Trajectories of the relationships of physical activity with body composition changes in older men: the MrOS study

Longitudinal Changes in the Body Composition of Non-Institutionalized Spanish Older Adults after 8 Years of Follow-Up: The Effects of Sex, Age, and Organized Physical Activity

Aging leads to physiological changes affecting body composition, mediated by lifestyle. However, the effectiveness of organized physical activities (OPAs) in attenuating or delaying these age-related transformations remains an area of limited understanding. The primary objectives of this study were threefold: (I) to comprehensively assess the evolution of body composition in a cohort of Spanish older adults over an 8-year period; (II) to compare this evolution in the different age groups; and (III) to investigate the influence of active engagement in OPAs on these age-related changes. From a sample of 3136 Spanish older adults recruited in 2008, 651 agreed to participate in the 8-year follow-up. Anthropometric and bioelectrical impedance data were included for 507 females (70.3 ± 4.4 years) and 144 males (77.8 ± 4.5 years). Age groups were categorized as follows: youngest (65-69 years), mid (70-74 years), and oldest (≥75 years). The engagement in OPA was recorded before and after the follow-up. A repeated measures ANOVA was performed to evaluate the 8-year changes. Males increased in hip (98.1 ± 9.3 vs. 101.5 ± 10.2 cm) and waist circumferences (101.2 ± 6.6 vs. 103.2 ± 6.1 cm), specifically in the youngest group (p < 0.05). Females decreased in weight (67.6 ± 10.0 vs. 66.6 ± 10.5 kg) and fat mass percentage (39.3 ± 5 vs. 38.8 ± 5.4%) and increased in hip circumference (104.4 ± 9.0 vs. 106.5 ± 9.7 cm); these effects were the most remarkable in the oldest group (all p < 0.05). OPA engagement seemed to slow down fat-free mass loses in males, but not in females (grouped by time, p < 0.05). Body composition changes caused by aging seem to happen earlier in males than in females. Moreover, participating in OPAs does not prevent fat-free mass due to aging.

Physical activity trajectories and their determinants in patients with chronic obstructive pulmonary disease: A cohort study

AIMS AND OBJECTIVES

The aim was to identify latent trajectories in physical activity (PA) and their determinants in adults with chronic obstructive pulmonary disease (COPD) based on the socio-ecological model.

BACKGROUND

PA has been linked to poor long-term outcomes in patients with COPD. However, few studies have explored their PA trajectories and their predictors.

DESIGN

Cohort study.

METHODS

We used data from a national cohort and included 215 participants. PA was quantified using a short PA questionnaire, and group-based trajectory modelling was used to explore the PA trajectories. Multinomial logistic regression was conducted to identify the predictors of PA trajectories. Generalised linear mixed models were used to elucidate the associations between predictors and PA during follow-up. A STROBE checklist was used to guide the reporting of this study.

RESULTS

Three PA trajectory patterns were identified among 215 COPD participants with an average age of 60.51 ± 8.87: stable inactive group (66.7%), sharp decline group (25.7%) and stable active group (7.5%). The logistic regression showed that age, sex, income, peak expiratory flow, upper limb capacity, depressive symptoms, the frequency of contact with children were PA predictors. Upper limb capacity weakness and depressive symptoms were found to be associated with a sharp decline in PA during follow-up.

CONCLUSIONS

This study revealed three PA trajectories among patients with COPD. In addition to strengthening the physical functions and mental health of patients, support from the family, community and society also play a crucial role in promoting PA of patients with COPD.

RELEVANCE TO CLINICAL PRACTICE

It is essential to identify distinct PA trajectories in patients with COPD to develop future interventions that promote PA.

NO PATIENT OR PUBLIC CONTRIBUTION

A national cohort study was used and no patients or the public were involved in the design and implementation of this study.

Associations of physical activity participation trajectories with subsequent motor function declines and incident frailty: A population-based cohort study

BACKGROUND

Maintaining physical function and delaying frailty are of significant importance in both quality of life and health longevity for successful aging. The objective of this study is to investigate whether different trajectories of long-term physical activity (PA) participation are associated with subsequent motor function declines and incident frailty in middle-aged and elderly adults.

