Background
Television (TV) viewing and computer use have been associated with higher risk of depression, but studies specifically assessing the impact of these and other types of sedentary behaviors ...(SBs) on the mental health of older adults are scarce and their results are inconclusive. Similarly, the association between specific types of recreational physical activity (rPA) and mental health in older adults is poorly understood.
Methods
In 2012, information on SBs, rPA, and other health behaviors was collected with validated questionnaires from community‐dwelling older adults participating in the Seniors‐ENRICA cohort. In 2012 and 2015, symptoms of depression and mental distress were assessed using the GDS‐10 and the General Health Questionnaire‐12 (GHQ‐12), respectively.
Results
Time spent watching TV was prospectively associated with higher (worse) GDS‐10 scores in women (β 95% confidence interval (CI) comparing the second and third tertiles of TV viewing to the first: 0.21 –0.04 to 0.46 and 0.37 0.13–0.62, respectively; P‐trend: < 0.01), but not in men (−0.11 –0.35 to 0.13 and –0.18 –0.44 to 0.08; P‐trend: 0.16). Women, but not men, who spent more time in other SBs, including reading, using the computer and commuting, showed a lower number of depressive symptoms (−0.19 –0.44 to 0.06 and –0.34 –0.60 to –0.08; P‐trend: 0.01) and lower (better) GHQ‐12 scores (−0.33 –0.67 to –0.00 and –0.35 –0.69 to –0.00; P‐trend: 0.05) at follow‐up. Both in men and women, higher levels of rPA, such as walking, practicing sports, and do‐it‐yourself activities, were associated with lower GDS‐10 scores (−0.07 –0.25 to 0.11 and –0.19 –0.36 to –0.01; P‐trend: 0.04) and with lower GHQ‐12 scores (−0.02 –0.26 to 0.22 and –0.23 –0.47 to –0.00; P‐trend: 0.06).
Conclusions
Older women who spent more time watching TV and less time in other SBs showed a higher number of depressive symptoms. Data suggest that increasing rPA may improve mental health in older adults, particularly among women.
Background and aims
Observational evidence that light‐to‐moderate alcohol consumption lowers mortality is questioned because of potential selection biases and residual confounding. We assess the ...association between alcohol intake and all‐cause death in older adults after accounting for those methodological issues.
Methods
Data came from 3045 individuals representative of the non‐institutionalized population aged ≥ 60 years in Spain. Participants were recruited in 2008–10, when they reported current and life‐time alcohol intake; drinkers were classified as occasional (< 1.43 g/day), light (≥ 1.43 but < 20 g/day for men and ≥ 1.43 but < 10 g/day for women), moderate (≥ 20 but < 40 g/day for men and ≥ 10 but < 20 g/day for women) or heavy (≥ 40 g/day for men and ≥ 24 g/day for women)/binge. Participants were followed‐up to 2017 to assess vital status. In analyses, ex‐drinkers were removed from the abstainer group and were classified according to their life‐time intake to address the ‘abstainer bias’. Moreover, analyses were replicated in individuals without functional limitations, and excluded deaths in the first year of follow‐up, to address reverse causation. Also, occasional drinkers were used as reference in some analyses to reduce the ‘healthy drinker/survivor’ bias. Results were adjusted for many covariates to minimize residual confounding.
Results
Compared with never‐drinkers, the hazard ratio (95% confidence interval) of mortality for light drinkers was 1.05 (0.71–1.56) and 1.20 (0.72–2.02) in those without functional limitations. Corresponding values for moderate drinkers were 1.28 (0.81–2.02) and 1.55 (0.87–2.75) and for heavy/binge drinkers 1.85 (1.07–3.23) and 2.15 (1.09–4.22). Results were consistent when occasional drinkers were used as reference. Among drinkers without functional limitations, the hazard ratio (95% confidence interval) of mortality per 10 g/day of alcohol was 1.12 (1.02–1.23).
Conclusion
After accounting for potential biases, light‐to‐moderate drinking among people 60+ years of age appears to have no statistically significant benefit on mortality compared with abstention from alcohol. By contrast, heavy/binge drinking shows a higher death risk compared with abstention from alcohol. Alcohol intake appears to have a positive dose–response with mortality among drinkers.
There is emerging evidence of the role of diabetes as a risk factor for frailty. However, the mechanisms of this association are uncertain.
Prospective cohort study of 1750 noninstitutionalized ...individuals aged 60 years or older recruited in 2008-2010. At baseline, information was obtained on health behaviors, morbidity, cardiometabolic biomarkers, and antidiabetic treatments. Individuals were considered diabetic if they reported a physician diagnosis or had fasting serum glucose of 126 mg/dL or higher. Study participants were followed through 2012 to assess incident frailty, defined as at least 3 of the 5 Fried criteria.
