Associations among metabolic syndrome, ischemia, inflammatory, oxidatives, and lipids biomarkers

CONTEXT

Metabolic syndrome (MS) is described as a cluster of cardiometabolic risk factors. Studies suggest that ischemia-modified albumin (IMA) is a biomarker of cardiovascular diseases. IMA levels could be associated with cardiometabolic risks and represent a possible indication of microvascular dysfunction in MS patients.

OBJECTIVE

To confirm this possible association, we evaluated the association between IMA levels and MS.

DESIGN

We performed a case-control study (32 healthy individuals and 74 subjects with MS) to evaluate the association between MS, IMA, and other biomarkers [high-sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoprotein (OxLDL), oxidized low-density lipoprotein autoantibodies (anti-OxLDL), IL-6, lipid profile, and glucose].

RESULTS

The MS group showed higher levels of IMA (0.618 +/- 0.1355) as well as higher levels of hs-CRP, OxLDL, anti-OxLDL, and IL-6 than did control subjects (IMA = 0.338 +/- 0.0486) (P < 0.01). Multivariate analysis showed that IMA and MS association was independent of sex, age, diabetes mellitus 2, and hypercholesterolemia.

CONCLUSION

We found an association between IMA and MS. Additional studies including prospective genetic variation approaches need to be performed to help elucidate this association between IMA and MS and its potential clinical role.

Effect of Exercise on Cognition, Conditioning, Muscle Endurance, and Balance in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial

BACKGROUND AND PURPOSE

Mild cognitive impairment (MCI) may be a precursor to dementia; however, its progression may be prevented or slowed with exercise. This study aimed at determining the effects of group aerobic and strength training on cognition, conditioning, muscle endurance, and balance in underprivileged community-dwelling older adults with MCI.

METHODS

This was a single-blind, randomized, and matched-pair controlled (gender, age, body mass index, and Addenbrooke's Cognitive Examination-Revised for MCI diagnosis) clinical trial. It was developed in 4 community centers. Fifty-two sedentary, functionally independent individuals, aged 60 years or more, with MCI were randomized into intervention group (n = 26) and control group (n = 26). Participants were tested before and after a 24-week exercise program. Sociodemographic characteristics, cognition (Mini-Mental State Examination), conditioning (2-minute stationary walk test), lower-limb endurance (30-second sit/stand test), and balance data (Functional Reach test) were collected. The intervention group walked and exercised twice weekly (60 minutes each) using ankle weights, latex resistance bands, and dumbbells. The exercise load and intensity were regularly increased on the basis of a preestablished incremental number of sets and repetitions and on the basis of the participants' correct movement execution with a given load. Data were analyzed with Pearson χ test, Fisher exact test, Student t test, Mann-Whitney U test, 2-way repeated measures analysis of variance, and the Cohen d.

RESULTS AND DISCUSSION

Before the intervention, no significant differences were found between groups for any of the variables. Postintervention, significant differences were observed in cognition, conditioning, muscle endurance, and balance. Significant time-by-group interactions were detected in all the intergroup analyses. The improvements observed in the intervention group had medium to large effect sizes (0.35-1.15). The control group's decrease in cognition (13.9%) had a large effect size, while its Functional Reach test decrease (11.4%) had a medium effect size, with no significant change in conditioning or muscle endurance.

CONCLUSION

The training program improved cognitive function, muscle endurance, aerobic conditioning, and balance in older adults with MCI.

Effect of green tea (Camellia sinensis) consumption on the components of metabolic syndrome in elderly

OBJECTIVE

To evaluate the effect of the consumption of green tea on components of MS in the elderly.

DESIGN

Intervention study.

SETTING

The sample was selected from the Geriatric Service of Hospital São Lucas of Pontifical Catholic University of Rio Grande do Sul.

PARTICIPANTS

45 elderly with MS were enrolled and allocated into two groups: green tea group (GTG, n= 24), who drank green tea and control group (CG, n= 21) without intervention.

INTERVENTION

The GTG received sachets of 1.0 g of green tea, and should drink three cups per day for 60 days and the CG was instructed not to make changes in their lifestyle.

