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Lima-Costa MF, de Melo Mambrini JV, Bof de Andrade F, de Souza PRB, de Vasconcellos MTL, Neri AL, Castro-Costa E, Macinko J, de Oliveira C. Cohort Profile: The Brazilian Longitudinal Study of Ageing (ELSI-Brazil). Int J Epidemiol 2022; 52:e57-e65. [PMID: 35748356 PMCID: PMC9908056 DOI: 10.1093/ije/dyac132] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/07/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Maria Fernanda Lima-Costa
- Corresponding author. Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fundação Oswaldo Cruz, Av. Augusto de Lima 1715, 6º andar, sala 614, Belo Horizonte, 30190-003, Brasil. E-mail:
| | | | | | - Paulo Roberto Borges de Souza
- Instituto de Comunicação e Informação Científica e Tecnológica e Tecnologia em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Erico Castro-Costa
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
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Pivetta NRS, Marincolo JCS, Neri AL, Aprahamian I, Yassuda MS, Borim FSA. Multimorbidity, frailty and functional disability in octogenarians: A structural equation analysis of relationship. Arch Gerontol Geriatr 2019; 86:103931. [PMID: 31541858 DOI: 10.1016/j.archger.2019.103931] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 07/26/2019] [Accepted: 08/01/2019] [Indexed: 01/08/2023]
Abstract
Path analysis allows for an understanding of the complex interrelationships between multiple variables and interactions in the octogenarians. The aim of this study was to estimate the isolated and combined prevalence of multimorbidity, frailty and functional disability and the direct and indirect association of these conditions in octogenarians. A cross-sectional study was conducted with 166 community-dwelling individuals aged 80 years or older participating in the FIBRA80+ epidemiological study. Multimorbidity was defined by three or more chronic diseases, frailty according to 3 or more components of physical frailty phenotype and functional disability as aid needed to perform one or more activities of daily living (ADLs). Associations were tested by Pearson's chi-square test; the relationship between the variables of interest and the mediating variables was tested with structural equation (path) analysis. We observed a higher prevalence of seniors with disability and multimordibity/disability. In path analysis, number of chronic diseases mediated the relation between sex and number of frailty components (p = 0.031), and these mediated the relation between number of diseases and disability (p = 0.008). The study points out the relationship between the simultaneous presence and interaction between multimorbidity, functional disability and frailty. Through path analysis, our findings provide characteristics in relation to the health-disease process, mainly mediation and interaction among octogenarians.
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Affiliation(s)
- N R S Pivetta
- Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil.
| | - J C S Marincolo
- Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | - A L Neri
- Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
| | | | - M S Yassuda
- Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil; School of Arts, Sciences and Humanities (EACH), University of São Paulo, São Paulo, Brazil
| | - F S A Borim
- Faculty of Medical Sciences, State University of Campinas, Campinas, Brazil
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Pereira AA, Borim FSA, Aprahamian I, Neri AL. Comparison of Two Models of Frailty for the Prediction of Mortality in Brazilian Community-Dwelling Older Adults: The FIBRA Study. J Nutr Health Aging 2019; 23:1004-1010. [PMID: 31781731 DOI: 10.1007/s12603-019-1264-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prevalence of frailty is significant in Latin America. However, no previous study evaluated mortality prediction using the two most used frailty models in Brazil. OBJECTIVES The aim of the present study was to compare the frailty phenotype and the frailty index with regard to accuracy in the prediction of mortality among community-dwelling older adults. METHODS A cohort study was conducted involving 674 older adults. Thirty-five variables (signs, symptoms, chronic diseases and disabilities) were used for the construction of the frailty index (FI). The frailty phenotype index (FPI) was defined based on the criteria proposed in the Cardiovascular Health Study. Periodic verifications were performed in the databank of the Mortality Information System. Cox regression was used to estimate the relative risk (RR) of mortality and Kaplan-Meier survival curves were used in the analysis. RESULTS The prevalence of frailty was greater based using the FI (16.3%) compared to the FPI (5.34%). Older adults classified as frail by the FPI had a greater risk of death (RR: 10.03; 95% CI: 4.43-22.74) that those classified as frail by the FI (RR: 0.87; 95% CI: 0.25-3.00). The lowest survival rate was found in the group of older adults classified as frail based on the FPI and classified as pre-frail and robust based on the FI. CONCLUSION The FPI demonstrated greater accuracy in predicting the risk of mortality among Brazilian older adults than the FI. The validation of frailty measures is fundamental to the identification of older adults who are more vulnerable to adverse health events.
