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Purpose As studies examining the association between bone mineral density (BMD) and airflow limitation (AL) have produced conflicting results, the current one set out to analyze if and to what degree there are any correlations between these variables in a population of fit elderly women. Methods One hundred and twenty-one non-smoking, fit and healthy women (age [greater than or equal to] 65 years) underwent anthropometric assessment, laboratory testing (serum 25-hydroxy vitamin D, parathormone, and cytokine levels), pulmonary function testing (PFT), and dual-energy X-ray absorptiometry to evaluate BMD values of the lumbar and femoral regions. Results A significant positive association was found between FEV.sub.1/FVC ratio (Tiffeneau index), a sensitive index of AL, and lumbar and femoral BMD; a 10 % increase in the FEV.sub.1/FVC ratio resulted in a significant increase of 0.025 g/cm.sup.2 in the total hip (p = 0.05), 0.027 g/cm.sup.2 in the femoral neck (p = 0.02), 0.028 g/cm.sup.2 in the femoral trochanter (p = 0.01), and 0.047 g/cm.sup.2 in the lumbar (p = 0.03) BMDs. Binary logistic analyses demonstrated more than a threefold higher risk of low BMD values for the lowest FEV.sub.1/FVC quartile in the lumbar (OR 4.62, 95 % CI 1.48-14.40, p = 0.008), total hip (OR 4.09, 95 % CI 1.28-13.05, p = 0.02 for the second quartile), and femoral trochanter regions (OR 3.90, 95 % CI 1.25-12.20, p = 0.02 for the third quartile). Conclusions AL was associated with a higher risk of reduced BMD in healthy, fit elderly women., Author(s): Caterina Trevisan[sup.1] , A. Vianello[sup.2] , N. Veronese[sup.1] , S. Carraro[sup.1] , S. Pizzato[sup.1] , P. Lucato[sup.1] , G. Girotti[sup.1] , C. Rinaldo[sup.2] , A. Coin[sup.1] , E. Manzato[sup.1] [...]

Androgen Insensitivity Syndrome represents a disorder due to partial (PAIS), mild (MAIS) or complete (CAIS) resistance to androgens caused by X-linked mutations of androgen receptor gene. CAIS is characterized by a female phenotype and XY karyotype. Cases of patients with CAIS and associated obesity have been reported, while to date, there are no reports about the onset of an Eating Disorder (ED) in the carriers of this condition. We describe the case of a patient affected by CAIS and Anorexia Nervosa (AN) restricting type later shifted to Bulimia Nervosa (BN). A previous overweight was present since childhood, contributing to severe Body Dissatisfaction (BD) and consequent restrictive behaviour in adolescence. Beyond its peculiarity, this case highlights also the importance of diagnosing and monitoring the overweight and BD in CAIS patients to avoid the onset of an ED.Level of Evidence: V, descriptive study., (© 2020. Springer Nature Switzerland AG.)

The age- and gender-related cardio-metabolic changes may limit the applicability of guidelines for the prevention of cardiovascular diseases (CVD) in older people. We investigated the association of cardiovascular risk profile with 20-year all-cause and CVD-mortality in older adults, focusing on age- and gender-specific differences. This prospective study involved 2895 community-dwelling individuals aged ≥65 years who participated in the Pro.V.A study. The sum of achieved target levels (smoking, diet, physical activity, body weight, blood pressure, lipids, and diabetes) recommended by the European Society of Cardiology 2016 guidelines was assessed in each participant. From this sum, cardiovascular risk profile was categorised as very high (0-2), high (3), medium (4), low (5), and very low (6-7 target levels achieved). All-cause and CV mortality data over 20 years were obtained from health registers. At Cox regression, lower cardiovascular risk profile was associated with reduced 20-year all-cause mortality in both genders, with stronger results for women (HR = 0.42 [95%CI:0.25-0.69] and HR = 0.61 [95%CI:0.42-0.89] for very low vs. very high cardiovascular risk profile in women and men, respectively). This trend was more marked for CVD mortality. Lower cardiovascular risk profile was associated with reduced all-cause and CVD mortality only in men < 75 years, while the associations persisted in the oldest old women. A lower cardiovascular risk profile, as defined by current guidelines, may reduce all-cause and CVD mortality in older people, with stronger and longer benefits in women. These findings suggest that personalised and life-course approaches considering gender and age differences may improve the delivery of preventive actions in older people., Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00620-y., (© The Author(s) 2021.)

Background: Polypharmacy has been associated with worse cognitive performance, but its impact on mild cognitive impairment (MCI) progression to dementia has not been explored., Aims: The aims of the study were to investigate the association between multidrug regimens and MCI progression, and the possible mediation of drug-drug interactions and drugs' anticholinergic effect in such association., Methods: This work included 342 older adults with MCI, who were involved in an Italian multicenter population-based cohort study. Information on drugs taken was derived from general practitioners' records and data on drug-drug interactions and anticholinergic burden [evaluated through the Anticholinergic Cognitive Burden and the Anticholinergic Risk Scale (ARS)] were extracted. Multinomial logistic regressions assessed the associations between mild polypharmacy (≥ 3 drugs/day), drug-drug interactions, and anticholinergic burden with MCI changes after 1-year follow-up. Mediation analysis evaluated potential mediators of that relationship., Results: Approximately, 50% of participants took ≥ 3 drugs/day. During the follow-up, 4.1% of MCI patients progressed to dementia. The odds of developing dementia was sixfold higher in those who took ≥ 3drugs/day (OR = 6.04, 95% CI 1.19-30.74), eightfold higher in those with ≥ 1 drug-drug interaction/s (OR = 8.45, 95% CI 1.70-41.91), and fivefold higher in those with ARS ≥ 1 (OR = 5.10, 95% CI 1.04-24.93). Drug-drug interactions mediated 70.4% of the association between medication number and MCI progression to dementia (p = 0.07)., Discussion: Our study suggests that even mild polypharmacy may increase the risk of MCI progression to dementia, probably due to the presence of drug-drug interactions, which often occur in multidrug regimens., Conclusions: Older people require careful management of pharmacological treatments, with special attention to drug-drug interactions and drug-related anticholinergic effects.

