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BACKGROUND/OBJECTIVES: The objective of this study was to ascertain the effect of weight loss over the course of 1 year on 5-year mortality in old nursing home (NH) residents in different classes of body mass index (BMI). SUBJECTS/METHODS: A longitudinal study was conducted on 161 NH residents aged ≥ 70 years at the Istituto di Riposo per Anziani, Padova, Italy. Data were collected using a comprehensive geriatric assessment at baseline and at a 1-year follow-up visit. Mortality was recorded over a 5-year follow-up. We divided our sample into four groups using as cutoffs a BMI of 25 and a weight gain or loss of 5% at 1 year (BMI ≥ 25 and weight stable/gain, BMI [greater than or equal to] 25 and weight loss, BMI < 25 and weight stable/gain and BMI < 25 and weight loss). RESULTS: People with a BMI ≥ 25 and weight loss suffered the worst decline in activities of daily living, whereas those with a BMI < 25 and weight loss had the most significant decline in nutritional status, which coincided with the worst decline in the Multidimensional Prognostic Index among the groups whose weight changed. Compared with those with a BMI ≥ 25 and weight stable/gain (reference group), those with a BMI < 25 were at the highest risk of dying (in association with weight loss: hazard ratio HR = 3.60, P = 0.005;in association with weight stable/gain: HR = 2.45, P = 0.01), and the mortality risk was also increased in people with a BMI [greater than or equal to] 25 and weight loss (HR = 1.74, P = 0.03). CONCLUSIONS: In conclusion, weight loss increases the mortality risk in frail, disabled NH residents, even if they are overweight or obese. European Journal of Clinical Nutrition (2015) 69, 1113-1118; doi:10.1038/ejcn.2015.19; published online 11 March 2015, INTRODUCTION Obesity is an increasingly important clinical issue, associated with cardiovascular morbidity, hypertension and diabetes. (1) As obesity has become more widespread, the proportion of older people who are obese [...]

Background/Objectives: Although there is plenty of evidence of the association between metabolic syndrome (MS) and cardiovascular disease, the relationship between alcohol consumption and MS is still questioned. The few publications with respect to the elderly seem to indicate that alcohol consumption is unassociated with MS. The aim of this study was to assess the association between alcohol consumption and the prevalence and incidence of MS, as well as its components in a large sample of Italian elderly people. Subjects/Methods: This is a multicenter study on a population-based sample of Italian people aged 65-84 years. The Italian Longitudinal Study on Aging (ILSA) included a prevalence phase in 1992 and an incidence phase from 1995 to 1996. The median length of follow-up was 3.5 years. In the present study, the analysis included 1321 men grouped into five alcohol consumption classes: abstainers, and those consuming ≤ 12, 13-24, 25-47 or ≥ 48g of alcohol in a day. Among the 1122 women considered, the last two of the above five categories were pooled together (>24g/day). MS was defined according to ATP III criteria. All statistical analyses were stratified by gender. Results: Adjusted odds ratios showed that categorized alcohol consumption was not significantly associated with the prevalence and incidence of MS when compared with abstainers in either gender. For the MS incidence survey, three of five components (systolic pressure, glycemia and waist circumference) proved to be significantly and harmfully affected by alcohol consumption in males, whereas no such significant association emerged in females. Conclusions: These results suggest that alcohol can modify an individual's metabolic condition and that, even among the elderly, men might be more sensitive to the effects of alcohol than women. European journal of Clinical Nutrition (2010) 64, 297-307; doi: 10.1038/ejcn.2009.136; published online 25 November 2009 Keywords: drinking; metabolic syndrome; elderly; cohort; epidemiology, Introduction Metabolic syndrome (MS) is increasingly recognized as a risk factor for cardiovascular diseases and cardiovascular mortality in the elderly population. MS has been found to yield independent prognostic information [...]

Objectives: The aims of this study were to investigate the relationship between sarcopenia, dietary intake, nutritional indices and hip bone mineral density (BMD) in the elderly, and to estimate the risk of low BMD due to specific independent predictor thresholds. Subjects and methods: Body mass index (BMI), serum albumin, energy and protein intake were studied in 352 elderly outpatients (216 women aged 73.5 [+ or -] 5.3 years and 136 men aged 73.9 [+ or -] 5.6 years). BMD at different hip sites and appendicular skeletal muscle mass (ASMM) were assessed by dual-energy X-ray absorptiometry. Results: The prevalence of osteoporosis was 13% in men and 45% in women, while the prevalence of sarcopenia (50%) and hypoalbuminemia (5%) were similar in both genders. BMI, albumin and ASMM were significantly associated with BMD in both genders: so was protein intake, but only in men. By multiple regression analysis, the variables that retained their independent explanatory role on total hip BMD, were BMI and protein intake in men, and BMI and albumin in women. By logistic regression analysis, men risked having a low BMD with a BMI Conclusions: BMI in both genders, albumin in women and protein intake in men have an independent effect on BMD. BMI values doi:10.1038/sj.ejcn.1602779; published online 18 July 2007 Keywords: osteoporosis; body mass index; serum albumin; protein intake; sarcopenia, Introduction Osteoporosis is a multifactorial condition characterized by low bone mineral density (BMD) and bone architecture deterioration, resulting in a greater risk of fracture, a growing healthcare burden and high [...]