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Affiliation(s)
- A A Pereira
- Ivan Aprahamian, MD, MS, PhD, FACP. Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, Jundiaí, Brazil. 250 Francisco Telles street. ZIP 13.202-550. E-mail:
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Fattori A, Santimaria MR, Alves RMA, Guariento ME, Neri AL. Influence of blood pressure profile on frailty phenotype in community-dwelling elders in Brazil - FIBRA study. Arch Gerontol Geriatr 2012; 56:343-9. [PMID: 22939428 DOI: 10.1016/j.archger.2012.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/06/2012] [Accepted: 08/08/2012] [Indexed: 11/29/2022]
Abstract
Frailty is a clinical condition associated with pathological aging and biological vulnerability. In the spectrum of events related to frailty, aging of the cardiocirculatory system and abnormalities in arterial blood pressure (BP) partly explain the changes in tissue perfusion and, potentially, the decrease in physiological reserves. This study investigated the relationship between BP levels, systemic arterial hypertension (SAH) and the frailty phenotype by analyzing frailty criteria in a cross-sectional model into the FIBRA network, a populational sample of community-dwelling elders in Southeastern Brazil. Study participants with ≥65 years were selected by probabilistic sampling of residents in the urban area of the municipality of Campinas (n=900). Considering frailty as a whole and the difference between genders, there was a greater proportion of frail or pre-frail individuals among women than men. Analysis of individual frailty criteria showed that weight loss and fatigue were more common among women (18.3% vs. 12.5%, p=0.034 and 22.5% vs. 11.9%, p<0.001, respectively). Comparison of individuals with or without SAH failed to reveal any differences related to frailty criteria. Nevertheless, averages of diastolic blood pressure (DBP) and mean arterial blood pressure values were lower among elderly individuals with reduced grip strength, physical activity and the frailty classification as a whole (OR 0.986, IC 0.975-0.997) (for every 1 mmHg reduction in MBP values, the likelihood of being frail increased 1.4%). Our findings corroborate the relationship between BP values and frailty in the elderly and contribute to an understanding of the pathophysiological mechanisms of the syndrome.
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Affiliation(s)
- A Fattori
- Faculty of Medical Sciences, Campinas State University, Unicamp, Brazil.
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Yassuda MS, Lopes A, Cachioni M, Falcao DVS, Batistoni SST, Guimaraes VV, Neri AL. Frailty criteria and cognitive performance are related: data from the FIBRA study in Ermelino Matarazzo, São Paulo, Brazil. J Nutr Health Aging 2012; 16:55-61. [PMID: 22238002 DOI: 10.1007/s12603-012-0003-6] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To assess the relationship between the CHS frailty criteria (Fried et al., 2001) and cognitive performance. DESIGN Cross sectional and population-based. SETTING Ermelino Matarazzo, a poor sub district of the city of São Paulo, Brazil. PARTICIPANTS 384 community dwelling older adults, 65 and older. MEASUREMENTS Assessment of the CHS frailty criteria, the Brief Cognitive Screening Battery (memorization of 10 black and white pictures, verbal fluency animal category, and the Clock Drawing Test) and the Mini-Mental State Examination (MMSE). RESULTS Frail older adults performed significantly lower than non-frail and pre frail elderly in most cognitive variables. Grip strength and age were associated to MMSE performance, age was associated to delayed memory recall, gait speed was associated to verbal fluency and CDT performance, and education was associated to CDT performance. CONCLUSION Being frail may be associated with cognitive decline, thus, gerontological assessments and interventions should consider that these forms of vulnerability may occur simultaneously.
