OBJECTIVE: A loss of skeletal muscle mass is frequently observed in older adults. The aim of the study was to investigate the impact of type 2 diabetes on the changes in body composition, with ...particular interest in the skeletal muscle mass. RESEARCH DESIGN AND METHODS: We examined total body composition with dual-energy X-ray absorptiometry annually for 6 years in 2,675 older adults. We also measured mid-thigh muscle cross-sectional area (CSA) with computed tomography in year 1 and year 6. At baseline, 75-g oral glucose challenge tests were performed. Diagnosed diabetes (n = 402, 15.0%) was identified by self-report or use of hypoglycemic agents. Undiagnosed diabetes (n = 226, 8.4%) was defined by fasting plasma glucose (greater-than-or-equal7 mmol/l) or 2-h postchallenge plasma glucose (greater-than-or-equal11.1 mmol/l). Longitudinal regression models were fit to examine the effect of diabetes on the changes in body composition variables. RESULTS: Older adults with either diagnosed or undiagnosed type 2 diabetes showed excessive loss of appendicular lean mass and trunk fat mass compared with nondiabetic subjects. Thigh muscle CSA declined two times faster in older women with diabetes than their nondiabetic counterparts. These findings remained significant after adjusting for age, sex, race, clinic site, baseline BMI, weight change intention, and actual weight changes over time. CONCLUSIONS: Type 2 diabetes is associated with excessive loss of skeletal muscle and trunk fat mass in community-dwelling older adults. Older women with type 2 diabetes are at especially high risk for loss of skeletal muscle mass.
Objectives
To examine whether deficient B12 status or low serum B12 levels are associated with worse sensory and motor peripheral nerve function in older adults.
Design
Cross‐sectional.
Setting
...Health, Aging and Body Composition Study.
Participants
Two thousand two hundred and eighty‐seven adults aged 72 to 83 (mean 76.5 ± 2.9; 51.4% female; 38.3% black).
Measurements
Low serum B12 was defined as serum B12 less than 260 pmol/L, and deficient B12 status was defined as B12 less than 260 pmol/L, methylmalonic acid (MMA) greater than 271 nmol/L, and MMA greater than 2‐methylcitrate. Peripheral nerve function was assessed according to peroneal nerve conduction amplitude and velocity (NCV) (motor), 1.4 g/10 g monofilament detection, average vibration threshold detection, and peripheral neuropathy symptoms (numbness, aching or burning pain, or both) (sensory).
Results
B12‐deficient status was found in 7.0% of participants, and an additional 10.1% had low serum B12 levels. B12 deficient status was associated with greater insensitivity to light (1.4 g) touch (odds ratio = 1.50, 95% confidence interval = 1.06–2.13) and worse NCV (42.3 vs 43.5 m/s) (β = −1.16, P = .01) after multivariable adjustment for demographics, lifestyle factors, and health conditions. Associations were consistent for the alternative definition using low serum B12 only. No significant associations were found for deficient B12 status or the alternative low serum B12 definition and vibration detection, nerve conduction amplitude, or peripheral neuropathy symptoms.
Conclusion
Poor B12 (deficient B12 status and low serum B12) is associated with worse sensory and motor peripheral nerve function. Nerve function impairments may lead to physical function declines and disability in older adults, suggesting that prevention and treatment of low B12 levels may be important to evaluate.
Objectives
To estimate the rate of restricting fatigue in community‐living older adults and to determine whether the rates differ according to age, sex, race, physical frailty, and depression.
Design
...Prospective cohort study.
Setting
Greater New Haven, Connecticut.
Participants
Nondisabled community‐living older men and women aged 70 and older (N = 754).
Measurements
Restricting fatigue was defined as staying in bed for at least half the day and/or cutting down on one's usual activities because of fatigue for 3 consecutive months or longer. Physical frailty was defined on the basis of slow gait speed, and depression was assessed using the Center for Epidemiologic Studies Depression Scale.
