Summary Background The Foundation for the National Institutes of Health Sarcopenia Project validated cutpoints for appendicular lean mass (ALM) to identify individuals at risk for functional ...impairment. Recognizing possible underlying mechanisms between adipose tissue and muscle, we sought to apply the recent definitions and determine the relationship with markers of glucose homeostasis and inflammation in individuals with sarcopenia and sarcopenic obesity. Methods The National Health and Nutrition Examination Surveys 1999-2004 were used to identify 4,984 adults aged ≥60 years with DEXA measures. Sarcopenia was defined using ALM (men<19.75 kg, women<15.02 kg) and ALM adjusted for body mass index (BMI; men<0.789 kg/m2 , women<0.512 kg/m2 ). Sarcopenic obesity was defined as subjects fulfilling the criteria for sarcopenia and obesity by body fat (men ≥25%, women ≥35%). We assessed the association between ALM and ALM:BMI with inflammatory and markers of glucose homestasis, both as continuous variables but also classifying as having sarcopenic obesity or not after adjusting for confounding variables including pro-inflammatory chronic diseases such as diabetes and cancer. Results Mean age was 71.1 years (56.5%) females. Prevalence of sarcopenia and sarcopenic obesity were (ALM definition: 29.9 and 24.4%; ALM:BMI definition: 23.0 and 22.7%). There were significant associations with ALM and ln C-reactive protein (β=0.0287;p=0.001), fibrinogen (β=0.519;p<0.001), and HOMA-IR (β=0.359;p<0.001). Using ALM:BMI, significant associations were observed with ln CRP (β=-2.58;p=0.001), fibrinogen (β=-124.2;p<0.001), and HOMA-IR (β=-6.63;p<0.001). Sarcopenic obesity using the ALM:BMI definition demonstrated significant associations with CRP (β=0.422;p<0.001), fibrinogen (β=22.5;p<0.001), but not HOMA-IR (β=1.19;p=0.13). Strong associations with seen with increased levels of fibrinogen and CRP with sarcopenic obesity (ALM:BMI definition) that persisted after adjusting for diabetes and cancer. Conclusions Biologically plausible associations exist between ALM:BMI and inflammation and HOMA-IR that were not observed when using ALM alone. Future study should validate each of these definitions to prevent disparate results from being determined.
Current body mass index (BMI) strata likely misrepresent the accuracy of true adiposity in older adults. Subjects with normal BMI with elevated body fat may metabolically have higher cardiovascular ...and overall mortality than previously suspected. We identified 4,489 subjects aged ≥60 years (BMI = 18.5 to 25 kg/m2 ) with anthropometric and bioelectrical impedance measurements from the National Health and Nutrition Examination Surveys III (1988 to 1994) and mortality data linked to the National Death Index. Normal weight obesity (NWO) was classified in 2 ways: creation of tertiles with highest percentage of body fat and body fat percent cutoffs (men >25% and women >35%). We compared overall and cardiovascular mortality rates, models adjusted for age, gender, smoking, race, diabetes, and BMI. The final sample included 1,528 subjects, mean age was 70 years, median (interquartile range) follow-up was 12.9 years (range 7.5 to 15.3) with 902 deaths (46.5% cardiovascular). Prevalence of NWO was 27.9% and 21.4% in men and 20.4% and 31.3% in women using tertiles and cutoffs, respectively. Subjects with NWO had higher rates of abnormal cardiovascular risk factors. Lean mass decreased, whereas leptin increased with increasing tertile. There were no gender-specific differences in overall mortality. Short-term mortality (<140 person-months) was higher in women, whereas long-term mortality (>140 person-months) was higher in men. We highlight the importance of considering body fat in gender-specific risk stratification in older adults with normal weight. In conclusion, NWO in older adults is associated with cardiometabolic dysregulation and is a risk for cardiovascular mortality independent of BMI and central fat distribution.
To describe the process of adapting an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness using ...an adaptive systems engineering framework and user-centered design.
First, we determined the technical abilities and needs of middle-aged and older adults with serious mental illnesses using smartphones. Then, we developed smartphone content through principles of user-centered design and modified an existing smartphone platform. Finally, we conducted a usability test using "think aloud" and verbal probing.