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Affiliation(s)
- M S Yassuda
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, Brazil.
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Cottone S, Vadalà A, Mangano MT, Riccobene R, Vella MC, Neri AL, Mulé G, Piazza G, Amato F, Zagarrigo C, Cerasola G. Endothelium-derived factors in microalbuminuric and nonmicroalbuminuric essential hypertensives. Am J Hypertens 2000; 13:172-6. [PMID: 10701817 DOI: 10.1016/s0895-7061(99)00169-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Previous evidence has demonstrated a relationship between growth factors and cardiovascular diseases. This study was aimed at evaluating levels of some endothelium-derived growth factors, and their relationship with microalbuminuria (MAU), in essential hypertension. Ninety-nine mild-moderate essential hypertensives (EH) and 25 healthy controls were studied. All patients underwent 24-h blood pressure monitoring, serum endothelin-1 (ET-1), basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF), and 24-h MAU assays. Later, EH were divided into two subsets consisting of microalbuminurics (MAU >11 microg/min) and nonmicroalbuminurics (MAU <11 microg/min). In microalbuminuric EH, circulating ET-1, bFGF, and PDGF were significantly higher than in nonmicroalbuminurics (P < .0001, P < .0001, P < .005, respectively) or in controls. In the group of 99 EH, significant positive correlations of MAU with both ET-1 and bFGF (r = 0.35, P < .001, and r = 0.34, P < .001, respectively) were found. ET-1 and bFGF correlated significantly (r = 0.31, P < .002). Circulating bFGF also correlated significantly with MAU in the microalbuminuric EH subset (r = 0.49, P < .01). Our results show that in microalbuminuric EH circulating levels of certain growth factors are increased. In human essential hypertension these factors are linked with MAU, an early cardiovascular and renal damage marker.
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Affiliation(s)
- S Cottone
- Cattedra di Medicina Interna, Istituto di Clinica Medica e Malattie Cardiovascolari, University of Palermo, Italy.
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Cottone S, Vella MC, Vadalà A, Neri AL, Riccobene R, Cerasola G. Influence of vascular load on plasma endothelin-1, cytokines and catecholamine levels in essential hypertensives. Blood Press 1998; 7:144-8. [PMID: 9758083 DOI: 10.1080/080370598437349] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In vitro studies demonstrated a relationship between ET-1 and basic Fibroblast Growth Factor (bFGF), and of bFGF with Platelet Derived Growth Factor (PDGF). The present study was carried out to investigate in vivo the behaviour after vascular stress of circulating ET-1, bFGF and PDGF, and catecholamines, and their relationship. In 12 healthy normotensives (NTs) and 15 essential hypertensives (Ehs) venous blood samples to determine circulating ET-1, bFGF and PDGF, and catecholamine (EPI and NE) levels were drawn before and at the third minute of a handgrip test. Blood pressures (BP) and heart rate were automatically recorded before starting, and at 1, 2, and 3 minutes during the test. The NTs showed, in basal condition, lower values than the EHs of all the examined parameters; later, the handgrip test induced significant increases in circulating levels of ET-1, bFGF and catecholamine. In the EHs at the third minute of the exercise significant increases in plasma ET-1 (p < 0.002), bFGF (p < 0.006), and EPI and NE (p < 0.0005) levels were observed. Systolic and diastolic BP significantly increased after handgrip test in NTs and EHs. Plasma ET-1 correlated with bFGF both before (p < 0.01) and at the acme (p < 0.05) of the isometric exercise. Our results show that in EHs plasma ET-1 and bFGF correlate each other, indicating that in human hypertension a linkage between ET-1 and bFGF exists.
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Affiliation(s)
- S Cottone
- Istituto di Clinica Medica e Malattie Cardiovascolari, Cattedra di Medicina Interna, University of Palermo, Italy
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