Genetic and environment interactions contribute to longevity : a case-control study with centenarians

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.Objective: Environmental or genetic factors, together with the interaction between them, may explain the increasing population of centenarians. This research aimed to understand these interactions that underlie centenarian’s phenotypes, namely gene-gene and gene-environment, particularly in relation to cardiovascular risk (CVR).info:eu-repo/semantics/publishedVersio

The older patient; the need for Geriatric Units

© 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved

Não fosse no pé o calcanhar de Aquiles - A propósito de um caso clínico Shouldn't the Achilles' Heel be on the foot - Regarding a clinical case

A suspeição está na base de uma investigação clínica completa, sendo de extrema importância a revisão dos casos clínicos nos quais não consigamos estabelecer um diagnóstico definitivo. Desta revisão surgem hipóteses diagnósticas que contemplam doenças raras, como a macroglobulinemia de Waldenstrom, doença linfoproliferativa de células tipo B, caracterizada por infiltração medular e produção de IgM monoclonal. Em 1% destas gamapatias são diagnosticadas formas biclonais. Apresentamos o caso clínico de um doente com 74 anos, internado em Outubro/04 por colecistite aguda, tendo os exames pré-operatórios revelado derrame pleural bilateral. Durante o internamento foi feita minuciosa investigação etiológica, que foi contudo inconclusiva. Em Maio/05 foi internado, tendo sido submetido a talcagem pleural direita e a investigação clínica, também esta inconclusiva. Em Julho/05 foi reinternado num serviço de medicina interna, por anasarca e dor nos pés. Fez-se nova investigação e o diagnóstico final foi de macroglobulinemia de Waldenstrom.Clinical suspicion is the bedrock of a thorough clinical work-up, and a review of the clinical files with no definitive diagnosis is a must. Such a review can uncover rare diagnoses, such as Waldenstrom's macroglobulinaemia, a proliferative B-cell disease characterised by medular infiltration and monoclonocal IgM production. 1% of these are biclonal. We present a case of a 74 year old patient diagnosed in October 2004 with acute cholecystitis. Surgical evaluation revealed bilateral pleural effusion with an inconclusive aetiology. Patient underwent a right pleurodesis in May 2005 and the aetiology remained inconclusive. The third evaluation, in July 2005, led to a final diagnosis of Waldenstrom's macroglobulinaemia

Erythrocyte acetylcholinesterase in essential hypertension

© by Springer-Verlag 1980Red cell acetylcholinesterase activity (AChE) has been studied in 58 patients suffering from essential hypertension; diastolic blood pressure values were about 130mm or higher in 45 patients (group A) and lower in 13 (group B). The very significant increase (p<0.001) of AChE activity in group A has been forced by the severity of systemic lesions. Meanwhile, the AChE values have been slightly increased, but not statistically significant in the patients of group B. These results are supporting the hypothesis that the blood pressure control can be mediated or normalized, at least in part, by cholinergic mechanisms.This work was supported by Instituto Nacional de Investigação Científica (project LMC-10)

Sarcopenia and osteoporosis in Portuguese centenarians

© 2016 Macmillan Publishers Limited, part of Springer Nature.Background/Objectives: To evaluate the prevalence of sarcopenia and osteoporosis in centenarians and its association with body composition and past physical activity (PPA). Subjects/Methods: We conducted an observational cross-sectional study in a representative nationwide population of 253 Portuguese centenarians. A clinically oriented questionnaire and anthropometric and body composition analysis by bioimpedance were executed. Sarcopenia was determined using a muscle mass (MM) index cutoff 16.7 kg/m2. Osteoporosis was defined through estimated bone mass (BM), according to gender and body weight. Inadequate physical performance was considered when the timed-up-and-go test was >12 s. Results: BM and MM were gender dependent, even after adjusting for multiple variables. We found a protective effect of intense PPA on sarcopenia risk (OR=0.41, 95% CI=0.20–0.82, P=0.013). Those with worse physical function status presented a significantly higher risk for osteoporosis (OR=8.9, 95% CI=1.94–40.08, P=0.005). Multivariate models showed that low MM, BM and fat mass (FM) were predictors of underweight in centenarians. Underweight, male gender, worst physical function, hypohydration and sarcopenia were associated with increased osteoporosis risk. The risk for sarcopenia was higher in women (P=0.002), in those underweight (P=0.005) and in osteoporotic individuals (P<0.0001). Conversely, increased MM was protective against osteoporosis (P<0.0001), whereas higher BM decreased the risk for sarcopenia (P=0.005). Conclusions: Gender was revealed to be a relevant factor influencing BM and MM in centenarians. MM and BM were better predictors of underweight than was dehydration. Healthy BM and MM were positively related with PPA intensity and determined physical performance, having a positive impact on the centenarian’s independence. During aging, improving physical function might add to sarcopenia and osteoporosis prevention, besides prevention of femur neck fractures and cardiovascular diseases.info:eu-repo/semantics/publishedVersio

