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Barker's hypothesis affirms that undernourishment in early-life induces metabolic reprogramming that compromises organism functions later in life, leading to age-related diseases. We are exposed to environmental and social conditions that impact our life trajectories, leading to ageing phenotypes as we grow. Epigenetic mechanisms constitute the link between both external stimuli and genetic programming. Studies have focused on describing the effect of early adverse events such as trauma, famines, or childhood labor on epigenetic markers in adulthood and the elderly. However, we lack information on epigenetic programming in individuals born in rural communities from underdeveloped countries, exposed to negative influences during fetal and postnatal development, particularly chronic malnutrition. Hence, in this exploratory analysis, we characterize the epigenome of individuals and some parents from Tlaltizapan (a rural community in Mexico originally studied almost 50 years ago) and collect anthropometric data on growth and development, as well on the living conditions of the families. Our results help build a biological hypothesis indicating that most of the epigenetic age measures of the subjects are significantly different among them. Interestingly, the most affected methylated regions correspond to pathways involved in neuronal system development, reproductive behaviour, learning and memory regulation., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2022. Published by Elsevier Inc.)

Timely and accurate diagnosis of Alzheimer's disease (AD) in clinical practice remains challenging. PET and CSF biomarkers are the most widely used biomarkers to aid diagnosis in clinical research but present limitations for clinical practice (i.e., cost, accessibility). Emerging blood-based markers have the potential to be accurate, cost-effective, and easily accessible for widespread clinical use, and could facilitate timely diagnosis. The EU/US CTAD Task Force met in May 2022 in a virtual meeting to discuss pathways to implementation of blood-based markers in clinical practice. Specifically, the CTAD Task Force assessed: the state-of-art for blood-based markers, the current use of blood-based markers in clinical trials, the potential use of blood-based markers in clinical practice, the current challenges with blood-based markers, and the next steps needed for broader adoption in clinical practice., Competing Interests: The Task Force was partially funded by registration fees from industrial participants. These corporations placed no restrictions on this work. D. Angioni is an investigator in clinical trials sponsored by Roche, Alector, Jansen, Alzheon, Otsuka, Novonordisk, UCB Pharma, Medesis Pharma and Eisai. No direct personal benefit is to be declared. J. Delrieu has received payment/honoraria from Biogen (presentation for Biogen in 2021); has participated on a Data Safety Monitoring Board or Advisory Board for French board for Roche in 2020-2022. H. Fillit is an unpaid consultant to Lilly and Biogen. He have received consulting fees from Alector, Samus Therapeutics, TauRx, Pinteon, Otsuka/Lundbeck, and Genentech during the past 3 years. P. Aisen reports grants from Janssen, NIA, FNIH, Alzheimer’s Association, Eisai and consultant fees from Merck, Biogen, Roche, ImmunoBrain Checkpoint, Abbvie, Rainbow Medical, Shionogi, Vigil Neuroscience, Inc, Hengrui USA, outside the submitted work. J. Cummings reports grants from: NIGMS grant P20GM109025; NINDS grant U01NS093334; NIA grant R01AG053798; NIA grant P20AG068053; NIA grant P30AG072959; NIA grant R35AG71476; Alzheimer’s Disease Drug Discovery Foundation (ADDF); Ted and Maria Quirk Endowment for the Pam Quirk Brain Health and Biomarker Laboratory; and the Joy Chambers-Grundy Endowment during the conduct of the study. J. Cummings receives consultant fees from AB Science, Acadia, Alkahest, AlphaCognition, ALZPathFinder, Annovis, AriBio, Artery, Avanir, Biogen, Biosplice, Cassava, Cerevel, Clinilabs, Cortexyme, Diadem, EIP Pharma, Eisai, GatehouseBio, GemVax, Genentech, Green Valley, Grifols, Janssen, Karuna, Lexeo, Lilly, Lundbeck, LSP, Merck, NervGen, Novo Nordisk, Oligomerix, Ono, Otsuka, PharmacotrophiX, PRODEO, Prothena, ReMYND, Renew, Resverlogix, Roche, Signant Health, Suven, Unlearn AI, Vaxxinity, VigilNeuro pharmaceutical, assessment, and investment companies, outside the submitted work. J. Cummings is the Chief Scientific Officer for CNS Innovations, LLC. J.R. Sims is an employee of Eli Lilly and Company: salary and minor stockholder. J. Braunstein is Employee of C2N Diagnostics. M. Sabbagh. Ownership interest (stock or stock options): NeuroTau, Optimal Cognitive Health Company, uMethod Health, Versanum, Athira, TransDermix, Seq BioMarque, NeuroReserve, Cortexyme/Quince Therapeutics; Consulting: Alzheon, Roche-Genentech, Eisai, KeifeRx, Lilly, Synaptogenix, NeuroTherapia, T3D, Signant Health, Novo Nordisk; Royalties: Humanix; Board of Director: Cortexyme/Quince Therapeutics, EIP Pharma. T. Bittner is a full time employee of F.Hoffmann-LaRoche AG and Genentech. M. Pontecorvo is an employee of Avid Radiopharmaceuticals, a wholly owned affiliate of Eli Lilly and Corporation and is a minor stockholder in Lilly. S. Bozeat is a full-time employee of Hoffman-La Roche and has stock options in the company. J.L. Dage is an inventor on patents or patent applications of Eli Lilly and Company relating to the assays, methods, reagents and/or compositions of matter related to measurement of P-tau217. Dr. Dage has served as a consultant for Genotix Biotechnologies Inc, Gates Ventures, Karuna Therapeutics, AlzPath Inc, Cognito, and received research support from ADx Neurosciences, Roche Diagnostics and Eli Lilly and Company in the past two years. E. Largent reports grants from National Institute on Aging, grants from Greenwall Foundation, outside the submitted work. S. Mattke reports personal fees from Biogen, Eisai, Roche/Genentech, Novartis, C2N, outside the submitted work. D.R. Willis is the principal investigator on a grant funded by the Devos Alzheimer’s Collaborative. This grant provides travel to the DAC in-person meetings. D.R. Willis did not participate or consume any food provided by industry partners. The DAC includes in-kind contributions from industry partners for patients to complete digital cognitive assessments (no charge for software or hardware) and blood-based biomarkers testing (sample processing). Contractual relationships between her university and each industry partner offering those in-kind resources (Linus Health and C2N Diagnostics respectively) prevent any undue influence over any scholarly work or dissemination related to the project. At the time of submission of this paper, they did not have sent any specimen to C2N for in-kind processing. To date no financial benefit has been received from C2N. Alireza Atri has received honoraria or support for consulting; participating in independent data safety monitoring boards; providing educational lectures, programs, and materials; or serving on advisory boards for AbbVie, Acadia, Allergan, the Alzheimer’s Association, Axovant, AZ Therapies, Biogen, Eisai, Grifols, Harvard Medical School Graduate Continuing Education, JOMDD, Lundbeck, Merck, Roche/Genentech, Novo Nordisk, Qynapse, Sunovion, Suven, and Synexus. Dr. Atri receives book royalties from Oxford University Press for a medical book on dementia. Dr. Atri currently receives institutional research grant/contract funding from NIA/NIH 1P30AG072980, AZ DHS CTR040636, Washington University St Louis, and Gates Ventures. Dr. Atri’s institution receives/received funding for clinical trial grants, contracts and projects from government, consortia, foundations and companies for which he serves/served as contracted site-PI. Washington University and R.J. Bateman have equity ownership interest in C2N Diagnostics and receive income based on technology (blood plasma assay) licensed by Washington University to Diagnostics. R.J. Bateman receives income from C2N Diagnostics for serving on the scientific advisory board. Washington University, with R.J. Bateman as co-inventor, has submitted the US nonprovisional patent application “Plasma Based Methods for Determining A-Beta Amyloidosis.” R.J. Bateman has received honoraria as a speaker/consultant/advisory board member from Amgen, Eisai, Hoffman-LaRoche, and Janssen; and reimbursement of travel expenses from, Hoffman-La Roche and Janssen. As an investigator, P.J. Ousset has received research funding from the following companies: Acadia Pharmaceuticals, Alector Inc., Alzheon Inc., Araclon Biotech S.L., AstraZeneca, Biogen, Avanir Pharmaceuticals, Cortexyme Inc., Eisai Inc., Eli Lilly, Genentech, Inc., Hoffmann-La Roche, Janssen Research and Development, Merck Sharp and Dohme, Novartis Pharmaceuticals, Novo Nordisk, Shanghai Green Valley Pharmaceutical Co., TauRx Therapeutics Ltd, UCB Biopharma. No direct personal benefit is to be declared. B. Vellas is an investigator in clinical trials sponsored by Biogen, Lilly, Roche, Eisai Pharmaceuticals and the Toulouse University Hospital. He has served as SAB member for Biogen, Alzheon, Green Valley, Norvo Nordisk, Longeveron, but received no personal compensation. He has served as consultant and/or SAB member for Roche, Lilly, Eisai, TauX with personal compensation. He is member of the Editorial Board of JPAD with no personal compensation; and did not have a role in the editorial process/review for this manuscript. M. Weiner reports serves on Editorial Boards for Alzheimer’s and Dementia, MRI and TMRI. He has served on Advisory Boards for Acumen Pharmaceutical, ADNI, Alzheon, Inc., Biogen, Brain Health Registry, Cerecin, Dolby Family Ventures, Eli Lilly, Merck Sharp and Dohme Corp., National Institute on Aging (NIA), Nestle/Nestec, PCORI/PPRN, Roche, University of Southern California (USC), NervGen. He has provided consulting to Baird Equity Capital, BioClinica, Cerecin, Inc., Cytox, Dolby Family Ventures, Duke University, Eisai, FUJIFILM-Toyama Chemical (Japan), Garfield Weston, Genentech, Guidepoint Global, Indiana University, Japanese Organization for Medical Device Development, Inc. (JOMDD), Medscape, Nestle/Nestec, NIH, Peerview Internal Medicine, Roche, T3D Therapeutics, University of Southern California (USC), WebMD, and Vida Ventures. He has acted as a speaker/lecturer to The Buck Institute for Research on Aging; China Association for Alzheimer’s Disease (CAAD); Japan Society for Dementia Research; and Korean Dementia Society. He holds stock options with Alzheon, Inc., Alzeca, and Anven. The following entities have provided funding for academic travel; University of Southern California (USC), NervGen, ASFNR, and CTAD Congres. Mr. Weiner receives support for his research from the following funding sources: Ðational Institutes of Health (NIH), Department of Defense (DOD), Patient-Centered Outcomes Research Institute (PCORI), California Department of Public Health (CDPH), University of Michigan, Siemens, Biogen, Hillblom Foundation, Alzheimer’s Association, The State of California, Johnson and Johnson, Kevin and Connie Shanahan, GE, VUmc, Australian Catholic University (HBI-BHR), The Stroke Foundation, and the Veterans Administration

