It is not yet resolved how lifestyle factors and intermediate phenotypes interrelate with metabolic pathways. We aimed to investigate the associations between diet, physical activity, ...cardiorespiratory fitness and obesity with serum metabolite networks in a population-based study.
The present study included 2380 participants of a randomly drawn subcohort of the European Prospective Investigation into Cancer and Nutrition-Potsdam. Targeted metabolomics was used to measure 127 serum metabolites. Additional data were available including anthropometric measurements, dietary assessment including intake of whole-grain bread, coffee and cake and cookies by food frequency questionnaire, and objectively measured physical activity energy expenditure and cardiorespiratory fitness in a subsample of 100 participants. In a data-driven approach, Gaussian graphical modeling was used to draw metabolite networks and depict relevant associations between exposures and serum metabolites. In addition, the relationship of different exposure metabolite networks was estimated.
In the serum metabolite network, the different metabolite classes could be separated. There was a big group of phospholipids and acylcarnitines, a group of amino acids and C6-sugar. Amino acids were particularly positively associated with cardiorespiratory fitness and physical activity. C6-sugar and acylcarnitines were positively associated with obesity and inversely with intake of whole-grain bread. Phospholipids showed opposite associations with obesity and coffee intake. Metabolite networks of coffee intake and obesity were strongly inversely correlated (body mass index (BMI): r = -0.57 and waist circumference: r = -0.59). A strong positive correlation was observed between metabolite networks of BMI and waist circumference (r = 0.99), as well as the metabolite networks of cake and cookie intake with cardiorespiratory fitness and intake of whole-grain bread (r = 0.52 and r = 0.50; respectively).
Lifestyle factors and phenotypes seem to interrelate in various metabolic pathways. A possible protective effect of coffee could be mediated via counterbalance of pathways of obesity involving hepatic phospholipids. Experimental studies should validate the biological mechanisms.
Serum metabolites have been linked to higher risk of chronic diseases but determinants of serum metabolites are not clear. We aimed to investigate the association between habitual diet as a ...modifiable risk factor and relevant serum metabolites.
This cross-sectional study comprised 2380 EPIC-Potsdam participants. Intake of 45 food groups was assessed by food frequency questionnaire and concentrations of 127 serum metabolites were measured by targeted metabolomics. Reduced rank regression was used to find dietary patterns that explain the maximum variation of metabolites.
In the multivariable-adjusted model, the proportion of explained variation by habitual diet was ranked as follows: acyl-alkyl-phosphatidylcholines (5.7%), sphingomyelins (5.1%), diacyl-phosphatidylcholines (4.4%), lyso-phosphatidylcholines (4.1%), acylcarnitines (3.5%), amino acids (2.2%) and hexose (1.6%). A pattern with high intake of butter and low intake of margarine was related to acylcarnitines, acyl-alkyl-phosphatidylcholines, lyso-phosphatidylcholines and hydroxy-sphingomyelins, particularly with saturated and monounsaturated fatty acid side chains. A pattern with high intake of red meat and fish and low intake of whole-grain bread and tea was related to hexose and phosphatidylcholines. A pattern consisting of high intake of potatoes, dairy products and cornflakes particularly explained methionine and branched chain amino acids. Dietary patterns related to type 2 diabetes-relevant metabolites included high intake of red meat and low intake of whole-grain bread, tea, coffee, cake and cookies, canned fruits and fish.
Dietary patterns characterized by intakes of red meat, whole-grain bread, tea and coffee were linked to relevant metabolites and could be potential targets for chronic disease prevention.
Physical therapy (PT) and other exercise-based interventions are core components of care for knee osteoarthritis (OA), but both are underutilized, and some patients have limited access to PT ...services. This clinical trial is examining a STepped Exercise Program for patients with Knee OsteoArthritis (STEP-KOA). This model of care can help to tailor exercise-based interventions to patient needs and also conserve higher resource services (such as PT) for patients who do not make clinically relevant improvements after receiving less costly interventions.
Step-KOA is a randomized trial of 345 patients with symptomatic knee OA from two Department of Veterans Affairs sites. Participants are randomized to STEP-KOA and Arthritis Education (AE) Control groups with a 2:1 ratio, respectively. STEP-KOA begins with 3 months of access to an internet-based exercise program (Step 1). Participants not meeting response criteria for clinically meaningful improvement in pain and function after Step 1 progress to Step 2, which involves bi-weekly physical activity coaching calls for 3 months. Participants not meeting response criteria after Step 2 progress to in-person PT visits (Step 3). Outcomes will be assessed at baseline, 3, 6 and 9 months (primary outcome time point). The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and secondary outcomes are objective measures of physical function. Linear mixed models will compare outcomes between the STEP-KOA and AE control groups at follow-up. We will also evaluate patient characteristics associated with treatment response and conduct a cost-effectiveness analysis of STEP-KOA.
