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Matsuo K, Yoneki K, Kobayashi K, Onoda D, Mibu K, Furuzono K, Mashimo N, Yasuda S, Suzuki T, Nakao K, Tatsuki H, Tamiya S. Impact of Changes in Rectus Femoris Cross-Sectional Area Measured by Ultrasound on the Prognosis of Patients With Acute Heart Failure. Circ J 2024; 88:713-721. [PMID: 38508754 DOI: 10.1253/circj.cj-23-0925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
BACKGROUND Low muscle mass in patients with acute heart failure (AHF) is associated with poor prognosis; however, this is based on a single baseline measurement, with little information on changes in muscle mass during hospitalization and their clinical implications. This study investigated the relationship between changes in rectus femoris cross-sectional area (RFCSA) on ultrasound and the prognosis of patients with AHF.Methods and Results: This is a retrospective evaluation of 284 AHF patients (mean [±SD] age 79.1±11.9 years; 116 female). RFCSA assessments at admission (pre-RFCSA), ∆RFCSA (i.e., the percentage change in RFCSA from admission to 2 weeks), and composite prognosis (all-cause death and heart failure-related readmission) within 1 year were determined. Patients were divided into 4 groups according to their median pre-RFCSA and ∆RFCSA after sex stratification: Group A, higher pre-RFCSA/better ∆RFCSA; Group B, higher pre-RFCSA/worse ∆RFCSA; Group C, lower pre-RFCSA/better ∆RFCSA; Group D, lower pre-RFCSA/worse ∆RFCSA. In the Cox regression analysis, with Group A as the reference, the cumulative event rate of Group C (hazard ratio [HR] 3.39; 95% confidence interval [CI] 0.71-16.09; P=0.124) did not differ significantly; however, the cumulative event rates of Group B (HR 7.93; 95% CI 1.99-31.60; P=0.003) and Group D (HR 9.24; 95% CI 2.57-33.26; P<0.001) were significantly higher. CONCLUSIONS ∆RFCSA during hospitalization is useful for risk assessment of prognosis in patients with AHF.
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Affiliation(s)
- Koji Matsuo
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Kei Yoneki
- Department of Rehabilitation, Sagamihara Kyodo Hospital
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University
| | | | - Daiki Onoda
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Kazuhiro Mibu
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | | | - Noa Mashimo
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Shiori Yasuda
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Toru Suzuki
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | - Ken Nakao
- Department of Rehabilitation, Sagamihara Kyodo Hospital
| | | | - Seiji Tamiya
- Department of Cardiovascular Medicine, Sagamihara Kyodo Hospital
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Santanasto AJ, Zmuda JM, Cvejkus RK, Gordon CL, Nair S, Carr JJ, Terry JG, Wheeler VW, Miljkovic I. Thigh and Calf Myosteatosis are Strongly Associated with Muscle and Physical Function in African Caribbean Men. J Gerontol A Biol Sci Med Sci 2023; 78:527-534. [PMID: 35661875 PMCID: PMC9977257 DOI: 10.1093/gerona/glac124] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND African Caribbeans have higher levels of myosteatosis than other populations; however, little is known about the impact of myosteatosis on physical function in African Caribbeans. Herein, we examined the association between regional myosteatosis of the calf, thigh, and abdomen versus physical function in 850 African-Ancestry men aged 64.2 ± 8.9 (range 50-95) living on the Caribbean Island of Tobago. METHODS Myosteatosis was measured using computed tomography and included intermuscular adipose tissue (IMAT) and muscle density levels of the thigh, calf, psoas, and paraspinous muscles. Outcomes included grip strength, time to complete 5 chair-rises, and 4-meter gait speed. Associations were quantified using separate linear models for each myosteatosis depot and were adjusted for age, height, demographics, physical activity, and chronic diseases. Beta coefficients were presented per standard deviation of each myosteatosis depot. RESULTS Higher thigh IMAT was the only IMAT depot significantly associated with weaker grip strength (β = -1.3 ± 0.43 kg, p = .003). However, lower muscle density of all 4 muscle groups was associated with weaker grip strength (all p < .05). Calf and thigh myosteatosis (IMAT and muscle density) were significantly associated with both worse chair rise time and gait speed (all p < .05), whereas psoas IMAT and paraspinous muscle density were associated with gait speed. CONCLUSION Myosteatosis of the calf and thigh-but not the abdomen-were strongly associated with grip strength and performance measures of physical function in African Caribbean men. However, posterior abdominal myosteatosis may have some utility when abdominal images are all that are available.
