La estandarización del fenotipo de fragilidad. El estudio de envejecimiento saludable de Toledo

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Medicina Preventiva, Salud Pública y Microbiología. Fecha de lectura: 5-07-201

Поліваріантність ефектів біоактивної води Нафтуся на вегетативну реактивність, їх ендокринний і імунний супровід та можливість прогнозування

Выявлены разнонаправленные изменения (а также отсутствие оных) в результате питьевой монотерапии биоактивной водой Нафтуся вегетативной реактивности у женщин детородного возраста с хронической гинекологически-эндокринной патологией. Прослежены сопутствующие изменения ряда эндокринных и иммунных показателей. Доказана возможность надежного прогнозирования (точность - 92%) типа эффекта по 30 исходным показателям, отобранным методом дискриминантного анализа.Are revealed various changes (and also absence these) as a result of drinking monotherapy by bioactive water Naftussya of vegetative reactivity at the women of reproductive age with chronic ginecological and endocrine pathology. Are investigated accompanying changes of line of endocrine and immune parameters. The opportunity of reliable forecasting (accuracy - 92 %) such as effect on 30 initial parameters selected method of discriminant analysis is proved

Sex Differences in the Association between Serum Levels of Testosterone and Frailty in an Elderly Population: The Toledo Study for Healthy Aging

BACKGROUND: Age-associated decline in testosterone levels represent one of the potential mechanisms involved in the development of frailty. Although this association has been widely reported in older men, very few data are available in women. We studied the association between testosterone and frailty in women and assessed sex differences in this relationship. METHODS: We used cross-sectional data from the Toledo Study for Healthy Aging, a population-based cohort study of Spanish elderly. Frailty was defined according to Fried's approach. Multivariate odds-ratios (OR) and 95% confidence intervals (CI) associated with total (TT) and free testosterone (FT) levels were estimated using polytomous logistic regression. RESULTS: In women, there was a U-shaped relationship between FT levels and frailty (p for FT(2) = 0.03). In addition, very low levels of FT were observed in women with ≥ 4 frailty criteria (age-adjusted geometric means = 0.13 versus 0.37 in subjects with <4 components, p = 0.010). The association of FT with frailty appeared confined to obese women (p-value for interaction = 0.05).In men, the risk of frailty levels linearly decreased with testosterone (adjusted OR for frailty = 2.9 (95%CI, 1.6-5.1) and 1.6 (95%CI, 1.0-2.5), for 1 SD decrease in TT and FT, respectively). TT and FT showed association with most of frailty criteria. No interaction was found with BMI. CONCLUSION: There is a relationship between circulating levels of FT and frailty in older women. This relation seems to be modulated by BMI. The relevance and the nature of the association of FT levels and frailty are sex-specific, suggesting that different biological mechanisms may be involved

Role of sarcopenia in the frailty transitions in older adults: a population‐based cohort study

Abstract Background Frailty and sarcopenia are age‐associated syndromes that have been associated with the risk of several adverse events, mainly functional decline and death, that usually coexist. However, the potential role of one of them (sarcopenia) in modulating some of those adverse events associated to the other one (frailty) has not been explored. The aim of this work is to assess the role of sarcopenia within the frailty transitions and mortality in older people. Methods Data from the Toledo Study of Healthy Aging (TSHA) were used. TSHA is a cohort of community‐dwelling older adults ≥65. Frailty was assessed according with the Frailty Phenotype (FP) and the Frailty Trait Scale‐5 (FTS5) at baseline and at follow‐up. Basal sarcopenia status was measured with the standardized Foundation for the National Institutes of Health criteria. Fisher's exact test and logistic regression model were used to determine if sarcopenia modified the transition of frailty states (median follow‐up of 2.99 years) and Cox proportional hazard model was used for assessing mortality. Results There were 1538 participants (74.73 ± 5.73; 45.51% men) included. Transitions from robustness to prefrailty and frailty according to FP were more frequent in sarcopenic than in non‐sarcopenic participants (32.37% vs. 15.18%, P ≤ 0.001; 5.76% vs. 1.12%; P ≤ 0.001, respectively) and from prefrailty‐to‐frailty (12.68% vs. 4.27%; P = 0.0026). Improvement from prefrail‐to‐robust and remaining robust was more frequent in non‐sarcopenic participants (52.56% vs. 33.80%, P ≤ 0.001; 80.18% vs 61.15%, P ≤ 0.001, respectively). When classified by FTS5, this was also the case for the transition from non‐frail‐to‐frail (25.91% vs. 4.47%, P ≤ 0.001) and for remaining stable as non‐frail (91.25% vs. 70.98%, P ≤ 0.001). Sarcopenia was associated with an increased risk of progression from robustness‐to‐prefrailty [odds ratio (OR) 2.34 (95% confidence interval, CI) (1.51, 3.63); P ≤ 0.001], from prefrailty‐to‐frailty [OR(95% CI) 2.50 (1.08, 5.79); P = 0.033] (FP), and from non‐frail‐to‐frail [OR(95% CI) 4.73 (2.94, 7.62); P‐value ≤ 0.001]. Sarcopenia does not seem to modify the risk of death associated with a poor frailty status (hazard ratios (HR, 95%) P > 0.05). Conclusions Transitions within frailty status, but not the risk of death associated to frailty, are modulated by the presence of sarcopenia

Relationship between Frailty Status and Total and Free Testosterone Concentration, in Men.

<p>Results from Polytomous Regression Analyses.</p>§<p> <i>Adjusted for age, body mass index, educational level, hypertension, hypercholesterolemia, diabetes, history of myocardial infarction and stroke.</i></p><p> <i>Significant differences are highlighted in bold.</i></p

Age-adjusted Geometric Means (GM)^*, Inter Quartile Range (IQR) of Total and Free Testosterone Concentration according to Frailty Status, by Sex.

<p>*<i>Age-adjusted GM were calculated using linear regression.</i></p

Age-adjusted GM^*, IQR value of total and free testosterone according to components and number of components of frailty, in Women.

<p>*<i>Age-adjusted GM were calculated using linear regression.</i></p>§<p> <i>Age-adjusted p-value were calculated using logistic regression.</i></p>#<p> <i>Age-adjusted p-value were calculated using ANOVA.</i></p><p> <i>Significant differences are highlighted in bold.</i></p

Means (standard deviation) of Total and Free Testosterone according to Subject's Sociodemographic and Medical Characteristics, by Sex.

<p>*<i>p-value are calculated from Student t-test or from ANOVA when the covariate had more than 2 categories, Significant differences are highlighted in bold.</i></p

Flow Chart of the Study Sample Selection.

<p>Flow Chart of the Study Sample Selection.</p