Long-term gait measurements in daily life: Results from the Berlin Aging Study II (BASE-II)

BACKGROUND: Walking ability is an important prerequisite for activity, social participation and independent living. While in most healthy adults, this ability can be assumed as given, limitations in walking ability occur with increasing age. Furthermore, slow walking speed is linked to several chronic conditions and overall morbidity. Measurements of gait parameters can be used as a proxy to detect functional decline and onset of chronic conditions. Up to now, gait characteristics used for this purpose are measured in standardized laboratory settings. There is some evidence, however, that long-term measurements of gait parameters in the living environment have some advantages over short-term laboratory measurements. METHODS: We evaluated cross-sectional data from an accelerometric sensor worn in a subgroup of 554 participants of the Berlin Aging Study II (BASE-II). Data from the two BASE-II age groups (age between 22-36 years and 60-79 years) were used for the current analysis of accelerometric data for a minimum of two days and a maximum of ten days were available. Real world walking speed, number of steps, maximum coherent distance and total distance were derived as average data per day. Linear regression analyses were performed on the different gait parameters in order to identify significant determinants. Additionally, Mann-Whitney-U-tests were performed to detect sex-specific differences. RESULTS: Age showed to be significantly associated with real world walking speed and with the total distance covered per day, while BMI contributed negatively to the number of walking steps, maximum coherent distance and total distance walked. Additionally, sex was associated with walking steps. However, R2-values for all models were low. Overall, women had significantly more walking steps and a larger coherent distance per day when compared to men. When separated by age group, this difference was significant only in the older participants. Additionally, walking speed was significantly higher in women compared to men in the subgroup of older people. CONCLUSIONS: Age- and sex-specific differences have to be considered when objective gait parameters are measured, e.g. in the context of clinical risk assessment. For this purpose normative data, differentiating for age and sex would have to be established to allow reliable classification of long-term measurements of gait

Low muscle strength and increased arterial stiffness go hand in hand

Low handgrip strength and increased arterial stiffness are both associated with poor health outcomes, but evidence on the relationship between handgrip strength and arterial stiffness is limited. In this cross-sectional analysis of combined baseline datasets from the LipidCardio and Berlin Aging Study II cohorts we aimed to examine whether handgrip strength (HGS) is associated with arterial stiffness. 1511 participants with a median age of 68.56 (IQR 63.13-73.08) years were included. Arterial stiffness was assessed by aortal pulse wave velocity (PWV) with the Mobil-O-Graph device. Handgrip strength was assessed with a handheld dynamometer.The mean HGS was 39.05 +/- 9.07 kg in men and 26.20 +/- 7.47 kg in women. According to multivariable linear regression analysis per 5 kg decrease in handgrip strength there was a mean increase in PWV of 0.08 m/s after adjustment for the confounders age, sex, coronary artery disease, systolic blood pressure, body mass index, cohort, and smoking. Thus, there was evidence that low handgrip strength and increased arterial stiffness go hand in hand. Arterial stiffness can possibly create the missing link between low handgrip strength and increased cardiovascular morbidity and mortality. Causality and direction of causality remain to be determined

Vitamin D insufficiency is associated with metabolic syndrome independent of insulin resistance and obesity in young adults ‐ The Berlin Aging Study II

Purpose: Age-related changes affect vitamin D absorption and metabolism. Low 25-hydroxyvitamin D concentrations have been reported as risk factor for the development of metabolic syndrome (MetS). However, recent evaluations suggest this association might be explained by obesity or insulin resistance (IR) in subjects with MetS. Our aim was to analyze associations between vitamin D insufficiency and MetS in a young cohort without diabetes and two senior cohorts with and without diabetes. Methods: Four hundred sixteen young and 1357 older BASE-II participants were analyzed. Type 2 diabetes (T2D) was defined according to European Society of Cardiology (ESC) guidelines, MetS as suggested by International Diabetes Federation/American Heart Association/National Heart, Lung and Blood Institute (IDF/AHA/NHLBI 2009). Vitamin D insufficiency was defined as 25-hydroxyvitamin D concentrations <50 nmol/L. Among other confounders, BMI and IR were taken into account. Results: MetS was prevalent in 7.7% of the young and in 35.6% of the older BASE-II participants and T2D occurred in 12.7% of the older participants. In young subjects without diabetes, vitamin D insufficiency was associated with an independent 3.2-fold increased odds of having MetS (OR: 3.2 CI: 1.0-8.7; p = 0.042). However, in the older participants, this association was lost once BMI was taken into account among those with diabetes, and once IR was taken into account among those without diabetes. Conclusion: Independent associations between vitamin D insufficiency and MetS were only found among young subjects without diabetes. In the older adults, BMI annihilated these associations among subjects without diabetes as did HOMA-IR among subjects with diabetes

