Is Traditional Chinese Exercise Associated With Lower Mortality Rates in Older People? Evidence From a Prospective Chinese Elderly Cohort Study in Hong Kong

Risk of cataract and glaucoma among older persons with diabetes in India: a cross-sectional study based on LASI, Wave-1

According to the International Diabetes Federation-2019 estimates, India is home to 77 million diabetic individuals which is projected to grow up to 147.2 million by 2045. Diabetes being a progressive health disorder leads to multiple morbidities and complications including eye diseases and visual impairments. As the burden of diabetes mellitus is increasing, eye problems like cataracts and glaucoma are commonly cited problems among the older adults. In this context, this study aims to provide the public health evidences on diabetes associated burden and risk of developing cataracts and glaucoma among older adults aged 60 and above in India. The analytical sample of this cross-sectional study comprised of 31,464 individuals aged 60 and above. Bivariate cross-tabulation and chi-square test were performed to understand the differential in the prevalence of cataracts and glaucoma by diabetes mellitus including the socio-economic and demographic characteristics of the individuals. Binary logistic regression estimation was executed to estimate the adjusted odds ratio for each of the outcome variables within a multivariate framework. The cataract problem affects more than one-fifth of the older people, while glaucoma affects 2% of them. The prevalence of cataract and glaucoma is 29% among diabetic older adults compared to 22% among non-diabetic persons. In terms of gender, the cataract prevalence is comparatively higher among females (25%) than males (21%). It is important to note that while adjusting for socio-economic and demographic characteristics, the likelihood of cataract (AOR 1.495; p-value < 0.01) and glaucoma (AOR 1.554; p-value < 0.01) is significantly higher among older adults with diabetes than among their counterparts. Medical practitioners should conduct prognosis for diabetic eye problems among patients and raise awareness about the potential risks of developing vision loss, such as cataracts and glaucoma, which are more prevalent among individuals with diabetes.

Large-scale multitrait genome-wide association analyses identify hundreds of glaucoma risk loci

Glaucoma, a leading cause of irreversible blindness, is a highly heritable human disease. Previous genome-wide association studies have identified over 100 loci for the most common form, primary open-angle glaucoma. Two key glaucoma-associated traits also show high heritability: intraocular pressure and optic nerve head excavation damage quantified as the vertical cup-to-disc ratio. Here, since much of glaucoma heritability remains unexplained, we conducted a large-scale multitrait genome-wide association study in participants of European ancestry combining primary open-angle glaucoma and its two associated traits (total sample size over 600,000) to substantially improve genetic discovery power (263 loci). We further increased our power by then employing a multiancestry approach, which increased the number of independent risk loci to 312, with the vast majority replicating in a large independent cohort from 23andMe, Inc. (total sample size over 2.8 million; 296 loci replicated at P < 0.05, 240 after Bonferroni correction). Leveraging multiomics datasets, we identified many potential druggable genes, including neuro-protection targets likely to act via the optic nerve, a key advance for glaucoma because all existing drugs only target intraocular pressure. We further used Mendelian randomization and genetic correlation-based approaches to identify novel links to other complex traits, including immune-related diseases such as multiple sclerosis and systemic lupus erythematosus.

Type 2 Diabetes, Fasting Glucose, Hemoglobin A1c Levels and Risk of Primary Open-Angle Glaucoma: A Mendelian Randomization Study

Purpose

To evaluate the potential causal associations between type 2 diabetes and fasting glucose and HbA1c levels and the risk of primary open-angle glaucoma (POAG) in European and East Asian populations.

Methods

We selected genetic variants (P < 5 × 10⁻⁸) for type 2 diabetes (898,130 Europeans; 433,540 East Asians), fasting glucose, and HbA1c (196,991 Europeans; 36,584 East Asians) from three meta-analyses of genome-wide association studies (GWAS). The GWAS for POAG provided summary statistics (192,702 Europeans; 46,523 East Asians). Mendelian randomization (MR) analysis was accomplished using the inverse variance–weighted method, weighted-median method, MR Egger method, and MR-Pleiotropy RESidual Sum and Outlier test.