Non-motor symptoms (NMSs) are common in Parkinson's disease (PD) and can precede, sometimes for several years. NMSs include, other than gastrointestinal symptoms like constipation and dysphagia, also hyposmia, weight loss and osteosarcopenia. These three NMSs seem to be inter-related and affect patients' health and quality of life. Unfortunately, patients with these symptoms usually are not initially seen by a neurologist, and by the time they are consulted, nearly ~ 80% of the dopaminergic neurons in the substantia nigra have died. To date, no guidelines exist for screening, assessment and management of NMSs in general. A better understanding of these specific NMSs, likely in the context of others, will make it possible to approach and optimise the treatment of the motor symptoms thereby enhancing the welfare of PD patients. Identifying the NMSs could be very helpful, and among them, hyposmia, weight loss and osteosarcopenia may play an important role in solving the limitations in the diagnosis of PD. A strict collaboration between general practitioners, clinicians, geriatricians and neurologists can be one approach towards the diagnosis of pre-PD. Waiting until the motor symptoms develop and the patient is finally visited by the neurologist could be too late, considering the catastrophic prognosis of the disease.

The synchronic loss of bone mineral density and decrease in muscle mass, strength, and function defines the scenario of osteosarcopenia, which is associated with an increased risk of falls and fractures in older adults. An important role in preventing muscle and bone loss is played by nutritional factors, in particular the intake of proteins, calcium, magnesium and vitamin D. This review summarizes the available literature concerning the influence of protein intake and supplementation (vitamin D, Ca, Mg, branched-chain amino acids) on the decline of musculoskeletal integrity in healthy older adults. Furthermore, in this paper, we attempted to give some suggestions to build up adequate nutritional and dietary strategies against the age-related loss of muscle and bone mass.

Background: Cardiac troponin I (cTnI) has been poorly studied in elderly inpatients., Aim: This study wanted to assess factors influencing the increase in cTnI and its prognostic value in hospitalized elderly patients., Methods: 354 elderly (mean age of 84.8 ± 6.9 years) patients consecutively admitted in the Geriatrics Division in Padua were tested for cTnI levels assay during the hospital stay. Number of subsequent patient deaths at 6 months and 2 years were registered., Results: Of the 354 patients, 27 (7.6%) died in hospital; their levels were not significantly higher or more frequently positive on cTnI than those of the remainder of the sample. 71 (20.01%) patients died within 6 months of being discharged, and in-hospital positive cTnI levels emerged as a mortality risk factor in this group [unadjusted HR 1.13 (1.04-1.23); p = 0.004]. At 2 years, a total of 174 patients (49.2%) had died, but in-hospital pathological cTnI levels were not a mortality risk factor in this group., Discussion: It should be noted that cTnI level was a risk factor for mortality at 6 months but no longer at 2 years after an elderly patient's hospitalization. This finding may relate to patients' limited physiological reserves or be driven by the fact that the elderly tend to receive fewer evidence-based treatments, and to be managed more conservatively than younger patients., Conclusions: In the multidimensional analysis of older patients, troponin I can be used to stratify patients and assess mortality risk at 6 months, but not at 2 years.

Purpose: This study was aimed to examine the structural and construct validity of the Italian version of the Yale Food Addiction Scale in a multisite sample of postgraduate students., Methods: Two hundred and fifty-six subjects (78.1% females) aged from 18 to 53 years (mean = 23.93, SD = 4.96) and attending different postgraduate university programs at multiple Italian universities completed the Italian YFAS, the Italian Binge Eating Scale (BES), the Italian Eating Attitudes Test-26 and the Italian Dutch Eating Behavior Questionnaire (DEBQ) online through Qualtrics., Results: Confirmatory Factor Analysis showed that the single-factor model of the Italian YFAS including all original items had adequate fit indexes (χ 2 252 = 454.183; p < 0.001; normed χ 2  = 1.802; RMSEA = 0.056; 90% CI 0.048-0.076; CFI = 0.761; WRMR = 1.592). However, item analysis revealed that item#25 had zero variance (all subjects were assigned the same score after item dichotomization) and item#24 had a low factor loading, and were thus removed. Furthermore, item#10 and item#11 showed to be almost perfectly correlated (r = 0.998) and were thus parceled. The resulting 19-item single-factor model revealed a better fit to the data (χ 2 152 = 235.69; p < 0.001; normed χ 2  = 1.556; RMSEA = 0.046; 90% CI 0.034-0.058; CFI = 0.858; WRMR = 1.236) and its internal consistency was acceptable (KR-20 = 0.72). Also, a single-factor model including the seven diagnostic symptoms was tested and showed adequate fit values (χ 2 20 = 41.911; p < 0.003; normed χ 2  = 2.09; RMSEA = 0.065; 90% CI 0.037-0.093; CFI = 0.946; WRMR = 1.132). Statistically significant and small-to-high correlations were found with all convergent measures, in particular with the BES., Conclusion: The Italian 19-item YFAS resulted to be a valid and reliable tool for the assessment of food addiction in postgraduate students., Level of Evidence: Level V, descriptive study.

A long history of diabetes mellitus and increasing age are associated with the onset of diabetic neuropathy, a painful and highly disabling complication with a prevalence peaking at 50% among elderly diabetic patients. Acetyl-L-carnitine (ALC) is a molecule derived from the acetylation of carnitine in the mitochondria that has an essential role in energy production. It has recently been proposed as a therapy to improve the symptoms of diabetic neuropathy. ALC is widely distributed in mammalian tissues, including the brain, blood-brain barrier, brain neurons, and astrocytes. Aside from its metabolic activity, ALC has demonstrated cytoprotective, antioxidant, and antiapoptotic effects in the nervous system. It exerts an analgesic action by reducing the concentration of glutamate in the synapses. It facilitates nerve regeneration and damage repair after primary trauma: its positive effects on metabolism promote the synthesis, fluidity, and functionality of neuronal membranes, increase protein synthesis, and improve the axonal transport of neurofilament proteins and tubulin. It also amplifies nerve growth factor responsiveness, an effect that is believed to enhance overall neurite growth. ALC has been proposed for the treatment of various neurological and psychiatric diseases, such as mood disorders and depression, dementias, Alzheimer's disease, and Parkinson's disease, because synaptic energy states and mitochondrial dysfunction are core factors in their pathogenesis.

Backgrounds: In non-critical hospitalized patients with diabetes mellitus, guidelines suggest subcutaneous insulin therapy with basal-bolus regimen, even in old and vulnerable inpatients., Aim: To evaluate safety, efficacy, and benefit on clinical management of the GesTIO protocol, a set of subcutaneous insulin administration rules, in old and vulnerable non-ICU inpatients., Methods: Retrospective, observational study. Patients admitted to Geriatric Clinic of Padua were studied. 88 patients matched the inclusion criteria: type 2 diabetes or hospital-related hyperglycemia, ≥65 years, regular measurements of capillary glycemia, and basal-bolus subcutaneous insulin regimen managed by "GesTIO protocol" for five consecutive days., Main Outcome Measures: ratio of patients with blood glucose (BG) <3.9 mmol/l; number of BG per patient in target range (5-11.1 mmol/l); daily mean BG; and calls to physicians for adjusting insulin therapy., Results: Mean age was 82 ± 7 years. 9.1% patients experienced mild hypoglycaemia, and no severe hypoglycaemia was reported. The median number of BG per patients in target range increased from 2.0 ± 2 to 3.0 ± 2 (p < 0.001). The daily mean BG decreased from 11.06 ± 3.03 to 9.64 ± 2.58 mmol/l (-12.8%, p < 0.005). The mean number of calls to physicians per patient decreased from 0.83 to 0.45 (p < 0.05)., Conclusions: Treatment with GesTIO protocol allows a safe and effective treatment even in very old and vulnerable inpatients with a faster management insulin therapy.

