Combined impact of traditional and non-traditional health behaviors on mortality: A national prospective cohort study in Spanish older adults

Background: Data on the combined effect of lifestyles on mortality in older people have generally been collected from highly selected populations and have been limited to traditional health behaviors. In this study, we examined the combined impact of three traditional (smoking, physical activity and diet) and three non-traditional health behaviors (sleep duration, sedentary time and social interaction) on mortality among older adults. Methods: A cohort of 3,465 individuals, representative of the Spanish population aged ≥60 years, was established in 2000/2001 and followed-up prospectively through 2011. At baseline, the following positive behaviors were selfreported: never smoking or quitting tobacco >15 years, being very or moderately physically active, having a healthy diet score ≥ median in the cohort, sleeping 7 to 8 h/d, spending <8 h/d in sitting time, and seeing friends daily. Analyses were performed with Cox regression and adjusted for the main confounders. Results: During an average nine-year follow-up, 1,244 persons died. Hazard ratios (95% confidence interval) for allcause mortality among participants with two, three, four, five and six compared to those with zero to one positive behaviors were, respectively, 0.63 (0.46 to 0.85), 0.41 (0.31 to 0.55), 0.32 (0.24 to 0.42), 0.26 (0.20 to 0.35) and 0.20 (0.15 to 0.28) (P for trend <0.001). The results were similar regardless of age, sex and health status at baseline. Those with six vs. zero to one positive health behaviors had an all-cause mortality risk equivalent to being 14 years younger. Adding the three non-traditional to the four traditional behaviors improved the model fit (likelihood ratio test, P <0.001) and the accuracy of mortality prediction (c-statistic: + 0.0031, P = 0.040). Conclusions: Adherence to some traditional and non-traditional health behaviors may substantially reduce mortality risk in older adults.This work was funded by grants from the FIS (ref. 12/1166) and the ‘Plan Nacional sobre Drogas’ (ref. 06/2010), and by the ‘Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular’. DMG had a “Juan de la Cierva” contract from the Spanish Ministry of Scienc

Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults

<p>Abstract</p> <p>Background</p> <p>Evidence on the relation between leisure-time physical activity (LTPA) and health-related quality of life (HRQoL) in older adults is based primarily on clinical trials of physical exercise programs in institutionalized persons and on cross-sectional studies of community-dwelling persons. Moreover, there is no evidence on whether leisure-time sedentary behavior (LTSB) is associated with HRQoL independently of LTPA. This study examined the longitudinal association between LTPA, LTSB, and HRQoL in older community-dwelling adults in Spain.</p> <p>Methods</p> <p>Prospective cohort study of 1,097 persons aged 62 and over. In 2003 LTPA in MET-hr/week was measured with a validated questionnaire, and LTSB was estimated by the number of sitting hours per week. In 2009 HRQoL was measured with the SF-36 questionnaire. Analyses were done with linear regression and adjusted for the main confounders.</p> <p>Results</p> <p>Compared with those who did no LTPA, subjects in the upper quartile of LTPA had better scores on the SF-36 scales of physical functioning (β 5.65; 95% confidence interval [CI] 1.32-9.98; p linear trend < 0.001), physical role (β 7.38; 95% CI 0.16-14.93; p linear trend < 0.001), bodily pain (β 6.92; 95% CI 1.86-11.98; p linear trend < 0.01), vitality (β 5.09; 95% CI 0.76-9.41; p linear trend < 0.004) social functioning (β 7.83; 95% CI 2.89-12.75; p linear trend < 0.001), emotional role (β 8.59; 95% CI 1.97-15.21; p linear trend < 0.02) and mental health (β 4.20; 95% CI 0.26-8.13; p linear trend < 0.06). As suggested by previous work in this field, these associations were clinically relevant because the β regression coefficients were higher than 3 points. Finally, the number of sitting hours showed a gradual and inverse relation with the scores on most of the SF-36 scales, which was also clinically relevant.</p> <p>Conclusions</p> <p>Greater LTPA and less LTSB were independently associated with better long-term HRQoL in older adults.</p

Diabetes and Risk of Frailty and Its Potential Mechanisms: A Prospective Cohort Study of Older Adults