Body composition assessment and nutritional status evaluation in men and women Portuguese centenarians

© Serdi and Springer-Verlag France 2016OBJECTIVES: To assess body composition, nutritional status and its differences between genders in a sample of Portuguese centenarians. DESIGN: Observational cross-sectional study. SETTING: Centenarians recruited in Portugal, able to give informed consent. PARTICIPANTS: A total of 252 subjects, with a median age of 100 years, mostly women (77.8%) who accepted to participate in the study, during the period of 2012 to 2014. MEASUREMENTS: Anthropometric data collected (weight, height, BMI, waist circumference, hip and waist/hip ratio) were evaluated according to WHO criteria. A portable tetrapolar bioimpedance analyzer was used to calculate body composition and to assess resting metabolism. Nutritional status was evaluated according to three different criteria: BMI, waist circumference and body fat percentage using anthropometric equations and bioimpedance. RESULTS: We observed an overall mean weight of 51.02±11.03Kg, height of 1.55±0.07m and a BMI of 21.07±3.69Kg/m2. For most of the evaluated parameters, we found substantial differences between genders. The prevalence of underweight and overweight were 25.3% and 13.3%, respectively. Only 5 subjects were obese. Overweight subjects were mostly men (W=10.6% vs. M=22.6%), whereas women were more underweight (W=28.7% vs. M=13.2%). When considering the waist circumference, 26.5% were above the cut-off value. Most of centenarians (72.9%) had a healthy level of visceral fat. This measurement was highly correlated with waist circumference (r= 0.687, p<0.001). The mean of body fat mass was 10.69±6.50Kg, fat-free mass 40.87±7.60Kg and total body water 27.54±6.25Kg. According to body fat mass criteria assessed by bioimpedance, the prevalence of obesity in study population was 6.0% with no gender differences (p = 0.225). Obesity prevalence using anthropometric equations was higher (Deurenberg: 77.7% and Gallagher: 42.8%) than the obtained value by bioimpedance analysis, although according to Bland-Altman analysis both equations showed a good agreement (Deurenberg: 95.8% and Gallagher: 97%) with bioimpedance method. The prevalence of hypohydration (12.9%) was tendentiously higher in women compared to men (W= 15.4% vs. M= 5.0%, p=0.087). Despite the frequency of osteoporosis was higher in women (W = 71.85% vs. M = 28.15%), 95% of men revealed criteria for osteoporosis. Resting metabolic rate (RMR) was significantly different between genders using bioimpedance analysis (W= 1123.33± 173.91; M= 1350.10± 188.88; p<0.001) or Harris Benedict equation (W= 934.92± 102.60; M= 1018.85± 171.68; p=0.001). Bland- Altman analysis between methods indicate that there was an agreement of 97.6%. The overall mean metabolic age obtained was 83.52±1.11 years, well below the chronologic age (p<0.001). CONCLUSION: In Portuguese centenarians, clinical and nutritional approach should be improved on the gender basis. In relation to nutritional status, centenarians were more frequently underweight than overweight. The thinness could be a natural process, contributing for the longevity being rather overweight a reducing factor in life expectancy. BMI and waist circumference showed a good correlation with body fat percentage. Despite the results of Bland- Altman analysis, Deurenberg and Gallagher equations are not suitable to evaluate obesity prevalence in centenarians. Harris Benedict equation seems to be a good option to measure RMR in centenaries, when BIA is not available. Body composition and nutritional characterization of Portuguese centenarians are relevant contribution in scientific evidence production for the action plan of healthy ageing in Europe (2012-2020) and also for clinical practice.info:eu-repo/semantics/publishedVersio

Impact on Longevity of Genetic Cardiovascular Risk and Lifestyle including Red Meat Consumption

