Background

Little is known about the simultaneous effect of socioeconomic status (SES), psychosocial, and health-related factors on race differences in mortality in older adults.

Purpose

This study examined the association between race and mortality and the role of SES, health insurance, psychosocial factors, behavioral factors, and health-related factors in explaining these differences.

Methods

Data consisted of 2,938 adults participating in the Health, Aging and Body Composition study. Mortality was assessed over 8 years.

Results

SES differences accounted for 60% of the racial differences in all-cause mortality; behavioral factors and self-rated health further reduced the disparity. The racial differences in coronary heart disease mortality were completely explained by SES. Health insurance and behavioral factors accounted for some, but not all, of the race differences in cancer mortality.

Conclusions

Race-related risk factors for mortality may differ by the underlying cause of mortality.

Background.

Stiffness of the central arteries in aging may contribute to cerebral microvascular disease independent of hypertension and other vascular risk factors. Few studies of older adults have evaluated the association of central arterial stiffness with longitudinal cognitive decline.

Methods.

We evaluated associations of aortic pulse wave velocity (centimeters per second), a measure of central arterial stiffness, with cognitive function and decline in 552 participants in the Health, Aging, and Body Composition (Health ABC) study Cognitive Vitality Substudy (mean age ± SD = 73.1 ± 2.7 years, 48% men and 42% black). Aortic pulse wave velocity was assessed at baseline via Doppler-recorded carotid and femoral pulse waveforms. Global cognitive function, verbal memory, psychomotor, and perceptual speed were evaluated over 6 years.

Results.

After adjustment for demographics, vascular risk factors, and chronic conditions, each 1 SD higher aortic pulse wave velocity (389 cm/s) was associated with poorer cognitive function: −0.11 SD for global function (SE = 0.04, p < .01), −0.09 SD for psychomotor speed (SE = 0.04, p = .03), and −0.12 SD for perceptual speed (SE = 0.04, p < .01). Higher aortic pulse wave velocity was also associated with greater decline in psychomotor speed, defined as greater than 1 SD more than the mean change (odds ratio = 1.42 [95% confidence interval = 1.06, 1.90]) but not with verbal memory or longitudinal decline in global function, verbal memory, or perceptual speed. Results were consistent with mixed models of decline in each cognitive test.

Conclusions.

In well-functioning older adults, central arterial stiffness may contribute to cognitive decline independent of hypertension and other vascular risk factors.

Objective

To examine the prevalence and correlates of non-opioid and opioid analgesic use and descriptively evaluate potential undertreatment in a sample of community-dwelling elders with symptomatic knee and/or hip osteoarthritis (OA).

Design

Cross-sectional

Setting

Health, Aging and Body Composition Study

Patients

652 participants attending the year 6 visit (2002-03) with symptomatic knee and/or hip OA.

Outcome Measures

Analgesic use was defined as taking ≥ 1 non-opioid and/or ≥ 1 opioid receptor agonist. Non-opioid and opioid doses were standardized across all agents by dividing the daily dose used by the minimum effective analgesic daily dose. Inadequate pain control was defined as severe/extreme OA pain in the past 30 days from a modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Results

Just over half (51.4%) reported taking at least one non-opioid analgesic and approximately 10% were taking an opioid, most (88.5%) of whom also took a non-opioid. One in five participants (19.3%) had inadequate pain control, 39% of whom were using < 1 standardized daily dose of either a non-opioid or opioid analgesic. In adjusted analyses, severe/extreme OA pain was significantly associated with both non-opioid (adjusted odds ratio [AOR]=2.44; 95% confidence interval [95% CI]=1.49-3.99) and opioid (AOR=2.64; 95% CI, 1.26-5.53) use.

Conclusions

Although older adults with severe/extreme knee and/or hip OA pain are more likely to take analgesics than those with less severe pain, a sizable proportion take less than therapeutic doses and thus may be undertreated. Further research is needed to examine barriers to optimal analgesic use.