STEP-KOA is a novel, efficient and patient-centered approach to delivering exercise-based interventions to patients with knee OA, one of the most prevalent and disabling health conditions. This trial will provide information on the effectiveness of STEP-KOA as a novel potential model of care for treatment of OA.
Clinicaltrials.gov, NCT02653768 (STepped Exercise Program for Knee OsteoArthritis (STEP-KOA)), Registered January 12, 2016.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Immobility during hospitalization is widely recognized as a contributor to deconditioning, functional loss, and increased need for institutional post-acute care. Several studies have demonstrated ...that inpatient walking programs can mitigate some of these negative outcomes, yet hospital mobility programs are not widely available in U.S. hospitals. STRIDE (assiSTed eaRly mobIlity for hospitalizeD older vEterans) is a supervised walking program for hospitalized older adults that fills this important gap in clinical care. This paper describes how STRIDE works and how it is being disseminated to other hospitals using the Replicating Effective Programs (REP) framework. Guided by REP, we define core components of the program and areas where the program can be tailored to better fit the needs and local conditions of its new context (hospital). We describe key adaptations made by four hospitals who have implemented the STRIDE program and discuss lessons learned for successful implementation of hospital mobility programs.
The accuracy of step detection in consumer-based wearable activity monitors in older adults with varied ambulatory abilities is not known.
We assessed the validity of two hip-worn (Fitbit One and ...Omron HJ-112) and two wrist-worn (Fitbit Flex and Jawbone UP) activity monitors in 99 older adults of varying ambulatory abilities and also included the validity results from the ankle-worn StepWatch as a comparison device. Nonimpaired, impaired (Short Physical Performance Battery Score < 9), cane-using, or walker-using older adults (62 and older) ambulated at a self-selected pace for 100 m wearing all activity monitors simultaneously. The criterion measure was directly observed steps. Intraclass correlation coefficients (ICC), mean percent error and mean absolute percent error, equivalency, and Bland-Altman plots were used to assess accuracy.
Nonimpaired adults steps were underestimated by 4.4% for StepWatch (ICC = 0.87), 2.6% for Fitbit One (ICC = 0.80), 4.5% for Omron HJ-112 (ICC = 0.72), 26.9% for Fitbit Flex (ICC = 0.15), and 2.9% for Jawbone UP (ICC = 0.55). Impaired adults steps were underestimated by 3.5% for StepWatch (ICC = 0.91), 1.7% for Fitbit One (ICC = 0.96), 3.2% for Omron HJ-112 (ICC = 0.89), 16.3% for Fitbit Flex (ICC = 0.25), and 8.4% for Jawbone UP (ICC = 0.50). Cane-user and walker-user steps were underestimated by StepWatch by 1.8% (ICC = 0.98) and 1.3% (ICC = 0.99), respectively, where all other monitors underestimated steps by >11.5% (ICCs < 0.05).
StepWatch, Omron HJ-112, Fitbit One, and Jawbone UP appeared accurate at measuring steps in older adults with nonimpaired and impaired ambulation during a self-paced walking test. StepWatch also appeared accurate at measuring steps in cane-users.
The metabolic consequences of type of body shape need further exploration. Whereas accumulation of body mass in the abdominal area is a well-established metabolic risk factor, accumulation in the ...gluteofemoral area is controversially debated. We evaluated the associations of anthropometric markers of overall body mass and body shape with 127 serum metabolites within a sub-sample of the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam cohort.
The cross-sectional analysis was conducted in 2270 participants, randomly drawn from the EPIC-Potsdam cohort. Metabolites were measured by targeted metabolomics. To select metabolites related with both waist circumference (WC) (abdominal subcutaneous and visceral fat) and hip circumference (HC) (gluteofemoral fat, muscles and bone structure) correlations (r) with body mass index (BMI) as aggregating marker of body mass (lean and fat mass) were calculated. Relations with body shape were assessed by median metabolite concentrations across tertiles of WC and HC, mutually adjusted to each other.
