Association of Mild Anemia with Cognitive, Functional, Mood and Quality of Life Outcomes in the Elderly: The “Health and Anemia” Study

BACKGROUND: In the elderly persons, hemoglobin concentrations slightly below the lower limit of normal are common, but scant evidence is available on their relationship with significant health indicators. The objective of the present study was to cross-sectionally investigate the association of mild grade anemia with cognitive, functional, mood, and quality of life (QoL) variables in community-dwelling elderly persons. METHODS: Among the 4,068 eligible individuals aged 65-84 years, all persons with mild anemia (n = 170) and a randomly selected sample of non-anemic controls (n = 547) were included in the study. Anemia was defined according to World Health Organization (WHO) criteria and mild grade anemia was defined as a hemoglobin concentration between 10.0 and 11.9 g/dL in women and between 10.0 and 12.9 g/dL in men. Cognition and functional status were assessed using measures of selective attention, episodic memory, cognitive flexibility and instrumental and basic activities of daily living. Mood and QoL were evaluated by means of the Geriatric Depression Scale-10, the Short-Form health survey (SF-12), and the Functional Assessment of Cancer Therapy-Anemia. RESULTS: In univariate analyses, mild anemic elderly persons had significantly worse results on almost all cognitive, functional, mood, and QoL measures. In multivariable logistic regressions, after adjustment for a large number of demographic and clinical confounders, mild anemia remained significantly associated with measures of selective attention and disease-specific QoL (all fully adjusted p<.046). When the lower limit of normal hemoglobin concentration according to WHO criteria was raised to define anemia (+0.2 g/dL), differences between mild anemic and non anemic elderly persons tended to increase on almost every variable. CONCLUSIONS: Cross-sectionally, mild grade anemia was independently associated with worse selective attention performance and disease-specific QoL ratings

Association of mild anemia with hospitalization and mortality in the elderly: the Health and Anemia population-based study

Mild anemia is a frequent laboratory finding in the elderly usually disregarded in clinical practice. This study shows that mild anemia is associated with increased risk of hospitalization and all-cause mortality in the elderly. See perspective article on page 1

Prevalence, incidence and types of mild anemia in the elderly: the “Health and Anemia” population-based study

Hemoglobin concentrations slightly below the lower limit of normal are a common laboratory finding in the elderly, but scant evidence is available on the actual occurrence of mild anemia despite its potential effect on health. The objectives of this study were to estimate the prevalence and incidence of mild grade anemia and to assess the frequency of anemia types in the elderly.This was a prospective, population-based study in all residents 65 years or older in Biella, Italy.Blood test results were available for analysis from 8,744 elderly. Hemoglobin concentration decreased and mild anemia increased steadily with increasing age. Mild anemia (defined as a hemoglobin concentration of 10.0-11.9 g/dL in women and 10.0-12.9 g/dL in men) affected 11.8\% of the elderly included in the analysis, while the estimated prevalence in the entire population was 11.1\%. Before hemoglobin determination, most mildly anemic individuals perceived themselves as non-anemic. Chronic disease anemia, thalassemia trait, and renal insufficiency were the most frequent types of mild anemia. The underlying cause of mild anemia remained unexplained in 26.4\% of the cases, almost one third of which might be accounted for by myelodysplastic syndromes. In a random sample of non-anemic elderly at baseline (n=529), after about 2 years, the annual incidence rate of mild anemia was 22.5 per 1000 person-years and increased with increasing age.The prevalence and incidence of mild anemia increase with age and mild anemia affects more than one out of ten elderly individuals. Unexplained anemia is common and may be due to myelodysplastic syndromes in some cases

Characteristics of mild anemic (WHO criteria) and non anemic individuals included in the impact study

*<p>Adjusted for oncological status.</p

Impact of mild grade anemia (WHO criteria) on cognitive, functional, mood, and quality of life variables in elderly individuals (65–84 years)

*<p>Between brackets score ranges with best scores on the right.</p>†<p>Model 1 includes mild anemic and oncological status only; Model 2 includes Model 1 plus age, sex, education, and (except: Geriatric Depression Scale, SF-12 Mental, and FACT scores) Geriatric Depression Scale score; Model 3 includes Model 2 plus hypertension, diabetes, heart failure, myocardial infarction, respiratory failure, neurologic disorders.</p

Impact of mild grade anemia (hemoglobin concentration: women, 10.0–12.1 g/dL; men, 10.0–13.1 g/dL) on cognitive, functional, mood, and quality of life variables in elderly individuals (65–84 years)

*<p>Between brackets score ranges with best scores on the right.</p>†<p>Model 1 includes mild anemic and oncological status only; Model 2 includes Model 1 plus age, sex, education, and (except: Geriatric Depression Scale, SF-12 Mental, and FACT scores) Geriatric Depression Scale score; Model 3 includes Model 2 plus hypertension, diabetes, heart failure, myocardial infarction, respiratory failure, neurologic disorders.</p

Flow chart of the study.

<p>Flow chart of the study.</p

Somatic mosaicism and common genetic variation contribute to the risk of very-early-onset inflammatory bowel disease

Very-early-onset inflammatory bowel disease (VEO-IBD) is a heterogeneous phenotype associated with a spectrum of rare Mendelian disorders. Here, we perform whole-exome-sequencing and genome-wide genotyping in 145 patients (median age-at-diagnosis of 3.5 years), in whom no Mendelian disorders were clinically suspected. In five patients we detect a primary immunodeficiency or enteropathy, with clinical consequences (XIAP, CYBA, SH2D1A, PCSK1). We also present a case study of a VEO-IBD patient with a mosaic de novo, pathogenic allele in CYBB. The mutation is present in ~70% of phagocytes and sufficient to result in defective bacterial handling but not life-threatening infections. Finally, we show that VEO-IBD patients have, on average, higher IBD polygenic risk scores than population controls (99 patients and 18,780 controls; P &lt; 4 × 10-10), and replicate this finding in an independent cohort of VEO-IBD cases and controls (117 patients and 2,603 controls; P &lt; 5 × 10-10). This discovery indicates that a polygenic component operates in VEO-IBD pathogenesis