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Affiliation(s)
- Adam J Santanasto
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph M Zmuda
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ryan K Cvejkus
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Sangeeta Nair
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Jeffrey Carr
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James G Terry
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Victor W Wheeler
- Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago
| | - Iva Miljkovic
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Santanasto AJ, Miljkovic I, Cvejkus RK, Boudreau RM, Wheeler VW, Zmuda JM. Body Composition Across the Adult Lifespan in African Caribbean Men: The Tobago Longitudinal Study of Aging. J Frailty Aging 2022; 11:40-44. [PMID: 35122089 PMCID: PMC8963274 DOI: 10.14283/jfa.2021.47] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Body composition and muscle strength change vary by age and ethnicity, and have a major impact on health and physical function. Little is known about the patterns of these changes in African-ancestry populations. Herein, we examined age-specific (5-year age groups) rates-of-change in lean and fat mass in 1918 African-ancestry men on the Caribbean island of Tobago (baseline age: 62.0±11.8 years, range: 40-99 years). Body composition (DXA) and grip strength were measured at three time points (baseline, 4- and 9-year follow-up). Annualized rates of change were calculated with all 3 time-points using Generalized Estimating Equations. We found that whole body lean mass declined at constant rate until age 65 (-0.72%/year; 95% CI: -0.76, -0.67), which accelerated to -0.92 %/year (-1.02, -0.82) among those 65-69, and again to -1.16 %/year (-1.30, -1.03 ) among those aged 70+. Whole body fat mass increased by a near constant rate of 2.93 %/year (2.72, 3.15%) across the lifespan. Finally, grip strength decline accelerated at age 50, and about 2x faster than lean mass through the lifespan after the age of 50. To conclude, in African-Caribbean men, the acceleration in muscle strength decline precedes the acceleration in lean mass decline by 10-15 years, suggesting decrements in factors other than lean mass drive this initial acceleration in muscle strength decline. We also found that African-Caribbean men undergo a constant shift to a more adipogenic phenotype throughout the adult lifespan (aged 40-99), which likely contributes to age-related loss of muscle and physical function.
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Affiliation(s)
| | - Iva Miljkovic
- Department, of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | - Ryan K. Cvejkus
- Department, of Epidemiology, University of Pittsburgh, Pittsburgh, PA
| | | | - Victor W. Wheeler
- Tobago Health Studies Office, Scarborough, Tobago, Trinidad & Tobago
| | - Joseph M. Zmuda
- Department, of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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Linge J, Petersson M, Forsgren MF, Sanyal AJ, Dahlqvist Leinhard O. Adverse muscle composition predicts all-cause mortality in the UK Biobank imaging study. J Cachexia Sarcopenia Muscle 2021; 12:1513-1526. [PMID: 34713982 PMCID: PMC8718078 DOI: 10.1002/jcsm.12834] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/06/2021] [Accepted: 09/24/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adverse muscle composition (MC) as measured by magnetic resonance imaging has previously been linked to poor function, comorbidity, and increased hospitalization. The aim of this study was to investigate if adverse MC predicts all-cause mortality using data from UK Biobank. METHODS There were 40 178 participants scanned using a 6 min magnetic resonance imaging protocol. Images were analysed for thigh fat-tissue free muscle volume and muscle fat infiltration (MFI) using AMRA® Researcher (AMRA Medical, Linköping, Sweden). For each participant, a sex, weight, and height invariant muscle volume z-score was calculated. Participants were partitioned into four MC groups: (i) normal MC, (ii) only low muscle volume [<25th percentile for muscle volume z-score (population wide)], (iii) only high MFI [>75th percentile (population wide, sex-specific)], and (iv) adverse MC (low muscle volume z-score and high MFI). Association of MC groups with mortality was investigated using Cox proportional-hazard modelling with normal MC as referent (unadjusted and adjusted for low hand grip strength, sex, age, body mass index, previous diagnosis of disease (cancer, type 2 diabetes and coronary heart disease), lifestyle, and socioeconomic factors (smoking, alcohol consumption, physical activity, and Townsend deprivation index). RESULTS Muscle composition measurements were complete for 39 804 participants [52% female, mean (SD) age 64.2 (7.6) years and body mass index 26.4 (4.4) kg/m2 ]. Three hundred twenty-eight deaths were recorded during a follow-up period of 2.9 (1.4) years after imaging. At imaging, adverse MC was detected in 10.5% of participants. The risk of death from any cause in adverse MC compared with normal MC was 3.71 (95% confidence interval 2.81-4.91, P < 0.001). Only low muscle volume and only high MFI were independently associated with all-cause mortality [1.58 (1.13-2.21), P = 0.007, and 2.02 (1.51-2.71), P < 0.001, respectively]. Adjustment of low hand grip strength [1.77 (1.28-2.44), P < 0.001] did not attenuate the associations with any of the MC groups. In the fully adjusted model, adverse MC and only high MFI remained significant (P < 0.001 and P = 0.020) while the association with only low muscle volume was attenuated to non-significance (P = 0.560). The predictive performance of adverse MC [1.96 (1.42-2.71), P < 0.001] was comparable with that of previous cancer diagnosis [1.93 (1.47-2.53), P < 0.001] and smoking [1.71 (1.02-2.84), P = 0.040]. Low hand grip strength was borderline non-significant [1.34 (0.96-1.88), P = 0.090]. CONCLUSIONS Adverse MC was a strong and independent predictor of all-cause mortality. Sarcopenia guidelines can be strengthened by including cut-offs for myosteatosis enabling detection of adverse MC.
