Falls amongst older people are common; however, around 40% of falls could be preventable. Medications are known to increase the risk of falls in older adults. The debate about reducing the number of ...prescribed medications remains controversial, and more evidence is needed to understand the relationship between polypharmacy and fall-related hospital admissions. We examined the effect of polypharmacy on hospitalization due to a fall, using a large nationally representative sample of older adults.
Data from the English Longitudinal Study of Ageing (ELSA) were used. We included 6220 participants aged 50+ with valid data collected between 2012 and 2018.The main outcome measure was hospital admission due to a fall. Polypharmacy -the number of long-term prescription drugs- was the main exposure coded as: no medications, 1-4 medications, 5-9 medications (polypharmacy) and 10+ medications (heightened polypharmacy). Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for common confounders, including multi-morbidity and fall risk-increasing drugs.
The prevalence of people admitted to hospital due to a fall increased according to the number of medications taken, from 1.5% of falls for people reporting no medications, to 4.7% of falls among those taking 1-4 medications, 7.9% of falls among those with polypharmacy and 14.8% among those reporting heightened polypharmacy. Fully adjusted SHRs for hospitalization due to a fall among people who reported taking 1-4 medications, polypharmacy and heightened polypharmacy were 1.79 (1.18; 2.71), 1.75 (1.04; 2.95), and 3.19 (1.61; 6.32) respectively, compared with people who were not taking medications.
The risk of hospitalization due to a fall increased with polypharmacy. It is suggested that prescriptions in older people should be revised on a regular basis, and that the number of medications prescribed be kept to a minimum, in order to reduce the risk of fall-related hospital admissions.
Abstract Background and aims Benefits of Mediterranean diet on MetS risk have been suggested, but overall prospective evidence in the general population is limited. For the first time, the ...prospective association of adherence to Mediterranean diet with the 6-y risk of MetS and its components was evaluated in a large cohort in Europe. Methods and results Subjects included were participants from the Supplémentation en Vitamines et Minéraux AntioXydants (SU.VI.MAX) study. Adherence to Mediterranean diet was assessed using traditional Mediterranean diet score (MDS), an updated Mediterranean score (MED) and Mediterranean style-dietary pattern score (MSDPS) calculated from at least three 24-h records. In 3232 subjects, the association between Mediterranean diet scores and 6-y risk of MetS was evaluated. The association between Mediterranean scores and MetS components was also estimated. A lower risk of MetS was observed with increasing MED score ( P -trend = 0.001) and MDS ( P -trend = 0.03) in multivariate models. The adjusted odds ratios (95% Confidence Interval) for MetS risk were 0.47 (0.32–0.69) and 0.50 (0.32–0.77) in subjects in the highest versus lowest tertile of MED score and MDS, respectively. The MED score was inversely associated with waist circumference, systolic blood pressure and triglycerides, and directly associated with HDL-cholesterol. The MDS was negatively associated with waist circumference and triglycerides, and MSDPS was positively associated with HDL-cholesterol. Conclusions All Mediterranean diet scores were associated in a potentially beneficial direction with components of MetS or MetS incidence. Our findings support that individuals should be encouraged to follow a Mediterranean dietary pattern for reduction of MetS risk. Trial Registration: clinicaltrials.gov Identifier: NCT00272428.
The relationship between diet quality and development of obesity is complex and unresolved. The aim of this study was to assess and compare the predictive value of six different dietary scores on ...both relative weight change and the risk of obesity after 13 years of follow-up in adults aged 45 years and older.
Six scores reflecting adherence to different nutritional recommendations (the French Programme National Nutrition Santé-Guideline Score (PNNS-GS), the Dietary Guidelines for Americans Index (DGAI), the Diet Quality Index-International (DQI-I), the Mediterranean Diet Scale (MDS), the relative Mediterranean Diet Score (rMED) and the Mediterranean Style Dietary Pattern Score (MSDPS)) were estimated in 3151 participants in the French SU.VI.MAX (SUpplémentation en VItamines et Minéraux AntioXydants) study. Associations of dietary scores with 13-year weight change were assessed through multivariate linear regression models, and obesity risk was analyzed with logistic regression, providing odds ratios (OR) and 95% confidence intervals (CI).
Except for the MSDPS, higher scores, that is, better adherence to nutritional guidelines or to a Mediterranean diet, were associated with lower weight gain in men (all P-value for trend <0.05). In addition, among men, ORs for becoming obese after 13 years associated with a 1 s.d. increase in dietary scores ranged from 0.63, 95% CI: 0.51, 0.78 for DGAI to 0.72, 95% CI: 0.59, 0.88 for MDS. These associations were weaker or not statistically significant in women.
