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Aim: To examine whether sex differences exist in the relationship between diabetes and geriatric conditions. Methods: This was a cross-sectional analysis of 2629 community-dwelling older adults, drawn from the 2003 wave of the “Survey of Health and Living Status of the Elderly in Taiwan.” Selected geriatric conditions included cognitive impairment, depression, falls and urinary incontinence (UI). Diabetes and comorbid conditions (heart disease, hypertension, chronic lung disease, stroke, hip fracture, arthritis, chronic kidney disease and cancer) were assessed using questionnaires. Results: A greater proportion of older women, compared with men, had cognitive impairment (15.8% vs 7.3%), depression (22.6% vs 10.4%), falls (26.7% vs 16.3%), and UI (20.9% vs 15.1%). After adjustment for basic demographics and comorbid conditions, diabetes was associated with increased risk for cognitive impairment (RR 1.85 [CI 1.12–3.05], P = 0.017), depression (RR 2.03 [CI 1.39–2.97], P = 0.0003) and falls (RR 1.72 [CI 1.2–2.48], P = 0.003), but not UI (RR 1.4 [CI 0.9–2.1], P = 0.067) among older women. However, we did not find any associations in men. Conclusions: Diabetes was associated with excessive risk for geriatric conditions among older women, but not men. The effect of sex differences on the relationship between diabetes and geriatric conditions requires further exploration. Geriatr Gerontol Int 2013; 13: 116–122.

Although C-reactive protein (CRP) and albuminuria are well-documented cardiovascular risk markers, the functional implications of these biomarkers and their combination on functional disability and metabolic risks in patients with cardiovascular disease (CVD) are unknown.Data were from 1403 adults (≥60 years, mean 73.2 years) with CVD, ascertained by self-reported diagnosis of angina, coronary heart disease, congestive heart failure, myocardial infarction or stroke, in the National Health and Nutrition Examination Survey 1999-2008. Disability in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), general physical activities (GPA), and lower-extremity mobility (LEM) were obtained from self-reports. The urinary albumin-to-creatinine ratio (UACR) was calculated by dividing the urinary albumin value by the urinary creatinine concentration. CRP levels were quantified by latex-enhanced nephelometry.Inflammation and albuminuria were associated with disability. In the full-adjusted models, odds ratios (ORs) (95% confidence intervals [CIs]) of disability in ADL, LSA, and LEM were 1.60 (1.13-2.28), 1.76 (1.22-2.55) and 2.31 (1.62-3.31), respectively, comparing participants in the highest CRP quartile to the lowest (p values for trend across CRP quartiles0.01). The corresponding ORs (95% CI) for disability in ADL, IADL, LSA, and LEM were 1.71 (1.20-2.45), 1.72 (1.21-2.45), 1.46 (1.01-2.12) and 2.50 (1.73-3.62), respectively, comparing participants in the highest UACR quartile to the lowest. We found combined association of inflammation and albuminuria with disability and with metabolic risks. Based on medians of both UACR and CRP, subjects with both higher levels of both markers had higher odds of disability and a more unfavorable metabolic profile than those with lower levels.Elevated levels of CRP and UACR independently correlate with disability among older adults with CVD. There is a combined association of inflammation and albuminuria on multiple domains of disability and metabolic risks, suggesting the presence of elevated UACR may amplify the association of inflammation with disability and with metabolic risk in older adults living with CVD.

Poor medication adherence (PMA) is associated with higher risks of morbidity, hospitalization, and mortality. Polypharmacy is not only a determinant of PMA but is also associated with many adverse health outcomes.We aimed to determine the prevalence and correlates of PMA in an older population with polypharmacy.Baseline data from 193 older adults from the Medication Safety Review Clinic Taiwan Study were analyzed. Patients were either prescribed ≥8 long-term medications or visited ≥3 different physicians between August and October 2007. PMA was defined as taking either80% or120% of prescribed amounts of a medication. Patients were classified as no (0%), low level (0 but25%), and high level (≥25%) PMA depending on what percentage of entire medication regimen taken reached PMA.Mean (SD) age was 76 (6) years, and mean number of medications was 9 (3), with a mean medication class number of 4 (1). Of the 1713 medications reviewed, 19% had PMA. However, at patient level, 34%, 32%, and 34% of patients were classified as no, low level, and high level PMA, respectively. Correlates varied by levels of PMA. Compared with patients without PMA, higher medication class number and use of alimentary tract, psychotropic, and hematologic agents were associated with both low and high level PMA. History of dizziness was associated with low level PMA, and higher Mini Mental Status Examination score was associated with high level PMA.To enhance medication adherence in older adults prescribed multiple medications, medication class numbers and certain high-risk medication classes should be taken into account. Physicians should also routinely assess systemic (eg, cognition) or drug-specific characteristics (eg, side effects).

Objectives The purpose of this study was to examine the association between human papillomavirus (HPV) and cardiovascular disease (CVD) among U.S. women. Background Oncogenic proteins derived from tumor-associated HPV induce the degradation of tumor suppressor protein p53. Inactivation of p53 is associated with accelerated atherosclerotic process. However, the association between HPV infection with CVD remains unclear. Methods Data were from 2,450 women (age 20 to 59 years) in the National Health and Nutrition Examination Survey, 2003 to 2006. Self-collected vaginal swab specimens were sent for HPV DNA analysis by L1 consensus polymerase chain reaction followed by type-specific hybridization. CVD was ascertained by self-reported diagnosis of myocardial infarction or stroke. Results A total of 60 females (39 women were HPV DNA positive, whereas 21 were negative) had coronary artery disease. Presence of vaginal HPV DNA was associated with CVD. Odds ratio (OR) of CVD comparing women with presence of vaginal HPV DNA to those without was 2.30 (95% confidence interval [CI]: 1.27 to 4.16) after controlling for demographics, health/sex behaviors, medical comorbidities, cardiovascular risk factors, and management. At the same level of adjustment, OR of CVD comparing women with cancer-associated HPV types to those with negative HPV was 2.86 (95% CI: 1.43 to 5.70). Conclusions HPV infection, especially cancer-associated oncogenic types, is associated with CVD among women.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Many different criteria have been developed to detect potentially inappropriate medications (PIMs), with wide variations in prevalence estimates and inconsistent associations with health outcomes. • Without head-to-head comparisons, it is difficult to know whether some PIM criteria systematically detect more or fewer PIMs than others in the same cohorts. WHAT THIS STUDY ADDS • Six sets of PIM criteria were applied to a single cohort, with PIM prevalence ranging from 24 to 73%. • Criteria with a higher number of statements and a higher percentage of local market/institution drug availability tended to detect more PIMs. • Caution should be exercised in applying PIM criteria developed in other regions when medication availability in the local market is limited. AIM Our aim was to compare the practicability of six different potentially inappropriate medication (PIM) criteria in geriatric outpatients with polypharmacy. METHODS We analysed baseline data from the Medication Safety Review Clinic in Taiwanese Elders (MSRC-Taiwan) study. The prevalence and correlates of PIMs were determined on the basis of criteria developed in the USA, Canada, France, Norway, Ireland and Thailand. The percentage of PIMs considered as drug-related problems and the problem-solving rate are reported. RESULTS In the 193 participants, the prevalence of PIM varied from 24 to 73%. Application of the criteria revealed that a high number of chronic medications was a common risk factor for having at least one PIM. Of the 1713 medications reviewed, 5.6–14.8% were considered PIMs. Only 30–40% of the identified PIMs were reported as drug-related problems by the MSRC team experts. Criteria with a higher number of statements and a higher percentage of local market/institution drug availability tended to detect more PIMs. CONCLUSIONS The prevalence of PIM varied significantly when different criteria were applied. Caution should be exercised in applying PIM criteria developed in other regions when medication availability in the local market is limited.