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Affiliation(s)
- Jennifer Linge
- AMRA Medical, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | - Mikael F Forsgren
- AMRA Medical, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Arun J Sanyal
- Department of Internal Medicine and Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA, USA
| | - Olof Dahlqvist Leinhard
- AMRA Medical, Linköping, Sweden.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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Kara M, Kaymak B, Frontera W, Ata AM, Ricci V, Ekiz T, Chang KV, Han DS, Michail X, Quittan M, Lim JY, Bean JF, Franchignoni F, Özçakar L. Diagnosing sarcopenia: Functional perspectives and a new algorithm from the ISarcoPRM. J Rehabil Med 2021; 53:jrm00209. [PMID: 34121127 PMCID: PMC8814891 DOI: 10.2340/16501977-2851] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/27/2022] Open
Abstract
Sarcopenia is an important public health problem, characterized by age-related loss of muscle mass and muscle function. It is a precursor of physical frailty, mobility limitation, and premature death. Muscle loss is mainly due to the loss of type II muscle fibres, and progressive loss of motor neurones is thought to be the primary underlying factor. Anterior thigh muscles undergo atrophy earlier, and the loss of anterior thigh muscle function may therefore be an antecedent finding. The aim of this review is to provide an in-depth (and holistic) neuromusculoskeletal approach to sarcopenia. In addition, under the umbrella of the International Society of Physical and Rehabilitation Medicine (ISPRM), a novel diagnostic algorithm is proposed, developed with the consensus of experts in the special interest group on sarcopenia (ISarcoPRM). The advantages of this algorithm over the others are: special caution concerning disorders related to the renin-angiotensin system at the case finding stage; emphasis on anterior thigh muscle mass and function loss; incorporation of ultrasound for the first time to measure the anterior thigh muscle; and addition of a chair stand test as a power/performance test to assess anterior thigh muscle function. Refining and testing the algorithm remains a priority for future research.
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Affiliation(s)
- Murat Kara
- Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey. E-mail:
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Cawthon PM, Manini T, Patel SM, Newman A, Travison T, Kiel DP, Santanasto AJ, Ensrud KE, Xue QL, Shardell M, Duchowny K, Erlandson KM, Pencina KM, Fielding RA, Magaziner J, Kwok T, Karlsson M, Ohlsson C, Mellström D, Hirani V, Ribom E, Correa-de-Araujo R, Bhasin S. Putative Cut-Points in Sarcopenia Components and Incident Adverse Health Outcomes: An SDOC Analysis. J Am Geriatr Soc 2020; 68:1429-1437. [PMID: 32633824 PMCID: PMC7508260 DOI: 10.1111/jgs.16517] [Citation(s) in RCA: 121] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/24/2020] [Accepted: 04/05/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Analyses performed by the Sarcopenia Definitions and Outcomes Consortium (SDOC) identified cut-points in several metrics of grip strength for consideration in a definition of sarcopenia. We describe the associations between the SDOC-identified metrics of low grip strength (absolute or standardized to body size/composition); low dual-energy x-ray absorptiometry (DXA) lean mass as previously defined in the literature (appendicular lean mass [ALM]/ht2 ); and slowness (walking speed <.8 m/s) with subsequent adverse outcomes (falls, hip fractures, mobility limitation, and mortality). DESIGN Individual-level, sex-stratified pooled analysis. We calculated odds ratios (ORs) or hazard ratios (HRs) for incident falls, mobility limitation, hip fractures, and mortality. Follow-up time ranged from 1 year for falls to 8.8 ± 2.3 years for mortality. SETTING Eight prospective observational cohort studies. PARTICIPANTS A total of 13,421 community-dwelling men and 4,828 community-dwelling women. MEASUREMENTS Grip strength by hand dynamometry, gait speed, and lean mass by DXA. RESULTS Low grip strength (absolute or standardized to body size/composition) was associated with incident outcomes, usually independently of slowness, in both men and women. ORs and HRs generally ranged from 1.2 to 3.0 for those below vs above the cut-point. DXA lean mass was not consistently associated with these outcomes. When considered together, those who had both muscle weakness by absolute grip strength (<35.5 kg in men and <20 kg in women) and slowness were consistently more likely to have a fall, hip fracture, mobility limitation, or die than those without either slowness or muscle weakness. CONCLUSION Older men and women with both muscle weakness and slowness have a higher likelihood of adverse health outcomes. These results support the inclusion of grip strength and walking speed as components in a summary definition of sarcopenia. J Am Geriatr Soc 68:1429-1437, 2020.