Background. Cardiovascular risk (CVR) underlies aging process and longevity. Previous work points to genetic and environmental factors associated with this risk. Objectives. The aim of this research is to look for any CVR gene-gene and gene-multifactorial/lifestyle interactions that may impact health and disease and underlie exceptional longevity. Methods. A case-control study involving 521 both gender individuals, 253 centenarians (100.26±1.98 years), and 268 controls (67.51±3.25 years), low (LCR, n=107) and high (HCR, n=161) CVR. Hypertension, diabetes, obesity (BMI, kg·m-2), and impaired kidney function were defined according to standard criteria. CVR was calculated using Q risk®. DNA was genotyping (ACE-rs4646994, AGT-rs4762, AGR1-rs5182, GRK4-rs2960306, GRK4-rs1024323, NOS3-rs1799983, and SLC12A3-rs13306673) through iPlex-MassARRAY®, read by MALDI-TOF mass spectrometry, and analyzed by EARTDECODE®. Results. Antilongevity factors consisted (OR 95% CI, p<0.05) BMI 1.558 (1.445-1.680), hypertension 2.358 (1.565-3.553), smoking habits 4.528 (2.579-7.949), diabetes 5.553 (2.889-10.675), hypercholesterolemia 1.016 (1.010-1.022), and regular consumption of red meat 22.363 (13.987-35.755). Genetic aspects particularly for HCR individuals ACE II (OR: 3.96 (1.83-8.56), p<0.0001) and NOS3 TT (OR: 3.11 (1.70-5.70), p<0.0001) genotypes were also risk associate. Obesity, smoking, hypercholesterolemia, and frequent consumption of red meat have an additive action to hypertension in the longevity process. There was a synergistic interaction between the endothelial NOS3 genotypes and the severity of arterial hypertension. An epistatic interaction between functional genetic variants of GRK4 and angiotensinogen was also observed. Conclusions. Cardiovascular risk-related genetic and multifactorial or predominantly lifestyle aspects and its interactions might influence the aging process and contribute to exceptional longevity in Portuguese centenarians. Besides lifestyle, the activity of nitrite oxide synthase may be one of the main physiologic regulators of cardiovascular protection in the path of longevity

Characterization of Portuguese Centenarian Eating Habits, Nutritional Biomarkers, and Cardiovascular Risk: A Case Control Study

Background and Aims. Eating habits may contribute to longevity. We characterized the eating habits and cardiovascular risk (CVR) biomarkers in Portuguese centenarians (CENT) compared to controls. Methods and Results. Centenarians (n=253), 100.26 ± 1.98 years, were compared with 268 controls (67.51 ± 3.25), low (LCR) and high (HCR) CVR (QRISK®2-2016). Anthropometric and body composition were evaluated by bioimpedance. Abdominal obesity, BMI, and fat mass (FM) cut-offs were according to the WHO. Sarcopenia was defined by muscle mass index cut-off ≤ 16.7 kg/m2. Daily red meat intake, adjusted for age and gender, was sarcopenia protective (OR = 0.25, 95% CI = 0.096–0.670, P=0.006); however, it contributes for FM excess (OR = 4.946, 95% CI = 1.471–16.626, P=0.01), overweight, and obesity (OR = 4.804, 95% CI = 1.666–13.851, P=0.004). This centenarian eating habit (2%) contrasts to HCR (64.3%). The history of red meat (P<0.0001) and canned/industrialized food intakes (P<0.0001) was associated with HCR. Basal metabolism was lower in centenarians versus LCR/HCR (CENT = 1176.78 ± 201.98; LCR = 1356.54 ± 170.65; HCR = 1561.33 ± 267.85; P<0.0001), BMI (CENT = 21.06 ± 3.68; LCR = 28.49 ± 4.69; HCR = 29.56 ± 5.26; P<0.0001), waist circumference (CENT = 85.29 ± 10.83; LCR = 96.02 ± 11.71; HCR = 104.50 ± 11.84; P<0.0001), and waist-hip ratio (CENT = 0.88 ± 0.07; LCR = 0.92 ± 0.08; HCR = 1.01 ± 0.08; P<0.0001). CENT had lower total cholesterol, LDL cholesterol, non-HDL cholesterol, and cholesterol/HDL ratio than controls. Conclusions. Frequent consumption of red meat, cholesterol, and heme iron rich may contribute to obesity and increased CVR. The low frequency of this consumption, observed in centenarians, although associated with sarcopenia, may be one of the keys to longevity