Results
During a median follow‐up of 111 months, the cumulative incidence of restricting fatigue was 31.1% for men and 42.1% for women. The overall incidence rate of restricting fatigue was 6.7 per 1,000 person‐months (7.8 for women and 4.4 for men, P < .001), which did not differ according to race. Rates were higher in persons who were physically frail than those who were not (P < .001), in those who were depressed than those who were not (P < .001), and in persons aged 75 to 79 and 80 to 84 than those aged 70 to 74 (both P < .01) but not in those aged 85 and older. Of the 459 episodes of restricting fatigue, the median duration was 3 months, which did not differ according to age, sex, race, physical frailty, or depression.
Conclusion
Restricting fatigue is common in community‐living older adults. Women, individuals aged 75 to 84, and individuals with physical frailty or depression had higher rates of restricting fatigue than their respective counterparts.
Objectives
To evaluate the prevalence of metabolic syndrome (MetS) and its association with physical capacity, disability, and self‐rated health in older adults at high risk of mobility disability, ...including those with and without diabetes mellitus.
Design
Cross‐sectional analysis.
Setting
Lifestyle Interventions and Independence for Elders (LIFE) Study.
Participants
Community‐dwelling sedentary adults aged 70 to 89 at high risk of mobility disability (Short Physical Performance Battery (SPPB) score ≤9; mean 7.4 ± 1.6) (N = 1,535).
Measurements
Metabolic syndrome was defined according to the 2009 multiagency harmonized criteria; outcomes were physical capacity (400‐m walk time, grip strength, SPPB score), disability (composite 19‐item score), and self‐rated health (5‐point scale ranging from excellent to poor).
Results
The prevalence of MetS was 49.8% in the overall sample (83.2% of those with diabetes mellitus, 38.1% of those without). MetS was associated with stronger grip strength (mean difference (Δ) = 1.2 kg, P = .01) in the overall sample and in participants without diabetes mellitus and with poorer self‐rated health (Δ = 0.1 kg, P < .001) in the overall sample only. No significant differences were found in 400‐m walk time, SPPB score, or disability score between participants with and without MetS, in the overall sample or diabetes mellitus subgroups.
Conclusion
Metabolic dysfunction is highly prevalent in older adults at risk of mobility disability, yet consistent associations were not observed between MetS and walking speed, lower extremity function, or self‐reported disability after adjusting for known and potential confounders. Longitudinal studies are needed to investigate whether MetS accelerates declines in functional status in high‐risk older adults and to inform clinical and public health interventions aimed at preventing or delaying disability in this group.
Background
This study aimed to estimate the anti‐SARS‐CoV‐2 antibody seroprevalence in the general population of Bobo‐Dioulasso and Ouagadougou (Burkina Faso).
Methods
We collected from March to ...April 2021 blood samples from randomly selected residents in both main cities based on the World Health Organization (WHO) sero‐epidemiological investigations protocols and tested them with WANTAI SARS‐CoV‐2 total antibodies enzyme‐linked immunosorbent assay (ELISA) kits intended for qualitative assessment. We also recorded participants' socio‐demographic and clinical characteristics and information on exposure to SARS‐CoV‐2. Data were analysed with descriptive and comparative statistics.
Results
We tested 5240 blood samples collected between 03 March and 16 April 2021. The overall test‐adjusted seroprevalence for SARS‐CoV‐2 antibodies was (67.8% 95% CI 65.9–70.2) (N = 3553/3982). Seroprevalence was highest among participants aged 15–18 years old (74.2% 95% CI 70.5–77.5) (N = 465/627), compared with those aged 10–14 years old (62.6% 95% CI 58.7–66.4) (N = 395/631), or those over 18 (67.6% 95% CI 66.2–69.1) (N = 2693/3982). Approximately 71.0% (601/860) of participants aged 10–18 years old who tested positive for SARS‐CoV‐2 antibodies experienced no clinical COVID‐19 symptoms in the weeks before the survey, compared with 39.3% (1059/2693) among those aged over 18 years old.
Conclusion
This study reports the results of the first known large serological survey in the general population of Burkina Faso. It shows high circulation of SARS‐CoV‐2 in the two cities and a high proportion of asymptomatic adolescents. Further studies are needed to identify the SARS‐CoV‐2 variants and to elucidate the factors protecting some infected individuals from developing clinical COVID‐19.
To determine whether older adults with diabetes are at increased risk of an injurious fall requiring hospitalization.
