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Bareiro FAQ, Carnicero JA, Acha AA, Artalejo CR, Jimenez MCG, Mañas LR, García García FJ. How cognitive performance changes according to the ankle-brachial index score in an elderly cohort? Results from the Toledo Study of Healthy Ageing. GeroScience 2024; 46:609-620. [PMID: 37870701 PMCID: PMC10828423 DOI: 10.1007/s11357-023-00966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
In the ageing process, the vascular system undergoes morphological and functional changes that may condition brain functioning; for this reason, the aims of this study were to assess the effect of vascular function indirectly measured by ankle-brachial index (ABI) on both cognitive performance at baseline and change in cognitive performance at end of follow-up. We developed a prospective, population-based, cohort study with 1147 participants aged > 65 years obtained from the Toledo Study for Healthy Ageing who had cognitive assessment and measured ABI in the first wave (2006-2009) were selected for the cross-sectional analysis. Those participants who also performed the cognitive assessment in the second wave (2011-2013) were selected for the prospective analysis. Cognitive impairment diagnosis and symptoms and/or history of cardio/neurovascular disease were used as exclusion criteria. Multivariate segmented regression model was used to assess the associations between ABI and cognitive performance in both the cross-sectional and prospective analyses. As ABI score decreased from 1.4, the cross-sectional analysis showed a higher decrease in cognitive performance and the prospective analysis showed a higher degree of worsening in cognitive performance. Our findings suggest that the ABI, a widespread measure of vascular health in primary care, may be a useful tool for predicting cognitive performance and its evolution.
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Affiliation(s)
- Fabio A Quiñónez Bareiro
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
| | - José A Carnicero
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.
- Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, Ctra. Toledo Km. 12.5, 28905, Getafe, Spain.
| | - Ana Alfaro Acha
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Cristina Rosado Artalejo
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - María C Grau Jimenez
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
| | - Leocadio Rodriguez Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Geriatric Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Francisco J García García
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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Lorenzo-Lozano MC, Blázquez-Manzanera AL, Carnicero JA. How kidney clock works: circadian pattern of eGFR based on a population data group. J Physiol Biochem 2023:10.1007/s13105-023-00948-2. [PMID: 36808081 DOI: 10.1007/s13105-023-00948-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/18/2022] [Accepted: 02/03/2023] [Indexed: 02/20/2023]
Abstract
A circadian regulation of renal function it has been described in the last few years. An intradaily variation in glomerular filtration rate (eGFR) has also been discovered at the individual level. The aim of this study was to check if there exists a circadian pattern of eGFR at population data group level and to compare the population results with those described at individual level. We have studied a total of 446,441 samples analysed in the emergency laboratories of two Spanish hospitals between January 2015 and December 2019. We selected all the records of eGFR values between 60 and 140 mL/min/1.73 m2 using CKD-EPI formula from patients between 18 and 85 years. The intradaily intrinsic eGFR pattern was computed using the extraction time of day in four nested mixed linear and sinusoidal regression models. All models showed an intradaily eGFR pattern, but the estimated model coefficients differed depending on whether age was included. The inclusion of age improved the performance of the model. In this model, the acrophase occurred at 7:46 h. We describe the distribution of eGFR values depending on the time in two different populations. This distribution is adjusted to a circadian rhythm that behaves similarly to the individual rhythm. This pattern is similar in each of the years studied from each hospital as well as between both hospitals. The results found suggest the incorporation of the concept of "population circadian rhythm" into the scientific world.
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Affiliation(s)
- M C Lorenzo-Lozano
- Hospital Universitario de Toledo, Complejo Hospitalario Universitario de Toledo, Toledo, Spain. .,Spanish Research Group in Biological Rhythms and Laboratory Medicine, Toledo, Spain.