Eur J Clin Invest 2011; 41 (5): 513–520 Abstract Background White blood cell (WBC) count is associated with many inflammatory diseases such as cardiovascular disease, diabetes and hypertension. Research on the relationship of WBC count and cognition in the elderly is relatively sparse. This study examined the association between WBC count and cognitive performance in older adults. Methods Data from the National Health and Nutrition Examination Survey (1999–2002) containing 1670 older adults were analysed. Every subject completed a household interview, examination of digit symbol substitution test (DSST) scores, WBC count measurement and a questionnaire regarding personal health. WBC count was restricted to the normal range and divided into quartiles, using a multiple hierarchical regression model to estimate the relationship between WBC counts and DSST scores. Quartile-based analysis with an extended-model approach was used for further covariates adjustment. Trends test examining the associations across increasing quartiles of WBC counts and DSST scores were also conducted. Results In the multiple hierarchical regression model, the β coefficient, representing the change of DSST scores for each 1000 cells uL−1 increase in WBC count, was −0·097 (R2 = 0·343, P

OBJECTIVES: To assess the strength of association between graded groups of oral health status and self-reported functional dependence in community-dwelling older adults. DESIGN: Population-based cross-sectional study. SETTING: National Health and Nutritional Examination Survey (NHANES) 1999 to 2004. PARTICIPANTS: Three thousand eight hundred fifty-six participants aged 60 and older (mean age 71.2) without missing values in the examined correlates. MEASUREMENTS: Oral health status was evaluated according to edentulism, severity of periodontal disease, and recommendation of periodontal care and compared with that of healthy controls. Self-reported functional dependence was assessed according to 19 questions in five domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM), and general physical activities (GPAs). RESULTS: After controlling for demographic and dental variables, health-related behaviors, C-reactive protein, and comorbidities, edentulism was significantly associated with disability in IADLs (odds ratio (OR)=1.58), LSAs (OR=1.63), LEM (OR=1.31), and GPAs (OR=1.45) compared with healthy controls. Likewise, severe periodontitis was associated with disability in IADLs (OR=1.58), LSAs (OR=1.70), and LEM (OR=1.63). The trends toward disability in IADLs, LSAs, LEM, and GPAs were statistically significant across increasing severity of oral health problems. CONCLUSION: Poor oral health, specifically edentulism and severe periodontitis, is associated with multiple domains of late-life disability, but a causal relationship cannot be established based on current study design.

OBJECTIVE To examine the relationship between albuminuria, inflammation, and disability in older adults with diabetes. RESEARCH DESIGN AND METHODS Data were from 1,729 adults (≥60 years) with diabetes in the National Health and Nutrition Examination Survey, 1999–2008. Disability in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), general physical activities (GPA), and lower-extremity mobility (LEM) was obtained from self-reports. Urinary albumin-to-creatinine ratio (UACR) (mg/g) was categorized into normal (UACR 300 mg/g). C-reactive protein (CRP) levels were quantified by latex-enhanced nephelometry. RESULTS In the full-adjusted model, microalbuminuria was associated with disability in ADL, LSA, and LEM with corresponding odds ratios (ORs) (95% CIs) of 1.51 (1.16–1.98), 1.62 (1.23–2.14), and 1.34 (1.03–1.74), respectively, compared with participants without albuminuria. Macroalbuminuria was associated with disability in ADL, IADL, and LEM with corresponding ORs (95% CIs) of 1.94 (1.24–3.03), 1.93 (1.23–3.02), and 2.20 (1.38–3.49), respectively, compared with participants without albuminuria. Elevated CRP (>0.3 mg/dL) was associated with increased odds of disability in ADL and LEM, with corresponding ORs (95% CIs) of 1.28 (1.00–1.62) and 1.68 (1.34–2.11), respectively. Subjects with both albuminuria and elevated CRP had higher odds of disability than individuals with no albuminuria and normal CRP. CONCLUSIONS Albuminuria and inflammation were independent correlates for disability among older adults with diabetes. There was an interaction of albuminuria and elevated CRP on disability, suggesting that the presence of subclinical inflammation may amplify the effect of albuminuria on disability in older adults living with diabetes.

Background Several lines of evidence from studies involving both general and non-diabetic populations have shown that a family history of diabetes was associated with an increased risk for cardiovascular diseases and metabolic alterations. However, little is known about the relationship of a family history of diabetes to glycemic control and metabolic risks among people with diabetes. Methods We conducted a cross-section study of 946 diabetic adults from the National Health and Nutrition Examination Survey between 1999 and 2004. Familial risk of diabetes was classified as average, moderate, or high. Logistic regression analyses were conducted to determine the association between familial risk of diabetes and poor glycemic control, as defined by A1C ≥8%. According to stratified levels of familial risk of diabetes, adjusted means of various metabolic risks, including A1C, BMI, lipid profiles, and C-reactive protein, were obtained by using multiple linear regression. Results Independent of basic demographics, health-related behaviors, use of anti-diabetic medications, diabetes duration, cardiovascular co-morbidities, and various metabolic risks, the odds ratio of poor glycemic control comparing participants with a high familial risk of diabetes to those with an average risk was 1.91 (95% confidence interval 1.02-3.58). In the multivariate analysis, the adjusted means of A1C in participants with high, moderate, and averaged familial risk of diabetes were 7.75%, 7.45%, and 7.25%, respectively (p for trend 0.036). Participants with a high familial risk of diabetes also had higher triglycerides and body mass index (p for trend 0.042 and 0.02, respectively). Conclusion Diabetic adults with a higher familial risk of diabetes have a worse glycemic control, higher BMI, and higher triglycerides. Obtaining family history of the disease is crucial in identifying and targeting high risk diabetic patients who may require more stringent lifestyle changes as well as pharmaceutical intervention.

Background. Prior studies have shown that sleep disturbances are related to falling and its risk factors, such as poorer cognition, depression, and physical function. However, little is know about the gender-specifi c associations between falling and sleep duration. Methods. Study participants were from the annual Health Examination for the Elderly Program in the National Taiwan University Hospital (135 women and 121 men, mean age 72.2 years). Self-reported sleep duration was grouped into three categories: less than 5, 5 ‐ 7.9, and 8 or more hours. Short sleep duration was defi ned as sleep duration less than 5 hours. Falling during the previous 12 months was ascertained by self-report questionnaire. The association of sleep duration with falling was examined by using multiple logistic regression. We approximated risk ratio (RR) of falls from the adjusted odds ratio (OR) after correction of falls incidence in the previous year. Results. Sleep duration was inversely associated with falling among women. After adjusting for multiple confounding factors including use of antihypertensives and psychotropic medications, the OR of falls for each hour decrease in sleep duration was 1.95 (95% confi dence interval [CI] 1.24 ‐ 3.06). Moreover, women with sleep deprivation had a greater odds of falls within the last year than those with longer sleep durations. The estimated RR of falls comparing women with short sleep duration (sleep

Background Patients with chronic viral hepatitis are at a higher risk for cognitive dysfunction. Little is known about the association between hepatitis A virus (HAV) infection and cognitive function. Methods From the National Health and Nutrition Examination Survey, 1999–2002, we selected study participants (≥60 years, n = 1,529) without hepatitis B, C, or D virus infection; without previous hepatitis A vaccination; and without abnormal liver function. HAV-seropositive participants represented people with previous HAV infection. Psychomotor speed and executive functioning domain of cognitive function were measured by the Digit Symbol Substitution Test (DSST). Results HAV-seropositive participants had lower DSST scores than HAV-seronegative participants (weighted mean, 44.4 vs 53.9, p < .001). We designated HAV-seronegative participants as the reference group. Univariate analysis demonstrated that the weighted β coefficient of DSST score was −9.55 (95% confidence interval [CI] −9.57 to −9.54, p < .001) for the HAV-seropositive participants. In a multivariable model, the weighted adjusted β coefficient of DSST score was −2.48 (95% CI −2.49 to −2.46, p < .001) for the HAV-seropositive participants. Conclusion HAV seropositivity is associated with slower psychomotor speed among the U.S. community-dwelling elders.