The longitudinal Health, Aging, and Body Composition Study included 3,075 adults ...aged 70-79 years at baseline. Hospitalizations that included ICD-9-Clinical Modification codes for a fall and an injury were identified. The effect of diabetes with and without insulin use on the rate of first fall-related injury hospitalization was assessed using proportional hazards models.
At baseline, 719 participants had diabetes, and 117 of them were using insulin. Of the 293 participants who were hospitalized for a fall-related injury, 71 had diabetes, and 16 were using insulin. Diabetes was associated with a higher rate of injurious fall requiring hospitalization (hazard ratio HR 1.48 95% CI 1.12-1.95) in models adjusted for age, race, sex, BMI, and education. In those participants using insulin, compared with participants without diabetes, the HR was 3.00 (1.78-5.07). Additional adjustment for potential intermediaries, such as fainting in the past year, standing balance score, cystatin C level, and number of prescription medications, accounted for some of the increased risk associated with diabetes (1.41 1.05-1.88) and insulin-treated diabetes (2.24 1.24-4.03). Among participants with diabetes, a history of falling, poor standing balance score, and A1C level ≥8% were risk factors for an injurious fall requiring hospitalization.
Older adults with diabetes, in particular those using insulin, are at greater risk of an injurious fall requiring hospitalization than those without diabetes. Among those with diabetes, poor glycemic control may increase the risk of an injurious fall.
Abstract Objective Prospective data on the association between resistin levels and cardiovascular disease (CVD) events are sparse with conflicting results. Methods We studied 3044 aged 70–79 years ...from the Health, Aging, and Body Composition Study. CVD events were defined as coronary heart disease (CHD) or stroke events. «Hard » CHD events were defined as CHD death or myocardial infarction. We estimated hazard ratio (HR) and 95% confidence intervals (CI) according to the quartiles of serum resistin concentrations and adjusted for clinical variables, and then further adjusted for metabolic disease (body mass index, fasting plasma glucose, abdominal visceral and subcutaneous adipose tissue, leptin, adiponectin, insulin) and inflammation (C-reactive protein, interleukin-6, tumor necrosis factors-α). Results During a median follow-up of 10.1 years, 559 patients had « hard » CHD events, 884 CHD events and 1106 CVD Events. Unadjusted incidence rate for CVD events was 36.6 (95% CI 32.1–41.1) per 1000 persons-year in the lowest quartile and 54.0 per 1000 persons-year in the highest quartile (95% CI 48.2–59.8, P for trend < 0.001). In the multivariate models adjusted for clinical variables, HRs for the highest vs. lowest quartile of resistin was 1.52 (95% CI 1.20–1.93, P < 0.001) for « Hard » CHD events, 1.41 (95% CI 1.16–1.70, P = 0.001) for CHD events and 1.35 (95% CI 1.14–1.59, P = 0.002) for CVD events. Further adjustment for metabolic disease slightly reduced the associations while adjustment for inflammation markedly reduced the associations. Conclusions In older adults, higher resistin levels are associated with CVD events independently of clinical risk factors and metabolic disease markers, but markedly attenuated by inflammation.
Introduction
In 2015, the World Health Organization recommended that all HIV‐infected individuals consider ART initiation as soon as possible after diagnosis. Sex differences in choice of initial ART ...regimen, indications for switching, time to switching and choice of second‐line regimens have not been well described. The aims of this study were to describe first‐line ART and CD4 count at ART initiation by sex, calendar year and region, and to analyse time to change or interruption in first‐line ART, according to sex in each region.
Methods
Participating cohorts included: Southern, East and West Africa (IeDEA‐Africa), North America (NA‐ACCORD), Caribbean, Central/South America (CCASAnet) and Asia‐Pacific including Australia (IeDEA Asia‐Pacific). The primary outcomes analysed for each region and according to sex were choice of initial ART, time to switching and time to discontinuation of the first‐line regimen.
Results and Discussion
The combined cohort data set comprised of 715,252 participants across seven regions from low‐ to high‐income settings. The median CD4 count at treatment initiation was lower in men compared with women in nearly all regions and time periods. Women from North America and Southern Africa were more likely to switch ART compared to men (p < 0.001) with approximately 90% of women reporting a major change after 10 years in North America. Overall, after 8 years on ART, >50% of HIV‐ positive men and women from Southern Africa, East Africa, South and Central America remained on their original regimen. Men were more likely to have a treatment interruption compared with women in low‐ and middle‐income countries from the Asia/Pacific region (p < 0.001) as were men from Southern Africa (p < 0.001). Greater than 75% of men and women did not report a treatment interruption after 10 years on ART from all regions except North America and Southern Africa.