| | - A L Blázquez-Manzanera
- Spanish Research Group in Biological Rhythms and Laboratory Medicine, Toledo, Spain.,Hospital General Universitario Rafael Méndez, Lorca, Murcia, Spain.,Hospital General de Villarrobledo, Villarrobledo, Albacete, Spain
| | - J A Carnicero
- Spanish Research Group in Biological Rhythms and Laboratory Medicine, Toledo, Spain.,Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain.,Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
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3
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Rodríguez-Gómez I, Sánchez-Martín C, García-García FJ, García-Esquinas E, Miret M, Vicente-Rodriguez G, Gusi N, Mañas A, Carnicero JA, Gonzalez-Gross M, Ayuso-Mateos JL, Rodríguez-Artalejo F, Rodríguez-Mañas L, Ara Royo I. The medium-term consequences of COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary, cardiovascular, and musculoskeletal-diseases, depression, and cancer. Epidemiol Health 2022; 44:e2022026. [PMID: 35209708 DOI: 10.4178/epih.e2022026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/14/2021] [Accepted: 02/21/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives To assess the influence of different chronic diseases on lifestyle and health behaviours changes after COVID-19 lockdown in Spanish older people compared to people without these diseases and compare the differences in these changes between both periods. Methods 1092 participants (80.3±5.6y;66.5%women) from two Spanish cohorts were included. Telephone-based questionaries were used to evaluate health risk behaviours and lifestyle during lockdown and 7-months later. Self-reported physician-based diagnosis of chronic diseases was also reported. Cox-proportional models adjusted for main confounders were applied. Results Improvements concerning lifestyle were found in older people with chronic diseases, although they worsened the physical component (except cancer). When they were compared to those without these diseases, hypertension was associated with a lower frequency of increased alcohol consumption (Hazard ratio:0.73[95% confidence interval:0.55;0.99]). Pulmonary diseases were associated with a lower risk of both decreased sedentary time (0.58[0.39;0.86]) and worsening sleep quality (0.56[0.36;0.87]), while CVD was only associated with a lower frequency of decreased sedentary time (0.58[0.38;0.88]). Depression was linked to a higher risk of increasing diet quality (1.53[1.00;2.36]). Cancer was less likely to worsen sleep quality (0.44[0.22;0.89]), but more likely to worsen their social contact frequency (2.05[1.05;3.99]). No significant association related to musculoskeletal diseases. Conclusion Beneficial changes in health risk behaviours and lifestyle after the COVID-19 lockdown in older people with chronic diseases were found. Particularly, older people with hypertension, pulmonary disease and cancer showed beneficial changes after lockdown compared to their counterparts without diseases. Those with CVD and depression showed lifestyles that could involve a health risk.
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Affiliation(s)
| | | | | | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid, Madrid, Korea
| | - Marta Miret
- Department of Psychiatry. School of Medicine. Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Narcís Gusi
- Instituto Internacional de Investigación e Innovación en Envejecimiento, Universidad de Extremadura, Cáceres, Spain
| | - Asier Mañas
- Universidad de Castilla-La Mancha, Toledo, Spain
| | | | | | - José L Ayuso-Mateos
- Department of Psychiatry. School of Medicine. Universidad Autónoma de Madrid , Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
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Quiñónez-Bareiro F, Carnicero JA, Alfaro-Acha A, Rosado-Artalejo C, Grau-Jimenez MC, Rodriguez-Mañas L, García-Garcia FJ. Risk of Frailty According to the Values of the Ankle-Brachial Index in the Toledo Study for Healthy Aging. J Frailty Aging 2022; 12:24-29. [PMID: 36629080 DOI: 10.14283/jfa.2022.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Vascular function (VF) is a general term used to describe the regulation of blood flow, arterial pressure, capillary recruitment, filtration and central venous pressure, it´s well known that age has direct effects on the VF, and this may affect the frailty status. OBJECTIVES To analyse the association between Frailty Trait Scale 5 (FTS 5) with VF and its changes at values below and above a nadir. DESIGN Prospective population-based cohort study. SETTING AND PARTICIPANTS Data from 1.230 patients were taken from the first wave (2006-2009) of the Toledo Study for Healthy Aging. MEASUREMENTS Frailty was evaluated using FTS 5, which evaluates 5 items: Body mass index, progressive Romberg, physical activity, usual gait speed and hand grip strength. VF was assessed using the ankle-brachial index (ABI) as an indirect measure of VF. Screening for cardiovascular and cerebrovascular disease was also performed by self-reporting and by searching medical records, and was used as exclusion criteria. RESULTS The optimal ABI cut-off point that maximized the adjusted R2 was 1.071. We observed a statistically significant association for FTS 5 score above and below the ABI cut-off points. For every tenth that the ABI decreased below the cut-off point the patient had an increase in the FTS 5 score of 0.47 points and in every tenth that increased above the cut-off point the increase in the FTS 5 score was 0.41 points. Of all FTS 5 items, the gait speed was the only item that showed a significant association with an ABI changes 0.28 and 0.21 points for every tenth below and above the cut-off point, respectively. CONCLUSIONS Frailty is highly associated with VF. In addition, FTS 5 and its gait speed criteria are useful to detect VF impairments, via changes in ABI.