Background: There is emerging evidence of the role of diabetes as a risk factor for frailty. However, the mechanisms of this association are uncertain. Methods: Prospective cohort study of 1750 non-institutionalized individuals aged ≥60 years recruited in 2008-2010. At baseline, information was obtained on health behaviors, morbidity, cardiometabolic biomarkers, and antidiabetic treatments. Individuals were considered diabetic if they reported a physician-diagnosis or had fasting serum glucose ≥126 mg/dl. Study participants were followed-up through 2012 to assess incident frailty, defined as at least three of the five Fried criteria. Results: At baseline, the cohort included 346 individuals with diabetes and 1404 without it. Over a mean 3.5-year follow-up, 115 cases of incident frailty were ascertained. After adjustment for age, sex and education, participants with diabetes showed an increased risk of frailty (odds ratio [OR]: 2.18; 95% confidence interval [CI]: 1.42-3.37). Additional adjustment for health behaviors and abdominal obesity yielded a 29.7% reduction in the OR (OR: 1.83; 95%CI: 1.16-2.90). Subsequent adjustment for morbidity produced an additional 8.4% reduction (OR: 1.76; 95%CI: 1.10-2.82), and for cardiometabolic biomarkers, a further 44% reduction (OR: 1.32; 95% 0.70-2.49). In particular, adjustment for HbA1c, lipoproteins and triglycerides accounted for the greatest reductions. Finally, additional adjustment for oral antidiabetic medication reduced the OR to 1.01 (95%CI: 0.46-2.20), while adjustment for nutritional therapy increased it to 1.64 (95%CI: 0.77-3.49). Conclusions: Diabetes mellitus is associated with higher risk of frailty; this association is partly explained by unhealthy behaviors and obesity and, to a greater extent, by poor glucose control and altered serum lipid profile among diabetic individuals. Conversely, diabetes nutritional therapy reduces the risk of frailtyBaseline data collection was funded by Sanofi-Aventis. Data collection during follow-up was funded by the Spanish Government FIS grants 09/1626 and 09/0104 (Instituto de Salud Carlos III). Funding specific for this analysis was obtained from the Spanish Government FIS grant 12/1166 (Instituto de Salud Carlos III) and the FP7-HEALTH-2012-Proposal No: 305483–2 (FRAILOMIC Initiative)

Physical Activity, Sitting Time, and Mortality From Inflammatory Diseases in Older Adults

Objective: The aim of this study was to examine the independent and combined associations of physical activity (PA) and sitting time (ST) with long-term mortality attributed to inflammatory causes other than cardiovascular disease (CVD) and cancer in a national cohort of older adults in Spain.Design: Prospective study.Setting and Participants: A cohort of 3,677 individuals (1,626 men) aged ≥60 years was followed-up during 14.3 years.Measures: At baseline, individuals reported PA and ST. The study outcome was death from inflammatory diseases when CVD or cancer mortality was excluded. This outcome was classified into infectious and non-infectious conditions. Analyses were performed with Cox regression and adjusted for PA, ST, and other main confounders (age, sex, educational level, smoking, alcohol consumption, body mass index, and chronic conditions).Results: During follow-up, 286 deaths from inflammatory diseases (77 from infectious diseases) were identified. Compared to individuals who defined themselves as inactive/less active, mortality from inflammatory diseases was lower in those who were moderately active (hazard ratio [HR] = 0.67, 95% confidence interval [CI] = 0.50–0.90) or very active (HR = 0.48, 95%CI = 0.33–0.68), independently of ST. Also, being seated ≥7 h/d vs. &lt;7 h/d was linked to higher mortality (HR = 1.38, 95%CI = 1.02–1.87). The largest risk of mortality was observed in inactive/less active individuals with ST≥7 h/d (HR = 2.29, 95%CI = 1.59–3.29) compared to those with moderate/very PA and ST &lt;7 h/d. Low PA and high ST were consistently associated with a higher risk of mortality from non-infectious inflammatory causes. Associations of PA and ST with mortality from infectious inflammatory causes showed a similar trend, but most of them did not reach statistical significance.Conclusions: Low PA and high ST were independently associated with higher mortality from inflammatory diseases other than CVD or cancer in older adults. Interventions addressing simultaneously both behaviors could have greater benefits than those focusing on only one of them

Valores de referencia y puntos de corte de leptina para identificar anormalidad cardiometabólica en la población española