Correlations revealed 23 metabolites related to BMI (r⩾I0.20 I). Metabolites showing relations with BMI were showing similar relations with HC adjusted WC (WCHC). In contrast, relations with WC adjusted HC (HCWC) were less concordant with relations of BMI and WCHC. In both sexes, metabolites with concordant relations regarding WCHC and HCWC included tyrosine, diacyl-phosphatidylcholine C38:3, C38:4, lyso-phosphatidylcholine C18:1, C18:2 and sphingomyelin C18:1; metabolites with opposite relations included isoleucine, diacyl-phosphatidylcholine C42:0, acyl-alkyl-phosphatidylcholine C34:3, C42:4, C42:5, C44:4 and C44:6. Metabolites specifically related to HCWC included acyl-alkyl-phosphatidylcholine C34:2, C36:2, C38:2 and C40:4, and were solely observed in men. Other metabolites were related to WCHC only.
The study revealed specific metabolic profiles for HCWC as marker of gluteofemoral body mass differing from those for BMI and WCHC as markers of overall body mass and abdominal fat, respectively. Thus, the study suggests that gluteofemoral mass may have less-adverse metabolic implications than abdominal fat.
OBJECTIVEThis study uses Leader-Member Exchange theory to explore the associations between contact frequency (CF) of nurse leaders and their team members, leader-member relationship, and patient ...safety culture.
BACKGROUNDLeader-member relationships are an important part of patient safety culture development. The behaviors of leaders to achieve these relationships are unknown. This study explores CF as a leader behavior to improve patient safety culture.
METHODSCross-sectional survey of bedside nurses (N = 746) from an 8-hospital system.
RESULTSA significant association was found between relationship strength and patient safety culture; CFʼs effect on relationship and patient safety culture was demonstrated.
CONCLUSIONContact frequency may support relationships between leaders and members and improve patient safety culture on nursing units. Future studies should explore factors that could be enhancing and limiting CF.
This paper reviews randomized, controlled trials (RCTs) that have used a physical activity/exercise intervention in older adults with heart failure and reported outcomes of physical function and/or ...health-related quality of life. An integrative review was necessary because a literature search indicated no reviews have been done regarding these outcomes which are deemed very important by the older adult population. Computerized database search strategies by authors between 2002 and 2015 resulted in 163 studies, with 12 meeting inclusion criteria. Interventions were performed in clinic and home-based, group and/or individual settings with durations from three to 12 months. Interventions were varied. Common methodological weaknesses of the studies include lack of theory guiding the intervention, small sample and low minority representation. Strengths included detailed intervention methods. There was a moderate effect of interventions with no reported adverse effects. Further work is essential to identify successful strategies to support older adults with heart failure to increase their physical activity levels.
Accurate mobility assessment of hospitalized older adults is necessary to aid nurses in planning and providing appropriate mobility support; however, nurses cite lack of resources and time ...limitations as barriers. Accelerometry enables a detailed objective measurement of predominant hospital mobility activities in the older adult population, such as percent time sitting, and the sit-to-stand (STS) transition. The current exploratory study examined the use of a novel, unobtrusive accelerometry technique to obtain postural and STS metrics on 27 older adults during their hospital stay. Total device wear time in the hospital was 96.2%. Participants spent 60.3% time lying, 20.3% time sitting, 5.3% time standing, and 2% time stepping during hospitalization, and, on average, completed the STS transition 20 times (
= 13) per 24-hour period. There were no participant complaints about wearing the device. Our exploratory study shows accelerometry provides automated, continuous data and may support accurate nursing assessment of patient mobility.
(5), 35-41..
The aim of this work was to investigate the predictive value of in-hospital posture and ambulatory activity for 30 days following discharge on functional status in older patients with heart failure.
...We undertook a prospective observational pilot study of 27 patients (78 ± 9.8 y, 51.8% female) admitted with heart failure. Participants wore 2 inclinometric accelerometers to record posture in-hospital and an ankle accelerometer to record ambulatory activity in-hospital and 30 days after discharge. Function was assessed on the day after discharge (Timed Up and Go TUG, Short Physical Performance Battery SPPB, hand grip strength) and 30 days after discharge. Length of stay was 5.1 ± 3.9 days. Participants spent 63.0 ± 19.2% of their hospital time lying down, 30.2 ± 18.7% sitting, 5.3 ± 4.2% standing, and 1.9 ± 8.6% ambulating. Thirty-day mean post-discharge stepping was 4890 ± 2285 steps/day. Each 10% increase in hospital lying time was associated with 0.7 s longer TUG time (95% confidence interval CI 0.2–1.9) at 30 days. Each 1000 additional daily steps in the post-discharge period was associated with a 0.8-point higher SPPB score (95% CI 0.1–1.0) at 30 days. Handgrip strength was unchanged.
Older patients with heart failure were sedentary during hospitalization, which may contribute to decreased functional performance. Physical activity after discharge may minimize this negative effect.
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