The assessment of body composition has important applications in the evaluation of nutritional status and estimating potential health risks. Bioelectrical impedance analysis (BIA) is a valid method for the assessment of body composition. BIA is an alternative to more invasive and expensive methods like dual-energy X-ray absorptiometry, computerized tomography, and magnetic resonance imaging. Bioelectrical impedance analysis is an easy-to-use and low-cost method for the estimation of fat-free mass (FFM) in physiological and pathological conditions. The reliability of BIA measurements is influenced by various factors related to the instrument itself, including electrodes, operator, subject, and environment. BIA assumptions beyond its use for body composition are the human body is empirically composed of cylinders, FFM contains virtually all the water and conducting electrolytes in the body, and its hydration is constant. FFM can be predicted by BIA through equations developed using reference methods. Several BIA prediction equations exist for the estimation of FFM, skeletal muscle mass (SMM), or appendicular SMM. The BIA prediction models differ according to the characteristics of the sample in which they have been derived and validated in addition to the parameters included in the multiple regression analysis. In choosing BIA equations, it is important to consider the characteristics of the sample in which it has been developed and validated, since, for example, age- and ethnicity-related differences could sensitively affect BIA estimates.

Purpose: To compare the relative prevalence of eating disorders moving from DSM-IV to DSM-5, and to reassess the overall medical impairment in the revised diagnostic classes., Methods: We applied DSM-5 to 206 patients (age 15-56 years) previously studied and classified according to DSM-IV. Medical impairment was classified as low, medium, or high, based on a cumulative score of clinical severity (SCS), computed as the sum of specific weights assigned to different pathological conditions and their ascertained prognostic impact., Results: Application of DSM-5 produced a decrease in Eating Disorders Not Otherwise Specified (EDNOS) by 17 %, an increase in anorexia (AN) by 14 % and bulimia (BN) by 2.4 %; 44.6 % of EDNOS migrated to AN, 8 % to BN, and 30.8 % was reclassified as Other Specified Feeding and Eating Disorders (OSFED). Mean SCS was higher in AN than in other diagnoses independent of classification. Differently from EDNOS, no high score was found in OSFED. BMI (OR 0.74, 95 % CI 0.56-0.98) and duration of amenorrhea >1 year (OR 6.63, 95 % CI 1.29-34.16) resulted significantly associated with the risk for medium-high SCS level in AN classified with DSM-5., Conclusion: The results confirmed that DSM-5 reduces the number of EDNOS. DSM-5 seems to better represent the clinical picture in OSFED than in EDNOS. The clinical relevance of BMI and duration of amenorrhea should be considered even more now that they are no longer used as diagnostic hallmarks of AN.

Background: Although nutritional status plays an important part in the physical performance and disability of older people, this relationship has been little studied in developing countries., Aims: A study on the effects of nutritional status on the physical performance and functional status of elderly people living in rural areas of the Peruvian Andes., Methods: The study concerned 222 people aged ≥65 years living in a rural area of the Peruvian Andes. The Mini-Nutritional Assessment (MNA) was used to classify participants as malnourished (MNA <= 17), at risk of malnutrition (MNA 18-23), or well-nourished (MNA>= 24). The short physical performance battery (SPPB) and six-minute walking test (6MWT) were used to measure participants' physical performance. Disabilities were investigated by assessing participants' self-reported difficulty in performing one or more basic activities of daily living (ADL), and instrumental activities of daily living (IADL)., Results: The prevalence of malnutrition was 9.4 %, and more than half of our samples were at risk of malnutrition. After adjusting for potential confounders, malnourished individuals performed significantly worse than the other MNA groups in the SPPB (p for trend=0.001), 6MWT and IADL (p for trend < 0.0001 for both outcomes), but not in the ADL (p for trend = 0.23). Taking the well-nourished for reference, and after adjusting for potential confounders, malnutrition was significantly associated with disability in IADL (OR 5.36, 95 % CI 1.02-56.94; p = 0.05), and poor performance in the 6MWT (OR 2.73, 95 % CI 1.06-12.08; p = 0.03) and SPPB (OR 4.94, 95 % CI 1.01-24.07; p = 0.04)., Conclusion: Poor nutritional status was found significantly associated with poor physical performance and poor functional status in elderly Peruvian individuals.

Although osteoarthritis (OA) and low levels of dehydroepiandrosterone sulfate (DHEAS) are common in the elderly, no studies on human beings are available concerning the possible relationship between them. We aimed to examine the relationship between DHEAS levels and any presence of OA in a cohort of community-dwelling older subjects. This study was part of the Progetto Veneto Anziani (Pro.V.A.), an Italian population-based cohort study on people over 65 years old. In this cross-sectional work, we considered 2050 individuals with a mean age of 74.2 ± 7.1 years (818 M and 1232 F), and with a complete set of information on OA and DHEAS levels. OA was defined using a standardized algorithm investigating disease history, medical records, symptoms, use of analgesic drugs for OA, and physical examination of the hand, hip, and knee. DHEAS levels were classified using gender-specific tertiles. OA at the three sites investigated was significantly more common in women than in men, and in individuals with lower serum DHEAS concentrations. On logistic regression analysis, taking those in the highest DHEAS tertile for reference and adjusting for potential confounders, subjects in the lowest tertile had significantly higher odds of OA involving the hand (men: OR = 1.49; 95 % CI 1.31-1.70, women: 1.28; 95 % CI 1.16-1.41), hip (men: 1.55; 95 % CI 1.33-1.81; women: 1.17; 95 % CI 1.06-1.30), and knee (men: 1.54; 95 % CI 1.35-1.76; women: 1.31 95 % CI 1.19-1.45). Similar findings emerged for individuals in the intermediate DHEAS tertile. Low DHEAS levels are associated with OA, irrespective of site and gender.

