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Context: Ghrelin regulates energy homeostasis and may contribute to the development of the metabolic syndrome (MS) in the elderly., Objective: To study the relationship between ghrelin and the MS, IGF-I and life style factors over a 2-year follow-up., Design: Longitudinal population-based study, starting from 2002; 2 years follow-up., Participants: Three hundred and thirteen (153 men/160 women) individuals living independently older than 70 years., Results: MS was found in 54.9% of men and 61% of women. In the 229 subjects available at follow-up, ghrelin was higher in men than in women at basal (P = 0.002) and 2-year follow-up (P = 0.004). Ghrelin decreased over time in both genders (P < 0.01). Ghrelin was lower in individuals showing MS compared to non-MS (P = 0.08), but this difference was more evident at 2-year follow-up (P = 0.016), mostly due to men with MS (P = 0.002) and even after adjustment for BMI, gender and age. Individuals with MS had an OR of 1.67 (95% CI: 1.0-2.78) for low ghrelin (< first tertile); when adjusting by BMI, gender and age, only high triglycerides with OR 1.8 (1.0-3.3), remained statistically significant among the MS components. IGF-I showed a positive correlation with ghrelin only in individuals without MS (r(s) 0.403, P < 0.001) with no gender differences; this relationship was not found in MS (r(s) 0.120, P = 0.129). A positive association of ghrelin was found with academic level, alcohol consumption and smoking., Conclusions: Ghrelin is higher in old men in comparison to women and decreases over time with a steeper decline in subjects with MS; moreover, in these subjects ghrelin/IGF-I correlation is lost.

Background and Aims: Successful aging is a worldwide aim, but its related factors and instruments of measurement are currently hotly debated. To investigate the relationship between muscle strength and functional capacity, and its association with successful aging., Methods: A population-based cross-sectional study was performed in Mataró (Spain). Included in the study were 313 subjects (153 men, 160 women) aged 70 years and over. Physical and cognitive functions were assessed, as well as muscle strength, nutritional status, lifestyle factors, and associated morbidities., Results: A state of successful aging (SA), defined as optimal functional and cognitive capacities with absence of cancer, stroke, cardiovascular or pulmonary chronic diseases, was found in 20% of women and 32% of men. SA was associated with higher muscle strength in comparison with the non-SA condition. Muscle strength measurements were higher in men, and decreased with age, poor balance, decreased functional capacity, and impaired cognitive status. It was also associated with higher academic level, regular exercise, and nutritional status in both genders. Multivariate analysis showed that independent variables related to SA were: hand grip, arthrosis, deafness and unipodal balance test, but not age or gender., Conclusions: Muscle strength is positively associated with the successful aging condition, and may be one of its functional links, reflecting the integrated health status of old men and women. The systematic inclusion of the measurement of muscle strength may be helpful in clinical evaluation of the elderly.

Objective: To study the potential associations among circulating insulinlike growth factor 1 (IGF-1) and adrenal and gonadal steroids with cognitive status and depression in a group of independently-living elders., Design: Population-based cross sectional study., Methods: A total of 313 individuals (160 women and 153 men, with a mean age of 76.7±7 years) participated in this study. A physical examination, assessment of functional capacity, cognitive function, depression, educational level and measurement of plasma cortisol, dehydroepiandrosterone (DHEA) and its sulphate (DHEAs), testosterone, estradiol, and IGF-1 were performed., Results: In women, adrenal steroids showed a negative correlation with global cognition (β=-0.79; p=0.03 for DHEA and β=-0.27; p=0.002 for cortisol). A positive correlation with IGF-1 (β=0.026; p=0.04) was found for cognition in women after adjustment for depression. For memory function, DHEA correlated negatively but no relationship with IGF-1 and cortisol was observed. No relationships with cognition were observed in men for any of the steroids or other hormones studied. Educational level showed the highest protective effect (odds ratio [OR] = 6.25) for preserved cognition for both sexes; in women, OR for deteriorated cognition with age, DHEA and cortisol were 1.14, 1.57 and 1.09, respectively. No associations between depression and hormonal profile were found in either sex., Conclusions: Educational level was positively associated with cognitive function in independently-living elderly men and women, while adrenal steroids were associated with impaired cognition in elderly women but not in men. The hormonal milieu seemed to have little or no influence on depression in the men and women studied., (Copyright © 2008 Sociedad Española de Endocrinología y Nutrición. Published by Elsevier Espana. All rights reserved.)

Background and Objective: The metabolic syndrome (MS) is a constellation of factors apparently associated to an increased cardiovascular risk, and with a reported increasing prevalence in parallel with aging process. The aim of this study was to assess the prevalence of MS in elder subjects according to the criteria of the National Education Program (ATP-III) and the International Diabetes Federation (IDF)., Subjects and Method: Population-based cross-sectional study including 313 individuals (153 men and 160 women) older than 70 years. The prevalence of MS was evaluated according to both definitions and its association with cardiovascular disease (CD) was investigated., Results: MS was observed in 50.2% of subjects according to ATP-III (41.5% of men and 58.6% of women; p = 0.004) and in 57.9% when using IDF criteria (54.9% of men and 61% of women; p = 0.29). Prevalence differences were observed between ATP-III and IDF only in men. No differences were found in the frequencies of the different components of the MS for the 2 definitions, neither for tobacco consumption, ethanol intake and educational level. There was no differences in the coexistence of CD in relation the presence or absence of MS, no matter the definition used; also, no special association with CD was found for any of the individual components of the MS., Conclusions: Among a representative population sample of old people living in a Mediterranean community, despite a very high frequency of MS, there was no excess prevalence of CD in those identified as having MS.

Background: Several experimental studies in rats have demonstrated that sulfonylurea treatment increases autoantigen expression in B-cells. This phenomenon may be deleterious for the preservation of residual beta cell function in patients with slowly progressing type 1 diabetes or latent autoimmune diabetes of adult (LADA)., Aim/hypothesis: The aim of the present study was to evaluate whether the exclusion of glibenclamide in the treatment of ICA positive type 2 diabetic patients may diminish or halt the humoral autoimmune response against B-cells as well as improve metabolic control and insulin secretion., Subjects and Methods: Fourteen type 2 diabetic patients with pancreatic autoimmunity (ICA+ and GABA+) and treated with insulin and glibenclamide (duration of disease 2.0 +/- 2.2, range 0.1-7 years and age 53 +/- 12.5, range 36-75 years) were studied. Patients were randomly assigned to two treatment groups, Group 1: insulin monotherapy (n = 8, age 53 +/- 6.4 years) (Exclusion of glibenclamide) and, Group 2: insulin plus glibenclamide (n = 6, age 53.5 +/- 16.9) (Unmodified treatment). Both groups were investigated at the beginning of the study and after one year for the following parameters: ICA and anti-GAD65 antibodies, fasting glucose and fasting C-peptide., Results: In group 1, six out of eight patients became ICA negative while all patients in group 2 remained ICA positive (p = 0.0097). Fasting glucose concentrations improved in group 1 (4.6 +/- 2.8) in relation to group 2 (11.5 +/- 5.5, p = 0.0023) after one year of treatment. No differences were found for anti-GAD antibodies and fasting C-Peptide between the groups., Conclusions: These data show that exclusion of glibenclamide in the treatment of ICA+ type 2 diabetic patients partially decreases specific autoimmunity against endocrine pancreatic cells and improves metabolic control. This may reflect decreased expression of B-cell autoantigens suggesting that insulin monotherapy is a better choice for the treatment of LADA.