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Affiliation(s)
- F Quiñónez-Bareiro
- Francisco Jose Garcia-Garcia, PhD, MD, Head of Geriatric Department, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Crta de Cobisa s/n, 45071, Toledo, Spain,
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5
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Rodríguez-Gómez I, Sánchez-Martín C, García-García FJ, García-Esquinas E, Miret M, Jiménez-Pavón D, Guadalupe-Grau A, Mañas A, Carnicero JA, Casajus JA, Ayuso-Mateos JL, Rodríguez-Artalejo F, Rodríguez-Mañas L, Ara I. The Medium-Term Changes in Health-Related Behaviours among Spanish Older People Lifestyles during Covid-19 Lockdown. J Nutr Health Aging 2022; 26:485-494. [PMID: 35587761 PMCID: PMC9020156 DOI: 10.1007/s12603-022-1781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim was to evaluate general changes and investigate the association between diet quality, physical activity (PA), and sedentary time (ST) during COVID-19 lockdown and the subsequent 7-month changes in health-related behaviours and lifestyles in older people. PARTICIPANTS 1092 participants (67-97y) from two Spanish cohorts were included. DESIGN Telephone-based questionaries were used to evaluate health-related behaviours and lifestyle. Multinomial logistic regression analyses with diet quality, PA, and ST during lockdown as predictors for health-related behaviours changes post-lockdown were applied. RESULTS Diet quality, PA, and ST significantly improved post-lockdown, while physical component score of the SF-12 worsened. Participants with a low diet quality during lockdown had higher worsening of post-lockdown ST and anxiety; whereas those with high diet quality showed less likelihood of remaining abstainers, worsening weight, and improving PA. Lower ST was associated with a higher likelihood of remaining abstainers, and worsening weight and improving social contact; nevertheless, higher ST was linked to improvement in sleep quality. Lower PA was more likely to decrease alcohol consumption, while higher PA showed the opposite. However, PA was more likely to be associated to remain abstainers. CONCLUSIONS Despite improvements in lifestyle after lockdown, it had health consequences for older people. Particularly, lower ST during lockdown seemed to provide the most medium-term remarkable lifestyle improvements.
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Affiliation(s)
- I Rodríguez-Gómez
- Ignacio Ara Royo, PhD, GENUD-Toledo Research Group, Universidad de Castilla-La Mancha, Avda. Carlos III, s/n, 45071, Toledo, Spain, Tel: +34 925268800 (Ext.5543); E-mail: ; @iara_royo
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García-Esquinas E, Ortolá R, Gine-Vázquez I, Carnicero JA, Mañas A, Lara E, Alvarez-Bustos A, Vicente-Rodriguez G, Sotos-Prieto M, Olaya B, Garcia-Garcia FJ, Gusi N, Banegas JR, Rodríguez-Gómez I, Struijk EA, Martínez-Gómez D, Lana A, Haro JM, Ayuso-Mateos JL, Rodríguez-Mañas L, Ara I, Miret M, Rodríguez-Artalejo F. Changes in Health Behaviors, Mental and Physical Health among Older Adults under Severe Lockdown Restrictions during the COVID-19 Pandemic in Spain. Int J Environ Res Public Health 2021; 18:ijerph18137067. [PMID: 34281004 PMCID: PMC8297096 DOI: 10.3390/ijerph18137067] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.
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Affiliation(s)
- Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- Correspondence:
| | - Rosario Ortolá
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - Iago Gine-Vázquez
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (B.O.); (J.M.H.)
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
| | - José A. Carnicero
- Foundation for Biomedical Research, Getafe University Hospital, 28905 Getafe, Spain; (J.A.C.); (A.A.-B.); (L.R.-M.)
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
| | - Asier Mañas
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | - Elvira Lara
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
- Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Alejandro Alvarez-Bustos
- Foundation for Biomedical Research, Getafe University Hospital, 28905 Getafe, Spain; (J.A.C.); (A.A.-B.); (L.R.-M.)
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
| | - German Vicente-Rodriguez
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón IA2, Universidad de Zaragoza, 50013 Zaragoza, Spain;
- CIBEROBN (CIBER of Obesity and Nutrition), 28029 Madrid, Spain
- Faculty of Health and Sport Science, University of Zaragoza, 22001 Huesca, Spain
- Department of Physiatry and Nursing, University of Zaragoza, 22002 Aragón, Spain
| | - Mercedes Sotos-Prieto
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
| | - Beatriz Olaya
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (B.O.); (J.M.H.)