We adapted a psychosocial self-management intervention to a smartphone application and tested its usability. Ten participants (mean age: 55.3 years, SD: 6.2 years) with serious mental illness and comorbid chronic health conditions reported a high level of usability and satisfaction with the smartphone application.
Middle-aged and older adults with serious mental illness and limited technical abilities were able to participate in a process involving user-centered design and adaptation of a self-management intervention to be delivered by a smartphone. High usability ratings suggest that middle-aged and older adults with serious mental illness have the potential to use tailored smartphone interventions. Future research is indicated to establish effectiveness and to determine the type and intensity of clinical support needed to successfully implement smartphone applications as a component of community-based services for older adults with psychiatric and medical conditions.
Abstract Introduction People with serious mental illness, including schizophrenia spectrum and mood disorders, are more physically inactive than people from the general population. Emerging wearable ...devices and smartphone applications afford opportunities for promoting physical activity in this group. This exploratory mixed methods study obtained feedback from participants with serious mental illness to assess the acceptability of using wearable devices and smartphones to support a lifestyle intervention targeting weight loss. Methods Participants with serious mental illness and obesity enrolled in a 6-month lifestyle intervention were given Fitbit activity tracking devices and smartphones to use for the study. Participants completed quantitative post-intervention usability and satisfaction surveys, and provided qualitative feedback regarding acceptability of using these devices and recommendations for improvement through in-depth interviews. Results Eleven participants wore Fitbits for an average of 84.7% (SD=18.1%) of the days enrolled in the study (median=93.8% of the days enrolled, interquartile range=83.6-94.3%). Participants were highly satisfied, stating that the devices encouraged them to be more physically active and were useful for self-monitoring physical activity and reaching daily step goals. Some participants experienced challenges using the companion mobile application on the smartphone, and recommended greater technical support, more detailed training, and group tutorials prior to using the devices. Discussion Participants’ perspectives highlight the feasibility and acceptability of using commercially available mHealth technologies to support health promotion efforts targeting people with serious mental illness. This study offers valuable insights for informing future research to assess the effectiveness of these devices for improving health outcomes in this high-risk group.
Introduction People with serious mental illness experience elevated severe obesity rates, yet limited evidence documents whether lifestyle intervention participation can benefit these individuals. ...This study examined the impact of the In SHAPE lifestyle intervention on weight loss among participants with serious mental illness and severe obesity (BMI ≥40) compared with participants who are overweight (BMI 25 to <30) and have class I (BMI 30 to <35) or class II (BMI 35 to <40) obesity. Methods Data were combined from three trials of the 12-month In SHAPE intervention for individuals with serious mental illness collected between 2007 and 2013 and analyzed in 2014. In SHAPE includes individual weekly meetings with a fitness trainer, a gym membership, and nutrition education. The primary outcome was weight loss. Secondary outcomes were fitness, blood pressure, lipids, and program adherence. Results Participants (N=192) were diagnosed with schizophrenia spectrum (53.1%) or mood (46.9%) disorders. At 12 months, the overall sample showed significant weight loss, but differences among BMI groups were not significant (severe obesity, 2.57% 7.98%; class II, 2.26% 8.69%; class I, 1.05% 6.86%; overweight, 0.83% 7.62%). One third of participants with severe obesity achieved ≥5% weight loss, which was comparable across groups. More participants with severe obesity achieved ≥10% weight loss (20%) than overweight (2.9%, p =0.001) and class I (5.9%, p <0.001), but not class II (17.8%, p =0.974), obesity groups. Conclusions People with severe obesity and serious mental illness benefit similarly to those in lower BMI groups from lifestyle intervention participation.
To determine whether leptin is related to all-cause and cardiovascular (CV) mortality in older adults.
Participants 60 years and older with plasma leptin level measurements from the National Health ...and Nutrition Examination Survey III (1988-1994) and mortality data linked to the National Death Index were included. We created sex-specific tertiles of leptin (men: 4.2-7.7 μg/L; women: 11.5-21.4 μg/L) to identify the effect of leptin on all-cause and CV mortality. We also determined whether leptin predicted mortality in patients with obesity. We classified obesity using 4 possible definitions: body mass index 30 kg/m(2) or greater; body fat 25% or more in men and 35% or more in women; waist circumference 102 cm or greater in men and 88 cm or greater in women; and waist-hip ratio 0.85 or higher in women and 0.95 or higher in men. Sex-specific proportional hazard models were used to assess the effect of leptin on all-cause and CV mortality.