Hyperlipidemias in elderly patients: results from the Berlin Aging Study II (BASEII), a cross-sectional study

Background: Hyperlipidemias are common and the last decades have seen substantially growing evidence of their causative role in the development of atherosclerosis and subsequent cardiovascular diseases. Since hyperlipidemias usually do not cause direct clinical symptoms, they often remain undiagnosed until a serious cardiovascular event occurs. Especially for LDL-hypercholesteremia, there are well-established treatment options available to prevent the occurrence of atherosclerosis. However, there is a lack of knowledge regarding the proper treatment of elderly patients. The goal of this study was to assess the prevalence of hyperlipidemia in a group of young and a group of elderly community-dwelling participants and to determine to what extent treatment of hyperlipidemia should be initiated or required. Methods: Crossectional data from a total of 2151 subjects (1657 in the elderly group, mean age 69, and 494 in the young group (control group), mean age 29) of the Berlin Aging Study II (BASE-II) were available. Medical history was assessed and recorded by trained physicians and prevalence of lipid disorders was determined with laboratory tests, including a lipid-profile. Results: A large proportion of subjects (39%) were unaware of an existing lipid disorder. The prevalence of hyperlipidemia was more frequent in the elderly group (76%) compared to the young group (41%). Hypercholesterolemia was the most common diagnosed disorder (64%), followed by hyperlipoproteinemia(a) (18%), hypertriglyceridemia (7%) and combined hyperlipoproteinaemia (5%). Only a minority of this cohort was treated with lipid-lowering medication (17%) and of those treatment targets according to ESC guidelines were reached only in 16.5 %. Conclusions: Hyperlipidemias appear underdiagnosed and undertreated. As the prevalence of these disorders increases with age and with regard to their role as a major modifiable risk factor for cardiovascular disease it seems to be advisable to aim for more consistent and sustainable screening and treatment of these common disorders. Trial registration: BASE-II registered with the clinical trial registry Deutsches Register Klinischer Studien (DRKS00009277)

Higher Lipoprotein (a) Levels Are Associated with Better Pulmonary Function in Community-Dwelling Older People - Data from the Berlin Aging Study II

Reduced pulmonary function and elevated serum cholesterol levels are recognized risk factors for cardiovascular disease. Currently, there is some controversy concerning relationships between cholesterol, LDL-cholesterol, HDL-cholesterol, serum triglycerides and lung function. However, most previous studies compared patients suffering from chronic obstructive pulmonary disease (COPD) with healthy controls, and only a small number examined this relationship in population-based cohorts. Moreover, lipoprotein a [Lp(a)], another lipid parameter independently associated with cardiovascular diseases, appears not to have been addressed at all in studies of lung function at the population level. Here, we determined relationships between lung function and several lipid parameters including Lp(a) in 606 older community-dwelling participants (55.1% women, 68±4 years old) from the Berlin Aging Study II (BASE-II). We found a significantly lower forced expiration volume in 1 second (FEV1) in men with low Lp(a) concentrations (t-test). This finding was further substantiated by linear regression models adjusting for known covariates, showing that these associations are statistically significant in both men and women. According to the highest adjusted model, men and women with Lp(a) levels below the 20th percentile had 217.3ml and 124.2ml less FEV1 and 239.0ml and 135.2ml less FVC, respectively, compared to participants with higher Lp(a) levels. The adjusted models also suggest that the known strong correlation between pro-inflammatory parameters and lung function has only a marginal impact on the Lp(a)-pulmonary function association. Our results do not support the hypothesis that higher Lp(a) levels are responsible for the increased CVD risk in people with reduced lung function, at least not in the group of community-dwelling older people studied here

Correction: Long-term gait measurements in daily life: Results from the Berlin Aging Study II (BASE-II)

[This corrects the article DOI: 10.1371/journal.pone.0225026.]