Results

Genetically predicted type 2 diabetes was potentially positively associated with POAG in the European ancestry (body mass index [BMI]–unadjusted: odds ratio [OR] = 1.07, 95% confidence interval [CI], 1.01–1.14, P = 0.028; BMI-adjusted: OR = 1.07, 95% CI, 1.01–1.15, P = 0.035), but not in the East Asian ancestry (BMI-unadjusted: OR = 1.01, 95% CI, 0.95–1.06, P = 0.866; BMI-adjusted: OR = 1.00, 95% CI, 0.94–1.05, P = 0.882). There was no evidence to support a causal association of fasting glucose (European: OR = 1.19, P = 0.157; East Asian: OR = 0.94, P = 0.715) and HbA1c (European: OR = 1.27, P = 0.178; East Asian: OR = 0.85, P = 0.508) levels with POAG.

Conclusions

The causal effect of type 2 diabetes on the risk of POAG is different in European and East Asian populations. The point estimates of fasting glucose and Hb1Ac with POAG are large but not statistically significant, which prompts the question of statistical power.

Leisure time physical activity and risk of pneumonia mortality: a dose-response meta-analysis

INTRODUCTION

This meta-analysis of cohort studies aimed to examine the doseresponse relationships between LPTA (Leisure time physical activity) and pneumonia mortality to provide some suggestions for the prevention of respiratory disease mortality.

EVIDENCE ACQUISITION

PubMed、WOS database was systematically searched for eligible studies until Nov.1, 2020. The prospective cohort study on the relationship between LPTA and pneumonia mortality was collected. The Meta-analysis was performed using Stata 14 software to calculate the combined effect size (HR) of pneumonia mortality and its 95% CI in a categorical dose-response relationship. The restrictive cubic spline model was used to fit the continuous dose-response relationship.

EVIDENCE SYNTHESIS

Eight cohort studies included 370045 subjects who met the inclusion criteria. The categorical dose-relational analysis revealed that the highest dose compared to the lowest LTPA dose reduced the risk of pneumonia mortality by 32%(HR=0.68.95% CI：0.64-0.73). The continuous dose-response relationship results showed a negative nonlinear relationship between LTPA and the risk of pneumonia mortality (PNon-linearity<0.05). The risk of pneumonia death HR decreased by 16%(p<0.01, HR=0.84.95%CI:0.82-0.86) for each additional 5 MET-h/week when LTPA below 20 MET-h/week. When LTPA was higher than 20 MET-h/week, the risk of pneumonia death HR decreased by 6% for each additional 5 MET-h/week(p<0.01, HR=0.94,95%CI:0.93-0.94).

CONCLUSIONS

All doses of LTPA are protective factors of pneumonia mortality risk and the protective effect on pneumonia mortality is enhanced if LTPA increases. The degree of enhancement is weakened when LTPA is higher than 20 MET-h/week.

Psychometric Properties of the Translated Tai Chi Exercise Self-Efficacy Scale for Chinese Adults with Coronary Heart Disease or Risk Factors

Tai Chi is an effective exercise option for individuals with coronary heart disease or its associated risk factors. An accurate and systematic assessment of a Mandarin-speaking adults’ self-efficacy in maintaining Tai Chi exercise is lacking. Mandarin Chinese has the most speakers worldwide. This study aimed to translate the Tai Chi Exercise Self-Efficacy scale and examine its psychometric properties. The 14-item Tai Chi Exercise Self-Efficacy scale was translated from English into Mandarin Chinese using a forward-translation, back-translation, committee approach, and pre-test procedure. Participants with coronary heart disease or risk factors (n = 140) enrolled in a cross-sectional study for scale validation. Confirmatory factor analysis indicated a good fit of the two-factor structure (Tai Chi exercise self-efficacy barriers and performance) to this sample. The translated scale demonstrated high internal consistency, with a Cronbach’s α value of 0.97, and good test-retest reliability, with an intra-class correlation coefficient of 0.86 (p < 0.01). Participants with prior Tai Chi experience reported significantly higher scores than those without (p < 0.001), supporting known-group validity. A significant correlation was observed between the translated scale and total exercise per week (r = 0.37, p < 0.01), providing evidence of concurrent validity. The Mandarin Chinese version of the Tai Chi Exercise Self-Efficacy scale is a valid and reliable scale for Chinese adults with coronary heart disease or risk factors.

Association of fine particulate matter with glucose and lipid metabolism: a longitudinal study in young adults

OBJECTIVES

This study aimed to evaluate whether PM2.5 exposure in a highly polluted area (>100 µg/m3) affects glucose and lipid metabolism in healthy adults.