MEASUREMENTS

The diagnostic criteria for MS used were the International Diabetes Federation. The lipidic and glycemic profile, and anthropometric measurements were evaluated before and after intervention.

RESULTS

There was a statistically significant weight loss only in GTG [71.5±12.6 kg to 70.3±12.6 kg (p<0.001)]. A statistically significant decrease in BMI [-0.5±0.4 kg/m2 in GTG and -0.2±0.6 kg/m2 in CG (P=0.032)] and waist circumference [-2.2±2.0 cm in GTG and - 0.3±1.8 cm in CG (P=0.002)] were observed. The intake of green tea did not change the biochemical parameters.

CONCLUSION

The consumption of green tea was effective in inducing weight loss, reducing BMI and waist circumference in the elderly with MS.

Impact of human aging and modern lifestyle on gut microbiota

Human evolution and lifestyle changes caused by the agricultural and industrial revolutions have led to great advances in medicine and increased life expectancy, whilst also profoundly altering the ecological relationships and disease patterns of populations. Studies involving populations that still enjoy a rural way of life and with traits similar to the Paleolithic period reveal them to present a more robust, resistant and diverse gut microbiota, in comparison to highly industrialized civilizations. The human diet has expanded and broadened to include the consumption of high-calorie foods, particularly from animal sources such as game meat and eggs. For some time, authors have been alert to the fact that a modern lifestyle leads to reduced intake of beneficial bacteria, suggesting that nonpathogenic bacteria are being eradicated. Furthermore, therapeutic procedures, including the use of probiotics and prebiotics, have been proposed to lead to recovery of this microbiota, which is altered due to both the ageing process and lifestyle related aspects. Accordingly, this article aims to review the impact of human aging and modern lifestyle on gut microbiota, within an evolutionary, ecological, epidemiological and therapeutic context.

A evolução do índice de envelhecimento no Brasil, nas suas regiões e unidades federativas no período de 1970 a 2010

INTRODUÇÃO: O Índice de Envelhecimento (IE) avalia o processo de ampliação do segmento idoso na população total em relação à variação relativa no grupo etário jovem, sendo obtido por meio da razão entre a população idosa e a população jovem. Este indicador permite observar a evolução do ritmo de envelhecimento da população, comparativamente entre áreas geográficas e grupos sociais e pode, assim, subsidiar a formulação, gestão e avaliação de políticas públicas nas áreas de saúde e de previdência social. OBJETIVO: Apresentar a evolução do IE no Brasil, regiões e unidades federativas, no período de 1970 a 2010. MÉTODOS: Foi realizado um estudo descritivo, com dados obtidos dos Censos Demográficos e dos Indicadores Sociais do IBGE, do período de 1970 a 2010. RESULTADOS: Em 2010, o IE do Brasil era de 44,8. Entre as regiões brasileiras, o Sul (54,94) e Sudeste (54,59) se equiparavam com o maior IE e o Norte (21,84) apresentava o menor IE. As unidades federativas com maior IE eram Rio Grande do Sul (65,47) e Rio de Janeiro (61,45). Os menores índices pertenciam aos estados do Amapá (15,45) e Roraima (16,57). No período de 1970 a 2010, observou-se aumento de 268% no IE do Brasil. CONCLUSÃO: Os resultados demonstram, indubitavelmente, que o Brasil se encontra em franco processo de envelhecimento da sua população, pois no período de 1970 a 2010, o IE teve um aumento progressivo, fato também observado nas suas diferentes regiões e unidades federativas.

Analysis of the association between apolipoprotein E polymorphism and cardiovascular risk factors in an elderly population with longevity

OBJECTIVE

To establish the allelic and genotypic frequencies related to apolipoprotein E (ApoE) polymorphism and association of the genotypes with risk factors and cardiovascular morbidity in an elderly population with longevity.

METHODS

We analyzed 70 elderly patients aged 80 years or more who were part of the Projeto Veranópolis. We used the gene amplification technique through the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and cleavage with the restriction enzyme Hha I to identify the ApoE genotypes. The most frequent genotypes were compared considering biological variables and cardiovascular risks and morbidity.