Relationship between Lipoprotein (a) and cognitive function – Results from the Berlin Aging Study II

It has been suggested that an age-related loss of cognitive function might be driven by atherosclerotic effects associated with altered lipid patterns. However, the relationship between Lipoprotein (a) [Lp(a)] and healthy cognitive aging has not yet been sufficiently investigated. For the current analysis we used the cross-sectional data of 1,380 Berlin Aging Study II (BASE-II) participants aged 60 years and older (52.2% women, mean age 68 ± 4 years). We employed the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD)-Plus test battery to establish latent factors representing continuous measures of domain specific cognitive functions. Regression models adjusted for APOE genotypes, lipid parameters and other risk factors for cognitive impairment were applied to assess the association between Lp(a) and performance in specific cognitive domains. Men within the lowest Lp(a)-quintile showed better cognitive performance in the cognitive domain executive functions and processing speed (p = 0.027). No significant results were observed in women. The results of the current analysis of predominantly healthy BASE-II participants point towards an association between low Lp(a) concentrations and better cognitive performance. However, evidence for this relationship resulting from the current analysis and the employment of a differentiated cognitive assessment is rather weak

Self-reported sleep relates to hippocampal atrophy across the adult lifespan: results from the Lifebrain consortium.

OBJECTIVES: Poor sleep is associated with multiple age-related neurodegenerative and neuropsychiatric conditions. The hippocampus plays a special role in sleep and sleep-dependent cognition, and accelerated hippocampal atrophy is typically seen with higher age. Hence, it is critical to establish how the relationship between sleep and hippocampal volume loss unfolds across the adult lifespan. METHODS: Self-reported sleep measures and MRI-derived hippocampal volumes were obtained from 3105 cognitively normal participants (18-90 years) from major European brain studies in the Lifebrain consortium. Hippocampal volume change was estimated from 5116 MRIs from 1299 participants for whom longitudinal MRIs were available, followed up to 11 years with a mean interval of 3.3 years. Cross-sectional analyses were repeated in a sample of 21,390 participants from the UK Biobank. RESULTS: No cross-sectional sleep-hippocampal volume relationships were found. However, worse sleep quality, efficiency, problems, and daytime tiredness were related to greater hippocampal volume loss over time, with high scorers showing 0.22% greater annual loss than low scorers. The relationship between sleep and hippocampal atrophy did not vary across age. Simulations showed that the observed longitudinal effects were too small to be detected as age-interactions in the cross-sectional analyses. CONCLUSIONS: Worse self-reported sleep is associated with higher rates of hippocampal volume decline across the adult lifespan. This suggests that sleep is relevant to understand individual differences in hippocampal atrophy, but limited effect sizes call for cautious interpretation

an investigation within the Berlin Aging Study-II (BASE-II)