Background.

Objective methods to measure daily energy expenditure in studies of aging are needed. We sought to determine the accuracy of total energy expenditure (TEE) and activity energy expenditure (AEE) estimates from the SenseWear Pro armband (SWA) using software versions 6.1 (SWA 6.1) and 5.1 (SWA 5.1) relative to criterion methods in free-living older adults.

Methods.

Participants (n = 19, mean age 82.0 years) wore a SWA for a mean ± SD 12.5 ± 1.1 days, including while sleeping. During this same period, criterion values for TEE were assessed with doubly labeled water and for resting metabolic rate (RMR) with indirect calorimetry. AEE was calculated as 0.9 TEE – RMR.

Results.

For TEE, there was no difference in mean ± SD values from doubly labeled water (2,040 ± 472 kcal/day) versus SWA 6.1 (2,012 ± 497 kcal/day, p = .593) or SWA 5.1 (2,066 ± 474 kcal/day, p = .606); individual values were highly correlated between methods (SWA 6.1 r = .893, p < .001; SWA 5.1 r = .901, p < .001) and demonstrated strong agreement (SWA 6.1 intraclass correlation coefficient = .896; SWA 5.1 intraclass correlation coefficient = .904). For AEE, mean values from SWA 6.1 (427 ± 304 kcal/day) were lower by 26.8% than criterion values (583 ± 242 kcal/day, p = .003), and mean values from SWA 5.1 (475 ± 299 kcal/day) were lower by 18.5% than criterion values (p = .021); however, individual values were highly correlated between methods (SWA 6.1 r = .760, p < .001; SWA 5.1 r = .786, p < .001) and demonstrated moderate agreement (SWA 6.1 intraclass correlation coefficient = .645; SWA 5.1 intraclass correlation coefficient = .720). Bland–Altman plots identified no systematic bias for TEE or AEE.

Conclusions.

Acceptable levels of agreement were observed between SWA and criterion measurements of TEE and AEE in older adults.

Background. Chronic kidney disease (CKD) is associated with insulin resistance (IR). Prior studies have found that in individuals with CKD, leptin is associated with fat mass but resistin is not and the associations with adiponectin are conflicting. This suggests that the mechanism and factors associated with IR in CKD may differ.

Methods. Of the 2418 individuals without reported diabetes at baseline, participating in the Health, Aging and Body Composition study, a study in older individuals aged 70–79 years, 15.6% had CKD defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73m2 based on cystatin C. IR was defined as the upper quartile of the homeostasis model assessment. The association of visceral and subcutaneous abdominal fat, percent body fat, muscle fat, lipids, inflammatory markers and adiponectin were tested with logistic regression. Interactions were checked to assess whether the factors associated with IR were different in those with and without CKD.

Results. Individuals with IR had a lower eGFR (80.7 ± 20.9 versus 75.6 ± 19.6, P < 0.001). After multivariable adjustment, eGFR (odds ratio per 10 mL/min/1.73m2 0.92, 95% confidence interval 0.87–0.98) and CKD (1.41, 1.04–1.92) remained independently associated with IR. In individuals with and without CKD, the significant predictors of IR were male sex, black race, higher visceral fat, abdominal subcutaneous fat and triglycerides. In individuals without CKD, IR was associated with lower high-density lipoprotein and current nonsmoking status in multivariate analysis. In contrast, among individuals with CKD, interleukin-6 (IL-6) was independently associated with IR. There was a significant interaction of eGFR with race and IL-6 with a trend for adionectin but no significant interactions with CKD (P > 0.1). In the fully adjusted model, there was a trend for an interaction with adiponectin for eGFR (P = 0.08) and significant for CKD (P = 0.04 ), where adiponectin was associated with IR in those without CKD but not in those with CKD.

Conclusions. In mainly Stage 3 CKD, kidney function is associated with IR; except for adiponectin, the correlates of IR are similar in those with and without CKD.