Author(s): N Veronese; S Watutantrige-Fernando; C Luchini; M Solmi; G Sartore; G Sergi; E Manzato; M Barbagallo; S Maggi; B Stubbs Correction to: European Journal of Clinical Nutrition advance online [...]

Prospective studies have suggested that hypovitaminosis D can predict the onset of obesity, but they relied mainly on body mass index, which could be scarcely reliable in older people. We investigated whether baseline hypovitaminosis D could predict higher fat mass (FM) levels using dual-energy X-ray absorptiometry in a sample of 116 fit and healthy older subjects. Although no significant differences in FM estimates emerged between subjects with and without hypovitaminosis D at the baseline, abdominal FM was found significantly higher in the former group (with hypovitaminosis D at the baseline) than in the latter after 3 years of follow-up. Adjusted logistic regression analysis confirmed these findings: hypovitaminosis D coincided with an approximately sixfold higher risk of subjects having higher abdominal FM levels at the follow-up. In conclusion, hypovitaminosis D predicts higher abdominal FM levels in the elderly. European Journal of Clinical Nutrition (2016) 70, 1080-1082; doi: 10.1038/ejcn.2016.95; published online 1 June 2016, Author(s): N Veronese [1]; C Trevisan [1]; S Carraro [1]; S Sarti [1]; B M Zanforlini [1]; M De Rui [1]; A Coin [2]; E Manzato [1, 3]; G Sergi [...]

We examined the effects of 2 months of psyllium treatment in optimizing metabolic control and lipoprotein profile, and its postprandial effects on lipids in type II diabetes. We recruited 40 type II diabetic patients who were on sulfonylureas and a controlled diet, sequentially assigning them to psyllium treatment (G1) or to a control group (G2) treated with dietary measures alone. After 2 months of treatment, body mass index, waist circumference, HbA1c (hemoglobin A1 c) and fasting plasma glucose levels had significantly decreased in both groups. There were no postprandial differences in the lipoprotein profile between the two groups. Triglycerides were significantly lower in G1, but not in G2. Our study contributes toward elucidating the effects of psyllium on serum lipids, and suggests that psyllium treatment may help in reducing triglycerides (a known risk factor for cardiovascular disease) in type II diabetic patients. doi:10.1038/ejcn.2009.60; published online 22 July 2009 Keywords: type 2 diabetes; lipoproteins; psyllium; dietary fiber, Introduction In addition to pharmacological treatments, dietary measures (in particular, the use of fibers) have recently become important in the treatment of diabetes. Soluble fibers render food absorption slower, and [...]

The aim of this study was to test whether ambulatory blood pressure monitoring (ABPM) in elderly patients with atrial fibrillation (AF) is as feasible and reliable as ABPM is in patients with normal sinus rhythm (SR). Studies of ABPM in the elderly remain limited, and the use of this method in patients with AF remains controversial. The Italian SIIA 2008 guidelines consider ABPM 'absolutely contraindicated' for AF patients. This study was conducted on 200 hospitalized patients aged ≥ 65 years (68% females; mean age 82.4 ± 6.3 years): 100 patients with SR and 100 patients with permanent AF. Each patient completed serial blood pressure (BP) measurements with a clinical sphygmomanometer (Sphyg) and ABPM. Differences in mean heart rate (HR) between patient groups were not statistically significant. A total of 99.5% of patients were hypertensive. There were no significant differences between SR and AF patients in mean systolic BP (SBP) and diastolic BP (DBP) values, as measured with the Sphyg or by ABPM. Compared with the Sphyg, errors associated with BP measurements obtained by ABPM did not significantly differ between the two groups. ABPM proved to be as feasible as Sphyg measurements in both AF patients (intraclass correlation coefficients=0.73, 0.67 and 0.74 for SBP, DBP and HR, respectively) and SR patients (intraclass correlation coefficients=0.74, 0.58 and 0.67 for SBP, DBP and HR, respectively). A Bland-Altman plot analysis confirmed that there was good agreement between the two methods. Stable AF (HR 60-100 b.p.m.) should not be considered as an absolute contraindication for the use of ABPM, even in the elderly; it could be a 'relative' contraindication for very unstable AF patients.

Obesity is frequently associated with several alterations of plasma lipid levels and lipoprotein metabolism. To evaluate the effects of severe obesity and weight loss on plasma lipoprotein sub-class levels and composition 11 grossly obese patients were examined before and six and 12 months after gastroplasty. Plasma lipoproteins were isolated by ultracentrifugation in a zonal rotor under rate flotation conditions. Mean body weight was 121.9 kg before gastroplasty, 97.6 kg after six months, and 90.7 kg after 12 months. Total plasma cholesterol was not affected by the weight reduction. Obese patients were characterized by increased levels of IDL and small dense LDL (LDL3). LDL levels, but not LDL3, were reduced following weight reduction. Plasma apo B levels of obese patients were always higher than in controls and were not affected by the weight reduction. After 12 month's weight loss total HDL cholesterol increased without modification of HDL sub-class cholesterol distribution, which was similar to that of normal controls. Plasma apo AI in obese patients was not affected by changes in body weight, and remained below normal. The percentage protein-lipid composition of LDL2 and HDL3 in obese patients was characterized by a decreased cholesterol ester content before gastroplasty which was normalized 12 months after gastroplasty. The presence of IDL and LDL3 in increased concentrations in severely obese patients may represent a vascular risk factor since similar abnormalities were recently observed in non-obese patients affected with vascular diseases.