Objectives: The aim of this study was to compare a short and a long version of an intrinsic capacity index and test their cross-sectional association with relevant health outcomes in older adults., Design: Cross-sectional analysis of the baseline data of the FraDySMex study., Participants: 543 community-dwelling adults aged 50 years and older living in 2 municipalities in Mexico City, from which 435 had complete data on the variables of interest., Methods: The intrinsic capacity indices were obtained using principal components analysis. The performance of the indices was tested respective to frailty, IADL and ADL., Results: The short and long versions of the IC index performed well for assessing functional status. Using biometrical variables like the phase angle, grip strength and gait speed measured by the GAIT rite improved the index performance vis a vis IADL disability (Lawton), but not to the other evaluated outcomes., Conclusions: Both the long and short versions of the intrinsic capacity indices tested were able to classify older adults according to their functional status and were associated with relevant health outcomes., Competing Interests: Authors declare no conflict of interest.

The human ageing process is universal, ubiquitous and inevitable. Every physiological function is being continuously diminished. There is a range between two distinct phenotypes of ageing, shaped by patterns of living - experiences and behaviours, and in particular by the presence or absence of physical activity (PA) and structured exercise (i.e., a sedentary lifestyle). Ageing and a sedentary lifestyle are associated with declines in muscle function and cardiorespiratory fitness, resulting in an impaired capacity to perform daily activities and maintain independent functioning. However, in the presence of adequate exercise/PA these changes in muscular and aerobic capacity with age are substantially attenuated. Additionally, both structured exercise and overall PA play important roles as preventive strategies for many chronic diseases, including cardiovascular disease, stroke, diabetes, osteoporosis, and obesity; improvement of mobility, mental health, and quality of life; and reduction in mortality, among other benefits. Notably, exercise intervention programmes improve the hallmarks of frailty (low body mass, strength, mobility, PA level, energy) and cognition, thus optimising functional capacity during ageing. In these pathological conditions exercise is used as a therapeutic agent and follows the precepts of identifying the cause of a disease and then using an agent in an evidence-based dose to eliminate or moderate the disease. Prescription of PA/structured exercise should therefore be based on the intended outcome (e.g., primary prevention, improvement in fitness or functional status or disease treatment), and individualised, adjusted and controlled like any other medical treatment. In addition, in line with other therapeutic agents, exercise shows a dose-response effect and can be individualised using different modalities, volumes and/or intensities as appropriate to the health state or medical condition. Importantly, exercise therapy is often directed at several physiological systems simultaneously, rather than targeted to a single outcome as is generally the case with pharmacological approaches to disease management. There are diseases for which exercise is an alternative to pharmacological treatment (such as depression), thus contributing to the goal of deprescribing of potentially inappropriate medications (PIMS). There are other conditions where no effective drug therapy is currently available (such as sarcopenia or dementia), where it may serve a primary role in prevention and treatment. Therefore, this consensus statement provides an evidence-based rationale for using exercise and PA for health promotion and disease prevention and treatment in older adults. Exercise prescription is discussed in terms of the specific modalities and doses that have been studied in randomised controlled trials for their effectiveness in attenuating physiological changes of ageing, disease prevention, and/or improvement of older adults with chronic disease and disability. Recommendations are proposed to bridge gaps in the current literature and to optimise the use of exercise/PA both as a preventative medicine and as a therapeutic agent., Competing Interests: Dr. Anker reports grants and personal fees from Vifor Int, personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Servier, grants and personal fees from Abbott Vascular, personal fees from Cardiac Dimensions, personal fees from Actimed, personal fees from Astra Zeneca, personal fees from Amgen, personal fees from Bioventrix, personal fees from Janssen, personal fees from Respicardia, personal fees from V-Wave, personal fees from Brahms, personal fees from Cordio, personal fees from Occlutech, outside the submitted work. Dr. Ruiz reports grants from Longeveron Inc, outside the submitted work. Dr. Marzetti reports personal fees from Abbott, personal fees from Nestlè, personal fees from Nutricia, personal fees from ThermoFisher, outside the submitted work. All the other authors have nothing to disclose.