Background.

Previous cross-sectional studies demonstrate positive associations of fat-free mass and negative associations of centrally distributed fat deposits with respiratory function in older adults. Few studies have evaluated whether greater losses of muscle and increases in fat are associated with more rapid decline in respiratory function in aging.

Methods.

Nine hundred and fifty-seven men and 1,024 women aged, respectively, 73.6 ± 2.8 years and 73.2 ± 2.8 years at baseline were followed for 5 years. Body weight, waist circumference, bone mineral density, fat-free mass, fat mass and fat mass percentage as measured by DXA, abdominal subcutaneous and visceral adipose tissue, thigh muscle area, thigh intermuscular fat by CT and forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were evaluated at baseline and after 5-years follow-up.

Results.

Cross-sectional analyses showed that height and thigh muscle area were positively and visceral adipose tissue negatively related to FEV1 and FVC. Increase in fat mass over five years was associated with concurrent FEV1 and FVC decline. In analyses stratified by weight-change categories, men and women who gained weight (vs stable/lost weight) had more rapid declines in FEV1 and FVC.

Conclusion.

In this well-functioning cohort, less muscle and greater abdominal fat were each associated with poorer lung spirometry cross-sectionally, whereas increase in fat mass over 5 years was associated with concurrent FEV1 and FVC decline. Weight gain and accompanying fat deposition may accelerate age-related declines in respiratory function.

Background

Guidelines for the prevention of coronary heart disease (CHD) recommend use of Framingham-based risk scores that were developed in white middle-aged populations. It remains unclear whether and how CHD risk prediction might be improved among older adults. We aimed to compare the prognostic performance of the Framingham risk score (FRS), directly and after recalibration, with refit functions derived from the present cohort, as well as to assess the utility of adding other routinely available risk parameters to FRS.

Methods

Among 2193 black and white older adults (mean age, 73.5 years) without pre-existing cardiovascular disease from the Health ABC cohort, we examined adjudicated CHD events, defined as incident myocardial infarction, CHD death, and hospitalization for angina or coronary revascularization.

Results

During 8-year follow-up, 351 participants experienced CHD events. The FRS poorly discriminated between persons who experienced CHD events vs. not (C-index: 0.577 in women; 0.583 in men) and underestimated absolute risk prediction by 51% in women and 8% in men. Recalibration of the FRS improved absolute risk prediction, particulary for women. For both genders, refitting these functions substantially improved absolute risk prediction, with similar discrimination to the FRS. Results did not differ between whites and blacks. The addition of lifestyle variables, waist circumference and creatinine did not improve risk prediction beyond risk factors of the FRS.

Conclusions

The FRS underestimates CHD risk in older adults, particularly in women, although traditional risk factors remain the best predictors of CHD. Re-estimated risk functions using these factors improve accurate estimation of absolute risk.

Objective

Although diabetes mellitus is implicated in susceptibility to infection, the association of diabetes with the subsequent course and outcome is unclear.

Design and setting

Retrospective analysis of two multicenter cohorts. We determined the association of pre-existing diabetes on the host immune response, acute organ function, and mortality in patients hospitalized with community-acquired pneumonia (CAP) in the GenIMS study (n=1895) and on mortality following either CAP or non-infectious hospitalizations in the population-based cohort study, Health ABC (n=1639).

Measurements

Mortality rate within first year, risk of organ dysfunction, and immune responses, including circulating inflammatory (tumor necrosis factor, interleukin-6, interleukin-10), coagulation (Factor IX, thrombin-antithrombin complexes, antithrombin), fibrinolysis (plasminogen-activator inhibitor-1, and D-dimer), and cell-surface markers (CD120a, CD120b, HLA-DR, TLR-2 and TLR-4).