Einleitung: Frühere Studien geben Hinweise darauf, dass es gemeinsame Pathomechanismen bei der Entstehung von pulmonaler Obstruktion und metabolischem Syndrom geben könnte. Einer dieser Verknüpfungspunkte könnte die systemische Inflammation darstellen. Ziel der Datenanalyse innerhalb der Berliner Altersstudie II war es, gemeinsame Faktoren von pulmonaler Obstruktion und dem metabolischen Syndrom herauszufinden. Methoden: Insgesamt wurden 1075 Probanden untersucht (Frauen = 57%, Männer = 43%, junge Probanden = 218, alte Probanden = 857). Pulmonale Obstruktion wurde durch prä- bronchodilatatorische Spirometrie erhoben und jeweils gemäß der Empfehlungen der Deutschen Atemwegsliga (DAL), nach den Kriterien der GOLD-Initiative und altersadaptiert wie durch Hardie et al. beschrieben diagnostiziert. Die Definition des metabolischen Syndroms erfolgte nach den 2009 erschienenen Kriterien der IDF/AHA/NHLBI. Ergebnisse: 43,5% unserer spirometrischer Messungen erfüllten die GOLD-Kriterien eines guten Qualitätsgrades. Die Prävalenz einer pulmonalen Obstruktion war je nach angewandter Definition zwischen 7,3-21,3% bei den älteren Probanden, 5% bei den jüngeren Probanden, unabhängig von der jeweiligen Definition. Die Prävalenz des metabolischen Syndroms befand sich bei älteren Probanden im Bereich zwischen 29,7% bei Frauen, 37,2% bei Männer und 13,3% bei Männern in der jungen Probandengruppe (0% in der Gruppe der jungen Frauen). Die Prävalenz des metabolischen Syndroms lag bei knapp 40% bei älteren Probanden mit pulmonaler Obstruktion. Diverse Faktoren des metabolischen Syndroms konnten in dieser Arbeit in Verbindung mit pulmonaler Obstruktion bzw. Lungenvolumina gebracht werden, insbesondere Triglyceridspiegel, Nüchternglukosespiegel und abdominelle Adipositas bei älteren Männern. Schlussfolgerung: Innerhalb der Auswertung im Rahmen der Berliner Altersstudie II sahen wir eine hohe Prävalenz des metabolischen Syndroms bei Probanden mit pulmonaler Obstruktion. Ein Screening von Personen mit pulmonaler Obstruktion auf metabolisches Syndrom könnte ein sinnvolles Werkzeug darstellen, um kardiale Erkrankungen zu verhindern. Im weiteren Verlauf wird bei der longitudinalen Betrachtung der Studienteilnehmer innerhalb der Berliner Altersstudie II interessant sein, wie sich diese Faktoren im höheren Alter verändern.Introduction: Earlier studies suggested a common pathomechanism for the metabolic syndrome (MetS) and airflow obstruction (AO). One of several causal links is systemic inflammation. One of the aims within the Berlin Aging Study II was to detect common aspects of the MetS and AO. Method: A total of 1075 subjects were analyzed (women= 57%, men=43%, 218 young, 857 old). AO was detected by pre-bronchodilatator spirometry and diagnosed according to the LLN-criteria (FEV1/FVC<LLN), GOLD-criteria (FEV1/FVC<70%) and the age-adjusted Hardie-criteria. MetS was diagnosed according to the IDF/AHA/NHLB criteria (2009). Results: 43.5% of our measurements met the GOLD spirometry quality criteria. The prevalence of AO within the older group was between 7.3% and 21.3% depending on the criteria used and 5% within the younger group (criteria independent). The prevalence of MetS was 29.7% in older women and 37.2% in older men, and 13.3% in younger men (0% in women). The prevalence of MetS was nearly 40% in older subjects with AO. Several characteristics of MetS such as triglyceride levels, fasting glucose levels and abdominal obesity were found to be significantly associated with the diagnosis of AO in men. Conclusion: Prevalence of MetS and AO was high in subjects of the Berlin Aging Study II. Determinants of the MetS could be shown to be also associated with AO. Screening subjects with AO for MetS could be a sufficient tool to prevent cardiac disease. In the longitudinal view changes in lungfunction and metabolic parameters will be interesting topics

T cell phenotypes associated with insulin resistance: results from the Berlin Aging Study II

Background: Obesity is associated with chronic low-grade inflammation leading to metabolic and cardiovascular diseases, but a subset of obese individuals is considered insulin sensitive (IS). The underlying pathophysiologic mechanisms remain elusive and clinical studies on the relationship between inflammatory markers and metabolically healthy obesity (MHO) are scarce. Methods: In this cross-sectional analysis, we included a sample of 437 older participants (60-84 years) from the Berlin Aging Study II (BASE-II). Peripheral blood mononuclear cells were isolated, immune cell subsets were analyzed with multiparameter flow cytometry and systemic cytokine levels were measured. Immune cell parameters were correlated with metabolic measures and multiple linear regression analysis was conducted and adjusted for various demographic and clinical factors. Results: We found that frequencies of naive and memory CD4(+) and CD8(+) T cells inversely correlated with measures for insulin sensitivity in the older population. Moreover, the percentages of naive CD4(+) and CD8(+) T cells were significantly higher, whereas activated T cells and IL-6 levels were lower in IS compared to insulin resistant (IR) obese individuals. The percentages of naive CD4(+) and CD8(+) T cells were predictive for impaired insulin sensitivity (ss = 0.16, p = 0.01 and ss = 0.11, p = 0.04), and the association of naive CD4(+) T cells with insulin sensitivity persisted after multivariate adjustment (ss = 0.14, p = 0.02). Conclusions: These findings support the hypothesis that parameters of systemic inflammation can differentiate IS from IR obese individuals that are at higher risk for cardiometabolic diseases and may have clinical implications with regard to obesity treatment stratification