Sex Differences in Vitamin D Status as a Risk Factor for Incidence of Disability in Instrumental Activities of Daily Living: Evidence from the ELSA Cohort Study

Vitamin D deficiency compromises elements underlying the disability process; however, there is no evidence demonstrating the association between vitamin D deficiency and the incidence of disability in instrumental activities of daily living (IADL). We investigated the association between vitamin D deficiency and the risk of incidence of IADL disability separately in men and women. A total of 4768 individuals aged ≥50 years from the English Longitudinal Study of Aging (ELSA) and without IADL disability according to the Lawton scale were available. Vitamin D was evaluated at baseline by serum 25(OH)D concentrations and classified as sufficient (>50 nmol/L), insufficient (>30 to ≤50 nmol/L) or deficient serum (≤30 nmol/L). IADL were reassessed after 4 years. Poisson models stratified by sex and controlled by covariates demonstrated that deficient serum 25(OH)D was a risk factor for the incidence of IADL disability in men (IRR: 1.43; 95% CI 1.02, 2.00), but not in women (IRR: 1.23; 95% CI 0.94, 1.62). Men appear to be more susceptible to the effect of vitamin D deficiency on the incidence of IADL disability, demonstrating the importance of early clinical investigation of serum 25(OH)D concentrations to prevent the onset of disability

Is dynapenic abdominal obesity a risk factor for cardiovascular mortality? A competing risk analysis

BACKGROUND: Dynapenic abdominal obesity has been shown as a risk factor for all-cause mortality in older adults. However, there is no evidence on the association between this condition and cardiovascular mortality. OBJECTIVE: We aimed to investigate whether dynapenic abdominal obesity is associated with cardiovascular mortality in individuals aged 50 and older. METHODS: A longitudinal study with an 8-year follow-up was conducted involving 7,030 participants of the English Longitudinal Study of Ageing study. Abdominal obesity and dynapenia were respectively defined based on waist circumference (> 102 cm for men and > 88 cm for women) and grip strength (< 26 kg for men and < 16 kg for women). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO). The outcome was cardiovascular mortality. The Fine-Grey regression model was used to estimate the risk of cardiovascular mortality as a function of abdominal obesity and dynapenia status in the presence of competing events controlled by socio-demographic, behavioural and clinical variables. RESULTS: The risk of cardiovascular mortality was significantly higher in individuals with D/AO compared with ND/NAO (SHR 1.85; 95% CI: 1.15-2.97). D/NAO was also associated with cardiovascular mortality (SHR: 1.62; 95% CI: 1.08-2.44). CONCLUSION: Dynapenic abdominal obesity is associated with cardiovascular mortality, with a larger effect size compared to dynapenia alone in individuals older than 50 years. Thus, prevention strategies and clinical interventions that enable mitigating the harmful effects of these conditions should be adopted to diminish such risk

Combination of dynapenia and abdominal obesity affects long-term physical performance trajectories in older adults: Sex differences

BACKGROUND: There is little epidemiological evidence of sex differences in the association between dynapenic abdominal obesity and the decline in physical performance among older adults. OBJECTIVE: The aims of the present study were to investigate whether the decline in physical performance is worse in individuals with dynapenic abdominal obese and whether there are sex differences in this association. METHODS: Out of 6,183 individuals aged 60 years or older from the English Longitudinal Study of Ageing, 2,308 participants with missing data were excluded. Therefore, a longitudinal analysis was conducted with 3,875 older adults. Abdominal obesity was determined based on waist circumference (>102 cm for male and >88 cm for female) and dynapenia was based on grip strength (<26 kg for male <16 kg for female). The sample was divided into four groups: non-dynapenic/non-abdominal obesity (ND/NAO), non-dynapenic/abdominal obesity (ND/AO), dynapenic/non-abdominal obesity (D/NAO) and dynapenic/abdominal obesity (D/AO). Decline in physical performance in an eight-year follow-up period was analyzed using generalized linear mixed models. RESULTS: At baseline, both male (-1.11 points; 95% CI: -1.58, -0.65; p <0.001) and female (-1.39 points; 95% CI: -1.76, -1.02; p <0.001) with D/AO had worse performances on the Short Physical Performance Battery (SPPB) than their counterparts in the ND/NAO group. Over the eight-year follow-up, male with D/AO had a faster rate of decline in the SPPB performance compared to male in the ND/NAO group (-0.11 points per year; 95% CI: -0.21, -0.01; p = 0.03). CONCLUSION: D/AO is associated with a stronger decline in physical performance in male but not female. The identification and management of dynapenic abdominal obesity may be essential to avoiding the first signs of functional impairment in older male

Are Serum 25-Hydroxyvitamin D Deficiency and Insufficiency Risk Factors for the Incidence of Dynapenia?