Results

In GenIMS, diabetes increased mortality rate within first year after CAP (unadjusted hazard ratio [HR]=1.41, 95% confidence interval [CI]=1.12–1.76, p=0.002), even after adjusting for pre-existing cardiovascular and renal disease (adjusted HR=1.3, CI=1.03–1.65, p=0.02). In Health ABC, diabetes increased mortality rate within first year following CAP hospitalization, but not after hospitalization for non-infectious illnesses (significant interaction for diabetes and reason for hospitalization [p=0.04]; HR for diabetes on mortality over first year after CAP 1.87, CI=0.76–4.6, p=0.16 and after non-infectious hospitalization=1.16, CI=0.8–1.6, p=0.37). In GenIMS, immediate immune response was similar, as evidenced by similar circulating immune marker levels in the emergency department and during the first week. Those with diabetes had higher risk of acute kidney injury during hospitalization (39.3% vs. 31.7%, p=0.005) and they were more likely to die due to cardiovascular and kidney disease (34.4% vs. 26.8% and 10.4% vs. 4.5%, p=0.03).

Conclusions

Pre-existing diabetes was associated with a higher risk of death following CAP. The mechanism is not due to an altered immune response, at least as measured by a broad panel of circulating and cell surface markers, but may be due to worsening of pre-existing cardiovascular and kidney disease.

Objectives

To determine the extent to which disease-related symptoms and impairments, which constitute measures of disease severity or targets of therapy, account for the associations between chronic diseases and universal health outcomes.

Design

Cross-sectional

Setting

Cardiovascular Health Study (CHS) and Health ABC.

Participants

5,654 CHS, and 2,706 Health ABC, members.

Measurements

Diseases included heart failure (HF), chronic obstructive pulmonary disease (COPD), osteoarthritis, and cognitive impairment. The universal health outcomes included self-rated health, basic and instrumental activities of daily living (BADLs-IADLs), and death. Disease-related symptoms/impairments included HF symptoms and ejection fraction (EF) for HF; Dyspnea Scale and FEV1 for COPD; joint pain for osteoarthritis, and executive function for cognitive impairment.

Results

The diseases were associated with the universal health outcomes (p<0.001) except osteoarthritis with death (both cohorts) and cognitive impairment with self-rated health (Health ABC). Symptoms/impairments accounted for ≥30% of each disease’s effect on the universal health outcomes. In CHS, for example, HF, compared with no HF, was associated with one fewer (0.918) BADLs-IADL performed without difficulty; 27% of this effect was accounted for by HF symptoms, only 5% by EF. The hazard ratio for death with HF was 6.5 (95% CI, 4.7, 8.9) with 40% accounted for by EF and only 14% by HF symptoms.

Conclusion

Disease-related symptoms/impairments accounted for much of the significant associations between the 4 chronic diseases and the universal health outcomes. Results support considering universal health outcomes as common metrics across diseases in clinical decision-making, perhaps by targeting the disease-related symptoms/impairments that contribute most strongly to the effect of the disease on the universal health outcomes.

Context

Depression has been hypothesized to result in abdominal obesity through the accumulation of visceral fat. No large study has tested this hypothesis longitudinally.

Objective

To examine whether depressive symptoms predict an increase in abdominal obesity in a large population-based sample of well-functioning older persons.

Design

The Health, Aging, and Body Composition Study, an ongoing prospective cohort study, with 5 years of follow-up.

Setting

Community-dwelling older persons residing in the areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee.

Participants

2088 well-functioning white and black persons aged 70–79 years.

Main Outcome Measures

Baseline depression was defined as a Center for Epidemiological Studies Depression (CES-D) score of ≥ 16. At baseline and after 5 years, overall obesity measures included body mass index and percent body fat (measured by dual energy x-ray absorptiometry). Abdominal obesity measures included waist circumference, sagittal diameter, and visceral fat (measured by computed tomography).

Results

After adjustment for sociodemographics, lifestyle, diseases and overall obesity, baseline depression was associated with a 5-year increase in sagittal diameter (β=.054, p=.01) and visceral fat (β=.080, p=.001).