MATERIALS AND METHODS

Data from 8,227 aged ≥ 50 years adults enrolled in the English Longitudinal Study of Aging were analyzed. Long-term PA participation trajectories were assessed using group-based trajectory modeling over the first 6-year period from wave 1 (2002-2003) to wave 4 (2008-2009). The longitudinal associations of PA trajectories with motor function declines and incident frailty were evaluated by a linear mixed model and Cox regression model, respectively, with follow-up of 10 years from wave 4 to wave 9 (2018-2019).

RESULTS

Five distinct trajectories of long-term PA participation were identified in the aging cohort, including persistently low-active trajectory (N = 2,039), increasing active trajectory (N = 1,711), declining active trajectory (N = 216), persistently moderate-active trajectory (N = 2,254), and persistently high-active trajectory (N = 2,007). Compared with the persistently low-active group, the participants in persistently moderate- and high-active groups experienced significantly decelerated grip strength decline, decreased gait speed decline, and faster chair rises after multiple-adjustment. Similarly, participants maintaining moderate- and high-active PA were also associated with a lower risk of incident frailty (multiple-adjusted hazard ratio: 0.70, 95% confidence interval: 0.62-0.80, and 0.42, 95% CI: 0.36-0.49, respectively), compared with those with persistently low PA. Notably, the participants with the increasing active trajectory got similar health benefits as those with persistently moderate and high levels of PA.

CONCLUSION

In addition to persistent PA, increasing PA was linked to a slower decline in motor function and lower risk of incident frailty in the cohort. Our findings suggest that regular PA is never too late.

Association between physical-activity trajectories and cognitive decline in adults 50 years of age or older

Aims

To investigate the associations of physical-activity trajectories with the level of cognitive performance and its decline in adults 50 years of age or older.

Methods

We studied 38729 individuals (63 ± 9 years; 57% women) enrolled in the Survey of Health, Ageing and Retirement in Europe (SHARE). Physical activity was self-reported and cognitive performance was assessed based on immediate recall, verbal fluency, and delayed recall. Physical-activity trajectories were estimated using growth mixture modelling and linear mixed effects models were used to investigate the associations between the trajectories and cognitive performance.

Results

The models identified two physical-activity trajectories of physical activity: constantly-high physical activity (N=27634: 71%) and decreasing physical activity (N=11095; 29%). Results showed that participants in the decreasing physical-activity group exhibited a lower level of cognitive performance compared to the high physical-activity group (immediate recall: ß=0.94; 95% confidence interval [CI]=0.92 to 0.95; verbal fluency: ß=0.98; 95% CI=0.97 to 0.98; delayed recall: ß=0.95; 95% CI=0.94 to 0.97). Moreover, compared with participants in the constantly-high physical-activity group, participants in the decreasing physical-activity group showed a steeper decline in all cognitive measures (immediate recall: ß=-0.04; 95% CI=-0.05 to -0.04; verbal fluency: ß=-0.22; 95% CI=-0.24 to -0.21; delayed recall: ß=-0.04; 95% CI=-0.05 to -0.04).

Conclusions

Physical-activity trajectories are associated with the level and evolution of cognitive performance in adults over 50 years. Specifically, our findings suggest that a decline in physical activity over multiple years is associated with a lower level and a steeper decline in cognitive performance.