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
| | - Francisco José Garcia-Garcia
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- Hospital Virgen del Valle, Complejo Hospitalario de Toledo, 45071 Toledo, Spain
| | - Narcis Gusi
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- AFYCAV (Physical Activity, Quality of Life and Health) Research Group, Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain
| | - Jose R. Banegas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - Irene Rodríguez-Gómez
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | - Ellen A. Struijk
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - David Martínez-Gómez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
| | - Alberto Lana
- Department of Medicine, School of Medicine and Health Sciences, Universidad de Oviedo/ISPA, 33003 Oviedo, Spain;
| | - Josep María Haro
- Parc Sanitari Sant Joan de Déu, 08830 Sant Boi de Llobregat, Spain; (I.G.-V.); (B.O.); (J.M.H.)
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
| | - José Luis Ayuso-Mateos
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
- Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Foundation for Biomedical Research, Getafe University Hospital, 28905 Getafe, Spain; (J.A.C.); (A.A.-B.); (L.R.-M.)
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
| | - Ignacio Ara
- CIBERFES (CIBER of Frailty and Healthy Aging), Instituto de Salud Carlos III, 28029 Madrid, Spain; (A.M.); (F.J.G.-G.); (N.G.); (I.R.-G.); (I.A.)
- GENUD Toledo Research Group, Universidad de Castilla-La Mancha, 45004 Toledo, Spain
| | - Marta Miret
- CIBERSAM (CIBER of Mental Health), 28029 Madrid, Spain; (E.L.); (J.L.A.-M.); (M.M.)
- Department of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Department of Psychiatry, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Hospital Universitario de La Princesa, 28006 Madrid, Spain
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain; (R.O.); (M.S.-P.); (J.R.B.); (E.A.S.); (D.M.-G.); (F.R.-A.)
- IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), 28029 Madrid, Spain
- CIBERESP (CIBER of Epidemiology and Public Health), 28029 Madrid, Spain
- IMDEA-Food Institute, CEI UAM+CSIC, 28049 Madrid, Spain
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7
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Rodríguez-Mañas L, Angulo J, Carnicero JA, El Assar M, García-García FJ, Sinclair AJ. Dual effects of insulin resistance on mortality and function in non-diabetic older adults: findings from the Toledo Study of Healthy Aging. GeroScience 2021; 44:1095-1108. [PMID: 34075557 DOI: 10.1007/s11357-021-00384-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 02/17/2021] [Accepted: 05/13/2021] [Indexed: 01/23/2023] Open
Abstract
Insulin signalling declines with increasing age and impacts skeletal muscle function and longevity in animal models. Our aim was to assess the relationships between insulin resistance (IR) and frailty and mortality in a unique community-dwelling cohort of older people. 991 non-diabetic subjects from the Toledo Study of Healthy Ageing (TSHA) cohort were included. IR was estimated by the homeostasis model assessment index (HOMA-IR) at baseline while frailty was determined by frailty phenotype (FP) and Frailty Trait Scale (FTS) at baseline and after 5-year follow-up. Deaths were also determined. Multivariate regression models were used to analyze the effects of HOMA-IR on outcomes. Age, gender, BMI, education level, cardio- and cerebro-vascular disease, glomerular filtration rate, and disability were included as potential confounding variables in progressive adjustment models. IR determined as increasing log HOMA-IR was inversely associated with risk of mortality. The association remained significant for all adjustment models (HR: 0.64-0.69). When we analyzed survival curves, the higher the HOMA-IR tertile, the lower the mortality rate (highest vs lowest tertile, p = 0.0082). In contrast, IR increased the risk of incident frailty determined by FP (OR 1.81 [1.14-2.87]) as well as deterioration of frailty status determined by worsening in FTS score (OR 1.28 [1.01-1.63]) at 5-year follow-up. In non-diabetic older subjects, IR significantly increases the risk for frailty and functional decline but decreased the risk of death at 5-year follow-up. This finding raises the need of assessing the effect of biomarkers on different outcomes before establishing their role as biomarkers of aging.
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Affiliation(s)
- Leocadio Rodríguez-Mañas
- Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain.
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain.