Introduction: The extranodal extension (ENE) of nodal metastases (the extension of neoplastic cells through the nodal capsule into the perinodal soft tissue) is a histological feature that has been considered a prognostic factor in several cancers, but the role in gastric cancer was not yet investigated. We aimed to investigate the prognostic role of ENE in patients affected by gastric cancer through a systematic review and meta-analysis., Material and Methods: Two independent authors searched major databases until 09/30/2015 to identify studies providing data on gastric cancer patients' prognostic parameters and comparing patients with ENE (ENE+) vs intra-nodal extension (ENE-). The data were summarized using risk ratios (RRs) for the number of deaths/recurrences and hazard ratios (HRs) with 95 % confidence intervals (CI), adjusted for potential confounders., Results: Nine studies followed up 3250 patients with gastric cancer (1064 ENE+ and 2186 ENE-). ENE+ was associated with a significantly higher risk of all-cause mortality (RR = 1.70; 95 % CI: 1.43-2.03, I (2) = 66 %; HR = 2.14; 95 % CI: 1.66-2.75, I (2) = 0 %), cancer-specific mortality (RR = 1.59; 95 % CI: 1.42-1.79; HR = 1.52; 95 % CI: 1.19-1.96), and disease recurrence (RR = 3.43, 95 % CI: 1.80-6.54, I (2) = 0 %)., Discussion: Judging from our results, ENE in gastric cancer patients should be considered for prognostic purposes from the gross sample to the pathology report.

Purpose: The purpose of the study is to evaluate whether donepezil (D) plasma concentrations and activity of CYP2D6 and CYP3A4 are associated with the therapeutic response of patients with mild to moderate Alzheimer's disease (AD)., Methods: This study comprised 54 patients affected by probable AD in therapy with D 10 mg/daily for at least 3 months. Plasma concentrations of D and its three main metabolites (6DD, 5DD, DNox) were assayed with a novel high performance liquid chromatography (HPLC) technique. Cognitive progression was assessed at baseline and at 9 months of follow-up with the mini mental state examination (MMSE). The activities of the two cytochromes involved in D metabolism-CYP2D6 and CYP3A4-were evaluated according to their metabolic ratios in plasma or urine, after test doses of probe drugs (dextromethorphan and omeprazole)., Results: A significant correlation was found between plasma levels of D and variations in MMSE scores after 9 months of therapy (r (2) = 0.14; p = 0.006). Neither the concentrations of D metabolites nor the metabolic ratios of CYP2D6 and CYP3A4 showed any correlations with cognitive variations. Low CYP2D6 activity and advanced age were associated with high D concentrations. Patients who were treated with CYP2D6 and P-glycoprotein (P-gp) inhibitors also had higher D plasma levels (mean difference = 19.6 ng/mL; p = 0.01) than those who were not., Conclusions: D plasma concentrations, but not cytochrome phenotyping, are associated with cognitive outcomes in AD patients.

Despite the recommendations in the guidelines, physicians still underuse warfarin in very elderly patients with non-valvular atrial fibrillation (NVAF). The risks of stroke and major bleeding both increase with age, but it is still not clear whether the beneficial effects of vitamin K antagonists (VKA) in preventing stroke outweigh the related bleeding risks in fragile, very elderly patients. The bleeding rates reported in real-world observational studies differ considerably. The aim of this study was to retrospectively assess the incidence of major bleeding in VKA-naïve patients over 80 years old with NVAF at a large anticoagulation clinic. Significant predictors of major bleeding were also investigated. Sixty-five major bleeding events (3.4 per 100 patient-years) and 25 thromboembolic events (1.3 per 100 patient-years) were recorded in a sample of 798 patients with a median follow-up of 2.2 years. Patients over 85 years old had significantly more major bleeding events than the 80- to 84-year olds (4.7 vs. 2.6 per 100 patient-years, p 0.014). Spontaneous bleeding was also significantly more common (3.0 vs. 1.3 per 100 patient-years, p 0.008) in the very elderly group. Age and diabetes were the only independent risk factor for bleeding on multivariate Cox analysis (Age HR 1.80, 95% CI 1.10-2.93; diabetes HR 1.76, 95% CI 1.00-3.09). These data show a sharp increase in major bleeding episodes among the very elderly with atrial fibrillation. Further studies are warranted with a view to identifying patients at risk.

Purpose: To study some psycho-social variables in a sample of non-weight loss treatment-seeking overweight adults and to evaluate the weight outcome and the possible risk factors for weight gain over a 1-year period., Methods: 167 Overweight (BMI range 25-29.9) subjects (66 % females, age 50 ± 10 years, BMI 28 ± 1.49) were recruited randomly in the surgeries of primary care physicians (PCPs). Data were collected through an ad hoc questionnaire with personal details and medical history. The following tests were administered: Binge Eating Scale (BES), Beck's Depression Inventory (BDI) and Body Uneasiness Test (BUT). Weight and height were measured using a mechanical balance with a stadiometer in standard conditions. At follow-up, 1 year after, updated data were collected for 125 subjects (75 %)., Results: At follow-up, there was remarkable weight instability: only 16 % of the subjects maintained their baseline weight, 40.8 % showed a decrease, and 43.2 % gained weight. In 14.4 % of cases, weight gain led to obesity (BMI ≥30). 18 individuals (14.4 %) reported having followed weight loss treatments in the last year, 11 among people with stable/decreased weight and 7 among those with weight gain. Lifetime comorbidity for anxiety and intense body uneasiness at baseline were the most important factors significantly associated with weight gain. Living with someone and habitually practicing sport resulted to play a protective role against weight increase., Conclusions: Our study highlights the importance of a multidimensional assessment (medical and psycho-social) of overweight patients, aimed to identify individuals at greater risk of weight gain. They should receive targeted interventions.

HIV is often assumed to only affect younger people, and many older people do not realize that they might risk acquiring the virus. Given that sexual transmission is by far the most common way to contract HIV around the world, health care professionals do not usually pay enough attention to the possibility of HIV/AIDS in older adults, based on the common conviction that they no longer have any sexual desires and that they are sexually inactive. Nevertheless, the sexual behavior of older people is likely to change over time, as aging baby boomers progress into their 60s and 70s, meeting the criteria for "successful aging", and not conforming to the stereotype of "sexless elderly". Hence the urgent need to awareness is that HIV remains as a major health threat even in advanced age. Prompt diagnosis and treatment are especially crucial in older adults because of their general frailty and high comorbidity levels. This article reviews recent literature concerning HIV/AIDS in older adults, as regard the related epidemiological, clinical and public health issues, with a view to suggesting how the rising rate of HIV transmission in this age group might be mitigated, and shows the main points that HCP should tackle to identify older people at risk of HIV infection. In summary, there is a pressing need to develop effective prevention schemes and to adapt clinical and programmatic approaches to improve the survival of older people with HIV.