Device-Measured Physical Activity, Sedentary Behaviors, Built Environment, and Adiposity Gain in Older Women: A Seven-Year Prospective Study

The search for determinants of adiposity gain in older women has become vitally important. This study aimed to (1) analyze the adiposity gain based on the participants’ age and (2) determine the prospective associations of baseline intrapersonal, built environment, physical activity, and sedentary behavior variables with the adiposity gain in older women. This was a seven-year prospective study (baseline: 2009 to 2012; follow-up: 2016 to 2019) in older women (n = 178, baseline age = 62.8 ± 4.1 years). Baseline and follow-up adiposity (bioelectrical impedance) and baseline physical activity, sedentary behavior (accelerometers), and intrapersonal and built environment (Neighborhood Environment Walkability Scale questionnaire) variables were included. The body mass index (BMI) increment tended to be inversely associated with the women’s age (p = 0.062). At follow-up, 48, 57, and 54% of the women had a relevant increase (d-Cohen > 0.2) in their BMI, percentage of body fat, and fat mass index, respectively. The women that spent ≥8 h/day being sedentary were 2.2 times (1.159 to 4.327 CI95%, p < 0.02) more likely to increase BMI (0.82 to 0.85 kg/m²) than non-sedentary women. No built environment variables were associated with seven-year adiposity gain (all ps > 0.05). A reduction in sedentary time should be promoted for adiposity gain prevention and health preservation in older women.

Age- and Sex-Specific Changes in Lower-Limb Muscle Power Throughout the Lifespan

BACKGROUND

Our main goal was to evaluate the pattern and time course of changes in relative muscle power and its constituting components throughout the life span.

METHODS

A total of 1,305 subjects (729 women and 576 men; aged 20-93 years) participating in the Copenhagen Sarcopenia Study took part. Body mass index (BMI), leg lean mass assessed by dual-energy X-ray absorptiometry (DXA), and leg extension muscle power (LEP) assessed by the Nottingham power rig were recorded. Relative muscle power (normalized to body mass) and specific muscle power (normalized to leg lean mass) were calculated. Segmented regression analyses were used to identify the onset and pattern of age-related changes in the recorded variables.

RESULTS

Relative muscle power began to decline above the age of 40 in both women and men, with women showing an attenuation of the decline above 75 years. Relative muscle power decreased with age due to (i) the loss of absolute LEP after the fourth decade of life and (ii) the increase in BMI up to the age of 75 years in women and 65 years in men. The decline in absolute LEP was caused by a decline in specific LEP up to the age of 75 in women and 65 in men, above which the loss in relative leg lean mass also contributed.

CONCLUSIONS

Relative power decreased (i) above 40 years by the loss in absolute power (specific power only) and the increase in body mass, and (ii) above ~70 years by the loss in absolute power (both specific power and leg lean mass).

Group‐based trajectory modeling of body mass index and body size over the life course: A scoping review

Background

Group‐based trajectory modeling has been applied to identify distinct trajectories of growth across the life course. Objectives of this study were to describe the methodological approaches for group‐based modeling of growth across the life course and to summarize outcomes across studies.

Methods

A scoping review with a systematic search of Medline, EMBASE, CINAL, and Web of Science was conducted. Studies that used a group‐based procedure to identify trajectories on any statistical software were included. Data were extracted on trajectory methodology, measures of growth, and association with outcomes.

Results

A total of 59 studies were included, and most were published from 2013 to 2020. Body mass index was the most common measure of growth (n = 43). The median number of identified trajectories was 4 (range: 2–9). PROC TRAJ in SAS was used by 33 studies, other procedures used include TRAJ in STATA, lcmm in R, and Mplus. Most studies evaluated associations between growth trajectories and chronic disease outcomes (n = 22).

Conclusions

Group‐based trajectory modeling of growth in adults is emerging in epidemiologic research, with four distinct trajectories observed somewhat consistently from all studies. Understanding life course growth trajectories may provide further insight for population health interventions.

Physical Activity Trajectories and Associated Changes in Physical Performance in Older Men: The MrOS Study

BACKGROUND

Physical activity (PA) is important to maintaining functional independence. It is not clear how patterns of change in late-life PA are associated with contemporaneous changes in physical performance measures.

METHODS

Self-reported PA, gait speed, grip strength, timed chair stand, and leg power were assessed in 3,865 men aged ≥ 65 years at baseline (2000-2002) and Year 7 (2007-2009). Group-based trajectory modeling, using up to four PA measures over this period, identified PA trajectories. Multivariate linear regression models (adjusted least square mean [95% confidence interval {CI}]) described associations between-PA trajectories and concurrent changes in performance.