METHODS

We recruited 110 healthy adults in Baoding city, Hebei, China, and followed them up between 2017 and 2018. Personal air samplers were used to monitor personal PM2.5 levels. Eight glucose and lipid metabolism parameters were quantified. We performed the linear mixed-effect models to investigate the relationships between PM2.5 and glucose and lipid metabolism parameters. Stratified analyses were further performed according to sex and body mass index (BMI).

RESULTS

The concentration of PM2.5 was the highest in spring, with a median of 232 μg/m3 and the lowest in autumn (139 μg/m3). After adjusting for potential confounders, we found that for each twofold increase in PM2.5, the median of insulin concentration decreased by 5.89% (95% CI -10.91% to -0.58%; p<0.05), and ox-LDL increased by 6.43% (95% CI 2.21% to 10.82%; p<0.05). Stratified analyses indicated that the associations were more pronounced in females, overweight and obese participants.

CONCLUSIONS

Exposure to high PM2.5 may have deleterious effects on glucose and lipid metabolism. Females, overweight and obese participants are more vulnerable.

"These Few Blocks, These Are My Village": The Physical Activity and Mobility of Foreign-Born Older Adults

BACKGROUND AND OBJECTIVES

The self-reported health of foreign-born older adults (FBOAs) is lower than that of nonimmigrant peers. Physical activity (PA) and mobility enhance health in older age, yet we know very little about the PA and mobility of FBOAs. In this analysis we sought to determine: (a) What factors facilitate PA amongst FBOAs? and (b) How do gender, culture, and personal biography affect participants' PA and mobility?

RESEARCH DESIGN AND METHODS

We worked closely with community partners to conduct a mixed-method study in Vancouver, Canada. Eighteen visible minority FBOAs completed an in-depth interview in English, Cantonese, Mandarin, Punjabi, or Hindi.

RESULTS

Three dominant factors promote participants' PA and mobility: (a) participants walk for well-being and socialization; (b) participants have access to a supportive social environment, which includes culturally familiar and linguistically accessible shops and services; and (c) gender and personal biography, including work history and a desire for independence, affect their PA and mobility behaviors.

DISCUSSION AND IMPLICATIONS

We extend the Webber et al. mobility framework, with examples that further articulate the role of gender (e.g., domestic work), culture (cultural familiarity) and personal biography (work history and a desire for familial independence) (Webber, S. C., Porter, M. M., & Menec, V. H. (2010). Mobility in older adults: A comprehensive framework. The Gerontologist, 50, 443-450. doi:10.1093/geront/gnq013). Future programming to support the PA of FBOAs should be culturally familiar and linguistically accessible.

Benefits of physical activity not affected by air pollution: a prospective cohort study

BACKGROUND

Physical activity (PA) is beneficial to human health, whereas long-term exposure to air pollution is harmful. However, their combined effects remain unclear. We aimed to estimate the combined (interactive) mortality effects of PA and long-term exposure to fine particulate matter (PM2.5) among older adults in Hong Kong.

METHODS

Participants aged ≥65 years from the Elderly Health Service Cohort (n = 66 820) reported their habitual PA at baseline (1998-2001) and were followed up till 31 December 2011. We used a satellite-based spatiotemporal model to estimate PM2.5 concentration at the residential address for each participant. We used Cox proportional hazards regression to assess the interaction between habitual PA and long-term exposure to PM2.5 on cardiovascular and respiratory mortality. We tested for additive interaction by estimating relative excess risk due to interaction and multiplicative interaction employing P-value for the interaction term.

RESULTS

The death risks were inversely associated with a higher volume of PA and were positively associated with long-term exposure to PM2.5. The benefits of PA were more pronounced for participation in traditional Chinese exercise (e.g. Tai Chi) and aerobic exercise (e.g. cycling). We found little evidence of interaction between PA (volume and type) and long-term exposure to PM2.5 on either additive or multiplicative scales.

CONCLUSIONS

In this cohort of older Chinese adults, PA may decrease the risk of mortality, be it in areas of relatively good or bad air quality. The beneficial mortality effects of habitual PA outweighed the detrimental effects of long-term exposure to air pollution in Hong Kong.