Overall, the six dietary scores predicted obesity risk equally well. Among French adults, strong adherence to dietary guidelines appears to be protective with regard to weight gain and obesity, especially in men.
High-protein (HP) diets exert a hypercalciuric effect at constant levels of calcium intake, even though the effect may depend on the nature of the dietary protein. Lower urinary pH is also ...consistently observed for subjects consuming HP diets. The combination of these two effects was suspected to be associated with a dietary environment favorable for demineralization of the skeleton. However, increased calcium excretion due to HP diet does not seem to be linked to impaired calcium balance. In contrast, some data indicate that HP intakes induce an increase of intestinal calcium absorption. Moreover, no clinical data support the hypothesis of a detrimental effect of HP diet on bone health, except in a context of inadequate calcium supply. In addition, HP intake promotes bone growth and retards bone loss and low-protein diet is associated with higher risk of hip fractures. The increase of acid and calcium excretion due to HP diet is also accused of constituting a favorable environment for kidney stones and renal diseases. However, in healthy subjects, no damaging effect of HP diets on kidney has been found in either observational or interventional studies and it seems that HP diets might be deleterious only in patients with preexisting metabolic renal dysfunction. Thus, HP diet does not seem to lead to calcium bone loss, and the role of protein seems to be complex and probably dependent on other dietary factors and the presence of other nutrients in the diet.
Obesity is subject to strong family clustering. The relatives of participants in weight-loss interventions may also modify their lifestyle and lose weight. The aim of this study was to examine the ...presence and magnitude of a halo effect in untreated family members of participants enrolled in a randomized, multi-component, lifestyle intervention.
A total of 148 untreated adult family members of participants in an intensive weight-loss lifestyle intervention (the PREDIMED-Plus study) were included. Changes at 1 and 2 years in body weight, physical activity, and adherence to a traditional Mediterranean diet (MedDiet) were measured. Generalized linear mixed models were used to assess whether the change differed between family members of the intervention group compared to the control.
Untreated family members from the intervention group displayed a greater weight loss than those from the control after 1 and 2 years: adjusted 2-year weight change difference between groups was -3.98 (SE 1.10) kg (p < 0.001). There was a halo effect with regard to adherence to the MedDiet at one year which was sustained at two years: 2-year adjusted difference in MedDiet score change +3.25 (SE 0.46) (p < 0.001). In contrast, no halo effect was observed with regard to physical activity, as the untreated family members did not substantially modify their physical activity levels in either group, and the adjusted difference at two years between the 2 groups was -272 (SE 624) METs.min/week (p = 0.665).
In the first prospective study to assess the influence on untreated family members of a diet and physical activity weight-loss intervention, we found evidence of a halo effect in relatives on weight loss and improvement in adherence to a MedDiet, but not on physical activity. The expansion of MedDiet changes from individuals involved in a weight-loss intervention to their family members can be a facilitator for obesity prevention.
There is a dearth of knowledge about the foods that Australian adults eat and a need for a flexible, easy-to-use tool that can estimate usual dietary intakes. The present study was to validate a ...commonly used Australian Commonwealth Scientific and Industrial Research Organisation (CSIRO) food-frequency questionnaire (C-FFQ) against two 4-day weighed food records (WFR), as the reference method. The C-FFQ, as the test item, was administrated before the WFR. Two 4-day WFR were administrated 4 weeks apart. Under-reporting was established using specific cut-off limits and estimated basal metabolic rate. Seventy-four women, aged 31-60 years, were enrolled from a free-living community setting. After exclusion for under-reporting, the final sample comprised 62 individuals. Correlations between protein intake from the WFR and urinary urea were significant. Overall agreement between FFQ and WFR was shown by 'levels of agreement' (LOA) and least products regressions. There was presence of fixed and proportional bias for almost half the nutrients, including energy, protein, fat and carbohydrates. For most of the nutrients that did not present bias, the LOA were 50-200%. Agreement was demonstrated for percentage dietary energy protein and fat; carbohydrate; and absolute amounts of thiamine, riboflavin, magnesium and iron. However, relative intake agreement was fair to moderate, with approximately 70% of (selected) nutrients exact or within ±1 quintile difference. The C-FFQ is reasonable at measuring percentage energy from macronutrients and some micronutrients, and comprises a valuable tool for ranking intakes by quintiles; however, it is poor at measuring many absolute nutrient intakes relative to WFR.
Abstract
Aims
The hypothesis of ‘metabolically healthy obesity’ implies that, in the absence of metabolic dysfunction, individuals with excess adiposity are not at greater cardiovascular risk. We ...tested this hypothesis in a large pan-European prospective study.