RESULTS

Three discrete PA patterns were identified, all with declining PA. Linear declines in each performance measure (baseline to Year 7) were observed across all three PA groups, but there was some variability in the rate of decline. Multivariate models assessing the graded response by PA trajectory showed a trend where the high-activity group had the smallest declines in performance while the low-activity group had the largest (p-for trend < .03). Changes in the high-activity group were the following: gait speed (-0.10 m/s [-0.12, -0.08]), grip strength (-3.79 kg [-4.35, -3.23]), and chair stands (-0.38 [-0.50, -0.25]), whereas changes in the low-activity group were the following: gait speed (-0.16 [-0.17, -0.14]), grip strength (-4.83 kg [-5.10, -4.55]), and chair stands (-0.53 [-0.59, -0.46]). Between-group differences in leg power trajectories across PA patterns were not significant.

CONCLUSIONS

Declines in functional performance were higher among those with lower PA trajectories, providing further evidence for the interrelationship between changes in PA and performance during old age.

Physical activity trajectories, mortality, hospitalization, and disability in the Toledo Study of Healthy Aging

BACKGROUND

Physical activity (PA) is a recognized contributor to healthy aging. However, the majority of studies exploring its associations with adverse outcomes in cohorts of older adults use single-time PA estimates, which do not consider its dynamic nature. The aim of the present study is to explore the presence of different PA trajectories in the Toledo Study of Healthy Aging and their association with adverse outcomes. Our hypothesis is that prospectively maintaining or increasing PA is associated with a reduced risk of adverse outcomes.

METHODS

We used data from 1679 participants enrolled in the Toledo Study of Healthy Aging. Trajectories based on the Physical Activity Scale for the Elderly were identified using group-based trajectory modelling. Cox and logistic regression were used to investigate associations between PA trajectories and mortality and hospitalization, and incident and worsening disability, respectively. Mortality was ascertained by linkage to the Spanish National Death Index; disability was evaluated through the Katz Index; and hospitalization was defined as the first admission to Toledo Hospital. Models were adjusted by age, sex, smoking, Charlson Index, education, cognitive impairment, polypharmacy, and Katz Index at Wave 2.

RESULTS

We found four PA-decreasing and one PA-increasing trajectories: high PA-consistent (n = 566), moderate PA-mildly decreasing (n = 392), low PA-increasing (n = 237), moderate PA-consistent (n = 191), and low PA-decreasing (n = 293). Belonging to the high PA-consistent trajectory group was associated with reduced risks of mortality as compared with the low PA-decreasing group [hazard ratio (HR) 1.68; 95% confidence interval (CI) = 1.21-2.31] and hospitalization compared with the low PA-increasing and low PA-decreasing trajectory groups (HR 1.24; 95% CI = 1.004-1.54 and HR 1.25; 95% CI = 1.01-1.55, respectively) and with lower rates of incident [odds ratio (OR) 3.14; 95% CI = 1.59-6.19] and worsening disability (OR 2.16; 95% CI = 1.35-3.45) in relation to the low PA-decreasing trajectory group and at follow-up. Increasing PA during late life (low PA-increasing group) was associated with lower incident disability rates (OR 0.38; 95% CI = 0.19-0.82) compared with decreasing PA (low PA-decreasing group), despite similar baseline PA.

CONCLUSIONS

Our results suggest that sustaining higher PA levels during aging might lead to healthy aging, characterized by a reduction in adverse outcomes. Our study supports the need for enhancing PA participation among older populations, with the goal of reducing personal and economic burden in a worldwide aging population.