Objective Bilirubin is a potent antioxidant and a cyroprotectant. Low serum bilirubin is associated with atherosclerosis. Little is known about its role in metabolic syndrome (MS) among children and adolescents. Methods We examined 4723 children and adolescents aged 12–17 years with reliable measures of various serum hepatic profiles and metabolic risks from Health and Nutrition Examination Survey 1999–2004. Results The results showed that the prevalence of the MS was from 6.6 ± 1.2% in the lowest quartile to 2.1 ± 1.9% in the highest quartile of the concentration of total bilirubin. The graded association remained significant after the adjustment of other co-variates. The odds ratios for the MS were around 0.29 (0.08–0.99) and 0.23 (0.08–0.65) for the upper two quartiles when using the lowest quartile as reference for the concentration of total bilirubin. The quartiles of the serum total bilirubin levels were inversely correlated with the homeostasis model assessment (HOMA-IR) and insulin while not associated with the serum C-reactive protein (CRP) levels. Conclusions The serum total bilirubin levels are inversely correlated with the prevalence of the MS. The mechanism of the association between MS and total bilirubin may be related to the insulin resistance status.

This study was designed to elucidate the relationship between chronic kidney disease (CKD), atherosclerotic complications, and the effects on functional performance in the elderly.A total of 2431 subjects aged 65 and above from the National Health and Nutrition Survey (NHANES) 1999-2002 were included to formulate a population-based observational study. A structural equation model (SEM) was constructed to validate the relationship between renal impairment, atherosclerotic complications, and cognitive and physical function.The results showed that renal impairment was independently associated with physical and cognitive function after adjustment of potential confounding factors (B=-0.12, p=0.02). Renal impairment was positively associated with atherosclerotic complications (B=0.26, p0.001), which was in turn negatively associated with functional performance (B=-0.24, p0.001). Variance analysis showed that 57% of the differences in physical and cognitive function could be attributed to CKD, CKD-associated atherosclerosis, and other cardiovascular risk factors.CKD may have impacts on the cognitive and physical function either directly or indirectly via atherosclerotic complications.

OBJECTIVES: To assess the association between cognitive function and periodontal disease in noninstitutionalized older adults. DESIGN: Population-based cross-sectional study. SETTING: National Health and Nutrition Examination Survey 2001 to 2002. PARTICIPANTS: Eight hundred three dentate participants aged 60 and older who completed the periodontal examination and cognitive function test. MEASUREMENTS: Periodontal examination, including assessment of probing depth and attachment loss, was performed. Periodontal disease was defined as at least 10% of sites with clinical attachment loss of more than 4 mm and at least 10% sites with probing depth greater than 3 mm. Cognitive function was measured using the 2-minute Digit Symbol Substitution Test (DSST). RESULTS: Higher cognitive function was associated with lower odds of periodontal disease. After controlling for demographics, educational level, body mass index, chronic diseases, health behaviors, bleeding on probing, and probing sites, the odds ratio for periodontal disease was 0.69 (95% confidence interval=0.51–0.94) for each standard deviation (SD) increase in the DSST score. Each SD increase in DSST score was associated with a 31% less likelihood of periodontal disease. Mean DSST scores for participants with and without periodontal disease were 42.2 and 45.5 (P=.02), respectively. CONCLUSION: Higher cognitive function was associated with lower odds of periodontal disease in noninstitutionalized older adults.

OBJECTIVE—Heart rate recovery (HRR) is a marker for survival. Little is known about the association between HRR and metabolic risks in healthy children or adolescents. RESEARCH DESIGN AND METHODS—We examined 993 healthy children and adolescents aged 12–19 years with reliable measures of cardiovascular fitness from the National Health and Nutrition Examination Survey 1999–2002. HRR parameters 1–3 min after exercise were calculated from exercise test results. Anthropometric and metabolic risk factors as well as metabolic Z score were obtained. RESULTS—The HRR parameters were inversely correlated with most of the metabolic risks, including waist circumference, systolic blood pressure (SBP), serum triglycerides, and serum C-reactive protein (CRP) levels, and were positively correlated with serum HDL levels. In multiple linear regression analysis, among the metabolic risks, waist circumference was the only parameter associated with HRR parameters (P = 0.038, 0.001, and 0.001 for 1-, 2-, and 3-min HRR, respectively) in boys. In girls, waist circumference (P = 0.001 and CONCLUSIONS—Metabolic risks are inversely associated with HRR in healthy children and adolescents. Our finding suggests that there is a link between metabolic risks and autonomic nervous system functions in healthy young ages.

Elevated homocysteine, causing tissue injury by such mechanisms as oxidative stress, endothelial damage, and protein homocysteinylation, is associated with multiple age-related problems including cardiovascular diseases, dementia, and osteoporotic fracture. Disability is one of the most common features in older adults. However, little is known about the role of homocysteine in physical disability among older adults.Participants (60 years, N = 1677) were from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Nineteen questionnaires in five major domains were administered to assess the level of difficulty in performing various tasks: activities of daily living (ADL), instrumental ADL (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA). Peak quadriceps strength was obtained by using an isokinetic dynamometer. Habitual gait speed was obtained from a 20-foot timed walk. Homocysteine levels were measured by the Abbott homocysteine assay, an automated fluorescence polarization immunoassay (FPIA).Elevated homocysteine was associated with disability in ADL, IADL, LSA, and GPA after multivariate adjustment. The odds ratios (ORs) for disability in these domains comparing participants in the highest quartile of homocysteine to those in the lowest were 2.18 (95% confidence interval [CI], 1.32-3.59) for ADL; 1.62 (95% CI, 1.02-2.57) for IADL; 2.00 (95% CI, 1.14-3.51) for LSA; and 1.52 (95% CI, 1.05-2.21) for GPA. The strength of associations weakened somewhat after additional adjustment of quadriceps strength and/or gait speed, suggesting a mediating role of quadriceps strength and gait speed in the association between homocysteine and disability. Homocysteine had an inverse relationship to quadriceps strength and gait speed. Likewise, quadriceps strength seemed to mediate the inverse association between homocysteine and gait speed.Elevated homocysteine is associated with multiple domains of disability mediated in part by muscle strength and gait speed. The results suggest that homocysteine levels may be important indicators of performance status in older adults.

Background Elevated C-reactive protein (CRP) is a risk factor for atherosclerosis. Cardiorespiratory fitness, the ability of active skeletal muscle to utilize oxygen during aerobic exercise, can be impaired by atherosclerotic changes peripherally affecting the vasculature or centrally perturbing the heart and coronary arteries. However, the association between cardiorespiratory fitness and CRP has not been adequately examined. Methods We examined 1438 adults aged 20–49 years with reliable measures of fitness and non-missing values in CRP from Health and Nutrition Examination Survey 1999–2002. Subjects with major cardiovascular and respiratory conditions were excluded from fitness test which measured the estimated maximal oxygen uptake (VO 2 max), by a submaximal exercise test. Levels of CRP were quantified by utilizing latex-enhanced nephelometry. Results In both genders, we observed inverse associations between estimated VO 2 max and levels of CRP after controlling for age, race, body mass index category, hypertension, diabetes, smoking status, alcohol consumption, and use of medications including aspirin, non-steroidal anti-inflammatory drugs, steroid, lipid-lowering agents, antimicrobials, or estrogen/progesterone (in women). Men in the 2nd, 3rd, and 4th quartiles of CRP concentrations had lower estimated VO 2 max compared to the first quartile (regression coefficients for quartile 2, −1.54 ml/kg/min, p =0.105; quartile 3, −1.46 ml/kg/min, p =0.130; quartile 4, −2.64 ml/kg/min, p =0.009; p for trend 0.013). Women in the highest quartile of CRP had a significantly lower estimated VO 2 max (2.40 ml/kg/min, p =0.023) compared to the lowest ( p for trend 0.025). Conclusions CRP levels, inversely related to cardiorespiratory fitness, are important indicators of exercise tolerance and may be useful in targeting individuals requiring endurance intervention to prevent loss of cardiovascular fitness and function.