Purpose: To evaluate the overall somatic involvement in patients with eating disorders (EDs)., Methods: The medical records of 206 patients (age 15-56 years, 96.1% females) with diagnosis of anorexia nervosa (AN, n = 63, 30.6%), bulimia nervosa (BN, n = 78, 37.9%), or eating disorder not otherwise specified (EDNOS, n = 65, 31.6 %) were analyzed. A cumulative score of clinical severity (SCS) was computed according to the presence of physical, instrumental, and laboratory abnormalities, as well as to their prognostic impact. Based on the tertile distribution of SCS, three levels of severity were defined: low, medium, and high., Results: A medium/high level of severity was found in 63% of the whole sample, 89% of AN, 49% of BN, and 55% of EDNOS. In the whole sample, the risk of medium/high SCS was significantly and inversely related to the body mass index (BMI) and to the lifetime minimum BMI. The severity level was significantly and positively associated with diagnosis of AN, duration of amenorrhea C1 year, and presence of ED-related symptoms. EDNOS patients showed a higher risk for increased SCS than BN patients, although not significantly., Conclusion: The non-negligible frequency of a relevant somatic involvement in patients with EDNOS suggests that a transdiagnostic scoring system might be helpful to identify ED cases at risk of medical complications.

For the vestibular system, aging is associated with degenerated otoconia and loss of hair cells, vestibular afferents, and cells in the vestibular nuclei. Further neurodegenerative processes involve cortical, extrapyramidal motor, and cerebellar structures. Dizziness is quite common in the elderly, limiting their mobility and activities. The role of vestibular rehabilitation in these patients is controversial. The present prospective, randomized, preliminary investigation aimed to compare the effect of a 6-week posturography-assisted vestibular rehabilitation protocol (30 min a week) combined with a home-based exercise program (group A, 14 randomly assigned elderly patients) with the same home-based exercise program alone (group B, 14 randomly assigned elderly patients) for treating dizziness due to central vestibular dysfunction in elderly patients. The outcomes were analyzed using the 25-item Dizziness Handicap Inventory (DHI) and computerized posturography. After rehabilitation, group A scored significantly better in the DHI for the functional (p = 0.0016) and emotional (p = 0.01) domains and total score (p = 0.001); only the emotional domain improved significantly in group B (p = 0.038). Group A improved significantly in some posturographic parameters in the motor tests (reaction time, movement velocity, and endpoint excursion), while group B experienced more limited improvements. Our preliminary results with a program of posturography-assisted vestibular rehabilitation, and home-based exercises are more promising than with home-based exercises alone. A new study on a larger series of elderly patients with central vestibular dysfunctions is currently underway at Padova University, considering the effect of a protocol involving rehabilitation with computerized posturography alone and the relationship between outcomes and the duration of rehabilitation programs.

Gout is the most common cause of inflammatory arthritis in men over 40 years old; it is a debilitating disease and, if untreated, can result in a chronic progressive disease, including tophaceous gout. In the elderly it represents a special issue, with notable clinical and therapeutic differences from the classical form with a systemic involvement. The burden of the disease increases particularly in the very old people, in whom arthritis, impaired gait and eyesight problems may enhance the related disability. Chronic gout moreover could aggravate heart and kidney disease and increase overall mortality and organ-related damage. Early diagnosis and appropriate treatment are important goals for the clinician that should to rely on the cooperation of specialists working together through the methodology of comprehensive geriatric assessment. The aim of the present review was to analyze chronic gout in old people in terms of epidemiology, pathophysiology, risk factors, clinical approach, and current treatment.

Background and Aims: Chronic mesenteric ischemia in older patients is a challenge for the physician because it coincides with a vague and non-specific clinical presentation with abdominal pain. It can frequently cause diagnostic errors and lead to legal consequences. The aim of this work was to evaluate the literature on chronic mesenteric ischemia and focus on the limited data concerning the geriatric population., Methods: This research focused on observational studies, randomized controlled trials, and clinical reports (excluding case reports and reviews) dealing with patients at least 65 years old with a clinical or instrumental diagnosis of chronic intestinal ischemia, published between 2000 and 2010. The search was conducted in PubMed using the following key words: chronic ischemic splanchnic disease, chronic mesenteric ischemia, angina abdominis, chronic abdominal angina, intestinal ischemia., Results: We selected 925 articles with the key words as follows: chronic mesenteric ischemia in 355 cases; chronic ischemic splanchnic disease in 46; angina abdominis in 4; abdominal angina in 242; and chronic intestinal ischemia in 278. We then excluded articles judged scarcely pertinent, case reports, reviews, works concentrating only on diagnostic, methodological, instrumental and surgical approaches, and articles based on animal or experimental models. This selection left us with 13 articles (after excluding duplicates), only three of which were considered valid for our purposes., Conclusions: Our review indicates that there is a shortage of useful literature on chronic intestinal ischemic disease diagnosed in the older adults, and the appropriate geriatric management of these patients is consequently not well established.

Taste disorders are common among older people and may have serious consequences on their health status: each of the five main flavors (salty, sweet, sour, bitter and umami) has a specific function and a declining taste acuity or taste loss predisposes the elderly to a higher risk of developing certain diseases. Taste disorders often go unrecognized or underestimated in elderly people, however, and there is little medical literature on this issue. This study focused on analyzing the existing literature, paying particular attention to the causes of taste disorders in the elderly and their potential consequences. The most common causes of taste disorders are drug use (21.7%), zinc deficiency (14.5%) and oral and systemic diseases (7.4% and 6.4%, respectively). All these factors can have a negative effect on gustatory system deficiencies due to physiological changes associated with aging. Elderly people are liable to have several chronic diseases and to routinely need multiple medications, and this carries a particular risk of taste disorders or severe loss of the ability to taste the five basic flavors. It is noteworthy that the most useful drugs for treating chronic diseases typical of the elderly are also a potential cause of taste disorders, so periodically reviewing pharmacological therapies is not just a matter of good clinical practice, but also helps to prevent or contain taste disorders. Assessing gustatory function should be a part of any comprehensive geriatric assessment, especially in elderly hospital outpatients or inpatients, or institutionalized cases, with severe conditions that require multiple pharmacological therapies, as well as in elderly patients who are malnourished or at risk of malnutrition, with a view to limiting the modifiable causes of taste disorders.