At baseline, the cohort included 346 individuals with diabetes and 1404 without diabetes. Over a mean 3.5-year follow-up, 115 cases of incident frailty were ascertained. After adjustment for age, sex, and education, participants with diabetes showed an increased risk of frailty (odds ratio OR 2.18, 95% confidence interval CI 1.42-3.37). Additional adjustment for health behaviors and abdominal obesity yielded a 29.7% reduction in the OR (OR 1.83, 95% CI 1.16-2.90). Subsequent adjustment for morbidity produced an additional 8.4% reduction (OR 1.76, 95% CI 1.10-2.82), and for cardiometabolic biomarkers, a further 44% reduction (OR 1.32, 95% CI 0.70-2.49). In particular, adjustment for HbA1c, lipoproteins, and triglycerides accounted for the greatest reductions. Finally, additional adjustment for oral antidiabetic medication reduced the OR to 1.01 (95% CI 0.46-2.20), whereas adjustment for nutritional therapy increased the OR to 1.64 (95% CI 0.77-3.49).
Diabetes mellitus is associated with higher risk of frailty; this association is partly explained by unhealthy behaviors and obesity and, to a greater extent, by poor glucose control and altered serum lipid profile among diabetic individuals. Conversely, diabetes nutritional therapy reduces the risk of frailty.
Objective
To evaluate for the first time the longitudinal relationship between abdominal obesity and the onset of frailty.
Methods
Study based on results from two population‐based cohorts, the ...Seniors‐ENRICA, with 1801 individuals aged ≥60, and the Toledo Study for Healthy Ageing (TSHA), with 1289 participants ≥65 years. Incident frailty was assessed with the Fried criteria.
Results
During 3.5 years of follow‐up, 125 individuals with incident frailty in Seniors‐ENRICA and 162 in TSHA were identified. After adjustment for the main confounders, the pooled odds ratio (pooled OR) for general obesity and risk of frailty was 1.73 (95% confidence interval CI: 1.18‐2.28). Abdominal obesity was also associated with frailty (pooled OR: 1.67; 95% CI: 1.09‐2.25). Compared with individuals with BMI <25 kg/m2 and no abdominal obesity, the risk of frailty was highest among individuals with concurrent general and abdominal obesity (pooled OR: 2.55; 95% CI: 1.23‐3.86). General obesity was associated with increased risk of exhaustion (pooled OR: 1.66; 95% CI: 1.11‐2.21), low physical activity (pooled OR: 1.57; 95% CI: 1.08‐2.05), and weakness (pooled OR: 1.63; 95% CI: 1.12‐2.05). For abdominal obesity, results were in the same direction, although they showed statistical significance only for weakness (OR: 1.46; 95% CI: 1.11‐1.80).
Conclusions
General and abdominal obesity are associated with incident frailty in the elderly.
Only a few studies have assessed the association between protein intake and frailty incidence and have obtained inconsistent results. This study examined the association of protein and other ...macronutrient intake with the risk of frailty in older adults.
A prospective cohort of 1,822 community-dwelling individuals aged 60 and older was recruited in 2008-2010 and followed-up through 2012. At baseline, food consumption was assessed with a validated, computerized face-to-face diet history. In 2012, individuals were contacted again to ascertain incident frailty, defined as the presence of at least three of the five Fried criteria: low physical activity, slowness, unintentional weight loss, muscle weakness, and exhaustion. Analyses were performed using logistic regression and adjusted for the main confounders, including total energy intake.
During a mean follow-up of 3.5 years, 132 persons with incident frailty were identified. The odds ratios (95% confidence interval) of frailty across increasing quartiles of total protein were 1.00, 0.55 (0.32-0.93), 0.45 (0.26-0.78), and 0.41 (0.23-0.72); p trend: .001. The corresponding figures for animal protein intake were 1.00, 0.68 (0.40-1.17), 0.56 (0.32-0.97), and 0.48 (0.26-0.87), p trend: .011. And for intake of monounsaturated fatty acids (MUFAs), the results were 1.00, 0.66 (0.37-1.20), 0.54 (0.28-1.02), and 0.50 (0.26-0.96); p trend: .038. No association was found between intake of vegetable protein, saturated fats, long-chain ω-3 fatty acids, α-linolenic acid, linoleic acid, simple sugars, or polysaccharides and the risk of frailty.
Intake of total protein, animal protein, and MUFAs was inversely associated with incident frailty. Promoting the intake of these nutrients might reduce frailty.
There is emerging evidence of the role of certain nutrients as risk factors for frailty. However, people eat food, rather than nutrients, and no previous study has examined the association between ...dietary patterns empirically derived from food consumption and the risk of frailty in older adults.