RESULTS

The frequencies of the E2, E3, and E4 alleles were 0.05, 0.84, and 0.11, respectively, and of the genotypes were as follows: E3E3 (0.70), E3E4 (0.22), E2E3 (0.06), and E2E2 (0.02). Individuals with the E3E4 had a mean age greater than those with the E3E3. No association was observed between the genotypes and the variables analyzed, except for obesity, which was associated with the E3E3 genotype. Individuals with the E3E4 genotype had high levels of LDL-cholesterol and fibrinogen as compared with those with the E3E3 genotype.

CONCLUSION

The results suggest that the E4E4 genotype may be associated with early mortality. A balance between the protective or neutral factors and the cardiovascular risk factors may occur among the individuals with different genotypes, attenuating the negative effects of the E4 allele.

Is Sensory Loss an Understudied Risk Factor for Frailty? A Systematic Review and Meta-analysis

Background

Age-related sensory loss and frailty are common conditions among older adults, but epidemiologic research on their possible links has been inconclusive. Clarifying this relationship is important because sensory loss may be a clinically relevant risk factor for frailty.

Methods

In this systematic review and meta-analysis, we searched 3 databases for observational studies investigating 4 sensory impairments—vision (VI), hearing (HI), smell (SI), and taste (TI)—and their relationships with frailty. We meta-analyzed the cross-sectional associations of VI/HI each with pre-frailty and frailty, investigated sources of heterogeneity using meta-regression and subgroup analyses, and assessed publication bias using Egger’s test.

Results

We included 17 cross-sectional and 7 longitudinal studies in our review (N = 34,085) from 766 records. Our cross-sectional meta-analyses found that HI and VI were, respectively, associated with 1.5- to 2-fold greater odds of pre-frailty and 2.5- to 3-fold greater odds of frailty. Our results remained largely unchanged after subgroup analyses and meta-regression, though the association between HI and pre-frailty was no longer significant in 2 subgroups which lacked sufficient studies. We did not detect publication bias. Longitudinal studies largely found positive associations between VI/HI and frailty progression from baseline robustness, though they were inconclusive about frailty progression from baseline pre-frailty. Sparse literature and heterogenous methods precluded meta-analyses and conclusions on the SI/TI–frailty relationships.

Conclusions

Our meta-analyses demonstrate significant cross-sectional associations between VI/HI with pre-frailty and frailty. Our review also highlights knowledge gaps on the directionality and modifiability of these relationships and the impact of SI/TI and multiple sensory impairments on frailty.

The effect of group exercises on balance, mobility, and depressive symptoms in older adults with mild cognitive impairment: a randomized controlled trial

OBJECTIVE:

To determine the effects of group exercises on balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment.

DESIGN:

Single blinded, randomized, matched pairs clinical trial.

SETTING:

Four primary healthcare units.

SUBJECTS:

Fifty-two sedentary subjects with mild cognitive impairment were paired (age, sex, body mass index, and Addenbrooke's Cognitive Examination Revised score), tested, and then randomized into an intervention group ( n = 26) and a control group ( n = 26).

INTERVENTION:

The intervention group performed strength (ankle weights, elastic bands, and dumbbells) and aerobic exercises (walking) in their communities' public spaces, twice a week (60 minutes each), during 24 weeks. The control group maintained its usual routine.

MAIN MEASURES:

Balance (Berg Balance Scale (BBS)), mobility (Timed Up and Go Test (TUG)), and depressive symptoms (Geriatric Depression Scale-15) were assessed before and after the intervention.

RESULTS:

Before the intervention, the two groups did not differ statistically. After, the intervention group showed significant improvement ( P < 0.05) in balance (before: 53 ± 3; after: 55.1 ± 1.1 points), mobility (before: 10.7 ± 2.9 seconds; after: 8.3 ± 2 seconds), and depressive symptoms (median punctuation (interquartile range) before: 4 (1.8-6); after: 2.5 (1-4)). The control group presented a significant increase in their depressive symptoms (median before: 3.5 (2-7.3); after: 4 (2-5.3)), while their balance and mobility showed no significant modification. Small effect sizes were observed in the intervention group and control group depressive symptoms, as well as in the control group's mobility and balance. Large effect sizes were observed the intervention group's mobility and balance.

CONCLUSION:

Group exercises improved balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment.