Background and Aims: In Italy there is a paucity of empirical data on practices concerning end-of-life decisions (ELDs) in geriatrics. We aimed to investigate the frequency and characteristics of ELDs made by Italian physicians and nurses in the geriatric setting., Methods: In 2009, an anonymous questionnaire was sent to 54 geriatric units, 21 hospices, and 382 nursing homes in the Veneto and Trentino Alto Adige regions, and to professionals in the area who are members of the Italian Gerontology and Geriatrics Association., Results: This paper reports the results of 552 questionnaires answered by 171 physicians, 368 nurses and 13 professionals who did not state their profession. Death was preceded by decisions to start or continue treatments likely to prolong the patients' life in 51.3% of cases. The proportion of deaths preceded by a decision to end life (DEL) was 20.8%; 18% of DELs concerned non-treatment decisions. There were 9 cases of ending of life without patient's explicit request. No cases of doctor-assisted suicide were reported, while there were 2 cases of euthanasia, one reported by a physician and one by a nurse., Conclusion: In geriatrics, DELs often precede the deaths of terminally-ill Italian patients. Nurses report making DELs more often than physicians, especially in incompetent patients. Continuous deep sedation was adopted by 39.5% of the Italian physicians for deaths not occurring suddenly and unexpectedly. Our report on physicians' and nurses' experiences of ELD making in geriatric settings can offer a valuable contribution to the current debate on end-of-life treatment, an issue that goes beyond national borders.

This case report concerns an elderly woman referred with a 6-month history of rising and falling fever in the range 38-40°C. She was examined repeatedly by her family doctor and given various antibiotic treatments before being hospitalized in our geriatric unit. Laboratory tests and microbiological studies led to a diagnosis of chronic Q fever, a zoonosis caused by Coxiella burnetii, a Gram-negative obligate intracellular coccobacillus; humans usually become infected by inhaling infectious airborne particles. The diagnosis of Q fever relies on serology with enzyme immunoassay (EIA). The main feature of Q fever is its clinical polymorphism: clinical signs may be aspecific and, in chronic cases, patients often do not recall having had the acute infection. As the most frequent and severe manifestation of Q fever is endocarditis, severe consequences may ensue. In our patient, broad-spectrum antibiotics were given before the serology results were available and rapid clinical improvement was achieved. This unusual disease should therefore also be considered in differential diagnosis of fever in the elderly, and age should not be considered as a contraindication for not performing all studies, because timely and adequate treatment is important partly to preserve elderly patients' self-sufficiency and to prevent them from becoming bedridden.

Gout is the most common cause of arthritis in the elderly. Its incidence among older people has risen worldwide due to an increase in risk factors such as renal diseases, metabolic syndrome, and a diet rich in purines. In older age, tophaceous gout may affect different joints from its classical presentation, due to other concomitant musculoskeletal diseases, but specific data on its epidemiology and clinical aspects in the elderly are limited to a few case reports. The present review focuses on the distinctive aspects of tophaceous gout in the elderly, revisiting all our clinical cases seen from 1990 to December 2011. Our findings indicate that: tophaceous gout can affect several joints in the elderly, including some unusual sites; its incidence is similar in both genders in the elderly even if the latency period between its initial diagnosis and the onset of tophi is higher in men; and vertebral localizations are rising and often solitary. The components of metabolic syndrome are the most common medical conditions associated with tophaceous gout. In conclusion, tophaceous gout in the elderly may be a growing medical problem and cause of disability in years, partly because of the new sites involved.

Background and Aims: Congestive heart failure (CHF) is characterized by high levels of B-type natriuretic peptide (BNP), expanded total body water (TBW) and extracellular water (ECW). Bioelectrical impedance analysis (BIA) has demonstrated high diagnostic accuracy in CHF but no information is available for older patients. We hypothesized that, in the follow-up of patients with CHF, body fluid changes estimated by BIA are related to BNP variations rather than with body weight. The aim of this study was to evaluate the relationship between variations in body fluid compartments, body weight and BNP in hospitalized elderly patients with decompensated CHF., Methods: 49 elderly patients admitted to the Geriatric Department for decompensated CHF were included in the study. On admission and at discharge, all patients underwent clinical and functional assessment and BNP dosage. TBW and ECW were also determined by the BIA method., Results: At discharge, all patients showed reductions in TBW (ΔTBW -2.9 ± 3.0 liters), ECW (ΔECW 1.9 ± 2.1 liters) and BNP levels (ΔBNP -219.6 ± 458.1 pg/mL). Variations in TBW and ECW were correlated with BNP changes (r=0.65 and 0.62, respectively) rather than with body weight variations and BNP changes (r=0.51)., Conclusions: The stronger relationship between fluid variations determined by BIA and BNP changes may make BIA a useful method in the follow-up of decompensated CHF elderly patients.

Aims: The aim of this study was to assess, in a natural setting, the development of cognitive, behavioral and functional performance of elderly dementia patients treated with cholinesterase inhibitors (ChEIs) during a 21-month follow-up. Another aim was to compare patterns of clinical changes in relation to patients' level of cognitive impairment at the beginning of therapy., Method: Of the 1987 elderly demented patients seen at our unit, 143 met the inclusion/ exclusion criteria, were followed for at least 21 months, and were thus included in the study. At baseline and each control point (up to 21 months), patients were scored for Mini Mental State Examination (MMSE), Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL)., Results: After 21 months' treatment with ChEIs, patients showed a significant reduction in MMSE, ADL and IADL values. The MMSE score decreased by 1.7 points/year (95% CI -2.1; -1.3), irrespective of initial cognitive level, and was lower than that expected in non-treated patients (-3/-4 points/year)., Conclusion: ChEI therapy is effective in slowing the progression of dementia, even in the long term, irrespective of baseline cognitive level.

Hemochromatosis is associated with increased risk of hematological neoplasias, but studies showing hemochromatosis gene mutations in myelodysplastic syndrome (MDS) are scanty, particularly in the elderly. The onset of MDS in hemochromatosis usually occurs between 60 and 70 years of age, while cases with advanced age are very rare. We report a case of a 78- year-old man with hemochromatosis who developed refractory anemia with excess of blasts. Our case suggests that in the elderly with hemochromatosis, myelodysplasia should be considered a possible cause of anemia.