This is a prospective cohort study of 1,872 non-institutionalized individuals aged ≥60 years recruited between 2008 and 2010. At baseline, food consumption was obtained with a validated diet history and, by using factor analysis, two dietary patterns were identified: a 'prudent' pattern, characterized by high intake of olive oil and vegetables, and a 'Westernized' pattern, with a high intake of refined bread, whole dairy products, and red and processed meat, as well as low consumption of fruit and vegetables. Participants were followed-up until 2012 to assess incident frailty, defined as at least three of the five Fried criteria (exhaustion, weakness, low physical activity, slow walking speed, and unintentional weight loss).
Over a 3.5-year follow-up, 96 cases of incident frailty were ascertained. The multivariate odds ratios (95% confidence interval) of frailty among those in the first (lowest), second, and third tertile of adherence to the prudent dietary pattern were 1, 0.64 (0.37-1.12), and 0.40 (0.2-0.81), respectively; P-trend = 0.009. The corresponding values for the Westernized pattern were 1, 1.53 (0.85-2.75), and 1.61 (0.85-3.03); P-trend = 0.14. Moreover, a greater adherence to the Westernized pattern was associated with an increasing risk of slow walking speed and weight loss.
In older adults, a prudent dietary pattern showed an inverse dose-response relationship with the risk of frailty while a Westernized pattern had a direct relationship with some of their components. Clinical trials should test whether a prudent pattern is effective in preventing or delaying frailty.
Consuming fruit and vegetables (FVs) may protect against frailty, but to our knowledge no study has yet assessed their prospective dose-response relation.
We sought to examine the dose-response ...association between FV consumption and the risk of frailty in older adults.
Data were taken from 3 independent cohorts of community-dwelling older adults: the Seniors-ENRICA (Study on Nutrition and Cardiovascular Risk Factors in Spain) cohort (n = 1872), Three-City (3C) Bordeaux cohort (n = 581), and integrated multidisciplinary approach cohort (n = 473). Baseline food consumption was assessed with a validated computerized diet history (Seniors-ENRICA) or with a food-frequency questionnaire (3C Bordeaux and AMI). In all cohorts, incident frailty was assessed with the use of the Fried criteria. Results across cohorts were pooled with the use of a random-effects model.
During a mean 2.5-y follow-up, 300 incident frailty cases occurred. Fully adjusted models showed that the pooled ORs (95% CIs) of incident frailty comparing participants who consumed 1, 2, or ≥3 portions of fruit/d to those with no consumption were, respectively, 0.59 (0.27, 0.90), 0.58 (0.29, 0.86), and 0.48 (0.20, 0.75), with a P-trend of 0.04. The corresponding values for vegetables were 0.69 (0.42, 0.97), 0.56 (0.35, 0.77), and 0.52 (0.13, 0.92), with a P-trend < 0.01. When FVs were analyzed together, the pooled ORs (95% CIs) of incident frailty were 0.41 (0.21, 0.60), 0.47 (0.25, 0.68), 0.36 (0.18, 0.53), and 0.31 (0.13, 0.48), with a P-trend < 0.01 for participants who consumed 2, 3, 4, or ≥5 portions/d, respectively, compared with those who consumed ≤1 portion/d. An inverse dose-response relation was also found between the baseline consumption of fruit and risk of exhaustion, low physical activity, and slow walking speed, whereas the consumption of vegetables was associated with a decreased risk of exhaustion and unintentional weight loss.
Among community-dwelling older adults, FV consumption was associated with a lower short-term risk of frailty in a dose-response manner, and the strongest association was obtained with 3 portions of fruit/d and 2 portions of vegetables/d.
Aims
To examine the association of alcohol consumption patterns with growth differentiation factor 15 (GDF‐15) in older drinkers, separately among individuals with cardiovascular disease ...(CVD)/diabetes and those without them, as GDF‐15 is a strong biomarker of chronic disease burden.
Design
Cross‐sectional study.
Setting
Population‐based study in Madrid (Spain).
Participants
A total of 2051 life‐time drinkers aged 65+ years included in the Seniors‐ENRICA‐2 study in 2015–17. Participants’ mean age was 71.4 years and 55.4% were men.
Measurements
According to their average life‐time alcohol intake, participants were classified as occasional (≤ 1.43 g/day), low‐risk (men: > 1.43–20 g/day; women: > 1.43–10 g/day), moderate‐risk (men: > 20–40 g/day; women: > 10–20 g/day) and high‐risk drinkers (men: > 40 g/day; women: > 20 g/day; or binge drinkers). We also ascertained wine preference (> 80% of alcohol derived from wine), drinking with meals and adherence to a Mediterranean drinking pattern (MDP) defined as low‐risk drinking, wine preference and one of the following: drinking only with meals; higher adherence to the Mediterranean diet; or any of these.
