Combined Effect of Dynapenia (Muscle Weakness) and Low Vitamin D Status on Incident Disability

BACKGROUND AND OBJECTIVE: There is little epidemiologic evidence considering the combined effect of dynapenia and low 25-hydroxyvitamin D [25 (OH) D] on incident disability. Our aim was to investigate whether the combination of dynapenia and low 25 (OH) D serum levels increases the risk of activities of daily living (ADL) incident disability. DESIGN: Prospective cohort study. SETTINGS: English Longitudinal Study of Aging. PARTICIPANTS: A total of 4630 community-dwelling adults aged 50 years and older without ADL disability at baseline. MEASUREMENTS: The baseline sample was categorized into 4 groups (ie, nondynapenic/normal 25 (OH) D, low 25 (OH) D only, dynapenic only, and dynapenic/low 25 (OH) D according to their handgrip strength (<26 kg for men and <16 kg for women) and 25 (OH) D (≤50 nmol/L). The outcome was the presence of any ADL disability 2 years after baseline according to the modified Katz Index. Incidence rate ratios (IRRs) adjusted by sociodemographic, behavioral, and clinical characteristics were estimated using Poisson regression. RESULTS: The fully adjusted model showed that older adults with dynapenia only and those with lower serum levels of 25 (OH) D combined with dynapenia had higher incident ADL disability risk compared with nondynapenic and those with normal serum levels of 25 (OH) D. The IRRs for lower 25 (OH) D serum levels combined with dynapenia were higher than for dynapenia only, however, the confidence intervals (CIs) showed similar effect for these 2 groups. The IRRs were 1.31 for low 25(OH) D only (95% CI 0.99-1.74), 1.77 for dynapenia only (95% CI 1.08-2.88), and 1.94 for combined dynapenia and low 25(OH)D (95% CI 1.28-2.94). CONCLUSIONS: Dynapenia only and dynapenia combined with low 25 (OH) D serum levels were important risk factors for ADL disability in middle-aged individuals and older adults in 2 years of follow-up

Differences in the prevalence of prediabetes, undiagnosed diabetes and diagnosed diabetes and associated factors in cohorts of Brazilian and English older adults

OBJECTIVE: To analyse differences in the prevalence of prediabetes (PD), undiagnosed diabetes (UDD) and diagnosed diabetes (DD) and associated factors between Brazilian and English older adults. DESIGN: Cross-sectional study. SETTING: England and Brazil. PARTICIPANTS: 5301 participants of the English Longitudinal Study of Ageing study and 1947 participants of the Brazilian Longitudinal Study of Aging study classified as non-diabetics, PD, UDD and DD. RESULTS: The prevalence of PD, UDD and DD was 48·6, 3 and 9·6 % in England and 33, 6 and 20 % in Brazil. In England, the increase in age, non-white skin colour, smoking, general obesity and abdominal obesity were associated with PD, UDD and DD, whereas hypertriglyceridaemia, low HDL levels, hypertension and stroke were associated with UDD and DD. In Brazil, the increase in age was associated with DD and UDD, non-white skin colour and smoking were associated with UDD and abdominal obesity and hypertriglyceridaemia were associated with all three conditions. CVD in England and schooling in Brazil were associated with PD and DD. A sedentary lifestyle was associated with DD in both samples. CONCLUSIONS: The prevalence of diabetes was higher in the Brazilian sample. Different associated factors were found in the two samples, which may be related to differences in nutritional transition, access to healthcare services and the use of such services

Accuracy of different handgrip values to identify mobility limitation in older adults

BACKGROUND/OBJECTIVE: Mobility limitation is commonly the first sign of impaired physical function and predisposes older adults to disability. Moreover, recent epidemiological studies have classified neuromuscular strength as the best explanator of mobility limitation. However, existing cutoffs have not been adequately analyzed regarding accuracy. Therefore, our aims were to define and compare the accuracy of different cutoff points of handgrip strength for the identification of mobility limitation. METHODS: Cross-sectional study with 5783 participants from the SABE (Saúde, Bem-Estar e Envelhecimento [Health, Wellbeing and Aging]) and ELSA (English Longitudinal Study of Ageing) cohorts aged 60 years or older. Handgrip strength was measured using a dynamometer. Walking speed <0.8 m/s was considered mobility limitation. Receiver operating characteristic curves and probabilities of presenting mobility limitation were calculated. RESULTS: Handgrip strength <32 kg for men and <21 kg for women demonstrated good diagnostic accuracy for mobility limitation, with 49.1% sensitivity and 79.8% specificity for men and 58.6% sensitivity and 72.9% specificity for women. The fully adjusted models had an area under the curve of 0.82 for men and 0.83 for women, with odds of presenting mobility limitation of 1.88 [95% CI: 1.50 - 2.37] for men and 1.89 [95% CI: 1.57 - 2.27] for women. CONCLUSIONS: The results of this study support the accuracy of handgrip strength as a clinical marker of mobility limitation. Furthermore, manual dynamometry is easily incorporated into clinical practice, has a good cost-benefit, besides being a simple, valid, reliable and effective method for use in both the scientific community and outpatient practice

Gender differences in the association between adverse events in childhood or adolescence and the risk of premature mortality

To examine, by gender, the relationship between adverse events in childhood or adolescence and the increased risk of early mortality (before 80 years). The study sample included 941 participants of the English Longitudinal Study of Aging who died between 2007 and 2018. Data on socioeconomic status, infectious diseases, and parental stress in childhood or adolescence were collected at baseline (2006). Logistic regression models were adjusted by socioeconomic, behavioral and clinical variables. Having lived with only one parent (OR 3.79; p = 0.01), overprotection from the father (OR 1.12; p = 0.04) and having had an infectious disease in childhood or adolescence (OR 2.05; p = 0.01) were risk factors for mortality before the age of 80 in men. In women, overprotection from the father (OR 1.22; p < 0.01) was the only risk factor for mortality before the age of 80, whereas a low occupation of the head of the family (OR 0.58; p = 0.04) and greater care from the mother in childhood or adolescence (OR 0.86; p = 0.03) were protective factors. Independently of one’s current characteristics, having worse socioeconomic status and health in childhood or adolescence increased the risk of early mortality in men. Parental overprotection increased the risk of early mortality in both sexes, whereas maternal care favored longevity in women