Background and Aims: The aim of this study was to analyse the end-of-life topics most frequently discussed by Italian physicians, nurses and psychologists with terminally ill patients and their relatives. Findings were compared with the levels of communication reported by physicians in other countries involved in the EURELD research project, in Europe and elsewhere., Methods: An ad hoc questionnaire was prepared to measure levels of communication and administered to 716 professionals (181 physicians, 454 nurses and 81 psychologists) employed in geriatric hospital wards, hospices and nursing homes, or registered with professional associations in the Veneto and Trentino Alto-Adige regions of north-east Italy. Statistical analyses (frequency analysis, multivariate logistic regression) were conducted on data from questionnaires returned by standard mail or email., Results: Communication levels vary for the various end-of-life issues which physicians, nurses and psychologists are required to discuss and the individuals with whom they deal. Italian physicians are more communicative with relatives than with patients, whereas psychologists tend to discuss these problems more with patients than with members of their families. Nurses behave in much the same way with both patients and relatives. By comparison with their colleagues elsewhere in Europe, Italian physicians reveal more evident differences in their willingness to discuss end-of-life issues, depending on whether they are communicating with patients or relatives. Having received bio-ethical training helps physicians communicate with their patients., Conclusions: Communicating is a fundamental part of providing care for terminally ill patients and support for their families. The patient care process involves several kinds of professionals, who are all increasingly called upon to be prepared to discuss the end of a patient's life, and to develop a therapeutic relationship which includes communicating without evading any of the aspects (and problems) relating to this crucial final stage of an individual's life.

Elderly subjects with advanced dementia are exposed, like all aging individuals, to a wide range of chronic degenerative and progressive medical conditions which can cause pain and discomfort, both physical and psychological. Pain is defined as an unpleasant subjective experience, generally assessed with verbal self-reporting methods. The inability to report pain verbally - a common occurrence in advanced stages of dementia - is widely recognized as the main confounding factor in identifying these patients' pain. As several previous studies on pain assessment in cognitively impaired elderly subjects systematically eliminated non-communicative demented patients, it is hard to estimate the prevalence of their pain. The lack of pain assessment methods which do not rely on self-reporting contributes to under-estimation of the prevalence of pain, particularly among institutionalized patients, the majority of whom suffer from some degree of dementia. Assessing chronic pain in these frail elderly patients requires careful monitoring of any changes in their behavior which may be due to a new source of discomfort, rather than an aggravation of their cognitive impairment. Although some currently available tools for pain assessment in non-verbal older adults seem promising, no single tool has yet been sufficiently validated as reliable for widespread adoption in clinical practice. Prior research has documented a significantly lower prescription of analgesic medications in demented patients than in cognitively intact peers: as untreated or under-treated pain can have adverse physical and psychological consequences, there is an urgent need for appropriate pain assessment methods in elderly patients with advanced dementia, since too many of them continue to suffer needlessly. The purpose of this review is to discuss the main tools developed in the last decade for pain assessment in non-communicative older individuals, highlighting the strengths and weaknesses of each, and providing a guide for their use in clinical practice, particularly in geriatric settings.

Aging-related physical changes do not necessarily lead to a decline in sexual functioning: good physical and mental health, a positive attitude toward sex in later life, and access to a healthy partner are associated with continued sexual activity, and regular sexual expression is associated with good physical and mental health. However, it is usually assumed that older adults do not have sexual desires, and elderly people often find it difficult to discuss this topic with their doctor. There are many potential barriers concerning sexuality in older age: the lack of a healthy sexual partner, depression, the monotony of a repetitive sexual relationship, a spouse's physical unattractiveness, hormone variability, and illness and/or iatrogenic factors. Adaptive coping strategies can considerably mitigate the impact of such factors, however, and one way of contributing to breaking down barriers and taboos is undoubtedly to ensure that physicians are willing to discuss their patients' sexual history. The aim of this review was to explore the barriers and taboos to sexual expression in seniors, to propose strategies to foster this aspect of their lives, and to help physicians investigate the sexual history of their elderly patients.

Aims: 1) to evaluate the prevalence of diabetes mellitus (DM) in a geriatric ward; 2) to assess the efficacy and safety of insulin analogs in elderly inpatients over 65 years of age., Methods: We analysed the medical records of 1851 elderly inpatients admitted to our geriatric clinic from March 2009 to September 2011, to identify patients with DM. The efficacy and safety of insulin analogs were measured in patients with a hospital stay of at least 9 days, by assessing the means of all glycemic sticks (4-7 sticks/day), number of hyperglycemic events (>250 mg/dL) and number of hypoglycemic events (<70 mg/dL) daily., Results: DM prevalence was 25% (463/1851). Diabetic patients' mean age was 82.9 ± 7.5 years. DM mortality during hospital stay was 10.8% vs 6.7% for non-diabetics (p<0.05). 206/463 diabetic inpatients were treated with insulin, and 85.9% of them received analogs (Rapid and Longer-Acting). Decreases in mean daily glycemia values (from 218.8 ± 81.6 mg/dL to 170.9 ± 42.9 mg/dL, p<0.001) and in number of hyperglycemic events (from 118 to 47) (p<0.012) were noted in 128 insulin analog-treated patients over the 9-day hospitalization. Only 35 hypoglycemic events were found out of 4745 sticks (0.7%)., Conclusions: 1) DM prevalence and mortality in our very old inpatients are high and similar to data reported in the literature. 2) Insulin therapy with analogs is effective (achieves good glycemic control) and safe (low rate of hypoglycemia) even in these frail, very old inpatients.

Background and Aims: After the onset of Alzheimer's disease (AD), a substantial percentage of patients experience involuntary weight loss (IWL), but there is some debate as to whether IWL is a cause or a consequence of AD. It may play a causal role, because nutritional deficiencies have been found to be associated with worsened cognitive performance, even in subjects without dementia. Conversely, it may be an effect of the disease, considering the hypothesis that the neurodegenerative process associated with AD may itself lead to IWL. The aim of the present review was to help to shed some light on the relationship between IWL and AD., Methods: We focus on the problem of the relationship between AD and IWL, and on which comes first., Results: Even when external factors are well controlled, the association between IWL and the progression of AD seems, for the time being, to be unavoidable., Conclusion: In the light of the literature on the topic, we conclude that IWL is more a consequence than a cause of AD, although chronic diseases and disabilities are factors that may facilitate cognitive decline and accelerate the onset of AD if they are not adequately treated from the nutritional standpoint.