Conclusions
There are regional variations in the ART regimen commenced at baseline and rates of major change and treatment interruption according to sex. Some of this is likely to reflect changes in local and international antiretroviral guideline recommendations but other sex‐specific factors such as pregnancy may contribute to these differences.
OBJECTIVE:--Muscle-strengthening activities (MSAs) may increase insulin sensitivity, thereby reducing the risk of diabetes. The purpose of this study was to assess the relationship between MSAs and ...insulin sensitivity among American adults. RESEARCH DESIGN AND METHODS--We analyzed data on 4,504 adults without diabetes, aged 20-79 years, who participated in the National Health and Nutrition Examination Survey 1999-2004 and had information on MSAs. Self-reported frequency (times/week) of MSAs was grouped as low (<1), moderate (1-2.9), or high (>=3). Insulin sensitivity was measured by the fasting quantitative insulin sensitivity check index x 100 (QUICKI). RESULTS:--After adjustment for age, race/ethnicity, physical activity other than MSAs, BMI, smoking, alcohol consumption, and daily total caloric intake, the mean values for QUICKI by low, moderate, and high MSA were 33.6, 33.9, and 34.2, respectively (P for linear trend = 0.008) for men and 34.2, 34.6, 34.6, respectively (P for linear trend = 0.009) for women. Mean fasting insulin (picomols per liter) concentrations were 75.0, 68.9, and 65.9, respectively (P for linear trend = 0.017) for men and 66.9, 63.3, 61.2, respectively (P for linear trend = 0.007) for women. There were no significant differences across MSA groups for fasting glucose among men or women. CONCLUSIONS:--MSA is independently associated with higher insulin sensitivity among U.S. adults. Efforts to increase MSA may be a realistic, feasible, and effective method of reducing insulin resistance among the U.S. population.
Although physical function decline is common with aging, the burden of this impairment remains underestimated in patients living with HIV (PLHIV), particularly in the older people receiving ...antiretroviral treatment (ART) and living in sub-Saharan Africa (SSA). PLHIV aged ≥50 years old and on ART since ≥6 months were included (N = 333) from three clinics (two in Côte d'Ivoire, one in Senegal) participating in the International epidemiological Databases to Evaluate AIDS (IeDEA) West Africa collaboration. Physical function was measured using the Short Physical Performance Battery (SPPB), the unipodal balance test and self-reported questionnaires. Grip strength was also assessed. Logistic regression was used to identify the factors associated with SPPB performance specifically. Median age was 57 (54-61) years, 57.7% were female and 82.7% had an undetectable viral load. The mean SPPB score was 10.2 ±1.8. Almost 30% had low SPPB performance with the 5-sit-to-stand test being the most altered subtest (64%). PLHIV with low SPPB performance also had significantly low performance on the unipodal balance test (54.2%, p = 0.001) and low mean grip strength (but only in men (p = 0.005)). They also showed some difficulties in daily life activities (climbing stairs, walking one block, both p<0.0001). Age ≥60 years (adjusted OR (aOR) = 3.4; CI95% = 1.9-5.9,), being a female (aOR = 2.1; CI95% = 1.1-4.1), having an abdominal obesity (aOR = 2.1; CI95% = 1.2-4.0), a longer duration of HIV infection (aOR = 2.9; CI95% = 1.5-5.7), old Nucleoside reverse transcriptase inhibitors (NRTIs) (i.e., AZT: zidovudine, ddI: didanosine, DDC: zalcitabine, D4T: stavudine) in current ART (aOR = 2.0 CI95% = 1.1-3.7) were associated with low SPPB performance. As in western countries, physical function limitation is now part of the burden of HIV disease complications of older PLHIV living in West Africa, putting this population at risk for disability. How to screen those impairments and integrate their management in the standards of care should be investigated, and specific research on developing adapted daily physical activity program might be conducted.
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