Conclusions

This study shows that depressive symptoms result in an increase in abdominal obesity, independent of overall obesity, suggesting that there may be specific pathophysiological mechanisms which link depression with visceral fat accumulation. These results might also help explain why depression increases risk of diabetes and cardiovascular disease.

Objective

Although several cross-sectional studies have linked obesity and depression, less is known about their longitudinal association and about the relative influence of obesity subtypes. We prospectively examined whether (abdominal) obesity increased the risk of onset of depression in a population-based sample of older persons.

Method

Participants were 2540 non-depressed well-functioning white and black persons, aged 70–79 years, enrolled in the Health ABC Study, an ongoing prospective community-based cohort study. Overall obesity was assessed by body mass index and percent body fat (measured by dual energy x-ray absorptiometry), whereas abdominal obesity measures included waist circumference, sagittal diameter, and visceral fat (measured by computer tomography). Onset of significant depressive symptoms was defined as a Center for Epidemiological Studies Depression 10-item score ≥ 10 at any annual follow-up over 5 years and/or new antidepressant medication use. Persistent depression was defined as depression at two consecutive follow-up visits.

Results

Over 5 years, significant depressive symptoms emerged in 23.7% of initially non-depressed persons. In men, both overall (BMI: HR per SD increase=1.20, 95%CI=1.03–1.40) and abdominal obesity (visceral fat: HR per SD increase=1.19, 95%CI=1.07–1.33) predicted onset of depressive symptoms after adjustment for sociodemographics. When BMI and visceral fat were adjusted for each other, only visceral fat was significantly associated with depression onset (HR=1.18, 95%CI=1.04–1.34). Stronger associations were found for persistent depressive symptoms. No associations were found in women.

Conclusion

This study shows that obesity, in particular visceral fat, increases the risk of onset of significant depressive symptoms in men. These results suggest that specific mechanisms might relate visceral fat to the onset of depression.

Objectives

This study examined the association of physical fitness, as assessed by ability and time to complete a 400-meter walk, on changes in body composition and muscle strength over a subsequent 7-year period.

Design

Prospective observational cohort study

Setting

Memphis, Tennessee and Pittsburgh, Pennsylvania

Participants

2,949 black and white men and women aged 70-79 participating in the Health, Aging and Body Composition (Health ABC) study.

Measurements

Body composition (fat and bone-free lean mass) was assessed by dual-energy x-ray absorptiometry in years 1-6, and 8. Knee extension strength was measured with isokinetic dynamometry and grip strength with isometric dynamometry in years 1,2,4,6, and 8.

Results

Compared to very fit men and women at baseline, less fit people had a higher weight, higher total percent fat, and lower total percent lean mass (p<0.01). Additionally, the least fit lost significantly more weight, fat mass, and lean mass over time compared to the very fit (p<0.01). Very fit people had the highest grip strength and knee extensor strength at baseline and follow-up; the decline in muscle strength was similar in every fitness group.

Conclusions

Low fitness in old age was associated with greater weight loss and loss of lean mass relative to having high fitness. Despite having lower muscle strength, the rate of decline in the least fit persons was similar to the most fit. In clinical practice, a long distance walk test as a measure of fitness might be useful to identify people at risk for these adverse health outcomes.

Objectives

To examine the association between strength, function, lean mass, muscle density and risk of hospitalization.

Design

Prospective cohort stud

Setting

Two U.S. clinical centers

Participants

Adults aged 70 – 80 years (N=3,011) from the Health, Aging and Body Composition Study.

Measurements

Measures included grip strength; knee extension strength; lean mass; walking speed; chair stand pace. Thigh computed tomography scans assessed muscle area and density (a proxy for muscle fat infiltration). Hospitalizations were confirmed by local review of medical records. Negative binomial regression models estimated incident rate ratios (IRRs) of hospitalization for race/sex specific quartiles of each muscle/function parameter separately. Multivariate models adjusted for age, body mass index, health status and coexisting medical conditions.