The aging process has been linked to the occurrence of chronic diseases and functional impairments, including cancer, sarcopenia, frailty, metabolic, cardiovascular, and neurodegenerative diseases. Nonetheless, aging is highly variable and heterogeneous and represents a challenge for its characterization. In this sense, intrinsic capacity (IC) stands as a novel perspective by the World Health Organization, which integrates the individual wellbeing, environment, and risk factors to understand aging. However, there is a lack of quantitative and qualitative attributes to define it objectively. Therefore, in this review we attempt to summarize the most relevant and promising biomarkers described in clinical studies at date over different molecular levels, including epigenomics, transcriptomics, proteomics, metabolomics, and the microbiome. To aid gerontologists, geriatricians, and biomedical researchers to understand the aging process through the IC. Aging biomarkers reflect the physiological state of individuals and the underlying mechanisms related to homeostatic changes throughout an individual lifespan; they demonstrated that aging could be measured independently of time (that may explain its heterogeneity) and to be helpful to predict age-related syndromes and mortality. In summary, we highlight the areas of opportunity and gaps of knowledge that must be addressed to fully integrate biomedical findings into clinically useful tools and interventions., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: Intrinsic capacity is a composite of five domains that summarizes the physical and mental capacities of an individual. Intrinsic capacity is increasing in relevance for adapting health systems to population ageing. Therefore, our objective was to analyse how intrinsic capacity has been assessed in older adults and if these measurements have been validated, as an initial step towards the construction of a standard intrinsic capacity index., Design: Narrative review with electronic searches performed in PubMed and Cochrane databases, including the studies which used the term "intrinsic capacity" in the context of human ageing and health. The full text was then accessed to select studies with at least one operationalised domain of intrinsic capacity. We also looked for information on the validity and reliability of the reported measures of intrinsic capacity., Results: We included ten articles reporting a quantitative measurement of intrinsic capacity. There were two intrinsic capacity scores which combined retrospective data on the intrinsic capacity domains sub-scores, with low concordance among tests chosen to measure each domain. Two studies reported on reliability and validity of the IC scores. The main gaps in the construction and validation process were a) analysis undertaken with each domain separately rather than for the construct of intrinsic capacity, b) lack of a clear conceptual and operational definition of the vitality domain, c) summary score that depends upon the distribution of the study sample., Conclusion: Further validation of the intrinsic capacity concept is needed, together with more robust approaches to measure it. A standard index of IC has not been validated for translation into clinical or research purposes., Competing Interests: The authors declare no competing interests.

Frailty is an age-associated condition, characterized by an inappropriate response to stress that results in a higher frequency of adverse outcomes (e.g., mortality, institutionalization and disability). Some light has been shed over its genetic background, but this is still a matter of debate. In the present study, we used network biology to analyze the interactome of frailty-related genes at different levels to relate them with pathways, clinical deficits and drugs with potential therapeutic implications. Significant pathways involved in frailty: apoptosis, proteolysis, muscle proliferation, and inflammation; genes as FN1, APP, CREBBP, EGFR playing a role as hubs and bottlenecks in the interactome network and epigenetic factors as HIST1H3 cluster and miR200 family were also involved. When connecting clinical deficits and genes, we identified five clusters that give insights into the biology of frailty: cancer, glucocorticoid receptor, TNF-α, myostatin, angiotensin converter enzyme, ApoE, interleukine-12 and -18. Finally, when performing network pharmacology analysis of the target nodes, some compounds were identified as potentially therapeutic (e.g., epigallocatechin gallate and antirheumatic agents); while some other substances appeared to be toxicants that may be involved in the development of this condition.

Objective: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults., Methods: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty., Competing Interests: E. Dent, J.E. Morley, A.J. Cruz-Jentoft, L. Rodríguez-Mañas, L.P. Fried, J. Woo, I. Aprahamian, A. Sanford, J. Lundy, J. Beilby, F.C. Martin, L. Ferrucci, R.A. Merchant, H. Arai, E.O. Hoogendijk, C.W. Won, A. Abbatecola, T. Cederholm, T. Strandberg, L.M. Gutiérrez Robledo, L. Flicker, M. Aubertin-Leheudre, H.A. Bischoff-Ferrari, J.M. Guralnik, J. Muscedere, M. Pahor, A.M. Negm, D.L. Waters declare there are no conflicts. L. Woodhouse reports personal fees from American Physical Therapy Association (APTA), personal fees from Focus on Therapeutic Outcomes (FOTO) Inc., personal fees from Canadian Physiotherapy Association (CPA), personal fees from Eli Lilly, personal fees from Scholar Rock, outside the submitted work. J.M. Bauer reports personal fees from Fresenius, personal fees from Nestlé, personal fees from Novartis, personal fees from Pfizer, personal fees from Bayer, grants and personal fees from Nutricia DANONE, outside the submitted work. J Ruiz: employees Longeveron. S. Bhasin reports grants from AbbVie, grants from Alivegen, grants from MIB, other from FPT, other from AbbVie, outside the submitted work. J.Y. Reginster reports grants and personal fees from IBSA-GENEVRIER, grants and personal fees from MYLAN, grants and personal fees from RADIUS HEALTH, personal fees from PIERRE FABRE, grants from CNIEL, personal fees from DAIRY RESEARCH COUNCIL (DRC), outside the submitted work. B. Vellas reports grants from Nestle, Nutricia, Novartis outside the submitted work.