OBJECTIVES: To assess the relationship between serum folate levels and periodontal disease in older adults. DESIGN: Population-based cross-sectional study. SETTING: National Health and Nutritional Examination Survey 2001/02. PARTICIPANTS: Eight hundred forty-four dentate elderly subjects aged 60 and older (mean age 70.6) who completed a periodontal examination and laboratory test for serum folate levels. MEASUREMENTS: Periodontal examination, including probing depth and attachment loss, was performed. Periodontal disease was defined as having at least 10% of sites with clinical attachment loss of more than 4 mm and at least 10% sites with probing depth of more than 3 mm. Serum folate levels were measured using a commercially available radioprotein binding assay kit. RESULTS: After controlling for demographics, educational level, body mass index, bleeding on probing, and probing sites, the odds ratio for periodontal disease was 0.74 (95% confidence interval=0.59–0.93) for each standard deviation increase in natural-log-transformed folate levels. After additionally controlling for levels of vitamin B12 and homocysteine, chronic diseases (hypertension, diabetes mellitus, heart disease, and stroke), and health behaviors (smoking status and alcohol consumption), the negative association between folate level and periodontal disease remained statistically significant and essentially unchanged. There was no effect modification of sex on the association between serum folate levels and periodontal disease. CONCLUSION: A low serum folate level was independently associated with periodontal disease in older adults. The results suggest that serum folate levels, important indicators of periodontal disease in older adults, may provide an important clinical target for intervention to promote oral health.

Chronic inflammation, measured by interleukin-6, predicts incident disability among elderly people. However, little is known about the relation of C-reactive protein (CRP) to disability.Participants (60 years old, N = 1680) were from the National Health and Nutrition Examination Survey 1999-2002. Disability in activities of daily living (ADL), instrumental activities of daily living (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA) was obtained by self-report. Peak muscle power was the product of isokinetic peak leg torque and peak force velocity. Functional limitations were evaluated via habitual walking speed, which was obtained from a 20-foot timed walk. CRP levels were quantified by using latex-enhanced nephelometry.Elevated CRP levels were associated with disability in IADL, LSA, LEM, and GPA, independent of basic demographics, chronic medical diseases, health behaviors, as well as nutritional markers. The corresponding odds ratios of disability for each standard-deviation increase in natural-log-transformed CRP were 1.18 (95% confidence interval [CI], 1.02-1.35), 1.18 (95% CI, 1.00-1.39), 1.17 (95% CI, 1.03-1.33), and 1.17 (95% CI, 1.05-1.31), respectively. The relationship diminished after additional adjustment of leg power and/or walking speed, meaning that impairment in leg power and limitations in gait speed likely mediate the association between CRP and disability. CRP had an inverse relationship to leg power and walking speed. Likewise, additional adjustment for leg power substantially diminished the association between CRP and walking speed, suggesting a mediating effect of power between CRP and gait speed.Independent of chronic diseases, elevated CRP is associated with multiple domains of disability through mediation of muscle power, habitual gait speed, or both. Future research is needed to understand CRP as a risk factor for disability in older populations.

Overweight and obesity are growing in prevalence among older adults.1 The prevalence of overweight and obesity is more than 50% in U.S. adults, with the highest prevalence observed in adults aged 50 and older.1 In association with various cardiovascular risk factors such as hypertension, diabetes mellitus, and heart disease, overweight and obesity are related to a host of adverse health outcomes in older adults and place a severe burden on the U.S. healthcare system.2 The relationship between body weight and selected geriatric syndromes has recently attracted significant research interest. Investigators have shown a positive association between body mass index (BMI) and depressive symptoms in elderly people.3 Studies have demonstrated that, in the elderly population, overweight and obesity were related to self-reported functional limitations,4 performance-based functional disability,5 urinary incontinence,6 and chronic osteoarthritic pain, but controversies still exist regarding the relationship between BMI and cognitive ability in older people. A positive relationship between BMI and cognition has been demonstrated,7 although some other reports have showed an inverse association between obesity and cognitive performance.8 Longitudinally, the relationship between BMI and dementia has not been consistent. One study followed 392 nondemented Swedish adults for 18 years and found that overweight was a risk factor for dementia in women,9 but the Personnes Agees QUID Study followed 3,646 individuals for 8 years and demonstrated that subjects with a BMI less than 21 had a greater risk of developing dementia than subjects whose BMI was between 23 and 26. The relationship was no longer significant after excluding individuals who developed dementia early during the follow-up.10 Therefore, the overarching goal of this study was to elucidate the relationship between body weight and cognitive function in late life by examining data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial.

Insulin resistance (IR) and chronic inflammation are inversely related to heart rate recovery (HRR), a marker of cardiac autonomic function. Little is known, however, about the joint effects of IR and inflammation on HRR.The study sample consisted of 2649 healthy individuals aged 12-49 years with measures of submaximal cardiopulmonary fitness testing from the National Health and Nutrition Examination Survey 1999-2004. HRR 1-min (HRR1) and 2-min (HRR2) after recovery were recorded (bpm). IR was defined if homeostasis model assessment (HOMA-IR) was ≥ 2.73. C-reactive protein (CRP) was quantified by latex-enhanced nephelometry.In the fully adjusted model, participants with IR had attenuated HRR compared to those without (mean HRR1 11.8 vs. 12.7, p = 0.011; mean HRR2 31.2 vs. 33.4, p0.001). Mean HRR1 for participants with CRP0.3 mg/dL, CRP 0.1-0.3 mg/dL, and CRP0.1 mg/dL were 11.6, 12.0, and 12.8 (p for trend 0.002), respectively. Mean HRR2 in the three corresponding groups were 33.0, 32.5, and 31.8 (p for trend 0.033), respectively. Participants with IR and CRP elevation had slower HRR than those without IR and with normal CRP. The mean HRR1 comparing participants with IR/CRP0.3 mg/dL to those with no IR/CRP0.1 mg/dL were 10.5 and 13.1 (p0.001), while the mean HRR2 for the same comparison were 29.1 and 33.8 (p0.001). HRR (especially HRR2) was inversely correlated with various metabolic risks.Insulin resistance and CRP levels were inversely associated with HRR in healthy adolescents and adults. Participants with IR and elevated CRP had the worst HRR. Our findings suggest a joint effect of IR and inflammation on cardiac autonomic dysfunction.

The prevalence of high blood pressure (BP) and diabetes mellitus (DM) increases with age, and the numbers of older persons with these cardiovascular risks are expected to grow as the elderly population increases in number.1,2 The National Health and Nutrition Examination Survey demonstrated that, in the noninstitutionalized population aged 65 and older, the overall prevalence of hypertension and DM is between 50% and 70% and 18% and 20%, respectively.1,2 Hypertension and DM are associated with a variety of cardiovascular conditions, such as peripheral vascular disease, myocardial infarction, and stroke, and impose a heavy public health burden in older people. DM and high BP, as well as their related cerebral changes,3,4 such as stroke, lacunes, and leukoaraiosis, have been shown to affect cognition, leading to cognitive impairment or dementia.5,6 Data from the Syst-Eur trial, a randomized, controlled trial recruiting 2,418 elderly subjects without dementia at baseline, showed that active treatment of hypertension with antihypertensive medications reduced the incidence of dementia by 50% after 2 years of follow-up.7 Recent evidence suggests that executive function, the cognitive ability associated with human frontal lobes, appears to be particularly vulnerable to increased loads of cardiovascular risks.8,9 Many population-based prospective studies10–12 have examined the relation of DM or hypertension to cognitive function, usually assessed using a global cognitive measure or ascertainment of incident dementia cases without further exploration of changes in different cognitive domains. Little is known about which specific cognitive domains elevated BP or DM affect. Furthermore, the relationship between hypertension and physical function, either cross-sectional or longitudinal, has not been adequately examined. The effect of DM on physical functioning has been examined in several cross-sectional studies. Patients with DM are more likely to report disability,13 have more days of restricted activity,14 and have more physical function limitations.15,16 Unfortunately, data from longitudinal studies examining the relationship between DM and functional decline are sparse. Therefore, we hypothesize that hypertension and DM have adverse effects on cognitive, particularly executive, and physical functions. The overarching goal of this study was to elucidate the predictive role of BP, DM, and their interaction on decline in cognitive and physical performance in later life by examining data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial.