Results

During an average 4.7 years of follow-up, 1,678 (55.7%) participants experienced ≥1 hospitalization. Participants in the lowest quartile of muscle density were more likely to be subsequently hospitalized (multivariate IRR: 1.47, 95% CI: 1.24, 1.73) compared to the highest quartile. Similarly, participants with the weakest grip strength were at increased risk of hospitalization (MIRR: 1.52, 95% CI: 1.30, 1.78, Q1 vs. Q4). Comparable results were seen for knee strength, walking pace and chair stands pace. Lean mass and muscle area were not associated with risk of hospitalization.

Conclusion

Weak strength, poor function and low muscle density, but not muscle size or lean mass, were associated with an increased risk of hospitalization. Interventions to reduce the disease burden associated with sarcopenia should focus on increasing muscle strength and improving physical function rather than simply increasing lean mass.

Objectives

To examine the association of cardiovascular disease (CVD) and its risk factors with age-associated hearing loss, in a cohort of older black and white adults.

Study Design

Cross-sectional cohort study

Setting

The Health, Aging, and Body Composition (Health ABC) study; A community-based cohort study of older adults from Pittsburgh, PA and Memphis TN.

Participants

2,049 well-functioning adults (mean age: 77.5 years; 37% black)

Measurements

Pure-tone audiometry and history of clinical CVD were obtained at the 4th annual follow-up visit. Pure-tone averages in decibels reflecting low frequencies (250, 500, and 1000 Hz) middle frequencies (500, 1000, and 2000 Hz) and high frequencies (2000, 4000, and 8000Hz) were calculated for each ear. CVD risk factors, aortic pulse-wave velocity, and ankle-arm index were obtained at the study baseline.

Results

In gender-stratified models, after adjustment for age, race, study site and occupational noise exposure, risk factors associated with poorer hearing sensitivity among men included higher triglyceride levels, higher resting heart rate and history of smoking. Among women, poorer hearing sensitivity was associated with higher BMI, higher resting heart rate, faster pulse-wave velocity, and low ankle-arm index.

Conclusion

Modifiable risk factors for CVD may play a role in the development of age-related hearing loss.

Context

Although caregivers report more stress than non-caregivers, few studies have found greater health decline in older caregivers. We hypothesized that caregivers may be more physically active than non-caregivers, which may protect them from health decline.

Objective

To evaluate total, and race- and gender-specific risk of mortality and functional decline in elderly caregivers versus non-caregivers, and whether these associations were mediated by total physical activity (including daily routine, leisure-time exercise, and caregiving activity).

Design and setting

The Health, Aging and Body Composition (Health ABC) study, a cohort study of 3075 healthy adults, aged 70–79 years in 1997–1998 who resided in Memphis, Tennessee or Pittsburgh, Pennsylvania and were followed through their eighth year of participation.

Participants

Participants were classified as caregivers (n=680, 22%) or non-caregivers (n=2369) if they reported providing “regular care or assistance for a child or a disabled or sick adult”.

Main Outcome Measure

All-cause mortality and incident mobility limitation, defined as reported difficulty walking ¼ mile or climbing 10 steps on two consecutive semi-annual contacts.

Results

Overall, 20.6% of caregivers died and 50.9% developed mobility limitation, versus 22.0% and 48.9% of non-caregivers, respectively. Associations with health outcomes differed by race and gender. Mortality and mobility limitation rates were 1.5 times higher in white caregivers compared to non-caregivers (e.g., among white females, adjusted hazards ratio for mortality, HR = 1.6, 1.0–2.5), but were lower in black female caregivers versus non-caregivers (e.g., HR for mortality = 0.9, 0.5–1.4). Physical activity mediated these associations in most race-gender groups. High-intensity caregivers (i.e., spending ≥ 24 hours/week caregiving) had elevated rates of decline when adjusted for physical activity, but lower rates when not adjusted for it.