Epidemiological evidence showing the association between low 25(OH)D and age-related reduction in neuromuscular strength (dynapenia) is a paucity and controversial and, to date, the effect of osteoporosis and vitamin D supplementation on these associations has not been measured. Thus, we analyze whether serum 25(OH)D deficiency and insufficiency are risk factors for the incidence of dynapenia in individuals aged 50 or older and whether osteoporosis or vitamin D supplementation modify these associations. For that, 3205 participants of the ELSA study who were non-dynapenic at baseline were followed for 4 years. Vitamin D was measured at baseline by the serum concentration of 25(OH)D and classified as sufficient (> 50 nmol/L), insufficient (≥ 30 and ≤ 50 nmol/L) or deficient (< 30 nmol/L). The incidence of dynapenia was determined by a grip strength < 26 kg for men and < 16 kg for women at the end of the 4-year follow-up. Poisson regression models were adjusted by sociodemographic, behavioral, clinical and biochemical characteristics. Serum 25(OH)D deficient was a risk factor for the incidence of dynapenia (IRR = 1.70; 95% CI 1.04-2.79). When only individuals without osteoporosis and those who did not use vitamin D supplementation were analyzed, both serum 25(OH)D deficiency (IRR = 1.78; 95% CI 1.01-3.13) and insufficiency (IRR = 1.77; 95% CI 1.06-2.94) were risk factors for the incidence of dynapenia. In conclusion, a serum level of 25(OH)D < 30 nmol/L is a risk factor for the incidence of dynapenia. Among individuals without osteoporosis and those who do not take vitamin D supplementation, the threshold of risk is higher (≤ 50 nmol/L)

Perceived health and its relationship with the outcomes syndrome fragility

Orientador: Maria José D'ElbouxDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Objetivo: Analisar a saúde percebida (SP) e as associações com a síndrome da fragilidade e seus desfechos, avaliadas em idosos atendidos em um serviço de geriatria de um hospital escola do município de Campinas, SP. Metodologia: Trata-se de um estudo quantitativo, comparativo e com delineamento longitudinal realizado em dois momentos. Na fase 1 (2005-2007), participaram do estudo 150 idosos em acompanhamento ambulatorial. Na fase 2 (2013), os idosos foram contatados, sendo 54 deles submetidos a uma reavaliação. Em ambas as fases, o fenótipo de fragilidade foi avaliado de acordo com o modelo de Fried et al., com algumas adaptações, levando-se em consideração os seguintes componentes: atividade física, perda de peso não intencional, preensão manual, velocidade de marcha e fadiga. A SP foi avaliada pelas seguintes opções de respostas: ruim, mais ou menos e boa. Resultado: A amostra tem predomínio do sexo feminino (64%) e idade igual ou superior a 80 anos (33,33%). A fase 2 apresentou um aumento do número de idosos com perfil de fragilidade (88,87%) quando comparada com a fase inicial da pesquisa (53,33%). Na fase 1, 85,79% dos idosos pré-frágeis avaliaram sua SP como "mais ou menos" ou "boa". Já na fase 2, 83,87% dos idosos frágeis avaliaram sua saúde como "mais ou menos". Ocorreu diferença estatística na fase 1 para SP "ruim" nos componentes "lentidão" (p=0,022) e "exaustão" (p=0,006). Na fase 2, 100% dos idosos que avaliaram sua saúde como "boa" pontuaram para baixo nível de atividade física. Conclusão: Os idosos dessa pesquisa em condição de fragilidade, apresentaram a autoavaliação de saúde positiva. Fazem-se necessários novos estudos sobre a associação dessa variável com a síndrome, já que são indicadores da qualidade de vida percebidaAbstract: Objective: This study aims to compare the changes in perceived health (SP) occurred in a six-to-eight-year period, according to the syndrome of weakness due to gender and age. Methodology: We applied a two-stagequantitative, comparative, and longitudinal approach. In phase 1 (2005-2007) 150 seniors in health attendance participated in the study. For phase 2 (2013), we contacted the elderly patients, and 54 of them accepted to be part of the study .Both frailty phenotype phases were evaluated according to Fried model with some adjustments, taking into account the components: physical activity, loss of unintentional weight, handgrip, walking speed and fatigue. The SP was evaluated by the following responses: bad, more or less, and good. Result: Female (64%) and 80-years-old (33,33%) subjects predominated in the sample . Phase 2 showed an increase in the number of elderly adults with frailty profile (88.87%) when compared with the initial phase of the research (53.33%). In phase 1, 85.79% of the pre-frail older people rated their SP as"more or less" or"good". Inphase 2, 83.87% of frail older people rated their health as "more or less". Statistical difference appeared in phase 1 to bad SP ,acoording to the components "slowness" (p = 0.022) and "exhaustion" (p = 0.006). In phase 2, 100% of seniors who rated their health as good scored for low levels of physical activity. Conclusion: The elderly of this research in fragile condition, had positive health self-assessment. There is a need further studies on the association of this variable with the fragility, as they are indicators of perceived quality of lifeMestradoGerontologiaMestra em Gerontologi

Self-rated health association with frailty syndrome in elderly people treated at a Geriatrics service