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Affiliation(s)
- Peggy M. Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | | | - Sheena M. Patel
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - Anne Newman
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Thomas Travison
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Douglas P. Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Adam J. Santanasto
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristine E. Ensrud
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Qian-Li Xue
- Division of Geriatric Medicine and Gerontology and Center on Aging and Health, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Michelle Shardell
- Longitudinal Studies Section, The National Institute on Aging, Baltimore, Maryland
| | - Kate Duchowny
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | | | - Karol M. Pencina
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Roger A. Fielding
- Nutrition, Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Timothy Kwok
- Department of Medicine & Therapeutics and School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Shatin, Hong Kong
| | - Magnus Karlsson
- Department of Clinical Sciences in Malmo, Lund University, Malmo, Sweden
| | - Claes Ohlsson
- Centre of Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Centre of Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vasant Hirani
- Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Eva Ribom
- Department of surgical sciences, Orthopeadic Unit, Uppsala University, Uppsala, Sweden
| | | | - Shalender Bhasin
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Santanasto AJ, Miljkovic I, Cvejkus RK, Wheeler VW, Zmuda JM. Sarcopenia Characteristics Are Associated with Incident Mobility Limitations in African Caribbean Men: The Tobago Longitudinal Study of Aging. J Gerontol A Biol Sci Med Sci 2020; 75:1346-1352. [PMID: 31593581 DOI: 10.1093/gerona/glz233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sarcopenia varies by ethnicity, and has a major impact on health in older adults. However, little is known about sarcopenia characteristics in African ancestry populations outside the United States. We examined sarcopenia characteristics in 2,142 African Caribbean men aged 59.0 ± 10.4 years (range: 40-92 years) in Tobago, and their association with incident mobility limitations in those aged 55+ (n = 738). METHODS Body mass index (BMI), grip strength, dual-x-ray absorptiometry (DXA) appendicular lean mass (ALM), and self-reported mobility limitations were measured at baseline, and 6 years later. Change in sarcopenia characteristics, including grip strength, grip strength/BMI, ALMBMI, and ALM/ht2, were determined. Foundations for the National Institutes of Health Sarcopenia Project (FNIH) and European Working Group for Sarcopenia in Older People 2 (EWGSOP2) cut-points were also examined. Odds ratios (OR) and 95% confidence intervals (CI) for mobility limitation were calculated using multivariable linear regression models adjusted for covariates. RESULTS Overall, sarcopenia prevalence was quite low using the FNIH (0.3%) and EWGSOP2 (0.6%) operational cut-points, but was higher in those aged 75+ (2.1% [FNIH] and 3.7% [EWGSOP2]). Prevalence was also higher when based on "weakness", versus "low ALM." When sarcopenia markers were examined separately, baseline levels, but not changes, were associated with incident mobility limitations. Baseline grip strength/BMI was a particularly strong risk factor for incident mobility limitations (OR per SD: 0.50; 95% CI: 0.37-0.68). CONCLUSIONS Our findings suggest that grip strength normalized to body mass, measured at one time point, may be a particularly useful phenotype for identifying African Caribbean men at risk for future mobility limitations.
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Affiliation(s)
| | - Iva Miljkovic
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Ryan K Cvejkus
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | | | - Joseph M Zmuda
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
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