Directly observed therapy of chronic hepatitis C with ledipasvir/sofosbuvir in people who inject drugs at risk of nonadherence to direct-acting antivirals

An important subgroup of people who inject drugs (PWID) receiving opioid agonist therapy (OAT) cannot be treated in the setting of a hepatology centre and would not regularly ingest their medication when handed to them for self-administration. Our hypothesis was that chronic hepatitis C in these patients could be ideally managed if modern, interferon-free regimens were administered together with OAT under direct observation of a physician or nurse at a low-threshold facility. In this open-label, noninterventional, proof-of-concept study (ClinicalTrials.gov number, NCT02638233), 40 PWID at risk of nonadherence to direct-acting antivirals (DAA) and previously untreated chronic hepatitis C virus genotype 1 infection without cirrhosis were treated with ledipasvir/sofosbuvir for 8 weeks. Patients received antiviral treatment together with OAT under direct observation of a physician or nurse at a low-threshold facility. By following the concept of directly observed therapy, excellent adherence to antiviral therapy was achieved as follows: only 0.16% (95% CI: 0.03-0.47) of scheduled dates for ingestion of the antiviral therapy in combination with OAT were missed by the 40 patients. The rate of sustained virological response 12 weeks after end of therapy was 100% (95% CI: 91.2-100.0). Between week 12 and week 24 of follow-up reinfections were recorded in 2 of 40 patients (5%). Directly observed therapy of chronic hepatitis C is highly effective in PWID at risk of nonadherence to DAA. By this new concept, a group of difficult-to-treat patients can be cured, who could not have been treated in settings of studies published so far.

Association between self-reported oral health, tooth loss and atherosclerotic burden

Previous studies have suggested that oral diseases may influence the development of atherosclerosis. The aim of this study was to test the hypothesis that poor self-reported oral health (SROH) and tooth loss are positively associated with coronary atherosclerotic burden (CAB). 382 consecutive subjects undergoing coronary angiography were included. Socio-demographic characteristics, cardiovascular risk factors and oral health status were collected using a standardized questionnaire, including data on SROH and use of dental prosthesis. Number of teeth and anthropometric measures were collected through clinical examinations. CAB at coronary angiography was quantified using the Friesinger score (FS). Prevalence ratios (PR) were calculated with Poisson regression analyses. Mean age was 60.3 ± 10.8 years, with 63.2% males. In the bivariate analysis, there was a significant association (p < 0.05) between CAB and age (> 60y) (PR = 1.01, 95%CI = 1.02-1.16), male gender (PR = 1.11, 95%CI = 1.03-1.19), smoking (PR = 1.08, 95%CI = 1.01- 1.16), hypertension (PR = 1.12, 95%CI = 1.03-1.22), diabetes (PR = 1.17, 95%CI = 1.05-1.21), poor SROH (PR = 1.22, 95%CI = 1.02-1.46) and tooth loss (< 20 teeth present) (PR = 1.10, 95%CI = 1.02-1.19). The use of dental prosthesis was not associated with CAB. The multivariate models, adjusted for age, gender, smoking, hypertension, diabetes and dyslipidemia showed that poor SROH (p = 0.03) and tooth loss (p = 0.02) were independently associated with CAB, confirming the study hypothesis.

Prevalência de obesidade em idosos longevos e sua associação com fatores de risco e morbidades cardiovasculares

OBJECTIVE

To evaluate the obesity prevalence and its association with risk factors and cardiovascular morbidity in the oldest old (>80 years old) residing at the municipality of Veranópolis - RS, Brazil.

METHODS

196 elderly participated in the study (69 male and 127 female), 91% of the population aged >80 until June, 1996. For obesity evaluation and classification, we used the body mass index (BMI) and the World Health Organization (WHO) and National Health and Nutrition Examination Survey (NHANES III) criteria. The cardiovascular risk factors investigated were sex, age, systemic hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes mellitus (DM) and smoking. For cardiovascular morbidities, we considered acute myocardial infarction, intermittent claudication and stroke. Waist-hip ratio (W/H), regular consumption of alcoholic beverages and physical activity were investigated too.