Of 1794 participants, 51.6% were women; the mean age was 70.3±0.4 years, and the follow-up period was 12.5 years with 994 deaths (469 were CV deaths). All-cause mortality in the highest leptin tertile was significant neither in men (hazard ratio HR, 1.23; 95% CI, 0.93-1.63) nor in women (HR, 0.97; 95% CI, 0.68-1.40). CV mortality was the highest in the highest leptin tertile in men (HR, 1.69; 95% CI, 1.06-2.70) but not in women (HR, 1.21; 95% CI, 0.73-1.98). Evaluating the effect of leptin in subgroups of different obesity definitions, we found that high leptin levels as predict CV mortality in men as measured by waist circumference or body fat.
Elevated leptin level is predictive of CV mortality only in men. Leptin may provide additional mortality discrimination in obese men.
Objective: Assess the feasibility and acceptability of Fitbit for supporting behavioral change in rural, older adults with obesity. Method: Eight adults aged ≥65 with a body mass index (BMI) ≥30kg/m2 ...were recruited from a rural practice and provided a Fitbit Zip device for 30 days. Participants completed validated questionnaires/interviews. Results: Mean age was 73.4 ± 4.0 years (50% female) with a mean BMI of 34.5 ± 4.5kg/m2. We observed reductions in exercise confidence (sticking to it: 34.5 ± 3.3 to 30.9 ± 4.3, p = .04; making time: 18.9 ± 1.3 to 17.0 ± 2.6, p = .03) but no changes in patient activation (45.4 ± 4.3 vs. 45.0 ± 3.9). All reported high satisfaction, seven (87.5%) found Fitbit easy to use, and five (62.5%) found the feedback useful. The majority (n = 6 75.0%) were mostly/very satisfied with the intervention. Consistent themes emerged regarding the benefit of self-monitoring and participant motivation. Common concerns included finding time to exercise and lack of a peer group. Conclusion: Use of Fitbit is feasible/acceptable for use among older rural obese adults but may lead to reduced confidence.
Abstract Background context In 2007, the Subaxial Cervical Spine Injury Classification (SLIC) system was introduced demonstrating moderate reliability in an internal validation study. Purpose To ...assess the agreement on the SLIC system using clinical data from a spinal trauma population and whether the SLIC treatment algorithm outcome improved agreement on treatment decisions among surgeons. Study design An external classification validation study. Patient sample Twelve spinal surgeons (five consultants and seven fellows) assessed 51 randomly selected cases. Outcome measures Raw agreement, Fleiss kappa, and intraclass correlation coefficient statistics were used for reliability analysis. Majority rules and latent class modeling were used for accuracy analysis. Methods Fifty-one randomly selected cases with significant injuries of the cervical spine from a prospective consecutive series of trauma patients were assessed using the SLIC system. Neurologic details, plain radiographs, and computed tomography scans were available for all cases as well as magnetic resonance imaging in 21 cases (41%). No funds were received in support of this study. The authors have no conflict of interest in the subject of this article. Results The inter-rater agreement on the most severely affected level of injury was strong (κ=0.76). The agreement on the morphologic injury characteristics was poor (κ=0.29) and agreement on the integrity of the discoligamentous complex was average (κ=0.46). The inter-rater agreement on the treatment verdict after the total SLIC injury severity score was slightly lower than the surgeons' agreement on personal treatment preference (κ=0.55 vs. κ=0.63). Latent class analysis was not converging and did not present accurate estimations of the true classification categories. Based on these findings, no second survey for testing intrarater agreement was performed. Conclusions We found poor agreement on the morphologic injury characteristics of the SLIC system, and its treatment algorithm showed no improved agreement on treatment decisions among surgeons. The authors discuss that the reproducibility of the SLIC system is likely to improve when unambiguous true morphologic injury characteristics are being implemented.
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