Antecedentes y objetivo: Estimar los valores de referencia de leptina y calcular los puntos de corte de leptinemia que identifiquen anormalidad cardiometabólica en España. Métodos: Estudio transversal realizado de 2008 a 2010 sobre 11.540 individuos representativos de la población española ≥ 18 años. La información se obtuvo mediante examen físico estandarizado y las analíticas se realizaron en un laboratorio central. La leptinemia se midió por inmunoensayo enzimático. Se definió anormalidad cardiometabólica como la presencia de ≥ 2 de las siguientes anormalidades: presión arterial elevada; triglicéridos elevados; colesterol unido a lipoproteínas de alta densidad bajo; valores altos de resistencia a insulina según homeostasis model assessment; proteína C reactiva y glucosa elevada. Resultados: Los niveles de leptina fueron mayores en mujeres que en varones (media geométrica 21,9 ng/ml y 6,6 ng/ml, respectivamente, p<0.001) y aumentaban con la edad y el índice de masa corporal (p<0,001). La mediana fue 24,5 ng/ml en mujeres (rango intercuartílico P25-P75: 14,1-37,0) y 7,2 ng/ml en varones (P25-P75: 3,3-14,3). La leptinemia fue mayor en sujetos con obesidad general o abdominal, diabetes, hipertensión o síndrome metabólico (p<0.001 en todos los casos). Los valores de leptinemia que identificaron anormalidad cardiometabólica fueron 23,75 ng/ml en mujeres (área bajo la curva 0,722, 72,3% sensibilidad y 58,7% especificidad), y 6,45 ng/ml en varones (área bajo la curva 0,716, 71,4% sensibilidad y 60,2% especificidad). Conclusiones: Estos resultados facilitan la interpretación de los valores de leptinemia en estudios clínicos y poblacionales. La leptina tiene sensibilidad y especificidad moderadas para identificar anormalidad cardiometabólica en ambos sexosLos datos de este análisis proceden del estudio ENRICA, que fue financiado por Sanofi-Aventis. La financiación específica para este análisis procede de los proyectos FIS PI13/02321 y “Cátedra UAM de Epidemiología y Control del Riesgo Cardiovascular”, Madri

Phthalate exposure and the metabolic syndrome: A systematic review and meta-analysis

Phthalates are chemicals widely used in plastic-based consumer products, and human exposure is universal. They are classified as endocrine disruptors, and specific phthalate metabolites have been associated with an increased risk of cardiometabolic diseases. The aim of this study was to assess the association between phthalate exposure and the metabolic syndrome in the general population. A comprehensive literature search was performed in four databases (Web of Science, Medline, PubMed, and Scopus). We included all the observational studies that evaluate the association between phthalate metabolites and the metabolic syndrome available until January 31st, 2023. Pooled Odds Ratios (OR) and their 95% confidence intervals were calculated by using the inversevariance weighted method. Nine cross-sectional studies and 25,365 participants aged from 12 to 80 were included. Comparing extreme categories of phthalate exposure, the pooled ORs for the metabolic syndrome were: 1.08 (95% CI, 1.02–1.16, I 2 = 28%) for low molecular weight phthalates, and 1.11 (95% CI, 1.07–1.16, I 2 = 7%) for high molecular weight phthalates. For individual phthalate metabolites, the pooled ORs that achieved statistical significance were: 1.13 (95% CI, 1.00–1.27, I 2 = 24%) for MiBP; 1.89 (95% CI, 1.17–3.07, I 2 = 15%) for MMP in men; 1.12 (95% CI, 1.00–1.25, I 2 = 22%) for MCOP; 1.09 (95% CI, 0.99–1.20, I 2 = 0%) for MCPP; 1.16 (95% CI, 1.05–1.28, I 2 = 6%) for MBzP; and 1.16 (95% CI, 1.09–1.24, I 2 = 14%) for DEHP (including ΣDEHP and its metabolites). In conclusion, both low molecular weight and high molecular weight phthalates were associated with an 8 and 11% higher prevalence of the MetS, respectively. The exposure to six specific phthalate metabolites was associated with a higher prevalence of the MetSData collection was funded by the following grants: FIS PI17/1709, PI20/144 (State Secretary of R + D and FEDER/FSE), and the CIBERESP, Instituto de Salud Carlos III. Madrid, Spain. MM has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement [(No 801342 (Tecniospring INDUSTRY)] and the Government of Catalonia’s Agency for Business Competitiveness (ACCIO) ´ (TECSPR19-1-0022

Physical activity, sitting time, and mortality from inflammatory diseases in older adults