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
- Division of Geriatric Medicine, Hospital Universitario de Getafe, Ctra de Toledo km 12,500, 28905, Getafe, Spain.
| | - Javier Angulo
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José A Carnicero
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Mariam El Assar
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - Alan J Sinclair
- Foundation for Diabetes Research in Older People (fDROP) and King's College London, London, UK
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8
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Jones G, Trajanoska K, Santanasto AJ, Stringa N, Kuo CL, Atkins JL, Lewis JR, Duong T, Hong S, Biggs ML, Luan J, Sarnowski C, Lunetta KL, Tanaka T, Wojczynski MK, Cvejkus R, Nethander M, Ghasemi S, Yang J, Zillikens MC, Walter S, Sicinski K, Kague E, Ackert-Bicknell CL, Arking DE, Windham BG, Boerwinkle E, Grove ML, Graff M, Spira D, Demuth I, van der Velde N, de Groot LCPGM, Psaty BM, Odden MC, Fohner AE, Langenberg C, Wareham NJ, Bandinelli S, van Schoor NM, Huisman M, Tan Q, Zmuda J, Mellström D, Karlsson M, Bennett DA, Buchman AS, De Jager PL, Uitterlinden AG, Völker U, Kocher T, Teumer A, Rodriguéz-Mañas L, García FJ, Carnicero JA, Herd P, Bertram L, Ohlsson C, Murabito JM, Melzer D, Kuchel GA, Ferrucci L, Karasik D, Rivadeneira F, Kiel DP, Pilling LC. Genome-wide meta-analysis of muscle weakness identifies 15 susceptibility loci in older men and women. Nat Commun 2021; 12:654. [PMID: 33510174 PMCID: PMC7844411 DOI: 10.1038/s41467-021-20918-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023] Open
Abstract
Low muscle strength is an important heritable indicator of poor health linked to morbidity and mortality in older people. In a genome-wide association study meta-analysis of 256,523 Europeans aged 60 years and over from 22 cohorts we identify 15 loci associated with muscle weakness (European Working Group on Sarcopenia in Older People definition: n = 48,596 cases, 18.9% of total), including 12 loci not implicated in previous analyses of continuous measures of grip strength. Loci include genes reportedly involved in autoimmune disease (HLA-DQA1 p = 4 × 10-17), arthritis (GDF5 p = 4 × 10-13), cell cycle control and cancer protection, regulation of transcription, and others involved in the development and maintenance of the musculoskeletal system. Using Mendelian randomization we report possible overlapping causal pathways, including diabetes susceptibility, haematological parameters, and the immune system. We conclude that muscle weakness in older adults has distinct mechanisms from continuous strength, including several pathways considered to be hallmarks of ageing.
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Affiliation(s)
- Garan Jones
- Epidemiology and Public Health Group, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Katerina Trajanoska
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adam J Santanasto
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA
| | - Najada Stringa
- Department of Epidemiology and Biostatistics, Amsterdam UMC- Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Chia-Ling Kuo
- Biostatistics Center, Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, CT, USA
| | - Janice L Atkins
- Epidemiology and Public Health Group, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Joshua R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School fo Public Health University of Sydney, Sydney, NSW, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - ThuyVy Duong
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shengjun Hong
- Lübeck Interdisciplinary Plattform for Genome Analytics, Institutes of Neurogenetics and Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Mary L Biggs
- Cardiovascular Health Research Unit, Department of Medicine, and Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jian'an Luan
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Chloe Sarnowski
- Biostatistics Department, Boston University School of Public Health, Boston, MA, USA
| | - Kathryn L Lunetta
- Biostatistics Department, Boston University School of Public Health, Boston, MA, USA
| | - Toshiko Tanaka
- Longitudinal Study Section, Translational Gerontology branch, National Institute on Aging, Baltimore, MD, USA
| | - Mary K Wojczynski
- Department of Genetics, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan Cvejkus
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA
| | - Maria Nethander
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Bioinformatics Core Facility, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sahar Ghasemi
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jingyun Yang
- Rush Alzheimer's Disease Center & Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Stefan Walter
- Department of Medicine and Public Health, Rey Juan Carlos University, Madrid, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Kamil Sicinski
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA
| | - Erika Kague
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
| | | | - Dan E Arking
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - B Gwen Windham
- Department of Medicine/Geriatrics, University of Mississippi School of Medicine, Jackson, MS, USA
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Megan L Grove
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Misa Graff
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, 27516, USA
| | - Dominik Spira
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Endocrinology and Metabolism, Berlin, Germany
| | - Ilja Demuth
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Department of Endocrinology and Metabolism, Berlin, Germany
- Charité - Universitätsmedizin Berlin, BCRT - Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Nathalie van der Velde
- Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lisette C P G M de Groot