The environment as a determinant of successful aging or frailty

The number of elderly persons is rising rapidly, and healthspan is a key factor in determining the well-being of individuals and the sustainability of national health systems. Environmental health is crucial for a "successful aging". Complex relationships between environmental factors and non-communicable diseases play a major role, causing or accelerating disabilities. Besides genetic factors, aging results from the concurrence of several environmental factors starting from early (i.e. in utero) life, able to increase susceptibility to diseases in adulthood, and to promote frailty in the elderly. In aged people, an unhealthy environment contributes to a fast and early decline and increases vulnerability. Exposure to pollutants facilitates the onset and progression of cardiovascular, respiratory, metabolic and neurologic diseases through direct effects and epigenetic mechanisms negatively affecting biological age. Healthy diet, healthy environment and constant physical activity could counteract, at least in part, the negative effects of environmental stressors. Almost all environmental factors generating detrimental effects on aging are modifiable, with relevant implications in terms of primary prevention measures potentially leading to decreased frailty, to an increase in the number of years lived without diseases or disability, and to a significant reduction in health expenditure.

Eight-Section Brocade Exercises Improve the Sleep Quality and Memory Consolidation and Cardiopulmonary Function of Older Adults With Atrial Fibrillation-Associated Stroke

Purpose: Poor sleep quality is harmful for everyone and potentially even more harmful for older adults with atrial fibrillation-associated stroke (AFAS). This study aims to explore the effects of eight-section brocade (ESB) on sleep quality, memory, and cardiopulmonary function in the older adults with AFAS. Methods: Older adults with AFAS and sleep disorders were recruited and divided into the ESB (EG, n = 85) and control groups (CG, general exercise, n = 85). EG patients received 60 min ESB exercises 5 times a week for 12 weeks; CG patients received normal exercise. Pittsburgh sleep quality index (PSQI) scores (poor sleepers ≥8 and normal sleepers < 8), memory for word pairs (poor memory ≤ 7 and normal memory > 7), left ventricular posterior wall (LVPW) thickness, and maximum ventilation (MV, to evaluate cardiopulmonary function) values were measured. The correlation between sleep and memory quality was analyzed using PSQI scores and word pairs via the Pearson correlation coefficients test. Adjusted Cox models were used to explore an interaction between PSQI and ESB exercise. Results: After 12-week exercise intervention, ESB improved sleep quality, latency, duration, disturbance and daytime dysfunction when compared to conventional exercise. In similar cases, the MV values in the EG were also higher than that in the CG (p = 0.009). ESB intervention could not affect the cardiac structure and left ventricular ejection fraction. Compared with the CG, the ESB intervention reduced PSQI scores and increased memorized word pairs (p < 0.001 for poor and normal sleepers in both unadjusted and adjusted analysis, p = 0.012 and 0.003 for poor and normal memory). The test of Pearson correlation coefficients showed that PSQI scores were strongly associated with the number of word pairs in both unadjusted and adjusted analyses (p < 0.0001). Conclusion: Eight-section brocade exercise improved sleep quality and memory consolidation and cardiopulmonary function by reducing PSQI scores, increasing word pairs and MV values in the older adults with AFAS.

The effects of traditional Chinese exercise on hypertension: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Several studies have reported the benefits of traditional Chinese exercises (TCEs) on hypertension; however, a consensus regarding the effectiveness and safety of TCEs for patients with hypertension has not been reached.

METHODS AND RESULTS

Only randomized controlled trials were included in our study. A total of 16 articles involving 1164 patients with hypertension met the inclusion criteria. The results showed that TCEs can reduce BP, blood lipids (including total cholesterol and triglyceride levels) and endothelin levels and improves quality of life in hypertensive patients, however, the low-quality of the included studies made the results be of questionable significance.

CONCLUSIONS

The results of this review suggest that there is no firm evidence to support the objective effectiveness and safety of TCEs for hypertension because of the poor quality of the studies. Well-designed, randomized placebo-controlled trial with objective outcome measures should be conducted in the future.

Exercise programmes to prevent falls among older adults: modelling health gain, cost-utility and equity impacts

BACKGROUND

Some falls prevention interventions for the older population appear cost-effective, but there is uncertainty about others. Therefore, we aimed to model three types of exercise programme each running for 25 years among 65+ year olds: (i) a peer-led group-based one; (ii) a home-based one and (iii) a commercial one.

METHODS

An established Markov model for studying falls prevention in New Zealand (NZ) was adapted to estimate incremental cost-effectiveness ratios (ICERs) in cost per quality-adjusted life-years (QALYs) gained. Detailed NZ experimental, epidemiological and cost data were used for the base year 2011. A health system perspective was taken and a discount rate of 3% applied. Intervention effectiveness estimates came from a Cochrane Review.