RESULTS

The obesity prevalence was 23.3% according to WHO (without difference between sex, p=0.124) and 45.6% according to NHANES III criteria (significantly higher in female, p=0.05). Obesity associations with risk factors were sex-dependent (the obese females presented higher levels of systolic blood pressure and glucose, lower levels of HDL-c, and higher systemic hypertension and DM frequencies; while the obese males presented higher levels of diastolic blood pressure, total cholesterol, LDL-c and higher hypercholesterolemia frequency). W/H and triglycerides, as well as hypertriglyceridemia frequency, were higher in obese people.

CONCLUSIONS

The obesity prevalence was high among the long-living elderly, and its association with cardiovascular risk factors was sex-dependent. As regards morbidities, we did not observe differences between obese and non-obese people.

Electrochemical flowcell for in-situ investigations by soft x-ray absorption and emission spectroscopy

A new liquid flow-cell designed for electronic structure investigations at the liquid-solid interface by soft X-ray absorption and emission spectroscopy is presented. A thin membrane serves simultaneously as a substrate for the working electrode and solid state samples as well as for separating the liquid from the surrounding vacuum conditions. In combination with counter and reference electrodes this approach allows in-situ studies of electrochemical deposition processes and catalytic reactions at the liquid-solid interface in combination with potentiostatic measurements. As model system in-situ monitoring of the deposition process of Co metal from a 10 mM CoCl2 aqueous solution by X-ray absorption and emission spectroscopy is presented.

[Cardiovascular mortality predictors in the oldest old]

This article investigates the association between cardiovascular risk factors and cardiovascular morbidity and mortality in the oldest old. In 1996, 91% of the population > or = 80 years of age from Veranópolis, Rio Grande do Sul State, Brazil, were evaluated to detect cardiovascular risk factors and morbidity. The sample was followed up for three years, with the assessment of deaths. The analysis was done using univariate statistics and multivariate logistic regression analysis. There were 41 deaths (21%): 20 men and 21 women. Deaths were distributed by year as follow: 03 (7.3%) in the first year, 08 (19.5%) in the second, and 30 (73.2%) in the third. There was a significant and independent association between death and the following variables: diastolic blood pressure (DBP), total cholesterol (TC), LDL-C, ApoA-I, prior stroke (CVA), right bundle branch block (RBBB), and left ventricular hypertrophy (LVH) by ECG. Survivors presented higher levels of DBP, TC, LDL-C, ApoA-I, CVA, RBBB and LVH. According to the multivariate analysis, the variables were independent risk factors for mortality. Cardiovascular risk factors appear to have a distinct impact on the oldest old.

Hematological parameters and prevalence of anemia among free-living elderly in south Brazil

OBJECTIVE

The aims of this study were to analyze the hematological parameters, the prevalence of anemia and the association between anemia and socioeconomic conditions in an elderly community-based population.

METHODS

A population-based study was performed as part of the Multidimensional Study of the Elderly in Porto Alegre, Brazil (EMIPOA). An initial total of 1058 community residents aged 60 years and older were interviewed. Of these, 392 agreed to have a physical evaluation and a blood sample was taken from each. The hematological parameters analyzed in the blood samples included the hemoglobin concentration, mean cell volume (MCV), mean corpuscular hemoglobin concentration (MCHC) and red cell distribution width (RDW). The association between the variables and the diagnosis of anemia was assessed using the chi-squared test and a multiple logistic regression model.

RESULTS

The overall prevalence of anemia was 12.8%. Anemia was present in 13.7% of women and in 10.4% of men. Normocytic normochromic anemia without anisocytosis was the most common type of anemia (46%). The assessment of erythrocyte morphology showed significant differences between anemic and non-anemic individuals (microcytosis = 12% vs. 1.5%, hypochromia = 40% vs. 8.8%, and anisocytosis = 26% vs. 7%). In the analysis of socioeconomic conditions, significant differences were found in respect to age and race.

CONCLUSION

The prevalence of anemia increases with age and is associated with race, microcytosis, hypochromia and anisocytosis. Anemia is not a condition that should be associated only with the aging process, as it may be due to pathological conditions that occur most frequently in this age group. As a result, a diagnosis of anemia warrants adequate clinical attention.