- Wageningen University, Division of Human Nutrition, PO-box 17, 6700 AA, Wageningen, The Netherlands
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health services, University of Washington, Seattle, WA, USA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Alison E Fohner
- Department of Epidemiology and Institute of Public Genetics, University of Washington, Seattle, WA, USA
| | - Claudia Langenberg
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, CB2 0QQ, UK
| | | | - Natasja M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam UMC- Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam UMC- Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Qihua Tan
- Epidemiology and Biostatistics, Department of Public Health, Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Joseph Zmuda
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA, USA
| | - Dan Mellström
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - David A Bennett
- Rush Alzheimer's Disease Center & Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center & Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Philip L De Jager
- Center for Translational and Systems Neuroimmunology, Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Andre G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine Greifswald, Greifswald, Germany
| | - Thomas Kocher
- Department of Restorative Dentistry, Periodontology, Endodontology, and Preventive and Pediatric Dentistry, University Medicine Greifswald, Greifswald, Germany
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Leocadio Rodriguéz-Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Department of Geriatrics, Getafe University Hospital, Getafe, Spain
| | - Francisco J García
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Department of Geriatrics, Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain
| | | | - Pamela Herd
- Professor of Public Policy, Georgetown University, Washington, DC, USA
| | - Lars Bertram
- Lübeck Interdisciplinary Plattform for Genome Analytics, Institutes of Neurogenetics and Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska University Hospital, Department of Drug Treatment, Gothenburg, Sweden
| | - Joanne M Murabito
- Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - David Melzer
- Epidemiology and Public Health Group, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - George A Kuchel
- Center on Aging, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | | | - David Karasik
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Epidemiology Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Douglas P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife and Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Broad Institute of MIT & Harvard, Boston, MA, USA
| | - Luke C Pilling
- Epidemiology and Public Health Group, Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK.
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El Assar M, Angulo J, Carnicero JA, Walter S, García-García FJ, Rodríguez-Artalejo F, Rodríguez-Mañas L. Association between telomere length, frailty and death in older adults. GeroScience 2020; 43:1015-1027. [PMID: 33190211 PMCID: PMC8110679 DOI: 10.1007/s11357-020-00291-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Received: 07/10/2020] [Accepted: 10/20/2020] [Indexed: 12/27/2022] Open
Abstract
Frailty is considered a clinical marker of functional ageing. Telomere length (TL) has been proposed as a biomarker of biological age but its role in human ageing is controversial. The main aim of the study was to evaluate the longitudinal association of TL with incident frailty and mortality in two cohorts of Spanish community-dwelling older adults. TL was determined at baseline in blood samples from older adults included in Toledo Study for Healthy Aging and ENRICA cohorts while frailty was determined by frailty phenotype (FP) at baseline and at follow-up (3.5 years). Deaths occurring during follow-up were also recorded. Associations of TL with frailty and mortality were analysed by logistic regression with progressive adjustment. Data were separately analysed in the two cohorts and in all subjects by performing a meta-analysis. TL was not different between frail and non-frail subjects. Longer telomeres were not associated with lower risk of prevalent frailty. Similarly, TL at baseline failed to predict incident frailty (OR: 1.04 [0.88-1.23]) or even the development of a new FP criterion (OR: 0.97 [0.90-1.05]) at follow-up. Lack of association was also observed when analysing the development of specific FP criteria. Finally, while frailty at baseline was significantly associated with higher risk of death at follow-up (OR: 4.08 [1.97-8.43], p < 0.001), TL did not significantly change the mortality risk (OR: 1.05 [0.94-1.16]). Results show that TL does not predict incident frailty or mortality in older adults. This suggests that TL is not a reliable biomarker of functional age.
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Affiliation(s)
- Mariam El Assar
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Angulo
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Servicio de Histología-Investigación, Unidad de Investigación Traslacional en Cardiología (IRYCIS-UFV), Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José A Carnicero
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Stefan Walter
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain
| | | | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, Universidad Autónoma de Madrid/IdiPaz, CIBERESP, and IMDEA Food Institute, Madrid, Spain
| | - Leocadio Rodríguez-Mañas
- Fundación de Investigación Biomédica del Hospital Universitario de Getafe, Getafe, Spain.
- Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.
- Servicio de Geriatría, Hospital Universitario de Getafe, Getafe, Spain.
- Division of Geriatric Medicine, Hospital Universitario de Getafe, Ctra de Toledo km 12,500, 28905, Getafe, Spain.