Conclusion

Older white caregivers have poorer health outcomes than black female caregivers. Physical activity appears to mask the adverse effects of high-intensity caregiving in most race-gender groups.

The protective mechanisms by which some obese individuals escape the detrimental metabolic consequences of obesity are not understood. This study examined differences in body fat distribution and adipocytokines in obese older persons with and without metabolic syndrome. Additionally, we examined whether adipocytokines mediate the association between body fat distribution and metabolic syndrome. Data were from 729 obese men and women (BMI≥30kg/m2), aged 70-79 participating in the Health, Aging and Body Composition (Health ABC) study. Thirty-one percent of these obese men and women did not have metabolic syndrome. Obese persons with metabolic syndrome had significantly more abdominal visceral fat (men:p=0.04; women:p<0.01) and less thigh subcutaneous fat (men:p=0.09; women:p<0.01) than those without metabolic syndrome. Additionally, those with metabolic syndrome had significantly higher levels of IL-6, TNF-α and PAI-1 than individuals without metabolic syndrome. Per standard deviation (SD) higher in visceral fat, the likelihood of metabolic syndrome significantly increased in women (odds ratio (OR):2.16, 95% confidence interval (CI):1.59-2.94). In contrast, the likelihood of metabolic syndrome decreased in both men (OR:0.56, 95%CI:0.39-0.80) and women (OR:0.49, 95%CI:0.34-0.69) with each SD higher in thigh subcutaneous fat. These associations were partly mediated by adipocytokines; the association between thigh subcutaneous fat and metabolic syndrome was no longer significant in men. In summary, metabolically healthy obese older persons had a more favorable fat distribution, characterized by lower visceral fat and greater thigh subcutaneous fat and a more favorable inflammatory profile compared to their metabolically unhealthy obese counterparts.

We examined whether a systemic marker of oxidative stress, F2-isoprostanes (F2-IP), was associated with total and regional adiposity, adipocytokines, and change in adiposity. Using data from 726 participants enrolled in the Health, Aging, and Body Composition study, F2-IP and adipocytokines were measured from baseline plasma samples. Total adiposity was measured by whole body DXA and regional adiposity by abdominal and thigh CT scans at baseline and 5-year follow-up. ANOVA models were estimated to examine associations between F2-IP tertiles and baseline adiposity and changes in body composition. Median F2-IP was 54.3 pg/ml; women had significantly higher levels than men (61.5 vs. 48.9 pg/ml, p<0.001). F2-IP was associated with higher levels of adiponectin, leptin, and TNF-α. Men in the highest F2-IP tertile had significantly higher total percent body fat than those in the lowest tertile. Positive associations were found between F2-IP and all measures of total and regional adiposity among women. In linear regression models, adipocytokines mediated associations among women. Over 5 years of follow up, women in the highest versus lowest F2-IP tertile exhibited significant loss of weight (lowest tertile: −1.1 kg, highest tertile: −2.7 kg, p<0.05). In conclusion, F2-isoprostanes were associated with measures of total and regional adiposity in women and with total body fat in men; associations for women were partially explained by adipocytokines. F2-isoprostanes predicted loss of total adiposity over time among women.

Objectives

Strength, physical performance, adiposity and lean mass may be independent risk factors for disability in older adults. The aim of this study was to empirically identify groupings of these interrelated measures and test how such groupings may relate to disability risk.

Design

Prospective Health, Aging and Body Composition Study (Health ABC)

Setting

Two US clinical centers

Participants

1,263 women and 1,221 men

Measurements

Weight, strength (knee extension, grip); walking speed; chair stands; dual x-ray absorptiometry (fat and lean mass for total body, arm, and leg; percent fat); and thigh computed tomography scans (muscle area, muscle density). Analyses were stratified by sex. Factor analysis reduced these variables into a smaller number of components, and proportional hazards models assessed risk of major disability for the components identified.