Objective measures of moderate to vigorous physical activity are associated with higher distal limb bone strength among elderly men

Our aim was to determine the association between objectively measured physical activity (PA) and bone strength of the distal limbs among older men. We studied 994 men from the MrOS cohort study (mean age 83.9) who had repeat (Year 7 and 14) 5-day activity assessment with at least 90% wear time (SenseWearPro3 Armband) and Year 14 measures using high resolution peripheral quantitative tomography (HR-pQCT) (Scanco). Total energy expenditure (TEE), total steps per day, peak cadence (mean of top 30 steps/min over 24 h) and time spent in a given level of activity: sedentary (reference, <1.5 metabolic equivalents of task [METs]), light (1.5 to <3 METs), or moderate to vigorous physical activity(MVPA: ≥3 METs) were calculated as mean over the two time points. Estimated failure load was determined from HR-pQCT data using finite element analysis. We used standardized variables and adjusted for potential confounders using linear regression. The means ±SDs for daily activity were: 2338 ± 356 kcal/d [TEE]; 5739 ± 2696 steps/day [step count], 60 ± 20 cpm [peak cadence], 67 ± 28 min/d [light activity], and 85 ± 52 min/d [MVPA]. Higher TEE, step count, and peak cadence were each associated with higher failure load of the distal radius (effect sizes respectively: 0.13 [95% CI: 0.05, 0.20], 0.11 [95% CI: 0.04, 0.18], and 0.08 [95% CI: 0.01, 0.15]) and higher failure load of the distal tibia (effect sizes respectively 0.21 [95% CI: 0.13, 0.28], 0.19 [95% CI: 0.13, 0.26], 0.19 [95% CI, 0.13, 0.25]). Time spent in MVPA vs. time sedentary was related to bone strength at both sites after adjustment, whereas time spent in light activity vs. time sedentary was not. TEE was associated with compartmental area and BMD parameters at distal tibia, but only area parameters at the distal radius. In summary, MVPA over a 7-year period of time may have a modest association with bone strength and geometry among older men.

Trajectories of physical activity, from young adulthood to older adulthood, and pancreatic cancer risk; a population-based case-control study in Ontario, Canada

Background

There is inconsistent evidence on the association between physical activity and pancreatic cancer risk and few studies have investigated early life or life-course physical activity. The objective of this study was to evaluate the association between trajectories of physical activity across the life-course and pancreatic cancer risk.

Methods

A population-based case-control study was conducted (2011–2013) using cases (n = 315) from the Ontario Pancreas Cancer Study and controls (n = 1254) from the Ontario Cancer Risk Factor Study. Self-reported recall of moderate and vigorous physical activity was measured at three time points: young adulthood (20s–30s), mid-adulthood (40s–50s) and older-adulthood (1 year prior to questionnaire completion). Physical activity trajectories were identified using latent class analysis. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from multivariable logistic regression adjusted for covariates: age, sex, race, alcohol, smoking, vegetable, fruit and meat consumption, and family history of pancreatic cancer.

Results

Six life-course physical activity trajectories were identified: inactive at all ages (41.2%), low activity at all ages (31.9%), increasingly active (3.6%), high activity in young adulthood with substantial decrease (13.0%), high activity in young adulthood with slight decrease (5.0%), and persistent high activity (5.3%). Compared to the inactive at all ages trajectory, the associations between each trajectory and pancreatic cancer after confounder adjustment were: low activity at all ages (OR: 1.11; 95% CI: 0.75, 1.66), increasingly active (OR: 1.11; 95% CI: 0.56, 2.21), high activity in young adulthood with substantial decrease in older adulthood (OR: 0.76; 95% CI: 0.47, 1.23), high activity in young adulthood with slight decrease in older adulthood (OR: 0.98; 95% CI: 0.62, 1.53), and persistently high activity (OR: 1.50; 95% CI: 0.86, 2.62). When time periods were evaluated separately, the OR for the association between high moderate activity in the 20s–30s and pancreatic cancer was 0.89 (95% CI: 0.64, 1.25) and some sex differences were observed.

Conclusion

Distinct life-course physical activity trajectories were identified, but there was no evidence that any of the trajectories were associated with pancreatic cancer. Future studies with larger sample sizes are needed to understand the associations between physical activity trajectories over the life-course and pancreatic cancer risk.