Methods and results
We conducted a case-cohort analysis in the 520 000-person European Prospective Investigation into Cancer and Nutrition study (‘EPIC-CVD’). During a median follow-up of 12.2 years, we recorded 7637 incident coronary heart disease (CHD) cases. Using cut-offs recommended by guidelines, we defined obesity and overweight using body mass index (BMI), and metabolic dysfunction (‘unhealthy’) as ≥ 3 of elevated blood pressure, hypertriglyceridaemia, low HDL-cholesterol, hyperglycaemia, and elevated waist circumference. We calculated hazard ratios (HRs) and 95% confidence intervals (95% CI) within each country using Prentice-weighted Cox proportional hazard regressions, accounting for age, sex, centre, education, smoking, diet, and physical activity. Compared with metabolically healthy normal weight people (reference), HRs were 2.15 (95% CI: 1.79; 2.57) for unhealthy normal weight, 2.33 (1.97; 2.76) for unhealthy overweight, and 2.54 (2.21; 2.92) for unhealthy obese people. Compared with the reference group, HRs were 1.26 (1.14; 1.40) and 1.28 (1.03; 1.58) for metabolically healthy overweight and obese people, respectively. These results were robust to various sensitivity analyses.
Conclusion
Irrespective of BMI, metabolically unhealthy individuals had higher CHD risk than their healthy counterparts. Conversely, irrespective of metabolic health, overweight and obese people had higher CHD risk than lean people. These findings challenge the concept of ‘metabolically healthy obesity’, encouraging population-wide strategies to tackle obesity.
Les profils nutritionnels, par l’attribution à chaque aliment d’un score de qualité nutritionnelle à partir de leur composition en macro- et micronutriments, permettent d’évaluer la qualité ...nutritionnelle des aliments au-delà de leur catégorisation au sein de groupes alimentaires définis par les recommandations nutritionnelles.
L’objectif était d’étudier les associations entre un score alimentaire individuel développé à partir du score de qualité nutritionnelle des aliments développé par la Food Standard Agency britannique (score FSA) et les consommations en aliments et nutriments des individus, le score d’adéquation aux recommandations du Programme National Nutrition Santé (score PNNS), et les biomarqueurs du statut nutritionnel.
Les données alimentaires étaient collectées via des enregistrements de 24 heures parmi les participants de l’étude SU.VIMAX en 1994–1996 (N=5 882). Les biomarqueurs de statut nutritionnel étaient collectés de manière standardisée au début de l’étude chez des sujets à jeun.
Le score FSA était calculé pour chaque aliments et boisson consommés. Les scores FSA de chaque aliment consommé ont été pondérés par l’apport énergétique provenant de l’aliment, et un score agrégé au niveau individuel a été calculé (score FSA-individu).
Les associations entre consommations alimentaires, apports nutritionnels, score PNNS, statut nutritionnel biologique et FSA-NPS-DI ont été étudiées par ANOVAs.
Le score FSA-individu permettait de discriminer la qualité de l’alimentation des sujets en termes d’apports en nutriments, en particulier la vitamine C (−29,7 % entre le premier quartile (le plus favorable) et le dernier quartile (le moins favorable) de score FSA-individu, P<0,001) β-carotène (−27,0 %, P<0,001) et fibres (−26,7 %, P<0,001).
L’adéquation aux recommandations du PNNS différait selon le score FSA-tant au niveau de l’adéquation globale (−17 %, P<0,001) que par recommandation : 73 % des sujets atteignaient la recommandation pour les fruits et légumes dans le quartile 1 vs. 43 % dans le quartile 4, P<0,001 ; 48% dans le quartile 1 pour la recommandation concernant le poisson vs. 33 % dans le quartile 4, P < 0,001.
Le score FSA-individu était également corrélé négativement au statut biologique en antioxydants : 9,31μmol/l dans le quartile 1 vs. 8,25μmol/l dans le quartile 4 pour la vitamine C, P<0,001, 1,11μmol/l vs. 1,08μmol/l pour le sélénium, P<0,001, 0,51μmol/l vs. 0,42μmol/l pour le (3-carotène, P<0,001. Le score FSA-individu était aussi associé au LDL-cholestérol : 3,68 mmol/l dans le quartile 1 vs. 3,62 mmol/l dans le quartile 4, P=0,04. Le cholestérol total, HDL-cholesterol, triglycérides et glycémie n’étaient pas significativement associés au score FSA-individu.
Le score FSA-individu s’avère être un outil permettant de discriminer la qualité nutritionnelle de l’alimentation des individus. Il est complémentaire aux scores fondés sur l’adéquation aux recommandations nutritionnelles, car il permet d’appréhender la variabilité nutritionnelle des aliments au sein des groupes alimentaires eux-mêmes.
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