Association between the Gln223Arg polymorphism of the leptin receptor and metabolic syndrome in free-living community elderly

BACKGROUND

Metabolic syndrome is a cluster of cardiovascular risk factors. Aging and gene-environmental interactions are involved in the pathophysiology of metabolic syndrome. The LEPR gene Gln223Arg polymorphism has been associated with energy metabolism and body weight.

METHODS

The association of the Gln223Arg polymorphism with metabolic syndrome was evaluated in a case-control study with elderly subjects (> or = 60 years old). The case-control groups were: (1) healthy group (HG), individuals without any cardio-metabolic diseases (CMD) or previous cardiovascular events (n = 64); (2) metabolic disorder group (MD), subjects with at least one metabolic disorder (hypertension, obesity, dyslipidemia, and impaired glucose tolerance, n = 306); and (3) metabolic syndrome group (MS) (n = 98). The Gln223Arg polymorphism of the LEPR gene was determined by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) using Msp I endonuclease enzyme restriction.

RESULTS

The mean age of the HG subjects was 70.12 +/- 7.7, and the MD and MS subjects were 69.7 +/- 6.4 and 69.68 +/- 5.0 years old, respectively. The MS group showed higher body mass index (BMI), waist circumference, systolic and diastolic blood pressure, glucose, cholesterol, triglycerides, and low-density lipoprotein cholesterol (LDL-C) levels than did the HG individuals. The analysis showed differences in genotype frequencies: reduction in the Gln/Gln genotype and an excess of the Arg/Arg genotype in MD (chi(2) = 7.886, P = 0.019) and MS (chi(2) = 14.941, P = 0.001) when compared to the HG group.

CONCLUSIONS

This study provides evidence for a role of the LEPR gene Gln223Arg polymorphism in predisposition to metabolic syndrome in the elderly.

Association between interleukin-1 beta polymorphism (+3953) and obesity

It now appears that obesity is associated with a low-grade inflammation of white adipose tissue resulting from chronic activation of the innate immune system as interleukin-1 beta (IL-1). Previous investigations have described a positive association between IL-1 beta +3953 (C>T) gene polymorphism (rs 1143634) and obesity, suggesting functional effects on fat mass, fat metabolism and body mass. However, it is necessary to determine if these results occur in other populations and if they are influenced by sex and age. Therefore, we performed a case-control study using 880 Caucasian subjects (59.7+/-11.9 years old) from the Brazilian Aging Research Program (non-overweight=283, overweight=334, obese=263) previously investigated in genetic studies, in whom we analyzed the IL-1 beta +3953C/T polymorphism. We observed higher T allele (CT/TT) frequency in non-overweight than overweight and obese groups. The odds ratio showed 1.340 (95% CI: 1.119-1.605) times more chance of the obese group being CC carriers compared to non-overweight group independent of sex and age. This study corroborates the idea that the IL-1 system is linked to the development of obesity.

Envelhecimento e longevidade no Rio Grande do Sul: um perfil histórico, étnico e de morbi-mortalidade dos idosos

O Estado Rio Grande do Sul apresenta uma grande diversidade étnica e cultural na sua população. Entretanto, pouco se sabe sobre o perfil genético desta população em relação às doenças crônicas não-transmissíveis (DCNT) e o do padrão de herança de acordo com a origem étnica. Fatores como etnia e composição genética, em conjunto com a Reforma Sanitária brasileira e com o estilo de vida, têm possivelmente contribuído de forma substancial para o aumento da expectativa média de vida ao nascer e da longevidade dos gaúchos. A população do Rio Grande do Sul tem apresentado um acelerado processo de envelhecimento populacional e com um padrão diferenciado de morbi-mortalidade para as faixas etárias acima de 60 anos. O aumento da longevidade da população trouxe consigo um aumento não somente da incidência e prevalência, mas também da mortalidade por DCNT, tais como doenças cardiovasculares e neoplasias. Por isso, as políticas públicas de saúde precisam contemplar as peculiaridades étnicas, culturais e biológicas para que a população possa envelhecer com qualidade de vida. É dentro desse contexto que o presente artigo pretende contribuir na discussão do processo de envelhecimento populacional do Rio Grande do Sul.