Findings
In participants without CVD/diabetes, GDF‐15 increased by 0.27% 95% confidence interval (CI) = 0.06%, 0.48% per 1 g/day increment in alcohol among high‐risk drinkers, but there was no clear evidence of association in those with lower intakes or in the overall group, or across categories of alcohol consumption status. Conversely, among those with CVD/diabetes, GDF‐15 rose by 0.19% (95% CI = 0.05%, 0.33%) per 1 g/day increment in the overall group and GDF‐15 was 26.89% (95% CI = 12.93%, 42.58%) higher in high‐risk versus low‐risk drinkers. Drinking with meals did not appear to be related to GDF‐15, but among those without CVD/diabetes, wine preference and adherence to the MDP were associated with lower GDF‐15, especially when combined with high adherence to the Mediterranean diet.
Conclusions
Among older life‐time drinkers in Madrid, Spain, high‐risk drinking was positively associated with growth differentiation factor 15 (a biomarker of chronic disease burden). There was inconclusive evidence of a beneficial association for low‐risk consumption.
Toenails have been used as biomarkers of exposure to toxic metals, but their validity for this purpose is not yet clear and might differ depending on the specific agent. To evaluate this issue, we ...reviewed the literature on: a) the time-window of exposure reflected by toenails; b) the reproducibility of toenail toxic-metal levels in repeated measures over time; c) their relationship with other biomarkers of exposure, and; d) their association with potential determinants (i.e. sociodemographic, anthropometric, or lifestyle characteristics) or with sources of exposure like diet or environmental pollution.
Thus, we performed a systematic review, searching for articles that provided original data for levels of any of the following toxic metals in toenails: aluminum, beryllium, cadmium, chromium, mercury, nickel, lead, thallium and uranium.
We identified 88 articles, reporting data from 67 different research projects, which were quite heterogeneous with regard to population profile, sample size and analytical technique. The most commonly studied metal was mercury. Concerning the time-window of exposure explored by toenails, some reports indicate that toenail cadmium, nickel and lead may reflect exposures that occurred 7–12 months before sampling. For repeated samples obtained 1–6 years apart, the range of intraindividual correlation coefficients of aluminum, chromium and mercury was 0.33–0.56. The correlation of toxic metal concentrations between toenails and other matrices was higher for hair and fingernails than for urine or blood. Mercury levels were consistently associated with fish intake, while other toxic metals were occasionally associated with specific sources (e.g. drinking water, place of residence, environmental pollution, and occupation). The most frequently evaluated health endpoints were cardiovascular diseases, cancer, and central nervous system diseases.
Available data suggest that toenail mercury levels reflected long-term exposures and showed positive associations with fish intake. The lack of standardization in sample collection, quality control, analytical techniques and procedures – along with the heterogeneity and conflicting results among studies – mean it is still difficult to conclude that toenails are a good biomarker of exposure to toxic metals. Further studies are needed to draw solid conclusions about the suitability of toenails as biomarkers of exposure to toxic metals.
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Inorganic arsenic, a carcinogen at high exposure levels, is a major global health problem. Prospective studies on carcinogenic effects at low-moderate arsenic levels are lacking.
We evaluated the ...association between baseline arsenic exposure and cancer mortality in 3,932 American Indians, 45 to 74 years of age, from Arizona, Oklahoma, and North/South Dakota who participated in the Strong Heart Study from 1989 to 1991 and were followed through 2008. We estimated inorganic arsenic exposure as the sum of inorganic and methylated species in urine. Cancer deaths (386 overall, 78 lung, 34 liver, 18 prostate, 26 kidney, 24 esophagus/stomach, 25 pancreas, 32 colon/rectal, 26 breast, and 40 lymphatic/hematopoietic) were assessed by mortality surveillance reviews. We hypothesized an association with lung, liver, prostate, and kidney cancers.
Median (interquartile range) urine concentration for inorganic plus methylated arsenic species was 9.7 (5.8-15.6) μg/g creatinine. The adjusted HRs 95% confidence interval (CI) comparing the 80th versus 20th percentiles of arsenic were 1.14 (0.92-1.41) for overall cancer, 1.56 (1.02-2.39) for lung cancer, 1.34 (0.66, 2.72) for liver cancer, 3.30 (1.28-8.48) for prostate cancer, and 0.44 (0.14, 1.14) for kidney cancer. The corresponding hazard ratios were 2.46 (1.09-5.58) for pancreatic cancer, and 0.46 (0.22-0.96) for lymphatic and hematopoietic cancers. Arsenic was not associated with cancers of the esophagus and stomach, colon and rectum, and breast.
Low to moderate exposure to inorganic arsenic was prospectively associated with increased mortality for cancers of the lung, prostate, and pancreas.
These findings support the role of low-moderate arsenic exposure in development of lung, prostate, and pancreas cancer and can inform arsenic risk assessment.
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