Objective: The aim of this study was to examine the independent and combined associations of physical activity (PA) and sitting time (ST) with long-term mortality attributed to inflammatory causes other than cardiovascular disease (CVD) and cancer in a national cohort of older adults in Spain. Design: Prospective study. Setting and Participants: A cohort of 3,677 individuals (1,626 men) aged =60 years was followed-up during 14.3 years. Measures: At baseline, individuals reported PA and ST. The study outcome was death from inflammatory diseases when CVD or cancer mortality was excluded. This outcome was classified into infectious and non-infectious conditions. Analyses were performed with Cox regression and adjusted for PA, ST, and other main confounders (age, sex, educational level, smoking, alcohol consumption, body mass index, and chronic conditions). Results: During follow-up, 286 deaths from inflammatory diseases (77 from infectious diseases) were identified. Compared to individuals who defined themselves as inactive/less active, mortality from inflammatory diseases was lower in those who were moderately active (hazard ratio [HR] = 0.67, 95% confidence interval [CI] = 0.50-0.90) or very active (HR = 0.48, 95%CI = 0.33-0.68), independently of ST. Also, being seated ≥7 h/d vs. &lt; 7 h/d was linked to higher mortality (HR = 1.38, 95%CI = 1.02-1.87). The largest risk of mortality was observed in inactive/less active individuals with ST≥7 h/d (HR = 2.29, 95%CI = 1.59-3.29) compared to those with moderate/very PA and ST &lt; 7 h/d. Low PA and high ST were consistently associated with a higher risk of mortality from non-infectious inflammatory causes. Associations of PA and ST with mortality from infectious inflammatory causes showed a similar trend, but most of them did not reach statistical significance. Conclusions: Low PA and high ST were independently associated with higher mortality from inflammatory diseases other than CVD or cancer in older adults. Interventions addressing simultaneously both behaviors could have greater benefits than those focusing on only one of themThis work was supported by FIS grant 16/609 (Instituto de Salud Carlos III, State Secretary of R+D+I and FEDER/FSE), MINECO R+D+I grant (DEP2013-47786-R), MECD mobility grant (JC2015-00080), the FRAILOMIC Initiative (European Union FP7-HEALTH-2012-Proposal No. 305483-2), and the ATHLOS project (European project H2020- Project ID: 635316

Leptin concentration and risk of impaired physical function in older adults: the Seniors-ENRICA cohort

This is a pre-copyedited, author-produced PDF of an article accepted for publication in Age and Ageing following peer review. The version of record Alberto Lana, Ellen Struijk, Pilar Guallar-Castillón, Jose María Martín-Moreno, Fernando Rodríguez Artalejo, Esther Lopez-Garcia; Leptin concentration and risk of impaired physical function in older adults: the Seniors-ENRICA cohort. Age Ageing 45.6 (2016): 819-826 is available online at: http://dx.doi.org/ 10.1093/ageing/afw142Leptin resistance, which may develop during the aging process, stimulates the production of proinflammatory cytokines and insulin resistance that could impair the muscle function. However, the role of leptin on physical functioning among older adults has not yet been elucidated. Objective: To examine the association between serum leptin levels and physical function impairment in older adults. Design and setting: Prospective study of 1,556 individuals aged ≥60 years from the Seniors-ENRICA cohort, who were free of physical function limitation at baseline. Main outcome measure: Serum leptin was measured in 2008-2010, and incident functional limitation was assessed through 2012. Self-reported limitations in agility and mobility were assessed with the Rosow and Breslau scale, limitation in the lower extremity function was measured with the Short Physical Performance Battery, and impairment in the overall physical performance with the physical component summary of the SF-12. Results: After adjustment for potential confounders, and compared to individuals in the lowest quartile of leptin concentration, those in the highest quartile showed increased risk of impaired physical function; the odds ratio (95% confidence interval) and p-trend was: 1.95 (1.11-3.43), p=0.006 for self-reported impaired mobility; 1.76 (1.08-2.87), p=0.02 for self-reported impaired agility; 1.48 (1.02-2.15), p=0.04 for limitation in the lower extremity function; and 1.97 (1.20-3.22), p=0.01 for decreased overall physical performance. These associations were only modestly explained by C-reactive protein and insulin resistance. Moreover, the associations held across groups with varying health status and were independent of estimated total body fat. Conclusions: Higher leptin concentration was associated with increased risk of impaired physical function. Preserving metabolic function during the old age could help delaying physical function declineThis work was supported by FIS grants 12/1166 and 13/0288 (Instituto de Salud Carlos III, State Secretary of R+D+I, and FEDER/FSE), the CIBERESP, the FRAILOMIC Initiative (FP7-HEALTH-2012-Proposal no. 305483-2) and the ATHLOS project (EU H2020- Project ID: 635316