Association of different anthropometric measures and indices with coronary atherosclerotic burden

BACKGROUND

The association between anthropometric parameters and atherosclerotic burden is not well established and few studies have addressed this issue.

OBJECTIVE

To evaluate the association of different anthropometric parameters with the coronary atherosclerotic burden.

METHODS

Adult patients undergoing coronary angiography were enrolled in the study. Sociodemographic characteristics and cardiovascular risk factors were collected through a standardized questionnaire. Weight, height, waist circumference (WC), abdominal circumference (AbC), hip circumference (HC) and neck circumference (NC) were measured and body mass index (BMI), waist-hip ratio (WHR), abdominal circumference-hip ratio (AbCHR) and waist-height ratio (WHtR) were calculated. The atherosclerotic burden at the coronary angiography was measured through Friesinger score (FS). Significant atherosclerosis was considered when FS ≥ 5.

RESULTS

The sample consisted of 337 patients, of whom 213 were men (63.2%). The mean age was 60.1 ± 10 years. Only WHR (r = 0.159 and p = 0.003) showed a significant linear correlation with the coronary atherosclerotic burden as measured by FS. When the sample was stratified by gender, we found a significant correlation between women's AbCHR (r = 0.238 and p = 0.008) and WHR (r = 0.198 and p = 0.028) with FS. Men showed no correlation between anthropometric parameters and FS. After adjusting for gender, age, hypertension, smoking and DM, no anthropometric parameter was associated with coronary atherosclerotic burden as measured by FS in the total sample or when separated by gender.

CONCLUSION

No anthropometric parameter was an independent risk factor for coronary atherosclerotic burden.

The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) Is a Valid and Low-Cost Tool for Evaluation of Dysphagia: A Gold-Standard Comparison Study

BACKGROUND

Dysphagia is a predictor of mortality in Parkinson's disease (PD). Developing alternative methods to videofluoroscopy swallowing study (VFSS) for the evaluation of dysphagia is a public health necessity. The Swallowing Clinical Assessment Score in Parkinson's Disease (SCAS-PD) is an alternative and low-cost tool for diagnosis of dysphagia, but had not been properly validated in comparison to the gold-standard method. The objective of this study was to assess the validity and reliability of the SCAS-PD.

METHODS

SCAS-PD was applied to 31 patients with PD, and VFSS was conducted concurrently. This clinical assessment uses different volumes and viscosities to identify signs of swallowing impairments. For validation purposes, the interclass correlation coefficient and the weighted kappa were calculated. The AUC of the ROC curve, sensitivity, and specificity values for detection of penetration/aspiration (PA) were assessed. Internal consistency was calculated by Cronbach's alpha.

RESULTS

Fifty-one percent of patients were classified with dysphagia. SCAS-PD was differentiated between normal/functional deglutition and dysphagia with AUC 0.97, 95% CI 0.92-1.00, and an optimal cutoff at 19 (sensitivity 100% and specificity 87.5%). The internal consistency was α = 0.91 for the total score. The internal consistency of the SCAS-PD domains was oral phase (α = 0.73), pharyngeal phase (α = 0.86), and signs of PA (α = 0.95). The weighted kappa analysis demonstrated a high rate of concordance at 0.71 (p < 0.001) between SCAS-PD and VFSS.

CONCLUSIONS

SCAS-PD has been shown to have a good concordance with the VFSS. Considering this, SCAS-PD is highly applicable in clinical settings, since it is a simple and low-cost diagnostic tool for detecting dysphagia in PD patients.

Accuracy of SARC-F and SARC-CalF for sarcopenia screening in older women from southern Brazil

OBJECTIVES

The aim of this study was to verify the accuracy of the SARC-F and the SARC-CalF as screening tools for sarcopenia in community-dwelling older women ≥60 y of age.

METHODS

This was a cross-sectional study evaluating a convenience sample of women ≥60 y of age, living in Southern Brazil. Sarcopenia was defined according to the criteria proposed in the latest European Working Group on Sarcopenia in Older People consensus (EWGSOP2). Appendicular muscle mass was assessed by dual-energy x-ray absorptiometry. Muscle strength was measured by handheld dynamometry, and physical performance through the 4-m gait speed test. The SARC-F questionnaire and SARC-CalF score for sarcopenia screening were also applied.

