HYPERLEPTINEMIA, METABOLIC SYNDROME, AND MORTALITY IN OLDER ADULTS

Background: Abdominal adiposity and fat mass increase with aging, and as does insulin resistance which is frequently associated with hyperleptinemia and leptin resistance. Serum leptin may predict risk of metabolic syndrome and mortality among older adults. Objectives: The objectives of the present study were to evaluate the relationship of serum leptin with risk of metabolic syndrome and mortality and to examine these associations in relation to the measures of body adiposity and proinflammatory cytokines. The influence of leptin receptor (I/D) gene polymorphism on diabetes as a contributing cause of mortality was also examined. Gender specific serum leptin cut off values as a biomarker for the risk of metabolic syndrome were determined. Design: The Health, Aging and Body Composition (HABC) study is a prospective cohort of 3,075 older adults aged 70 to 79 years. Body composition, demographic information, biochemical variables including, markers of systemic inflammation, and genetic variation were assessed in detail. Results: Women in quintile 2, 3, 4 and 5 of serum leptin were at significantly lower risk for metabolic syndrome as compared to those in quintile 1 after controlling for confounders. Serum leptin was independently associated with risk of metabolic syndrome after sequentially adjusting for demographic variables (p<0.0001), fat depots (p=.0024), and proinflammatory cytokines (p=.0098) in women. Among men, the association between serum leptin and risk of metabolic syndrome was explained by body adiposity. Women in quartile 2 and 3 of serum leptin were at lower risk than women in quintile 1 for all-cause mortality and mortality from cardiovascular disease independent of body fat and proinflammatory cytokines. Additionally, elevated level of serum leptin was associated with increased risk for diabetes as a contributing cause of mortality for both genders after sequentially adjusting for potential confounders, body fat and proinflammatory cytokines. Significant interaction was found between leptin receptor genotype and total percent fat (p=0.008) in association with diabetes as a contributing cause of mortality among women. The cut off serum leptin level that suggests the possible risk of metabolic syndrome was determined to be 6.45 ng/ml with 60% sensitivity and 63% specificity among men and 18.25 ng/ml with 55% sensitivity and 62% specificity among women. Conclusion: Elevated levels of serum leptin may be associated with increased risk of metabolic syndrome and risk of diabetes as a contributing cause of mortality among older women. However, intermediary levels of serum leptin may lower the risk of all-cause mortality and mortality from CVD, suggesting a paradoxical association of serum leptin with cardiovascular risk factors and mortality from CVD among older wome

Study on pattern of consumption of fruits and vegetables and associated factors among medical students of Delhi

Background: Fruits and vegetables are a rich source of essential micronutrients i.e. vitamins/minerals and dietary fibers required for the normal daily functionality of the body. Young adults such as medical students are a particularly vulnerable population in terms of health issues and adequate diet. Objective of the study was to find the pattern of fruits and vegetables consumption in undergraduate medical students of Delhi.Methods: A cross-sectional study was planned among 300 undergraduate students from medical college in New Delhi. The questionnaire consisted of questions about identification data, pattern of fruit and vegetable consumption. Data was analyzed by SPSS software version 21.0 and for qualitative data analysis chi-square test was used.Results: Mean age of study subjects was 20.82±2.1 years and females (52.7%) were more as compared to (47.3%) males. Out of 300 participants, only one third (33.3%) of study participants consumed more than five servings of fruits and vegetables. More than half of study participants felt that unsafe use of pesticides, difficult to eat five servings in a day, poor handling and poor quality of fruits and vegetables were the most common barriers in consumption of FVs. Age and semester of study participants and education status of mothers were found significant predictors of consumption of recommended number of serving of FVs in day.  Conclusions: This study concludes that only one third of study participants consumed more than five servings of fruits and vegetables which is recommended number of serving in a day. So, there is a need to increase awareness about importance of fruits and vegetables consumption among study population

Adaptation policy and practice in densely populated glacier-fed river basins of South Asia : a systematic review

This paper reviews literature for three major glacier-fed river systems of South Asia, the Brahmaputra, Ganga, and Indus, to understand governance mechanisms for climate adaptation in the region. A systematic review methodology is applied to examine adaptation responses in the riparian countries of these Himalayan river basins at three different levels: policy objectives, institutions, and practice. Using a systematic review methodology, it presents a comprehensive assessment of the state-of-knowledge as well as state-of-affairs with respect to climate change adaptation policy and practice in the South Asia region

Dairy intake and risk of hip fracture in prospective cohort studies: non-linear algorithmic dose-response analysis in 486 950 adults