Investigation of the Diet-Gut-Muscle Axis in the Osteoporotic Fractures in Men Study

OBJECTIVES

To investigate the association between dietary fiber density (grams of fiber consumed per 100 kcal) with the gut-muscle axis in older adult men.

DESIGN

Cross-sectional study.

SETTING

Osteoporotic Fractures in Men (MrOS) cohort participants at Visit 4 (2014-16).

PARTICIPANTS

Older adult men (average age, 85y) from the MrOS study.

MEASUREMENTS

Men who were in the highest tertiles for dietary fiber density and the percentage of whole body lean mass were defined as T3T3 (n=42), whereas men who were in the lowest and intermediate tertiles for these variables were defined as T1T1 (n=32), T1T3 (n=24), and T3T1 (n=13), respectively. Additionally, measures of physical function, including the short physical performance battery (SPPB) score and grip strength were higher in T3T3 when compared with T1T1. Gut bacterial abundance was quantified with use of 16S v4 rRNA sequencing, and the bacterial functional potential was derived from the 16S data with PICRUSt. Chao1, ACE, Shannon, Simpson, and Fisher indices were used as measures of α-diversity. Weighted and unweighted Unifrac, and Bray-Curtis were used as measures of β-diversity. Age, physical activity score, smoking, and number of medications-adjusted DESeq2 models were used to identify bacteria and functions that were different when comparing T3T3 with T1T1, but that were not also different when comparing T3T3 with T1T3 or T3T1.

RESULTS

α-diversity was not different, but significant differences for β-diversity (unweighted UniFrac, Bray-Curtis) were identified when comparing T3T3 with T1T1. Known butyrate-producing bacteria, including Ruminococcus, Lachnospira, and Clostridia, and gene counts for butyrate production (KEGG IDs: K01034, K01035) were higher in T3T3, when compared with T1T1.

CONCLUSION

These data suggest that a high-fiber diet may positively impact butyrate-producing genera and gene counts, which collectively may be involved in mechanisms related to the percentage of whole body lean mass and physical functioning in older adult men. Future studies aimed at testing the causative role of this hypothesis are of interest.

Trajectories of physical activity from midlife to old age and associations with subsequent cardiovascular disease and all-cause mortality

Introduction

It is well established that physical activity (PA) protects against mortality and morbidity, but how long-term patterns of PA are associated with mortality and cardiovascular disease (CVD) remains unclear.

Methods

3231 men recruited to the British Regional Heart Study, a prospective cohort study, reported usual PA levels at baseline in 1978–1980 (aged 40–59 years) and at 12-year, 16-year and 20-year follow ups. Twenty-year trajectories of PA, spanning from 1978/1980 to 2000, were identified using group-based trajectory modelling. Men were subsequently followed up until 30 June 2016 for mortality through National Health Service central registers and for non-fatal CVD events through primary and secondary care records. Data analyses were conducted in 2019.

Results

Three PA trajectories were identified: low/decreasing (22.7%), light/stable (51.0%) and moderate/increasing (26.3%). Over a median follow-up of 16.4 years, there were 1735 deaths. Compared with the low/decreasing group, membership of the light/stable (HR 0.83, 95% CI 0.74 to 0.94) and moderate/increasing (HR 0.76, 95% CI 0.66 to 0.88) groups was associated with a lower risk of all-cause mortality. Similar associations were observed for CVD mortality, major coronary heart disease and all CVD events. Associations were only partially explained by a range of confounders. Sensitivity analyses suggested that survival benefits were largely driven by most recent/current PA.

Conclusions

A dose-response relationship was observed, with higher levels of PA from midlife to old age associated with additional benefits. However, even fairly modest and sustained PA was protective and may be more achievable for the most inactive.

Distinct trajectories of physical activity and related factors during the life course in the general population: a systematic review

BACKGROUND

In recent years, researchers have begun applying a trajectory approach to identify homogeneous subgroups of physical activity (PA) in heterogeneous populations. This study systematically reviewed the articles identifying longitudinal PA trajectory classes and the related factors (e.g., determinants, predictors, and outcomes) in the general population during different life phases.