RESULTS

We evaluated 288 participants, with a mean age of 67.6 ± 5.8 y. The frequency of probable and confirmed sarcopenia in the sample was 7.3% and 2.1%, respectively. The frequency of risk for sarcopenia assessed by the SARC-F was 4.5% and SARC-CalF 22.2%. Despite the excellent specificity (95.4%) demonstrated by the SARC-F, its sensitivity in identifying confirmed cases was null, whereas the SARC-CalF showed high sensitivity (83.3%) and good specificity (79%).

CONCLUSION

The present study findings suggested that SARC-CalF may be able to outperform SARC-F as a sarcopenia screening tool in women ≥60 y of age even under the new EWGSOP2 criteria, the main determinant of which is strength as observed in studies based on the previous definition.

Association between T102C polymorphism of serotonin 2A receptor gene and urinary incontinence in older women

BACKGROUND

The bladder's regulatory function is influenced by central serotonergic modulation. T102C polymorphism of the serotonin 2A (5-HT(2A)) receptor gene is associated with urinary incontinence (UI) that has been reported by older community dwellers. We analyzed the association between 5-HT(2A) receptor gene polymorphism and urodynamic tests for UI in older women.

METHODS

A case-control study was performed with 68 older women submitted to urodynamic evaluation and 162 older women without urinary problems (self-reported), all community dwellers enrolled in the Gravataí-GENESIS Project, Brazil. Clinical interviews, complete urodynamic evaluation following the International Continence Society Report on Good Urodynamic Practice (case group), and molecular analyses were performed (case and control groups). Serotonin 2A receptor gene genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism using the restriction enzyme HpaII. We excluded patients with diabetes mellitus, neurologic damage, and diuretic intake.

RESULTS

The subjects' mean (SD) age was 68.1 (6.5) years (range, 60-92 years). We found an association between the TT genotype versus CC + CT genotypes and UI (P = 0.013; odds ratio, 2.69; 95% confidence interval, 1.37-5.29) and, in addition, an association with urgency UI, maximal cystometric capacity (TT, 349 mL; CC + CT, 429.5 mL [P = 0.047]), detrusor pressure at maximum cystometric capacity (TT, 11 cm H(2)O; CC + CT, 6.75 cm H(2)O [P = 0.032]), and detrusor compliance (TT, 34 mL/cm H(2)O; CC + CT, 61.25 mL/cm H(2)O [P = 0.006]).

CONCLUSIONS

We confirmed our previous findings of a genetic influence of the TT genotype on UI involving the serotonergic pathway among older women. Further investigations including 5-HT(2A) expression in the bladder, pelvic floor, and striated sphincter muscle must be performed.

Is there an association between T102C polymorphism of the serotonin receptor 2A gene and urinary incontinence?

The regulation of bladder function is influenced by central serotonergic modulation. Several genetic polymorphisms related to serotonin control have been described in the literature. T102C polymorphism of the serotonin receptor 2A gene (5-HT2A) has been shown to be associated with certain diseases such as non-fatal acute myocardial infarction, essential hypertension, and alcoholism. In the present study, we examined the association between 5-HT2A gene polymorphism and urinary incontinence in the elderly. A case-control study was performed in 298 elderly community dwellers enrolled in the Gravataí-GENESIS Project, Brazil, which studies gene-environmental interactions in aging and age-related diseases. Clinical, physical, biochemical, and molecular analyses were performed on volunteers. 5-HT2A genotyping was determined by PCR-RFLP techniques using the HpaII restriction enzyme. The subjects had a mean age of 68.05 +/- 6.35 years (60-100 years), with 16.9% males and 83.1% females. The C allele frequency was 0.494 and the T allele frequency was 0.506. The CC genotype frequency was 21.78%, the CT genotype frequency was 55.24% and the TT genotype frequency was 22.98%. We found an independent significant association between the TT genotype (35.7%) and urinary incontinence (OR = 2.06, 95%CI = 1.16-3.65). Additionally, urinary incontinence was associated with functional dependence and systolic hypertension. The results suggest a possible genetic influence on urinary incontinence involving the serotonergic pathway. Further investigations including urodynamic evaluation will be performed to better explain our findings.