Previous studies on the relationship between dairy consumption and hip fracture risk have reported inconsistent findings. Therefore, we aimed to conduct an algorithmically driven non-linear dose-response meta-analysis of studies assessing dairy intake and risk of developing incident hip fracture. Meta-analysis from PubMed and Google Scholar searches for articles of prospective studies of dairy intake and risk of hip fracture, supplemented by additional detailed data provided by authors. Meta-regression derived dose-response relative risks, with comprehensive algorithm-driven dose assessment across the entire dairy consumption spectrum for non-linear associations. Review of studies published in English from 1946 through December 2021. A search yielded 13 studies, with 486 950 adults and 15 320 fractures. Non-linear dose models were found to be empirically superior to a linear explanation for the effects of milk. Milk consumption was associated with incrementally higher risk of hip fractures up to an intake of 400 g/d, with a 7 % higher risk of hip fracture per 200 g/d of milk (RR 1⋅07, 95 % CI 1⋅05, 1⋅10; P < 0⋅0001), peaking with 15 % higher risk (RR 1⋅15, 95 % CI 1⋅09, 1⋅21, P < 0⋅0001) at 400 g/d versus 0 g/d. Although there is a dose-risk attenuation above 400 g/d, milk consumption nevertheless continued to exhibit elevated risk of hip fracture, compared to zero intake, up to 750 g/d. Meanwhile, the analysis of five cohort studies of yoghurt intake per 250 g/d found a linear inverse association with fracture risk (RR 0⋅85, 95 % CI 0⋅82, 0⋅89), as did the five studies of cheese intake per 43 g/d (~1 serving/day) (RR 0⋅81, 95 % CI 0⋅72, 0⋅92); these studies did not control for socioeconomic status. However, no apparent association between total dairy intake and hip fracture (RR per 250 g/d of total dairy = 0⋅97, 95 % CI 0⋅93, 1⋅004; P = 0⋅079). There were both non-linear effects and overall elevated risk of hip fracture associated with greater milk intake, while lower risks of hip fracture were reported for higher yoghurt and cheese intakes

Association between dietary protein intake and grip strength among adults aged 51 years and over: What We Eat in America, National Health and Nutrition Examination Survey 2011-2014.

Distributing daily protein intake evenly across meals (∼25-30g/meal) has been suggested to improve muscle mass. The aim of this research is to examine the association between grip strength, total protein intake and its distribution across day's meals in older adults.Nationally representative dietary intake data of adults aged 51 years and older (n = 4,123) who participated in What We Eat in America, NHANES 2011-2014 were analyzed. Protein intake per day and per eating occasion (breakfast, lunch, dinner, and snack) were determined. Combined grip strength was calculated and expressed in kilograms. Grip strength of individuals consuming ≥25g protein at 1 eating occasion was compared with those consuming same level of protein at 2 and 3 or more eating occasions. Grip strength of individuals in quartile 1 of daily protein intake was compared to those in the other quartiles. All associations were examined without and with adjustment for age, race/ethnicity, physical activity, health status, and smoking status. The comparison involving eating occasions and protein intake quartiles were further adjusted for daily protein intake and energy intake, respectively.Only 33% of men and 19% of women had protein intake of ≥25g at 2 or more eating occasions. These individuals also had higher grip strength and daily protein intake. Grip strength was positively associated with consumption of ≥25g protein at 2 eating occasions as compared to consumption of same level of protein at 1 eating occasion (p<0.05) in unadjusted model, but not when adjusted. Grip strength was positively associated with daily protein intake among women in quartiles 3 and 4 (p<0.05) of protein intake in both unadjusted and adjusted models compared to lowest protein intake. Among men, grip strength was associated with daily protein intake in quartiles 3 and 4 (p<0.05) in the unadjusted model, but not when adjusted.In a nationally representative sample of older adults, consuming ≥25g protein at 2 or more eating occasions was not associated with grip strength. However, higher daily protein intake was positively associated with grip strength in women

Grip strength, daily protein intake, and protein intake at breakfast, lunch, dinner, and snacks by intake of ≥25g protein at various eating occasions ^a.

<p>Grip strength, daily protein intake, and protein intake at breakfast, lunch, dinner, and snacks by intake of ≥25g protein at various eating occasions <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0191368#t003fn001" target="_blank">^a</a>.</p

Distribution of selected characteristics by daily protein intake quartile in women ^a.

<p>Distribution of selected characteristics by daily protein intake quartile in women <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0191368#t002fn001" target="_blank">^a</a>.</p

Association between grip strength and daily protein intake before and after adjusting for potential confounders ^a.

<p>Association between grip strength and daily protein intake before and after adjusting for potential confounders <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0191368#t005fn001" target="_blank">^a</a>.</p