Objectives: Intrinsic capacity (IC) is one of the latest views of positive aging. In its current status lacks a biological substrate amenable to be intervened. The aim of this study was to determine the association of allostatic load (AL) with IC., Design: We present a cross-sectional analysis of the Costa Rican Longevity and Healthy Aging Study., Setting: This report is from a representative sample of Costa Rican older adults; one of the countries that integrate the Central America region., Participants: 2,827, 60-year or older community-dwelling individuals., Methods: An IC index was gathered and validated, including different domains: cognitive, psychological, sensory, vitality and locomotion. AL was integrated with: blood pressure, abdominal obesity, body mass index, HDL-cholesterol, glycosylated hemoglobin, DHEAS, cortisol, epinephrine and norepinephrine. AL was grouped in three categories according to the number of abnormal biomarkers (0-1, 2-3 and ≥4). Chronic diseases, socioeconomic level, sex and age were the adjusting variables. Ordinal logistic regression models were estimated in order to test the strength of the association., Results: From a total sample of 1,888 individuals, 51% (n=962) were women, 36.4% were in the 60-69 age category. The mean score of the IC index was of 6.6 (±2.2). Odds ratio (OR) of the adjusted models were significant for the group of those with 2-3 abnormal biomarkers of AL (OR 0.67, p=0.007) and also for those with ≥4 (OR 0.56, p=0.002), when compared to the reference group of AL (0-1 abnormal biomarkers)., Conclusions and Implications: AL showed an incremental association with IC, even when adjusted for factors such as socioeconomic status and chronic diseases. Targeting therapeutically AL could potentially improve IC in older adults and therefore decreasing the progression to disability or to overt dependency., Competing Interests: Authors declare no conflict of interest

Objectives: Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR)., Methods: To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process., Recommendations: We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.

The nuclear matrix elements for the spin operator and the momentum quadrupole operator are important for the interpretation of precision atomic physics experiments that search for violations of local Lorentz and CPT symmetry and for new spin-dependent forces. We use the configuration-interaction nuclear shell model and self-consistent mean-field theory to calculate the momentum matrix elements for ^{21}Ne, ^{23}Na, ^{133}Cs, ^{173}Yb, and ^{201}Hg. We show that these momentum matrix are strongly suppressed by the many-body correlations, in contrast to the well-known enhancement of the spatial quadrupole nuclear matrix elements.

Despite the more than 1 order of magnitude difference between the measured dipole moments in ^{144}Ba and ^{146}Ba, the octupole correlations in ^{146}Ba are found to be as strong as those in ^{144}Ba with a similarly large value of B(E3;3^{-}→0^{+}) determined as 48(+21-29)  W.u. The new results not only establish unambiguously the presence of a region of octupole deformation centered on these neutron-rich Ba isotopes, but also manifest the dependence of the electric dipole moments on the occupancy of different neutron orbitals in nuclei with enhanced octupole strength, as revealed by fully microscopic calculations.

This article reviews how nuclear fission is described within nuclear density functional theory. A distinction should be made between spontaneous fission, where half-lives are the main observables and quantum tunnelling the essential concept, and induced fission, where the focus is on fragment properties and explicitly time-dependent approaches are often invoked. Overall, the cornerstone of the density functional theory approach to fission is the energy density functional formalism. The basic tenets of this method, including some well-known tools such as the Hartree-Fock-Bogoliubov (HFB) theory, effective two-body nuclear potentials such as the Skyrme and Gogny force, finite-temperature extensions and beyond mean-field corrections, are presented succinctly. The energy density functional approach is often combined with the hypothesis that the time-scale of the large amplitude collective motion driving the system to fission is slow compared to typical time-scales of nucleons inside the nucleus. In practice, this hypothesis of adiabaticity is implemented by introducing (a few) collective variables and mapping out the many-body Schrödinger equation into a collective Schrödinger-like equation for the nuclear wave-packet. The region of the collective space where the system transitions from one nucleus to two (or more) fragments defines what are called the scission configurations. The inertia tensor that enters the kinetic energy term of the collective Schrödinger-like equation is one of the most essential ingredients of the theory, since it includes the response of the system to small changes in the collective variables. For this reason, the two main approximations used to compute this inertia tensor, the adiabatic time-dependent HFB and the generator coordinate method, are presented in detail, both in their general formulation and in their most common approximations. The collective inertia tensor enters also the Wentzel-Kramers-Brillouin (WKB) formula used to extract spontaneous fission half-lives from multi-dimensional quantum tunnelling probabilities (For the sake of completeness, other approaches to tunnelling based on functional integrals are also briefly discussed, although there are very few applications.) It is also an important component of some of the time-dependent methods that have been used in fission studies. Concerning the latter, both the semi-classical approaches to time-dependent nuclear dynamics and more microscopic theories involving explicit quantum-many-body methods are presented. One of the hallmarks of the microscopic theory of fission is the tremendous amount of computing needed for practical applications. In particular, the successful implementation of the theories presented in this article requires a very precise numerical resolution of the HFB equations for large values of the collective variables. This aspect is often overlooked, and several sections are devoted to discussing the resolution of the HFB equations, especially in the context of very deformed nuclear shapes. In particular, the numerical precision and iterative methods employed to obtain the HFB solution are documented in detail. Finally, a selection of the most recent and representative results obtained for both spontaneous and induced fission is presented, with the goal of emphasizing the coherence of the microscopic approaches employed. Although impressive progress has been achieved over the last two decades to understand fission microscopically, much work remains to be done. Several possible lines of research are outlined in the conclusion.

Introduction: Calf circumference is a surrogate measurement of muscle mass. However, there is scarce evidence on its validity in predicting adverse outcomes such as mobility disability. The aim of this report is to determine if calf circumference could predict incident mobility disability in Mexican 60-year or older adults., Methods: This is a secondary analysis of the Mexican Health and Aging Study and in particular of its two first waves. Sixty-year or older adults without mobility disability in the first assessment were included and followed-up for two years. Calf circumference quartile groups were compared to test the difference of incident mobility disability. Logistic regression models were fitted to test the independent association when including confounding variables., Results: A total of 745 older adults were assessed, from which 24.4% of the older adults developed mobility disability at follow-up. A calf circumference > 38 cm was associated with a higher risk of developing mobility disability, even after adjustment in the multivariate model, with an odds ratio 0.55 (95% confidence interval 0.31-0.99, P = 0.049)., Conclusions: High calf circumference in Mexican older adults is independently associated with incident mobility disability. This could reflect the impact of adverse health conditions such as obesity (with high fat tissue) or edema. Further research should aim at testing these results in different populations.

Background: The implementation of an aging biomarker into clinical practice is under debate. The Frailty Index is a model of deficit accumulation and has shown to accurately capture frailty in older adults, thus bridging biological with clinical practice., Objectives: To describe the association of socio-demographic characteristics and the Frailty Index in different age groups (from 20 to over one hundred years) in a representative sample of Mexican subjects., Design: Cross-sectional analysis., Setting: Nationwide and population-representative survey., Participants: Adults 20-years and older interviewed during the last Mexican National Health and Nutrition Survey (2012)., Measurements: A 30-item Frailty Index following standard construction was developed. Multi-level regression models were performed to test the associations of the Frailty Index with multiple socio-demographic characteristics across age groups., Results: A total of 29,504 subjects was analyzed. The 30-item Frailty Index showed the highest scores in the older age groups, especially in women. No sociodemographic variable was associated with the Frailty Index in all the studied age groups. However, employment, economic income, and smoking status were more consistently found across age groups., Conclusions: To our knowledge, this is the first report describing the Frailty Index in a representative large sample of a Latin American country. Increasing age and gender were closely associated with a higher score.