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10
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Pérez-Rodríguez R, Guevara-Guevara T, Moreno-Sánchez PA, Villalba-Mora E, Valdés-Aragonés M, Oviedo-Briones M, Carnicero JA, Rodríguez-Mañas L. Monitoring and Intervention Technologies to Manage Diabetic Older Persons: The CAPACITY Case-A Pilot Study. Front Endocrinol (Lausanne) 2020; 11:300. [PMID: 32528409 PMCID: PMC7247856 DOI: 10.3389/fendo.2020.00300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetes Mellitus is a chronic disease with a high prevalence among older people, and it is related to an increased risk of functional and cognitive decline, in addition to classic micro and macrovascular disease and a moderate increase in the risk of death. Technology aimed to improve elder care and quality of life needs to focus in the early detection of decline, monitoring the functional evolution of the individuals and providing ways to foster physical activity, to recommend adequate nutritional habits and to control polypharmacy. But apart from all these core features, some other elements or modules covering disease-specific needs should be added to complement care. In the case of diabetes these functionalities could include control mechanisms for blood glucose and cardiovascular risk factors, specific nutritional recommendations, suited physical activity programs, diabetes-specific educational contents, and self-care recommendations. This research work focuses on those core aspects of the technology, leaving out disease-specific modules. These central technological components have been developed within the scope of two research and innovation projects (FACET and POSITIVE, funded by the EIT-Health), that revolve around the provision of integrated, continuous and coordinated care to frail older population, who are at a high risk of functional decline. Obtained results indicate that a geriatric multimodal intervention is effective for preventing functional decline and for reducing the use of healthcare resources if administered to diabetic pre-frail and frail older persons. And if such intervention is supported by the CAPACITY technological ecosystem, it becomes more efficient.
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Affiliation(s)
- Rodrigo Pérez-Rodríguez
- Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Pedro A Moreno-Sánchez
- Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Elena Villalba-Mora
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
| | - Myriam Valdés-Aragonés
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
- Geriatrics Service, Getafe University Hospital, Getafe, Spain
| | | | - José A Carnicero
- Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
| | - Leocadio Rodríguez-Mañas
- Biomedical Research Foundation, Getafe University Hospital, Getafe, Spain
- Centre for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
- Geriatrics Service, Getafe University Hospital, Getafe, Spain
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11
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Rosado-Artalejo C, Carnicero JA, Losa-Reyna J, Castillo C, Cobos-Antoranz B, Alfaro-Acha A, Rodríguez-Mañas L, García-García FJ. Global Performance of Executive Function Is Predictor of Risk of Frailty and Disability in Older Adults. J Nutr Health Aging 2017; 21:980-987. [PMID: 29083438 DOI: 10.1007/s12603-017-0895-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 11/28/2022]
Abstract
INTRODUCTION The executive function is a complex set of skills affected during the aging process and translate into subclinical cerebrovascular disease. Postural instability or motor slowness are some clinical manifestations, being consubstantial with the frailty phenotype, genuine expression of aging. Executive dysfunction is also considered a predictor of adverse health events in the elderly. AIM To study whether the executive dysfunction can be used as an early marker for frailty and the viability of use as a predictor of mortality, hospitalization and/or disability in a Mediterranean population. DESIGN A population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA). METHODS 1690 Spanish elders aged ≥65 years underwent a neuropsychological evaluation in order to measure executive function. To assess whether the accumulation of dysfunctions (in severity and amplitude) could increase the predictive value of adverse health events in relation to each dimension separately an executive dysfunction cumulative index was constructed. Cox proportional hazards model was used to examine mortality and hospitalization over 5.02 and 3.1 years of follow-up, respectively. RESULTS Executive dysfunction is a powerful predictor of mortality, frailty and disability. Cumulative differences in executive function are associated with high risk of frailty and disability, thus, for each one point increment in the executive function index, the risk of death increased by 7 %, frailty by 13% and disability by 11% (P<0.05). Moreover, the executive impairment exhibits a strong positive tendency with age, comorbidity and mortality. CONCLUSIONS Cumulative differences in four executive dimensions widely used in clinical practice improves the ability to predict frailty and disability compared to each dimension separately.