Summary Evidence suggests that a high concentration of C-reactive protein (CRP) is a cardiovascular risk factor and an important correlate of cognitive disorders and depression. Recently, population-based studies examining the association between CRP and stroke, cognitive impairment, or depression have been done but have not yet been systematically reviewed. Here we present a systematic review of the associations between CRP and stroke, cognitive impairment, and depression. Hospital or clinic-based studies were excluded because the inferences might not be easily applicable to the general population. 19 eligible studies of CRP were selected: seven for stroke, six for cognitive disorders, and six for depression. Raised CRP concentrations were associated with history of stroke and increased risk of incident stroke. Meta-analysis of studies with long follow-up (>8 years) showed that the risk for stroke in healthy individuals with the highest quartile of CRP concentrations increased nearly 70% compared to those with the lowest quartile. High concentrations of CRP were predictive of cognitive decline and dementia. The relations of CRP to depression were all cross-sectional and were not consistent. We conclude that high concentrations of CRP are associated with increased risk of stroke and cognitive impairment. The association between CRP and depression should be studied prospectively.

Cerebral white matter lesions (WMLs), also called "leukoaraiosis," are common neuroradiological findings in elderly people. WMLs are often located at periventricular and subcortical areas and manifest as hyperintensities in magnetic resonance imaging. Recent studies suggest that cardiovascular risk factors are associated with the development of WMLs. These lesions are associated with different geriatric syndromes such as falls, executive cognitive impairment, depressive symptoms, and urinary incontinence. Damage to associative pathways in frontal and subcortical regions due to hypoperfusion may disrupt frontal executive, motor control, and other systems, resulting in these manifestations. WMLs are associated with substantial disability and should not be considered a benign and silent condition as once believed. Interventions addressing cardiovascular risk factors should be undertaken in early or mid-life in order to prevent late-life functional impairment associated with WMLs. After these lesions develop and impair executive cognitive functions, the patient's ability to comply with a complex risk reduction program may be significantly compromised.

To examine whether sex differences exist in the relationship between diabetes and geriatric conditions.This was a cross-sectional analysis of 2629 community-dwelling older adults, drawn from the 2003 wave of the "Survey of Health and Living Status of the Elderly in Taiwan." Selected geriatric conditions included cognitive impairment, depression, falls and urinary incontinence (UI). Diabetes and comorbid conditions (heart disease, hypertension, chronic lung disease, stroke, hip fracture, arthritis, chronic kidney disease and cancer) were assessed using questionnaires.A greater proportion of older women, compared with men, had cognitive impairment (15.8% vs 7.3%), depression (22.6% vs 10.4%), falls (26.7% vs 16.3%), and UI (20.9% vs 15.1%). After adjustment for basic demographics and comorbid conditions, diabetes was associated with increased risk for cognitive impairment (RR 1.85 [CI 1.12-3.05], P=0.017), depression (RR 2.03 [CI 1.39-2.97], P=0.0003) and falls (RR 1.72 [CI 1.2-2.48], P=0.003), but not UI (RR 1.4 [CI 0.9-2.1], P=0.067) among older women. However, we did not find any associations in men.Diabetes was associated with excessive risk for geriatric conditions among older women, but not men. The effect of sex differences on the relationship between diabetes and geriatric conditions requires further exploration.

White blood cell (WBC) count is associated with many inflammatory diseases such as cardiovascular disease, diabetes and hypertension. Research on the relationship of WBC count and cognition in the elderly is relatively sparse. This study examined the association between WBC count and cognitive performance in older adults.Data from the National Health and Nutrition Examination Survey (1999-2002) containing 1670 older adults were analysed. Every subject completed a household interview, examination of digit symbol substitution test (DSST) scores, WBC count measurement and a questionnaire regarding personal health. WBC count was restricted to the normal range and divided into quartiles, using a multiple hierarchical regression model to estimate the relationship between WBC counts and DSST scores. Quartile-based analysis with an extended-model approach was used for further covariates adjustment. Trends test examining the associations across increasing quartiles of WBC counts and DSST scores were also conducted.In the multiple hierarchical regression model, the β coefficient, representing the change of DSST scores for each 1000 cells uL(-1) increase in WBC count, was -0·097 (R(2) = 0·343, P0·001). After additional competent covariates adjustment, the negative correlation remained (all P 0·001). In quartile-based multiple linear regression, the negative trends between DSST scores and WBC count quartiles in the stratified comparison with extended-model approach were all statistically significant (P for trends0·001).Higher WBC counts, even within the normal range, were associated with poor psychomotor cognitive performance in the elderly.

To assess the strength of association between graded groups of oral health status and self-reported functional dependence in community-dwelling older adults.Population-based cross-sectional study.National Health and Nutritional Examination Survey (NHANES) 1999 to 2004.Three thousand eight hundred fifty-six participants aged 60 and older (mean age 71.2) without missing values in the examined correlates.Oral health status was evaluated according to edentulism, severity of periodontal disease, and recommendation of periodontal care and compared with that of healthy controls. Self-reported functional dependence was assessed according to 19 questions in five domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), leisure and social activities (LSAs), lower extremity mobility (LEM), and general physical activities (GPAs).After controlling for demographic and dental variables, health-related behaviors, C-reactive protein, and comorbidities, edentulism was significantly associated with disability in IADLs (odds ratio (OR)=1.58), LSAs (OR=1.63), LEM (OR=1.31), and GPAs (OR=1.45) compared with healthy controls. Likewise, severe periodontitis was associated with disability in IADLs (OR=1.58), LSAs (OR=1.70), and LEM (OR=1.63). The trends toward disability in IADLs, LSAs, LEM, and GPAs were statistically significant across increasing severity of oral health problems.Poor oral health, specifically edentulism and severe periodontitis, is associated with multiple domains of late-life disability, but a causal relationship cannot be established based on current study design.

Drug-related problems (DRPs) were identified from baseline data of 193 Medication Safety Review Clinic (MSRC) patients. MSRCs enroll older adults (≥ 65 years) with either (1) prescriptions of ≥ 8 chronic medications (drugs prescribed for ≥ 28 days) or (2) a visit to ≥ 3 different physicians at the two participating hospitals in Taipei, Taiwan from August to October 2007. The Pharmaceutical Care Network Europe (PCNE) Classification Version 5.01 was used to report DRPs. Mean age was 76.2 ± 6.2 years and 53% of participants were male. Participants had, on average, 9.0 ± 2.6 chronic conditions and took 8.9 ± 3.1 chronic medications and 1.7 ± 1.8 dietary supplements. Eighty-seven percent had at least one DRP. Being older, having orthostatic hypotension and taking more chronic medications were associated with higher likelihood of having at least one DRP. For the 1713 medications and 331 diet supplements reviewed, 427 DRPs were found, 490 causes (1.1 ± 0.4 per problem) identified and 1067 interventions proposed (2.5 ± 0.6 per problem). The most common DRP category was "drug not taken/administered" (35%), and the most common offending drug category was cardiovascular agents (33%). Prevalence of DRPs was high among geriatric outpatients prescribed multiple medications. Careful medication review is needed in routine clinical practice to improve prescription quality.