Objective: To estimate the prevalence of sarcopenia in Mexican older adults using simple measurements and tailored cutoff values for the components of the European Working Group on Sarcopenia in Older People algorithm., Material and Methods: This study used cross-sectional data from the third wave (2012) of the Mexican Health and Aging Study. Gait speed and handgrip strength cutoff values were tailored for Mexican older adults. Muscle mass was estimated by a formula, which uses simple anthropometry and demographic characteristics., Results: From the total of 1,238 older adults included in our study, sarcopenia prevalence was 11% (n = 137). When categorizing sarcopenia, 39.1% (n = 484) had pre-sarcopenia, 8.3% (n = 103) moderate sarcopenia, and 2.75% (n = 34) had severe sarcopenia., Conclusions: Sarcopenia is a common problem in Mexican older adults, and its frequency along with its severity increases with age. Tailored cutoff values could help in identifying those subjects that could have benefited from intervention., Competing Interests: DECLARATION OF INTEREST The authors declare that they have no conflict of interest. Dr. Pérez was funded by Universidad Nacional Autónoma de México and the Gerontopole of To-louse University Paul Sabatier.

Background: Physical performance tests play a major role in the geriatric assessment. In particular, gait speed has shown to be useful for predicting adverse outcomes. However, risk factors for slow gait speed (slowness) are not clearly described., Objectives: To determine risk factors associated with slowness in Mexican older adults., Design: A two-step process was adopted for exploring the antecedent risk factors of slow gait speed. First, the cut-off values for gait speed were determined in a representative sample of Mexican older adults. Then, antecedent risk factors of slow gait speed (defined using the identified cut-points) were explored in a nested, cohort case-control study., Setting Participants: One representative sample of a cross-sectional survey for the first step and the Mexican Health and Aging Study (a cohort characterized by a 10-year follow-up)., Measurements: A 4-meter usual gait speed test was conducted. Lowest gender and height-stratified groups were considered as defining slow gait speed. Sociodemographic characteristics, comorbidities, psychological and health-care related variables were explored to find those associated with the subsequent development of slow gait speed. Unadjusted and adjusted logistic regression models were performed., Results: In the final model, age, diabetes, hypertension, and history of fractures were associated with the development of slow gait speed., Conclusions: Early identification of subjects at risk of developing slow gait speed may halt the path to disability due to the robust association of this physical performance test with functional decline.

Physical performance tests are associated with different adverse outcomes in older people. The objective of this study was to test the association between handgrip strength and gait speed with incident disability in community-dwelling, well-functioning, Mexican older adults (age ≥70 years). Incident disability was defined as the onset of any difficulty in basic or instrumental activities of daily living. Of a total of 133 participants, 52.6% (n=70) experienced incident disability during one year of follow-up. Significant associations of handgrip strength (odds ratio [OR] 0.96, 95% confidence interval [95%CI] 0.93-0.99) and gait speed (OR 0.27, 95%CI 0.07-0.99) with incident disability were reported. The inclusion of covariates in the models reduced the statistical significance of the associations without substantially modifying the magnitude of them. Handgrip strength and gait speed are independently associated with incident disability in Mexican older adults.

There is strong circumstantial evidence that certain heavy, unstable atomic nuclei are 'octupole deformed', that is, distorted into a pear shape. This contrasts with the more prevalent rugby-ball shape of nuclei with reflection-symmetric, quadrupole deformations. The elusive octupole deformed nuclei are of importance for nuclear structure theory, and also in searches for physics beyond the standard model; any measurable electric-dipole moment (a signature of the latter) is expected to be amplified in such nuclei. Here we determine electric octupole transition strengths (a direct measure of octupole correlations) for short-lived isotopes of radon and radium. Coulomb excitation experiments were performed using accelerated beams of heavy, radioactive ions. Our data on (220)Rn and (224)Ra show clear evidence for stronger octupole deformation in the latter. The results enable discrimination between differing theoretical approaches to octupole correlations, and help to constrain suitable candidates for experimental studies of atomic electric-dipole moments that might reveal extensions to the standard model.

Objective: To understand the public policy-making process as it relates to breast cancer care in five Latin American countries., Methods: An exploratory-evaluative study was conducted in Argentina, Brazil, Colombia, Mexico, and Venezuela in 2010, with the selection of countries based on convenience sampling. Sixty-five semi-structured interviews were conducted with government officials, academics, and representatives of trade associations and civil society organizations. A content analysis of secondary sources was performed. Information sources, data, and informants were mixed using the triangulation method for purposes of analysis., Results: The countries that have made the most progress in public policy-making related to breast cancer are Brazil and Mexico. Although Argentina, Colombia, and Venezuela do not have policies, they do have breast cancer care programs and activities. Two perspectives on the development of public policies became evident: the first includes the broad participation of both governmental and nongovernmental sectors, whereas the second, more narrow approach involves government authorities alone., Conclusions: The results point to significant differences in public policy-making related to breast cancer in the Region. They also show that greater progress has been made in countries where policies have been developed through inclusive participation processes.

Sarcopenia has an important impact in elderly. Recently the European Working Group on Sarcopenia in Older People (EWGSOP) defined sarcopenia as the loss of muscle mass plus low muscle strength or low physical performance. Lack of clinical sounding outcomes (ie external validity), is one of the flaws of this algorithm. The aim of our study was to determine the association of sarcopenia and mortality in a group of Mexican elderly. A total of 345 elderly were recruited in Mexico City, and followed up for three years. The EWGSOP algorithm was integrated by: gait speed, grip strength and calf circumference. Other covariates were assessed in order to test the independent association of sarcopenia with mortality. Of the 345 subjects, 53.3% were women; with a mean age of 78.5 (SD 7) years. During the three year follow-up a total of 43 (12.4%) subjects died. Age, cognition, ADL, IADL, health self-perception, ischemic heart disease and sarcopenia were associated in the bivariate analysis with survival. Negative predictive value for sarcopenia regarding mortality was of 90%. Kaplan-Meier curves along with their respective log-rank test were significant for sarcopenia. The components of the final Cox-regression multivariate model were age, ischemic heart disease, ADL and sarcopenia. Adjusted HR for age was 3.24 (CI 95% 1.55-6.78 p 0.002), IHD 5.07 (CI 95% 1.89-13.59 p 0.001), health self-perception 5.07 (CI 95% 1.9-13.6 p 0.001), ADL 0.75 (CI 95% 0.56-0.99 p 0.048) and sarcopenia 2.39 (CI 95% 1.05-5.43 p 0.037).