RESULTS

The intervention generating the greatest health gain and costing the least was the home-based exercise programme intervention. Lifetime health gains were estimated at 47 100 QALYs (95%uncertainty interval (UI) 22 300 to 74 400). Cost-effectiveness was high (ICER: US$4640 per QALY gained; (95% UI US$996 to 10 500)), and probably more so than a home safety assessment and modification intervention using the same basic model (ICER: US$6060). The peer-led group-based exercise programme was estimated to generate 42 000 QALYs with an ICER of US$9490. The commercially provided group programme was more expensive and less cost-effective (ICER: US$34 500). Further analyses by sex, age group and ethnicity (Indigenous Māori and non-Māori) for the peer-led group-intervention showed similar health gains and cost-effectiveness.

CONCLUSIONS

Implementing any of these three types of exercise programme for falls prevention in older people could produce considerable health gain, but with the home-based version being likely to be the most cost-effective.

Alterations in retinal nerve fiber layer thickness in early stages of diabetic retinopathy and potential risk factors

AIMS

To investigate the loss of retinal nerve fiber layer (RNFL) in type-2 diabetic patients with early-stage diabetic retinopathy (DR) and to identify potential risk factors accounting for these alterations.

METHODS

In this cross-sectional study, 158 type-2 diabetic patients were divided into three groups based on their DR status. RNFL thickness and other optic disc parameters were obtained by optical coherence tomography (OCT) and then compared among different groups. We investigated the potential association between RNFL loss and systemic risk factors for DR, including diabetes duration, body mass index (BMI), serum lipids, hemoglobin A1c (HbA1c) and albumin-creatinine ratio (ACR). One-way ANOVA was carried out to compare RNFL thickness among different groups, Pearson correlation and multivariate linear regression analysis were performed to determine potential risk factors related to RNFL thickness in these patients.

RESULTS

There were significant differences in the average (F = 8.872, P = 0.003), superior (F = 8.769, P = 0.004), and inferior (F = 8.857, P = 0.003) RNFL thickness of both eyes among the groups, but no obvious difference in optic disc parameters was found. Diabetic duration, BMI, TG, High density lipoprotein cholesterol (HDL), HbA1c, and ACR were found negatively related to the RNFL thickness in both or single eye according to Pearson correlation analysis. After controlling for age, gender, and axis length (AL) in multivariate linear regression analysis, the diabetic duration was associated significantly with RNFL thickness of superior in both eye (right eye: p = 0.016, left eye: p = 0.024), BMI was related to the nasal quadrant of the right eye (p = 0.034), and TG was related to the inferior of the right eye (p = 0.037), HbA1c (p = 0.026) was associated significantly with the average RNFL thickness of the right eye. In addition, ACR was found negatively related to average (p = 0.042) and inferior quadrant (p = 0.014) of the left eye, respectively.

CONCLUSIONS

RNFL loss might be the earliest structural change of retina in diabetic patients, and associated with diabetic duration, BMI, TG, HbA1c, and ACR. The conclusions of this study need to be proved by other well-matched and large-scale prospective clinical trials in the future, because the correlations discovered in our study were weak.

Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs

Background

There is some evidence that home safety assessment and modification (HSAM) is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level.

Methods and findings

A previously established Markov macro-simulation model built for the whole New Zealand (NZ) population (Pega et al 2016, Injury Prevention) was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial.

In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280). The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million). The incremental cost-effectiveness ratio (ICER) was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]). Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively) with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population) vs non-Māori.

Conclusions

This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.

Presence and Risk Factors for Glaucoma in Patients with Diabetes

Diabetes mellitus represents a growing international public health issue with a near quadrupling in its worldwide prevalence since 1980. Though it has many known microvascular complications, vision loss from diabetic retinopathy is one of the most devastating for affected individuals. In addition, there is increasing evidence to suggest that diabetic patients have a greater risk for glaucoma as well. Though the pathophysiology of glaucoma is not completely understood, both diabetes and glaucoma appear to share some common risk factors and pathophysiologic similarities with studies also reporting that the presence of diabetes and elevated fasting glucose levels are associated with elevated intraocular pressure-the primary risk factor for glaucomatous optic neuropathy. While no study has completely addressed the possibility of detection bias, most recent epidemiologic evidence suggests that diabetic populations are likely enriched with glaucoma patients. As the association between diabetes and glaucoma becomes better defined, routine evaluation for glaucoma in diabetic patients, particularly in the telemedicine setting, may become a reasonable consideration to reduce the risk of vision loss in these patients.