Background Sarcopenia refers to the loss of skeletal muscle mass with aging. It is believed to be associated with functional impairment and physical disability. Objective The purposes of this study were: (1) to compare the physical activity, muscle strength (force-generating capacity), cardiopulmonary fitness, and physical disability in community-dwelling elderly people with sarcopenia, borderline sarcopenia, and normal skeletal muscle mass in Taiwan and (2) to test the hypothesis that sarcopenia is associated with physical disability and examine whether the association is mediated by decreased muscle strength or cardiopulmonary fitness. Design This was a cross-sectional investigation. Methods Two hundred seventy-five community-dwelling elderly people (148 men, 127 women) aged ≥65 years participated in the study. The participants were recruited from communities in the district of Zhongzheng, Taipei. Predicted skeletal muscle mass was estimated using a bioelectrical impedance analysis equation. The skeletal muscle mass index (SMI) was calculated by dividing skeletal muscle mass by height squared. Physical disability was assessed using the Groningen Activity Restriction Scale. Physical activity was assessed using a 7-day recall physical activity questionnaire. Cardiopulmonary fitness was assessed using a 3-minute step test, and grip strength was measured to represent muscle strength. Results Cardiopulmonary fitness was significantly lower in elderly people with sarcopenia than in those with normal SMIs. Grip strength and daily energy expenditure (kcal/kg/day) were not significantly different between the participants with sarcopenia and those with normal SMIs. The odds ratio for physical disability between the participants with sarcopenia and those with normal SMIs was 3.03 (95% confidence interval=1.21–7.61). The odds ratio decreased and the significant difference diminished after controlling for cardiopulmonary fitness. Limitations A causal relationship between sarcopenia and physical activity, cardiopulmonary fitness, and physical disability cannot be established because of the cross-sectional nature of study design. Conclusions Sarcopenia was associated with physical disability in elderly men. The association between sarcopenia and physical disability was mediated to a large extent by decreased cardiopulmonary fitness.

BACKGROUND AND AIMS: Recent evidence suggests that hyperuricemia might increase the risk of cardiovascular disease. Cardiovascular risk factors are well recognized to be associated with cerebral white matter lesion (WML). We hypothesized that hyperuricemia is related to higher grade of WML in both men and women. METHODS AND RESULTS: A total of 108 men and 123 women were enrolled from those who signed up for the annual Health Examination for the Elderly Program in Taipei from 2006 to 2008. Information in interview data, clinical and laboratory examinations were collected. Hyperuricemia was defined by uric acid ≥458.0 μmol/L in men and ≥392.6 μmol/L in women. Two types of WML including periventricular hyper-intensity (PVH) and deep white matter hyper-intensity (DWMH), ascertained by cranial magnetic resonance imaging, were graded. Association between hyperuricemia and high grade WML was evaluated by using multiple logistic regression analysis. The prevalences of hyperuricemia were 13.9% and 17.9% for men and women, respectively. The prevalences of moderate-to-severe PVH among men and women were 16.7% and 7.3%; while the prevalences of moderate-to-severe DWMH for men and women were 19.4% and 11.4%, respectively. Hyperuricemia was related to moderate-to-severe DWMH in men, after controlling for age, education years, smoking, alcohol consumption, metabolic Z score, silent infarct, and the use of anti-hypertensives, lipid-lowering and anti-diabetic agents, the association remained significant. The relationship was not evident among women. We did not find an association between hyperuricemia and PVH. CONCLUSIONS: Hyperuricemia was positively associated with high grade DWMH in older men, but not in women.

Background Recent studies have revealed the associations between insulin resistance (IR) and geriatric conditions such as frailty and cognitive impairment. However, little is known about the relation of IR to physical impairment and limitation in the aging process, eg. slow gait speed and poor muscle strength. The aim of this study is to determine the effect of IR in performance-based physical function, specifically gait speed and leg strength, among nondiabetic older adults. Methods Cross-sectional data were from the population-based National Health and Nutrition Examination Survey (1999-2002). A total of 1168 nondiabetic adults (≥ 50 years) with nonmissing values in fasting measures of insulin and glucose, habitual gait speed (HGS), and leg strength were analyzed. IR was assessed by homeostasis model assessment (HOMA-IR), whereas HGS and peak leg strength by the 20-foot timed walk test and an isokinetic dynamometer, respectively. We used multiple linear regression to examine the association between IR and performance-based physical function. Results IR was inversely associated with gait speed among the men. After adjusting demographics, body mass index, alcohol consumption, smoking status, chronic co-morbidities, and markers of nutrition and cardiovascular risk, each increment of 1 standard deviation in the HOMA-IR level was associated with a 0.04 m/sec decrease (p = 0.003) in the HGS in men. We did not find such association among the women. The IR-HGS association was not changed after further adjustment of leg strength. Last, HOMA-IR was not demonstrated in association with peak leg strength. Conclusion IR is inversely associated with HGS among older men without diabetes. The results suggest that IR, an important indicator of gait function among men, could be further investigated as an intervenable target to prevent walking limitation.

OBJECTIVE Exposure to acrylamide in foodstuffs and smoking has become a worldwide concern. The effect of acrylamide on glucose homeostasis is not known. The goal of the present study was to test the hypothesis that trace acrylamide exposure might be independently associated with both reduced blood insulin and reduced insulin resistance. RESEARCH DESIGN AND METHODS We examined 1,356 participants with reliable measures of glucose homeostasis and Hb adducts of acrylamide (HbAA) and glycidamide from the National Health and Nutrition Examination Survey, 2003–2004. Glucose homeostasis was assessed by the measurement of plasma glucose, serum insulin, and the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS In a linear regression model, a 1-unit increase in log HbAA was associated with a decrease in serum insulin (β coefficient = −0.20 ± 0.05, P = 0.001) and HOMA-IR (β coefficient = −0.23 ± 0.05, P < 0.001). After HbAA concentrations were divided into quartiles in the fully adjusted models, the adjusted serum insulin level and HOMA-IR significantly decreased across quartiles of HbAA (Ptrend < 0.001 for both). In subgroup analysis, the association of HbAA levels with HOMA-IR and insulin levels was stronger in subjects who were white or had ever smoked or in subjects with a lower education level or a BMI 30 kg/m2. CONCLUSIONS Acrylamide is associated with reduced serum insulin levels in adults. Further clinical and animal studies are warranted to clarify the putative causal relationship.

Background Our study aimed to assess the nationwide trends in the incidence of severe gallstone disease in Taiwan among adults aged ≥20. Methods A retrospective longitudinal study was conducted using Taiwan National Health Insurance Research Database collected during 1997–2005. Patients with incident severe gallstone disease (acute cholecystitis, biliary pancreatitis, acute cholangitis) and gallstone-related procedures (elective and non-elective cholecystectomy, endoscopic retrograde cholangiopancreatography [ERCP]) that led to hospital admission were identified using ICD-9-CM diagnostic and procedure codes. Annual incidence rates of gallstone-related complications and procedures were calculated and their 95% confidence intervals (CI) were estimated assuming a Poisson distribution. Results The hospital admission rate for severe gallstone disease increased with advancing age and the age-standardized rate (95% CI) per 1000 population was 0.60 (0.59–0.60) for men and 0.59 (0.59–0.60) for women. Men had a higher rate of acute cholecystitis, probably due to the substantially lower rate of elective cholecystectomy among men than women. For those aged 20–39, hospital admissions for all gallstone-related complications and procedures increased significantly. For those aged ≥60, incidences of biliary pancreatitis, acute cholangitis, and hospital admission for gallstone receiving ERCP increased significantly without substantial change in the incidence of acute cholecystitis and despite a decreased rate of elective cholecystectomy. Conclusion This population-based study found a substantial increase in the rate of admission for severe gallstone disease among those aged 20–39. Concurrently, the incidences of biliary pancreatitis and acute cholangitis have risen among those aged ≥60.