Unlabelled: Frailty tends to be considered as a major risk for adverse outcomes in older persons, but some important aspects remain matter of debate., Objectives: The purpose of this paper is to present expert's positions on the main aspects of the frailty syndrome in the older persons., Participants: Workshop organized by International Association of Gerontology and Geriatrics (IAGG), World Health Organization (WHO) and Société Française de Gériatrie et de Gérontologie (SFGG)., Results: Frailty is widely recognized as an important risk factor for adverse health outcomes in older persons. This can be of particular value in evaluating non-disabled older persons with chronic diseases but today no operational definition has been established. Nutritional status, mobility, activity, strength, endurance, cognition, and mood have been proposed as markers of frailty. Another approach calculates a multidimensional score ranging from "very fit" to "severely frail", but it is difficult to apply into the medical practice. Frailty appears to be secondary to multiple conditions using multiple pathways leading to a vulnerability to a stressor. Biological (inflammation, loss of hormones), clinical (sarcopenia, osteoporosis etc.), as well as social factors (isolation, financial situation) are involved in the vulnerability process. In clinical practice, detection of frailty is of major interest in oncology because of the high prevalence of cancer in older persons and the bad tolerance of the drug therapies. Presence of frailty should also be taken into account in the definition of the cardiovascular risks in the older population. The experts of the workshop have listed the points reached an agreement and those must to be a priority for improving understanding and use of frailty syndrome in practice., Conclusion: Frailty in older adults is a syndrome corresponding to a vulnerability to a stressor. Diagnostic tools have been developed but none can integrate at the same time the large spectrum of factors and the simplicity asked by the clinical practice. An agreement with an international common definition is necessary to develop screening and to reduce the morbidity in older persons.

Background: "Frailty" has emerged as a condition associated with an increased risk of functional decline among the elderly, which may be differentiated from aging, disability, and co-morbidities., Objective: The Mexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly has emerged to help answer many questions about frailty among the older adults. This report presents the design of the study and baseline data of its participants., Design: The "Coyoacan cohort" is a longitudinal observational study developed in Mexico City., Participants: A representative sample of 1,294 non-institutionalized men and women aged 70 years and older were randomly recruited to undergo a face-to-face interview and a comprehensive geriatric assessment (including clinical evaluations and blood samples) between 2008 and 2009., Measurements: Data collected included socio-demographic and economic characteristics, medical history, oral health, drug use, cognitive function and mood, nutritional status, physical performance and functional status, physical activity, quality of life, social networks, and biological data. Frailty was defined as the presence of ≥3 of the following components: slowness, poor muscle strength, low physical activity, exhaustion and unintentional weight loss., Results: A total of 1,124 participants completed the interview. The mean age was 79.5 ± 7.1 years, and 55.9% were female. Nine hundred and forty-five subjects completed the clinical evaluation and 743 blood samples were collected. The baseline prevalence of frailty was 14.1%., Conclusions: Understanding the medical, biological, and environmental factors that contribute to the phenomenon of frailty is the goal of the current research in the field.

Objectives: Beyond the well-known effect of educational level on cognitive performances, the present study investigates the specific effect of literacy acquisition independently of education., Design: A sample of 175 unschooled elderly participants was selected from a larger Mexican population-based cohort study., Participants: The sample of 175 subjects who never went to school was divided in two groups: 109 who never acquired literacy skills and 66 who declared having acquired reading and writing abilities., Measurements: Cognitive performances on commonly used tests (mini mental state examination, Isaacs set test, free and cued selective reminding test and clock-drawing test) were compared between the two groups taking into account several potentially confounding factors., Results: The participants with reading and writing skills performed better than their counterparts in most tests, even though no difference was observed for the Isaacs Set Test and the delayed recall of the free and cued selective reminding test., Conclusion: Writing and reading skills in elderly people with no formal education influence performances in very commonly used test. Not only educational level but also literacy acquisition should be taken into account when conducting cognitive assessment in very low educated elderly people.

The neutron-rich nuclei 94,96Kr were studied via projectile Coulomb excitation at the REX-ISOLDE facility at CERN. Level energies of the first excited 2(+) states and their absolute E2 transition strengths to the ground state are determined and discussed in the context of the E(2(1)(+)) and B(E2;2(1)(+)→0(1)(+)) systematics of the krypton chain. Contrary to previously published results no sudden onset of deformation is observed. This experimental result is supported by a new proton-neutron interacting boson model calculation based on the constrained Hartree-Fock-Bogoliubov approach using the microscopic Gogny-D1M energy density functional.

We present a Pfaffian formula for projection and symmetry restoration for wave functions of the general Bogoliubov form, including quasiparticle excited states and linear combinations of them. This solves a long-standing problem in calculating states of good symmetry, arising from the sign ambiguity of the commonly used determinant formula. A simple example is given of projecting a good particle number and angular momentum from a Bogoliubov wave function in the Fock space of a single j-shell.

Traditionally, frailty has been understood as a biological syndrome associated with bad health-related outcomes. However, nowadays there are no universally accepted diagnostic criteria for this syndrome, much less studies approaching it from a non-biological framework. Some previous work has been able to highlight social factors as important features implicated in the development of this entity, and are now recognized as relevant to understand frailty. However, research in this field is still limited. It seems clear that social factors, often ignored in the medical context, might represent risk factors for the development of this geriatric syndrome. To identify these factors, as well as their role in the physiopathology of frailty, could be of great importance in order to establish potential multidimensional models to treat frailty. A life course approach to determine the correlates and trajectories of frailty seems to be necessary. The allostatic load through life and chronic inflammation in the elderly are potential mediators of this relationship. Therefore, social profile should be systematically assessed and taken into account when evaluating an elderly person. So, the present review proposes how to include social factors as another determinant of frailty.

Background: Frailty represents a major public health priority in Western countries. Specific social and cultural factors may influence the prevalence and predictive value for negative health-related events of this syndrome., Objective: To determine the prevalence and predictive value of the phenotype of frailty among community-dwelling Mexican American older persons., Design, Setting and Participants: Two-year longitudinal study of 5,644 men and women aged 60 years and older participating in the Mexican Health and Aging Study., Measurements: The Frailty index used in the present study was a modified version of the operational definition proposed in the Cardiovascular Health Study (CHS). Frailty was defined by the presence of at least three of the four following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. The main outcomes were incident disability and mortality. Chi-square, ANOVA and multiple logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest., Results: The mean age of the study sample was 68.7 (SD 6.9) years. Thirty-seven percent of participants (n=2,102) met the definition of frailty. Frail subjects were significantly older, and more likely to be women than non-frail participants. They also presented lower education, more chronic diseases, lower income, and poorer self-reported health status. After adjusting for potential confounders, frailty was found to be a predictor of incident mobility disability (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.37-2.66), activities of daily living (ADL) disability (OR 9.33; 95%CI 3.37-25.82), and instrumental ADL (IADL) disability (OR 1.81, 95%CI 1.23-2.68). The risk of mortality among frail participants was almost three-fold higher than in non-frail ones., Conclusion: The prevalence of frailty is higher in this elderly population than what previously reported in other cohorts. The phenotype of frailty was confirmed to be a predictor for adverse health-related outcomes (including mobility, ADL, and IADL disability). Further studies in Latin American countries are needed to identify frailty and develop adapted interventions for the prevention of adverse outcomes in older persons.