Results

In both sexes, factor analysis reduced the 14 individual variables into three components that explained 76–77% of the data variance: Factor 1, an adiposity component, with strong loading by fat mass, weight and muscle density; Factor 2, a strength/lean body size component with strong loading by lean mass, weight and strength; Factor 3, a physical performance component with positive loading by walking speed and chair stands performance. Factor 1 (adiposity) and Factor 3 (performance), but not Factor 2 (strength/lean body size), were associated with disability over 6.1 (± 2.6 SD) years.

Conclusion

Adiposity and physical performance constructs, but not the strength/lean body size construct, were associated with disability risk, suggesting that adiposity and performance should be considered as risk factors for disability.

Abstract

Background

The specific health benefits of meeting physical activity guidelines are unclear in older adults. We examined the association between meeting, not meeting, or change in status of meeting physical activity guidelines through walking and the 5-year incidence of metabolic syndrome in older adults.

Methods

A total of 1,863 Health, Aging, and Body Composition (Health ABC) Study participants aged 70–79 were followed for 5 years (1997–1998 to 2002–2003). Four walking groups were created based on self-report during years 1 and 6: Sustained low (Year 1, <150 min/week, and year 6, <150 min/week), decreased (year 1, >150 min/week, and year 6, <150 min/week), increased (year 1, <150 min/week, and year 6, >150 min/week), and sustained high (year 1, >150 min/week, and year 6, >150 min/week). Based on the Adult Treatment Panel III (ATP III) panel guidelines, the metabolic syndrome criterion was having three of five factors: Large waist circumference, elevated blood pressure, triglycerides, blood glucose, and low high-density lipoprotein (HDL) levels.

Results

Compared to the sustained low group, the sustained high group had a 39% reduction in odds of incident metabolic syndrome [adjusted odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.40–0.93], and a significantly lower likelihood of developing the number of metabolic syndrome risk factors that the sustained low group developed over 5 years (β = −0.16, P = 0.04).

Conclusions

Meeting or exceeding the physical activity guidelines via walking significantly reduced the odds of incident metabolic syndrome and onset of new metabolic syndrome components in older adults. This protective association was found only in individuals who sustained high levels of walking for physical activity.

Context

Lower plasma β-amyloid (Aβ) 42 and 42/40 have been associated with incident dementia, but results are conflicting and few have investigated cognitive decline among non-demented elders.

Objective

To determine if plasma β-amyloid is associated with cognitive decline and if this association is modified by measures of cognitive reserve.

Design, Setting, Participants

We studied 997 black and white community-dwelling older adults from Memphis, TN and Pittsburgh, PA enrolled in the Health ABC Study, a prospective observational study begun in 1997–98 with 10-year follow-up in 2006–07.

Main Outcome Measures

Association of near baseline plasma β-amyloid (42 and 42/40 measured in 2010) and repeatedly measured Modified Mini-Mental State Exam (3MS).

Results

Participant mean age was 74.0 (3.0) years, 55.2% (N=550) were female, 54.0% (N=538) were black. Low β-amyloid 42/40 level was associated with greater 9-year 3MS cognitive decline (Low tertile [mean(95% CI)] −6.59 −(5.21–7.67) points, mid −6.16 −(4.92–7.32) and high −3.60 −(2.27–4.73), p<0.001). Results were similar after multivariate adjustment for age, race, education, diabetes, smoking and APOE e4 and after excluding the 72 participants with incident dementia. Measures of cognitive reserve modified this association whereby among those with high reserve (education ≥ high school (HS), literacy >6th grade, or no APOE e4), β-amyloid 42/40 was less associated with multivariate adjusted 9-year decline. For example, among participants with education

Conclusions

Lower plasma β-amyloid 42/40 is associated with greater cognitive decline among non-demented elders over 9 years, and this association is stronger among those with low measures of cognitive reserve.