Obesity leads to increased risk of cardiovascular disease and glucose intolerance, which are phenomena of chronic inflammation. This study was performed to determine whether a higher body mass index (BMI) and central obesity are associated with low-grade inflammation.An analysis of 8 453 adults agedor =20 years was performed. Every subject completed a household interview and a questionnaire regarding personal health, and their BMI and serum C-reactive protein (CRP) level were measured. The BMI data were divided into quintiles, using multiple linear regression to estimate the relationship between CRP level and BMI quintiles. An extended-model approach was used for covariate adjustment. The association between central obesity and CRP level was examined by this method as well.After controlling for demographics, chronic diseases, health behaviours and levels of folate and vitamin B12, the beta coefficient (which represents the change of natural-log-transformed levels of CRP for each kg/m2 increase in BMI) was 0.078 (p0.001). The CRP levels also increased across increasing quintiles of BMI (p for trend0.001). The beta coefficient, representing the change of natural-log-transformed levels of CRP comparing subjects with central obesity to those without, was 0.876 (p0.001).Higher BMIs as well as central obesity are independently associated with higher levels of CRP.

Background Arterial stiffness, an age-related feature and measured noninvasively by pulse wave velocity (PWV), is associated with a variety of cardiovascular diseases. Although white matter lesion (WML), representing cerebrovascular micro-angiopathy, is typically considered as a preclinical cardiovascular disease, little is know about the association between PWV and WML. The aim of this study is to examine the association between PWV and WML. Method We examined the extent of white matter lesion on cranial magnetic resonance imaging of 93 participants (mean 72.46 years) from the annual Health Examination for the Elderly Program in the National Taiwan University Hospital. Two subtypes of WML including periventricular hyperintensity (PVH) and deep white matter hyperintensity (DWMH) were graded according to Fazekas et al. The brachial-ankle PWV (baPWV) and heart-ankle PWV (haPWV) were measured using an automatic waveform analyzer. Results PVH and DWHM were found in 71 (76%) and 58 (62%) participants. Various degree of WML was observed in 80 (86%) participants. Hypertension, use of anti-hypertensive medications, and elevated blood pressure were identified as risk factors of WML. The baPWV and haPWV were correlated with many metabolic risks, including systolic blood pressure, pulse pressure, and serum triglycerides. The baPWV and haPWV were greater in participants with higher grades of WML in the multivariate analyses. The receiver operating characteristics analyses demonstrated that area under curves for haPWV to identify moderate-to-severe PVH and DWMH were 0.78 (95% confidence interval [CI] 0.66–0.91) and 0.72 (95% CI 0.59–0.85), respectively. Conclusion Greater PWV is associated with higher grades of WML among high-functioning older adults. Our findings support the notion that measurement of arterial stiffness is useful in clinical practice for detection of preclinical cerebrovascular disease.

The objective of this study was to examine the role of obesity in the development of the metabolic syndrome (MS). A total of 3,596 whites aged 19 years and above, who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2002, were included for analysis. Anthropometric measurements, biochemical profiles, and high-sensitivity C-reactive protein (CRP) were measured. A structural equation model (SEM) was constructed to elucidate a pathway in which obesity initiated the cascade leading to full MS. The results of SEM demonstrated that obesity was positively associated with elevated CRP level (B = 0.05, P < 0.001). This higher inflammatory state directed to insulin resistance (B = 0.32, P < 0.001), which in turn was positively associated with dyslipidemia (B = 0.06, P < 0.001). Obesity could also directly and positively affect blood pressure (B = 0.51, P < 0.001), without the mediation of insulin resistance and/or inflammation. The results of the cross-sectional analysis in the white subjects have shown that obesity has a strong influence on hypertension that obtains little additional influence from inflammation or insulin resistance. The metabolic profile in the NHANES group has been confirmatory with the statement that there is a sequential effect from obesity to inflammation, insulin resistance, and dyslipidemia. This approach has allowed to inferring important biological insights about the nature of the relationships among the components of MS.

This study was designed to elucidate the effects of obesity, self-reported physical activity and cardiorespiratory fitness on blood pressure, inflammation, and insulin resistance.Data from 950 Caucasian subjects ranging in age from 19 to 49 years from the National Health and Nutrition Survey (NHANES), 1999-2002, were included to construct a population-based observational study. Cardiorespiratory fitness (VO(2) max) was predicted from a submaximal exercise stress test. Self-reported physical activity was measured by metabolic equivalent score transformed from a questionnaire. A structural equation model (SEM) was developed to examine the relationship between obesity, cardiorespiratory fitness, self-reported physical activity, and hypertension, inflammation, and insulin resistance. The model showed that obesity was positively linked to hypertension (B=0.50, P0.001) and C-reactive protein (CRP; B=0.15, p0.05), which in turn led to insulin resistance (B=0.44, P0.05). Increased cardiorespiratory fitness was negatively associated with CRP (Γ=-0.23, P0.01), but not correlated to hypertension after adjustment for potential confounding factors. No significant association was found between self-reported physical activity and hypertension, insulin resistance, and CRP.Obesity contributes to the development of hypertension, inflammation, and insulin resistance. Improved cardiorespiratory fitness might lead to clinical and biochemical improvement in insulin resistance by reducing the inflammatory state.

Background Observational studies suggested an association between diabetes and the risk of various geriatric conditions (i.e., cognitive impairment, dementia, depression, mobility impairment, disability, falls, and urinary incontinence). However, the magnitude and impact of diabetes on older adults have not been reviewed. Methodology/Principal Findings MEDLINE and PSYCINFO databases were searched through November 2007 for published studies, supplemented by manual searches of bibliographies of key articles. Population-based, prospective cohort studies that reported risk of geriatric outcomes in relation to diabetes status at baseline were selected. Two authors independently extracted the data, including study population and follow-up duration, ascertainment of diabetes status at baseline, outcomes of interest and their ascertainment, adjusted covariates, measures of association, and brief results. Fifteen studies examined the association of DM with cognitive dysfunction. DM was associated with a faster decline in cognitive function among older adults. The pooled adjusted risk ratio (RR) for all dementia when persons with DM were compared to those without was 1.47 (95% CI, 1.25 to 1.73). Summary RRs for Alzheimer's disease and vascular dementia comparing persons with DM to those without were 1.39 (CI, 1.16 to 1.66) and 2.38 (CI, 1.79 to 3.18), respectively. Four of 5 studies found significant association of DM with faster mobility decline and incident disability. Two studies examined the association of diabetes with falls in older women. Both found statistically significant associations. Insulin users had higher RR for recurrent falls. One study for urinary incontinence in older women found statistically significant associations. Two studies for depression did not suggest that DM was an independent predictor of incident depression. Conclusions/Significance Current evidence supports that DM is associated with increased risk for selected geriatric conditions. Clinicians should increase their awareness and provide appropriate care. Future research is required to elucidate the underlying pathological pathway.

