage point increase in the probability of being in very good or good self-reported health, a 3 percentage point increase in the probability of reporting no difficulties with activities of daily living or instrumental activities of daily living, and between a fifth and a quarter of a standard deviation increase in grip strength and lung function. Adopting a methodology previously used in the research on inequality, I also summarise the height-grip strength gradient for each country using the concentration index, and provide a decomposition analysis.