Background: To investigate the impact on bone and muscle of pathological conditions involving only one of the upper limbs, it is important to know the physiological differences due to the dominance effect., Aim: To evaluate any physiological differences between dominant and non-dominant upper limbs in terms of bone mineral density (BMD), muscle mass, and muscle density at different levels., Subjects and Methods: The study considered 60 right-handed healthy adults, 30 men and 30 women. Cortical BMD, muscle area, and muscle density were investigated by pQCT-XCT-3000 Stratec at the proximal radius, trabecular and total BMD at the distal radius, and trabecular and cortical BMD at the second phalanx of the third finger. Hand grip strength was also measured., Results: No significant differences in BMD were found between the dominant and non-dominant upper limbs at any of the sites considered, in men or women. Muscle density was also similar on the two sides, whereas muscle area at the proximal radius was significantly lower on the non-dominant side in both men [4177.5+/-475.1 vs 4009.3+/-552.7 mm2; Delta%: 4.1%; 95% confidence interval (CI) 1.7%-6.5%] and women (2903.9+/-470.9 vs 2720.3+/-411.7 mm2; Delta%: 6.1%; 95%CI 4.3%-7.9%). Hand grip strength proved greater on the right side in both men (48.5+/-8.8 vs 45.2+/-8.7 kg; Delta% 7.1; p<0.001) and women (29.1+/-4.3 vs 27.0+/-5.1 kg; Delta% 7.1; p<0.001)., Conclusion: The dominance effect does not seem to influence trabecular or cortical BMD at any of the sites in the upper limb. Muscle density is not modified by dominance, while muscle area is reduced on the non-dominant side and this should be borne in mind when the effect of pathological conditions on the body composition of a single forearm is investigated.

Background and Aims: The prevalence of the metabolic syndrome increases with age, although only few data are available about its prevalence in the general elderly population. This study describes the prevalence of the metabolic syndrome in an elderly population, and its association with cardiovascular diseases., Methods: The Progetto Veneto Anziani (Pro.V.A.) is an observational study of 3,099 subjects aged 65 and older, randomly selected from the general population of Northern Italy. Cardiovascular diseases and metabolic syndrome according to Adult Treatment Panel III were evaluated in 2,910 subjects., Results: The metabolic syndrome was present in 25.6% of men and 48.1% of women. Its prevalence was mainly due to high blood pressure (93%) in both sexes, and to abdominal obesity in 73% of women. The prevalence of cardiovascular diseases was significantly higher among subjects with metabolic syndrome. Together with age and former smoking habits, the metabolic syndrome was significantly associated with cardiovascular diseases. High blood pressure and low HDL were independently associated with cardiovascular diseases in men, and with high fasting plasma glucose and waist circumference in women., Conclusions: The metabolic syndrome is frequent, and significantly but not independently associated with prevalent cardiovascular diseases in the elderly. In old people, rather than the metabolic syndrome per se, some of its components are independently associated with cardiovascular diseases.

The aim of this prospective study was to evaluate the changes of the metabolism of circulating and storage lipids in patients with ulcerative colitis after restorative proctocolectomy. Fifteen consecutive patients and 15 sex- and age-matched healthy controls were enrolled. Disease activity, diet, inflammatory parameters, plasma lipoprotein concentrations, and fatty acids (FA) of serum phospholipids and of the subcutaneous adipose tissue were assessed at colectomy and at ileostomy closure. In ulcerative colitis patients, total cholesterol and docosahexaenoic acid were lower than in healthy subjects (p < 0.01 and p < 0.05). The median interval between colectomy and ileostomy closure was 6 (range 2-9) months. During that interval, the inflammatory parameters improved, high-density lipoproteins (HDL) cholesterol increased (p < 0.01), and low-density (LDL) cholesterol decreased (p = 0.01). At ileostomy closure, serum arachidonic acid levels were increased (p = 0.04), whereas serum oleic acid level was decreased (p = 0.02). In this interval, no significant alteration, either in serum n-3 FA precursors or in the FA of subcutaneous adipose tissue, was observed. The increase of serum arachidonic acid after colectomy might suggest a lower utilization for inflammatory process. The reduction of LDL cholesterol is an index of malabsorption probably due to the accelerated transit and to the exclusion of the terminal ileum caused by the covering ileostomy.

Background and Aims: Environmental, life-style, and dietary factors, including the type of dietary fatty acids consumed, may influence the onset of dementia. The aim of the present study was therefore to examine whether type of dietary fats consumed is associated with cognitive performance., Methods: Using gaschromatography, plasma phospholipid fatty acid composition was determined in a sample of subjects (age > or = 65 years) randomly selected from the general Pro.V.A. study population. Plasma phospholipid fatty acid composition is a reliable marker of the type of fats present in the diet. The subjects' cognitive capacity was tested using the Mini-Mental State Examination (MMSE)., Results: At multiple regression analysis, the MMSE score variance was correlated with age and education level In 30% of cases, whereas the other variables considered (including type of fatty acids consumed) had an almost negligible effect., Conclusions: In free-living elderly subjects, moderate to severe cognitive impairment is not associated with dietary fatty acids.

Background and Aims: The prevalence of diabetes is increasing worldwide indicating that life-style habits are important determinants for this disease. The aim of this study was to examine the effects of dietary fats on insulin sensitivity in diabetic patients., Methods: In a randomly selected sample of population aged 65 and older, plasma phospholipid fatty acid composition was determined by gaschromatography. The plasma phospholipid fatty acid composition is a reliable marker of the type of fats present in the diet. Insulin resistance was estimated with the Homeostasis Model Assessment (HOMA)., Results: Body weight, height, body mass index (BMI), waist circumference, serum cholesterol as well as fasting insulin, and the HOMA index were lower in the older groups. With increasing age, there was an increase in the monounsaturated fatty acid content and a decrease in the polyunsaturated and n-6 polyunsaturated fatty acids. In the linear regression analysis, saturated fatty acids were significantly related to waist circumference, fasting glucose, fasting insulin, and HOMA. Significant relations were also obserued between HOMA and BMI, triglycerides, waist circumference, and age. Triglycerides and HDL cholesterol were strongly interrelated as well as BMI and waist circumference. In the multiple regression analysis including age, BMI, waist circumference, triglycerides, HDL cholesterol, and saturated fatty acids, the HOMA index was predicted significantly only by age, BMI, and triglycerides. This model explained 28% of the HOMA variance., Conclusions: In elderly diabetic patients insulin sensitivity is modulated by age, BMI, and triglycerides, but the type of dietary fats is not independently associated with insulin sensitivity.

Combined hyperlipidaemia and the presence of small and dense LDL particles in the circulation are associated with an increased risk of myocardial infarction. The effect of pravastatin on plasma lipoproteins and on LDL size has been evaluated in a single-blind, randomised, placebo-controlled study in 24 patients with combined hyperlipidaemia; 12 patients on pravastatin and 12 on placebo. After 16 weeks on pravastatin, plasma total (-15%) and LDL (-23%) cholesterol and apo B (-13%) levels were significantly reduced and apo AI (+6%) had increased. LDL size (measured by gradient gel electrophoresis) had not changed. No adverse effect was observed. The study suggests that, in combined hyperlipidaemia, LDL size is not affected by variation in LDL receptor activity.