Objective: To determine the association of the five frailty criteria from the Cardiovascular Health Study, as well as cognitive impairment, with prevalent disability for the instrumental (IADL) and basic activities of daily living (ADL)., Design: Cross-sectional study of 475 community-dwelling subjects aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty., Measurements: Six probable frailty criteria were considered: weight loss, poor endurance, low physical activity, slowness, weakness, and cognitive impairment. The association of each component of frailty for IADL and ADL disability as main outcomes was determined constructing multivariate logistic regression analyses. Final models were adjusted by socio-demographic factors and the presence of the other five frailty components as covariates., Results: Mean age of participants was 78.1 (SD=6.2). The unadjusted results showed that each of the components of frailty, except weight loss, was associated with both IADL and ADL disability. However, after adjustment, only low physical activity [Odds ratio (OR) =3.27; 95% CI=1.56 to 6.85] and cognitive impairment (OR=2.06; 95% CI=1.04 to 4.06) remain independently associated with IADL disability. Regarding ADL disability, only a lower physical activity (OR=7.72; 95% CI=1.28 to 46.46) was associated with this outcome, whereas cognitive impairment was marginally associated but was not statistically significant (OR=5.45; 95% CI=0.91 to 32.57)., Conclusions: Cognitive impairment and low physical activity are the main contributing factors of frailty phenotype to disability. Better understanding the independent contribution of each frailty subdimension to the different adverse-health outcomes may help to provide a more adequate management of frail elderly.

Shape coexistence in the nuclei (182-192)Pb is analyzed with the Hartree-Fock-Bogoliubov approach and the Gogny force. Good agreement with the experimental energies is found for the coexisting spherical, oblate, and prolate states. Contrary to the established interpretation, it is found that the low-lying prolate and oblate 0+ states are predominantly characterized by neutron correlations whereas the protons behave, in general, rather as spectators than playing an active role.

Introduction: Oral health status in older people is frequently poor which can contribute to inadequate dietary patterns and nutrition status., Objective: To investigate whether an association between the number of teeth present and dietary fiber intake exists in elderly people living independently, across different geographic and socioeconomic locations., Methods: A cross-sectional household survey was undertaken in three Mexican communities (urban, marginal urban, and rural), incorporating geographic and socio-demographic information and a 24-hour diet recall. Dental status (teeth present, coronal and root caries, and periodontal status) was determined by clinical examination. Data were analyzed using ANOVA, Pearson's chi2 and Tukey's range tests., Results: 407 persons 60 years old and over participated in the study. Subjects in the rural community had better dental/periodontal status and more teeth present than urban and marginal-urban participants. Intake of fiber was 8.4 g/day for the urban, 7.6 g/day for the marginal-urban, and 13.5 g/day for the rural community. While gender had no detectable effect, the location of residence and the number of teeth present were associated with mean fiber intake; having more than 21 teeth and/or living in a rural location were associated with increased mean fiber intake.

Background: An adequate nutritional status is essential for maintaining the independence in the elderly. The height and weight self-report is considered a useful alternative for the estimation of body mass index (BMI). The validity of the self-report is an issue that has not been dealt with in developing countries., Aim: To assess the validity of the height and weight self-report in adults Mexican citizens., Design: Transversal study., Study Population: 1707 persons (836 males, 871 females) were asked for their height and weight and were measured., Results: Mean (+/- standard deviation) age was 59.09 +/- 9.86 SD; mean years of education was 5.51 +/-4.67 years. We found a high correlation between self-reported and measured weight (R2= 0.837); the difference between both values rose along with the age (from 0.4 kg to 1.74 kg). A systematic difference between self-reported and measured height was found. Self-reported height was over-estimated, and the bias increased along with the age of the subjects (from 1.57 cm to 2.57 cm); further, over-estimation was larger in female individuals (+2.22 cm in female vs. +1.21 cm in male subjects). We calculated a linear model that predicts real height from self-reported height with moderate, although statistically significant results (R2= 0.39 y 0.50, for female and male, respectively, p < 0.0001). Knee height was also used to estimate "adulthood height" and thus, BMI. This method showed age-related dissimilarities, and the linear regression model yielded an unacceptably low correlation (R2= <0.10). The best method to estimate real BMI was to consider self-reported parameters., Discussion: Height and weight estimation using self-reported parameters is an acceptable method. Its precision is not so high in subjects > 75 years. Height over-estimation is an expected finding congruent with age-related corporal changes. The estimation of height using knee height is not a useful method., Conclusion: Height and weight self-report is a valid method that may be used to accurately estimate height and weight in Mexican people.

The objective of this comparative cross-sectional study was to determine the prevalence of dyslipidemias and examine its association with food intake and metabolic variables in urban and rural elder Mexican populations. Three different communities (urban areas of medium and low income and a rural area) were studied. A total of 344 subjects aged 60 years and older and 273 aged 35 to 59 years were included. The evaluated parameters were personal medical data, 24-hour diet recall, and fasting plasma lipids, insulin, and glucose levels. Older subjects, especially men, living in the rural area had lower cholesterol levels (5.02 +/- 0.97 v 5.6 +/- 1.07 mmol/L; P <.05) and insulin levels (12 +/- 10 v 42 +/- 68 mU/mL) and higher high-density lipoprotein cholesterol concentrations (1.31 +/- 0.36 v 1.07 +/-0.28 mmol/L) than the elders from the urban medium-income group. Possible explanations for these differences are found in the dietary habits of the groups. Rural elders had higher amounts of fiber (20 +/- 11 v 10 +/- 6 g/d) and carbohydrate (70% +/- 0.08% v 52% +/- 0.11% of calories) and lower fat (18% +/- 0.07% v 33% +/- 0.1% of calories) in their diets. In the urban groups, low-density lipoprotein hypercholesterolemia was present in 17.8% of adult and 39.1% of elderly women (P =.00001). In conclusion, environmental factors still play a prominent role in the pathophysiology of the dyslipidemias in the elderly., (Copyright 2001 by W.B. Saunders Company)

Objective: To determine the prevalence of obesity and its association to different variables in urban and rural older Mexican populations., Methods and Procedures: A cross-sectional study of three different Mexican communities. A total of 121 men and 223 women 60 years and older and 93 men and 180 women aged 35 to 59 years old were selected randomly for inclusion in the survey. A personal interview assessed demographic information, personal medical history and functional status and a 24-hour diet recall was obtained. The physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin and glucose., Results: Obesity was highly prevalent in women, in individuals from the urban communities and diminished with advancing age. A BMI > or =30 kg/m2 was observed in 23.6% younger vs. 15.6% older adult men (p=0.21) and 28.4% younger vs. 19.7% older adult women (p = 0.06). The association of obesity with other variables was estimated using a stepwise multivariate logistic regression, increased insulin levels [Odds Ratio (OR) 1.68, p=0.006] and living in an urban area (OR 5.90, p<0.007) were variables independently associated to obesity in adult older individuals. In the younger adults, obesity was associated with hypertension (OR 2.74, p<0.0009), higher insulin levels (OR 1.31, p<0.03) and central adiposity (OR 2.97, p = 0.05), these relationship were not observed with gender, distribution of food or alcohol intake or other coronary risk factors., Conclusions: The present survey confirms the high prevalence of obesity in the Mexican urban population that declines with advanced age. Studies in elderly population must consider the bias produced by increased early mortality in those individuals with a more unfavorable risk profile.