METHODS

The included studies used finite mixture models for identifying trajectories of PA, exercise, or sport participation. Three electronic databases, PubMed (Medline), Web of Science, and CINAHL, were searched from the year 2000 to 13 February 2018. The study was conducted according to the PRISMA recommendations.

RESULTS

Twenty-seven articles were included and organized into three age group: youngest (eleven articles), middle (eight articles), and oldest (eight articles). The youngest group consisted mainly of youth, the middle group of adults and the oldest group of late middle-aged and older adults. Most commonly, three or four trajectory classes were reported. Several trajectories describing a decline in PA were reported, especially in the youngest group, whereas trajectories of consistently increasing PA were observed in the middle and oldest group. While the proportion of persistently physically inactive individuals increased with age, the proportion was relatively high at all ages. Generally, male gender, being Caucasian, non-smoking, having low television viewing time, higher socioeconomic status, no chronic illnesses, and family support for PA were associated either with persistent or increasing PA.

CONCLUSIONS

The reviewed articles identified various PA subgroups, indicating that finite mixture modeling can yield new information on the complexity of PA behavior compared to studying population mean PA level only. The studies also provided novel information how different factors relate to changes in PA during life course. The recognition of the PA subgroups and their determinants is important for the more precise targeting of PA promotion and PA interventions.

TRIAL REGISTRATION

PROSPERO registration number: CRD42018088120 .

The Association Between Trajectories of Physical Activity and All-Cause and Cause-Specific Mortality

Background

The benefits of physical activity (PA) for health have primarily been evaluated during midlife. Whether patterns of change in late-life PA associate with overall and cause-specific mortality remains unclear.

Methods

We examined the association between PA trajectories and subsequent mortality among 3,767 men aged ≥65 years. Men self-reported PA using the Physical Activity Scale for the Elderly (PASE) at up to four time points from 2000 through 2009 (Year 7); mortality was assessed over an average of 7.1 years after the Year 7 contact. Group-based trajectory modeling identified patterns of PA change. Cox proportional hazards models described associations between patterns of change in PA, Year 7 PA, and subsequent mortality risk.

Results

Three discrete PA patterns were identified, all with declining PA. Compared to low-activity declining men, moderate (hazard ratio [HR] = 0.78; 95% confidence interval [CI]: 0.70, 0.88) and high-activity (HR = 0.69, 95% CI: 0.57, 0.83) declining groups were associated with lower risk of all-cause mortality. Among models with a single time point, the last time point (Year 7 PA score) was a strong predictor of mortality with HR = 0.85 (95% CI: 0.78, 0.93) per SD increase in PASE score. PA patterns were not a risk factor for mortality after adjustment for the Year 7 PA score.

Conclusions

Recent PA levels are a stronger indicator of subsequent mortality risk than PA patterns reported over the prior 7 years or prior PA level, suggesting that current PA rather than history of PA is the most relevant parameter in clinical settings.

The final word on nutritional screening and assessment in older persons

PURPOSE OF REVIEW

To provide an updated perspective of how nutritional screening and assessment in older persons should be performed and reasonably implemented in the near future.

RECENT FINDINGS

Although nutritional screening and assessment should be fast and easy procedures, there is increasing evidence that more time should be dedicated to them. This is probably an answer to the claim to a medicine being more preventive than curative. Increasing interest is currently given to healthy aging and nutritional status is more likely to be addressed for its implications on functional status and disability. Important prognostic conditions, such as frailty, sarcopenia, and cachexia, which are closely linked to the nutritional domain, are at the top of the agenda. Therefore, body composition is a key issue and functional status is suggested as primary endpoint of nutrition trials. In this scenario, there is also a rationale for systematic assessment of inflammation, protein intake, and vitamin D status as potential contributing factors to reduced muscle mass and function.

SUMMARY

A 'second-generation' multidimensional nutritional screening and assessment including the evaluation of body composition, frailty, sarcopenia, and cachexia could be hypothesized. Nutritional assessment should be also completed by the systematic evaluation of inflammation, protein intake, and vitamin D status.