Objetivo: analisar a associação entre a autoavaliação de saúde e a síndrome da fragilidade em idosos atendidos no serviço de geriatria.Método: trata-se de um estudo longitudinal que teve na linha de base a participação de 150 idosos. Após oito anos de estudo, 54 idosos da amostra inicial receberam uma segunda avaliação. Os participantes foram avaliados e reavaliados quanto a autoavaliação de saúde que foi classificada em ruim, mais ou menos e boa, assim como, pelo fenótipo da fragilidade identificada por cinco componentes: fraqueza, lentidão, baixo nível de atividade física, exaustão e perda de peso não intencional. Aqueles com nenhum componente foi classificado como não-frágil, aqueles com um ou dois componentes foram classificados como pré-frágeis e aqueles com três ou mais componentes foram considerados frágeis. Para comparar as variáveis de autoavaliação de saúde (ruim, mais ou menos ou boa); classificação da fragilidade (não-frágil, pré-frágil e frágil) e componentes da fragilidade (fraqueza, lentidão, baixo nível de atividade física, exaustão e perda de peso não intencional ), foram realizados os testes de qui-quadrado e exato de Fisher.Resultados: a autoavaliação de saúde “ruim” associou-se com os componentes “lentidão” e “exaustão” com maior frequência (87,5%) e (100,0%), respectivamente (p&lt;0,05).Conclusão: a relação entre medidas subjetivas em saúde e a síndrome da fragilidade prevalente nos idosos, avigora a boa concordância da subjetividade em saúde e condições clínicas capaz de mostrar a relevância de instrumentos que consideram a percepção individual do estado de saúde junto ao rastreio de vulnerabilidade nesta população.Objective:  to analyze the association between self-rated health and the frailty syndrome in the elderly assisted in a geriatric service.Method: this longitudinal study had the participation of 150 elderly people at the baseline. After eight years of study, 54 elderly people from the initial sample received a second evaluation. Participants were assessed and reassessed for their self-rated health, which was classified as poor, more or less, and good, as well as for the frailty phenotype identified by five components: weakness, slowness, low level of physical activity, exhaustion and non-weight loss intentional. Those with no components were classified as non-frail, those with one or two components were classified as pre-frail and those with three or more components were considered frail. To compare the variables of self-rated health (poor, more or less or good); frailty classification (non-frail, pre-frail and frail) and frailty components (weakness, slowness, low level of physical activity, exhaustion and unintentional weight loss), chi-square and Fisher's exact tests were performed.Results: self-rated “poor” health was associated with the components “slowness” and “exhaustion” (p &lt;0.005) more frequently (87.5%) and (100.0%), respectively.Conclusion: The relationship between subjective measures in health and the frailty syndrome prevalent in the elderly strengthens the good agreement of subjectivity in health and clinical conditions capable of showing the relevance of instruments that consider the individual perception of health status along with the vulnerability screening in this population

Does the incidence of frailty differ between men and women over time?

BACKGROUND/OBJECTIVE: The mechanisms, risk factors and influence of sex on the incidence of frailty components are not fully understood. The aim of this study was to analyse sex differences in factors associated with the increase in the number of frailty components. METHODS: A 12-year follow-up analysis was conducted with 1,747 participants aged ≥ 60 of the ELSA Study with no frailty at baseline. Generalised linear mixed models were used to analyse the increase in the number of frailty components stratified by sex, considering socioeconomic, behavioural, clinical and biochemical characteristics as exposure variables. RESULTS: The increase in the number of frailty components in both sexes was associated with an advanced age (70 to 79 years and 80 years or older), low educational level, sedentary lifestyle, elevated depressive symptoms, joint disease, high C-reactive protein levels, perception of poor vision and uncontrolled diabetes (p < 0.05). Osteoporosis, low weight, heart disease, living with one or more people and perception of poor hearing were associated with an increase in the number of frailty components in men. High fibrinogen concentration, controlled diabetes, stroke and perception of fair vision were associated with the outcome in women (p < 0.05). Obese women and men and overweight women had a lower increase in the number of frailty components compared to those in the ideal weight range. CONCLUSIONS: Socioeconomic factors, musculoskeletal disorders, heart disease and low weight seem to sustain the frailty process in men, whereas cardiovascular and neuroendocrine disorders seem to sustain the frailty process in women

Practice of physical activity by elderly frequenters of basic health units

OBJECTIVES: This study aimed to identify the factors associated with the physical activity of elderly assisted at the basic health units (BHU) of the city of Matelândia, Paraná, Brazil. METHODS: This is a cross-sectional study, in which 343 elderly users of the BHU of this city were surveyed. A socio-demographic questionnaire, the International Physical Activity Questionnaire (IPAQ), and the questionnaire of barriers to physical activity practice were used. RESULTS: In relation to the level of physical activity, 88.9% of the elderlies were classified as active/very active. Higher level of physical activity was significantly associated with the amount of medication used (p = 0.024), reason to go to BHU (p = 0.037), and indication of physical activity by UBS (p = 0.040). Lack of energy (p = 0.048) was a more frequent and significant barrier for the active/very active elderly. CONCLUSION: There is a large number of active/very active elderly users of the BHU of Matelândia, Paraná, Brazil, and this was associated with lower age, lower medication use, going to BHU to withdraw medication/others and indication of physical activity by the BHU. For those who do not fit into these levels, lack of financial resources and insufficiently safe environment are the most common barriers to physical activity.</p