Objective: To determine the prevalence of diabetes and examine its association with food intake, anthropometric and metabolic variables, and other coronary risk factors in urban and rural older Mexican populations., Design: A cross-sectional study., Setting: Three Mexican communities (urban areas of medium and low income and a rural area)., Participants: A total of 121 men and 223 women aged 60 years and older and 93 men and 180 women aged 35 to 59 years were selected randomly for inclusion in the survey, which was derived from the CRONOS study (Cross-Cultural Research on Nutrition in the Older Adult Study Group) promoted by the European Economic Community., Measurements: A personal interview assessed demographic information, personal medical history, and functional status, and a 24-hour diet recall was obtained. A physical examination included anthropometric and blood pressure measurements. A fasting blood sample was obtained for measurements of lipids, insulin, and glucose., Results: Diabetes prevalence was higher in men than in women for all age groups: 16.7% versus 9.5% in younger adults and 30.8% versus 22.8% in older adults. For all age groups, diabetes was more highly prevalent in urban communities. Using a multivariate stepwise logistic regression, variables associated independently with diabetes in older individuals were: gender (male sex: OR = 2.1; P < .009); diminished carbohydrate intake in the diet (OR = 0.77; P < .03); central distribution of adiposity (OR = 1.9; P < .03); and functional disability (OR = 2.3; P < .01). This relationship was not observed with living area, income, education, fiber and alcohol intake, body mass index, or age. Individuals 80 years and older had a diminished atherogenic risk profile. Diabetes in older people was associated significantly with hypertriglyceridemia, impaired functional status, and an increased prevalence of ischemic heart disease; in younger adults diabetes was associated with low density lipoprotein (LDL) hypercholesterolemia, hypertriglyceridemia, and a proportionally higher fat intake., Conclusion: This survey confirms the high prevalence of diabetes in the older Mexican population - particularly in men and in individuals living in urban areas - associated with an increased prevalence of other coronary risk factors. Diabetes was associated with higher fat, low carbohydrate, low fiber diets and increased prevalence of central distribution of adiposity. In the older subjects, diabetes was associated significantly with hypertriglyceridemia, impaired functional status, and increased prevalence of ischemic heart disease. A bias produced by early mortality and a survivorship effect must be considered in studies of older individuals. The health situation in the older Mexican population presents a complex problem that needs correct diagnosis and better strategies to benefit those segments of the population at increased risk.

Objective: To critically analyze the level and quality of infrastructure, human resources and organization of long term care institutions for the elderly in Mexico City and to describe the functional status and care requirements of their residents., Material and Methods: A census was made of the institutions located in the metropolitan area of Mexico City which totalled 115. These were classified according to their belonging to the public or private sector (for profit and non-profit). In each category we made a random selection of 33 institutions which were all assessed according to the methodology described by Firevicius and applied by PAHO in several countries in Latin-America. This questionnaire was applied by a single interviewer. Within the selected institutions, 30% of the residents, who were also randomly selected were assessed by means of the Kuntzman's care requirements scale. Out of a total population of 1955, 617 (34%) residents were assessed., Results: The mean score obtained by the institutions was under 50% of the maximum possible score with a great deal of dispersion of the results. The lowest scores were identified in the private for profit sector and in a subgroup of public institutions. The highest scores were found among private non-profit institutions and a sector of the public institutions. The most important shortcomings identified were related to infrastructure and quality of human resources. The mean age of the institutionalized elderly is 76; 48.1% are functionally independent, 21.3% partially dependent and 30.6% totally dependent. When trying to correlate the mean functional status of the population of a given institution with its resources for care-giving we usually found no correlation. It is commonplace to find highly dependent populations living in poorly staffed or inadequately equipped institutions and vice versa, Conclusions: Quality of care in long term care institutions in Mexico City is often poor and this is particularly true for private for profit institutions. Lack of norms and supervision pertaining to the functioning of such institutions contributes greatly to this reality.

Objective: The aim of the present study was to estimate basic anthropometric measurements in a group of elderly men and women from Mexico City., Material and Methods: A cross-sectional study was carried out among senior citizens registered in the National Institute of the Elderly and National Institute of Social security in Mexico City. Standardized protocols were used to measure the anthropometric characteristics of the study group. The analysis included Student t tests to detect differences in average values between men and women in general and in each age subgroup formed. In addition, Pearson correlation analysis of the body mass index (BMI) with anthropometric variables was performed; p < 0.05 was taken as the level of significance., Results: A total of 508 people aged 60 or older participated in the study; 230 were males and 278 were females. The average age was 66.9-years-old in the male group and 67.3-years-old in the female group. Among men the average weight was 70.7 kg, standard deviation (SD 9.9), height was 164 cm (SD 6.5) and BMI was 26.4 (SD 3.7). Among women the average weight was 60.8 kg (SD 9.9), height was 150 cm (SD 5.9) and BMI was 27.1 (SD 4.0). The distribution of the BMI showed that 50.9% of men and 54% of women were between 25.0 and 29.9. A correlation coefficient over r 0.70 (p < 0.001) was found between BMI and waist and hip circumferences., Conclusions: Based on the BMI about three-quarters of the population was overweight or obese. It is possible that the assessment of being overweight and of obesity in elderly people needs to be adjusted considering revised normality values.

Objective: The purpose of this study was to determine the characteristics of hospital utilization by the elderly in three hospitals in Mexico City during 1992 and 1993. Main reason for admission, average length of stay and type of treatment received were some of the variables studied., Material and Methods: A random sample of 820 clinical files were selected, 308 from the Instituto Nacional de la Nutrición Salvador Zubirán (INNSZ), 189 from the Hospital General Manuel Gea González (HGMGG) and 323 from the Hospital Regional Adolfo López Mateos (HRALM). The principal reasons for admission, average days spent in the hospital and type of treatment received were identified for patients 60 years and older. Univariate and bivariate analysis was performed with hypothesis test for differences between sexes., Results: Diabetes mellitus and hypertension were the principal reasons for admission length of stay varied considerably and was the longest at the INNSZ (median: 12 days) and the shortest at the HRALM (median: 8 days). Most of the patients were admitted through the emergency service, except in the INNSZ where most came for ambulatory visit.

The problem of population aging and its consequences for health has not been analysed in depth in Mexico. This paper is a critical review of available data on the epidemiology of aging in Mexico. Available data, even though incomplete serves us to identify the main problems afflicting the elderly population: poverty, absence of specialized services, high prevalence of disabilities and multiple pathology and weakening of the family and social support network. throughout the analysis of this information, a proposal is made towards the development of a gerontological services network.