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Affiliation(s)
- C Rosado-Artalejo
- Francisco José García-García. MD, Geriatric Department, Complejo Hospitalario de Toledo, Ctra de Cobisas/n, 45071 Toledo, Spain. Phone: 0034925269300. Ext 26107, Fax: 0034925269355, e-mail: ,
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12
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Guadalupe-Grau A, Carnicero JA, Gómez-Cabello A, Gutiérrez Avila G, Humanes S, Alegre LM, Castro M, Rodríguez-Mañas L, García-García FJ. Association of regional muscle strength with mortality and hospitalisation in older people. Age Ageing 2015; 44:790-5. [PMID: 26163682 DOI: 10.1093/ageing/afv080] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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] [Received: 09/05/2014] [Accepted: 03/13/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND the association between muscular strength, mortality and hospitalisation with ageing can change depending on sex and the body region analysed (e.g. upper and lower limb muscles). OBJECTIVE to determine the effect of measuring lower and upper extremities muscular strength on the relationship between strength, mortality and hospitalisation risk in elder men and women. DESIGN a population-based cohort study using data from the Toledo Study for Healthy Aging (TSHA). METHODS a Spanish population sample of 1,755 elders aged ≥65 years participated in this study. Upper (handgrip and shoulder) and lower limbs (knee and hip) maximal voluntary isometric strength was obtained using standardised techniques and equipment. Cox proportional hazards model was used to examine mortality and hospitalisation over 5.5 and 3 years of follow-up, respectively. RESULTS after adjustment for potential confounding factors, including co-morbidities and BMI, hazard ratio of death and hospitalisation was significantly lower in the stronger women and men, but showing regional- and sex-specific differences. That is shoulder, knee and hip muscle regions in women and handgrip and shoulder in men (all P < 0.05). There was a cumulative effect of measuring several muscle strengths over the risk of health events (P < 0.05), so that mortality hazard ratio increased by 45% in women and 25% in men per muscular strength (shoulder, grip, knee and hip) in the weaker strength quartile increase (P < 0.01). CONCLUSIONS regional muscle strength is a predictor of medium-term mortality and hospitalisation in elder men and women. Multiple strength measures including lower and upper body limb muscles are better predictors than a single strength measurement.
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Affiliation(s)
- Amelia Guadalupe-Grau
- Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain
| | - José A Carnicero
- Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Alba Gómez-Cabello
- Hospital Virgen del Valle, Complejo Hospitalario de Toledo, Toledo, Spain Centro Universitario de la Defensa, Zaragoza, Spain
| | - Gonzalo Gutiérrez Avila
- Servicio de Epidemiología de la Consejería de Sanidad y Bienestar Social. Junta de Comunidades de Castilla la Mancha, Toledo, Spain
| | - Sonia Humanes
- Servicio de Epidemiología de la Consejería de Sanidad y Bienestar Social. Junta de Comunidades de Castilla la Mancha, Toledo, Spain
| | - Luis M Alegre
- GENUD Toledo Research Group, University of Castilla-La Mancha, Toledo, Spain
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13
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Pérez Mota A, Alberdi JM, Pita L, Galán JL, García Benito MD, Crespo L, Blanco MA, Güemes C, Villalgordo C, Carnicero JA, Beckford C, Pérez Muñoz C, Fernández Velázquez J, Casanova A. Helicobacter pylori, efficacy of the new triple therapy in six and twelve-day schedules. Rev Esp Enferm Dig 1997; 89:879-84. [PMID: 9494375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Assessment of four eradicating patterns of 6 and 12 days duration with new triple therapies adapted to our environment. PATIENTS After an endoscopic diagnosis of Duodenal or Gastric Ulcer, and the confirmation of the presence of Helicobacter pylori using a rapid urease test in antral biopsies, 274 patients were treated with one of four eradicating therapies, verifying its efficacy with the C-13 urea breath test, at least one month after the end of the treatment and 10 days after withdrawal of proton pump inhibitors. RESULTS Maximum eradicating efficacy was achieved with Omeprazole (20 mg/12 hours), Clarithromycin (500 mg/12 hours) and Amoxycillin (1 g/12 hours), given for 12 days (96.6%), and Omeprazole (20 mg/12 hours), Tinidazole (500 mg/12 hours) and Clarithromycin (500 mg/12 hours), also given for 12 days (95.2%). The same drugs and doses, when given during six days, achieved percentages of 78.3% and 82.2% respectively. Results with Tinidazole suggest lack of resistance to this drug in the Community of Madrid.
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14
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Abstract
The clinical and pathological findings in a patient with extrarenal angiomyolipoma arising in the perinephric space are presented. This location has been reported only rarely and sets forth some diagnostic and therapeutic difficulties that are also discussed.
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Affiliation(s)
- J C Angulo
- Department of Urology, Hospital de Basurto, Bilbao, Spain
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