Objectives. Microalbuminuria (MA) has been increasingly identified as a marker of cardiovascular risk. Although poor cognitive function has been implicated as a sequelae of increased cardiovascular burden, little is known about the association between MA and cognitive function. Design. Population-based cross-sectional study. Settings. National Health and Nutrition Examination Survey 1999–2002 in the USA. Subjects. 2049 noninstitutionalized adults (≥60 years) with nonmissing values in cognitive test, urinary albumin-to-creatinine ratio (UACR) and ankle-brachial blood pressure index (ABPI) was analysed. Participants with UACR >300 μg mg−1 were excluded. Main outcome measures. The UACR, in the unit of μg mg−1, was calculated by dividing the urinary albumin value by the urinary creatinine concentration. MA was defined as UACR between 30 and 300 μg mg−1. Cognitive function was measured by a 2-min Digit Symbol Substitution Test (DSST). Peripheral artery disease (PAD) was defined as an ABPI

Impaired heart rate recovery (HRR) after exercise, a marker of cardiac autonomic dysfunction, predicts mortality in healthy adults. Although there is an inverse relation of both inflammation (IF) and insulin resistance (IR) to HRR, little is known about the combined effect of IR and IF on HRR. The

To investigate the relation of both peak leg power and usual gait speed in their association with varying domains of late-life disability.Participants (or =60 yrs of age, n = 1753) were from the National Health and Nutrition Examination Survey, 1999-2002. Disability in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities was obtained by self-report. Peak muscle power was the product of isokinetic peak leg torque and peak force velocity. Functional limitations were evaluated via usual gait speed, which was obtained from a 20-foot timed walk.Low usual gait speed was associated with disability independent of basic demographics, cognitive performance, co-morbidities, health behaviors, and inflammatory markers. The odds ratios for disabilities in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities for each standard-deviation increase in walking speed were 0.72 (95% confidence interval [CI], 0.59-0.87), 0.63 (95% CI, 0.52-0.77), 0.57 (95% CI, 0.45-0.72), 0.56 (95% CI, 0.47-0.67), and 0.74 (95% CI, 0.64-0.85), respectively. The odds ratios for disabilities in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities for each standard-deviation increase in leg power were 0.70 (95% CI, 0.55-0.89), 0.67 (95% CI, 0.53-0.86), 0.62 (95% CI, 0.47-0.83), 0.58 (95% CI, 0.47-0.72), and 0.73 (95% CI, 0.61-0.87), respectively. Supplementary adjustment for walking speed mildly attenuated the relation of leg power to disability.Peak leg power and habitual gait speed were associated with varying domains of late-life disability. The association between peak leg power and disability seems to be partially mediated through usual gait speed.

To assess how elevated body mass index (BMI) affects cognitive function in elderly people.Cross-sectional study.Data for this cross-sectional study were taken from a multicenter randomized controlled trial, the Advanced Cognitive Training for Independent and Vital Elderly trial.The analytic sample included 2,684 normal-weight, overweight, or obese subjects aged 65 to 94.Evaluation of cognitive abilities was performed in several domains: global cognition, memory, reasoning, and speed of processing. Cross-sectional association between body weight status and cognitive functions was analyzed using multiple linear regression.Overweight subjects had better performance on a reasoning task (beta=0.23, standard error (SE)=0.11, P=.04) and the Useful Field of View (UFOV) measure (beta=-39.46, SE=12.95, P=.002), a test of visuospatial speed of processing, after controlling for age, sex, race, years of education, intervention group, study site, and cardiovascular risk factors. Subjects with class I (BMI 30.0-34.9 kg/m2) and class II (BMI35.0 kg/m2) obesity had better UFOV measure scores (beta=-38.98, SE=14.77, P=.008; beta=-35.75, SE=17.65, and P=.04, respectively) in the multivariate model than normal-weight subjects. The relationships between BMI and individual cognitive domains were nonlinear.Overweight participants had better cognitive performance in terms of reasoning and visuospatial speed of processing than normal-weight participants. Obesity was associated with better performance in visuospatial speed of processing than normal weight. The relationship between BMI and cognitive function should be studied prospectively.

Background: Both cognitive function and gait speed are important correlates of disability. However, little is known about the combined effect of cognitive function and gait speed on multiple domains of disability as well as about the role of gait speed in the association between cognitive function and late-life disability. Objective: To investigate (1) how cognition and habitual gait speed are related to late-life disability; (2) the role of habitual gait speed in the cognitiondisability association; and (3) the combined effect of cognitive function and habitual gait speed on late-life disability. Method: Participants (>60 years, n = 2,481) were from the National Health and Nutrition Examination Survey 1999–2002. Disability in activities of daily living (ADL), instrumental ADL (IADL), leisure and social activities (LSA), and lower extremity mobility (LEM) was obtained by self-report. Cognitive function was measured by a 2-min timed Digit Symbol Substitution Test (DSST), an executive function measure from the Wechsler Adult Intelligence Test. Habitual gait speed was obtained from a 20-foot timed walk. Multiple logistic regression was used to assess the association between cognitive function and disability. Results: Cognitive function was associated with decreased likelihood for disability in each domain. The odds ratios (ORs) for disability in ADL, IADL, LSA, and LEM for each standard deviation (SD) increase in the DSST score were 0.47 (95% confidence interval [CI] = 0.34–0.64), 0.53 (95% CI = 0.42–0.67), 0.61 (95% CI = 0.47–0.79), and 0.73 (95% CI = 0.61–0.86), respectively, in the multi-variable models. After additional adjustment for habitual gait speed in the cognition-disability relationship, DSST score was no longer a significant correlate for LSA and LEM disability. The strength of the association between DSST score and disability in ADL/IADL was also diminished. The attenuated association between cognition and disability implies that limitation in gait speed likely mediates the association between cognitive function and disability. We found additive effects of cognition and habitual gait speed on late-life disability. The OR of disability in respective domains were lowest among participants with high-DSST score (high executive function) and with high gait speed. In contrast, the OR tended to be highest among participants with low-DSST score (low executive function) and low gait speed. Conclusion: Cognitive function was associated with multiple domains of disability. There was a joint effect of cognitive function and gait speed on late-life disability. This study also suggested that habitual gait speed partially mediated the inverse association between cognitive function and late-life disability, providing a mechanistic explanation in the context of disablement process.

To evaluate the effect of blood pressure (BP) and diabetes mellitus (DM) on cognitive and physical performance in older, independent-living adults.Longitudinal study with secondary data analysis from the Advanced Cognitive Training for Independent and Vital Elderly randomized intervention trial.Six field sites in the United States.Two thousand eight hundred two independent-living subjects aged 65 to 94.Cognitive functions in different domains and physical functions measured using activities of daily living, instrumental activities of daily living (IADLs), and the physical function subscale from the Medical Outcomes Study Short Form-36 (SF-36) Health Survey.After the first annual examination, hypertension was associated with a faster decline in performance on logical reasoning tasks (ability to solve problems following a serial pattern), whereas DM was associated with accelerated decline on the Digit Symbol Substitution Test (speed of processing). The reasoning and Digit Symbol Substitution test are executive function tasks thought to be related to frontal-lobe function. Hypertension and DM were associated with a significantly faster pace of decline on the SF-36 physical function component score. Individuals with DM had a faster pace of decline in IADL functioning than nondiabetic subjects. There was no evidence for an interaction between BP and DM on cognitive or physical function decline.Hypertension and DM are associated with accelerated decline in executive measures and physical function in independent-living elderly subjects. Further research is needed to determine whether cardiovascular risk modification ameliorates cognitive and functional decline in elderly people.

Background. Little is known about what specific cognitive functions are affected by elevated blood pressure (BP) and how orthostatic BP change is related to cognitive impairment. The aim of this study was to determine the effect of BP and its postural change on cognitive functions in otherwise healthy elders. Methods. In 70 healthy persons (mean age, 72 6 4 years), supine systolic BP (SBP) was assessed 3 times using a sphygmomanometer, and the average values were obtained for the analysis. After 1, 3, and 5 minutes of standing, 3 BP measurements were obtained and the orthostatic SBP changes were determined by subtracting these values from the supine average. Neuropsychological tests were administered to assess short-term and long-term verbal and visual memory, visuospatial skills, and frontal-executive functions. Participants were considered impaired in the specific cognitive performance if their scores fell below the 25th percentile of the study population. Multiple logistic regression models were used to evaluate the relation of SBP and the magnitude of orthostatic SBP decline to risk for impairment in each of the cognitive tests. Results. Controlling for potential confounders, each 10 mmHg increase in supine SBP was associated with a 2.31-fold increase (95% confidence interval, 1.14 to 4.66) in risk for impairment in psychomotor speed and set shifting as measured using the Trailmaking Part-B test. There was no significant association between cognitive functions and orthostatic SBP decline at 1, 3, and 5 minutes of standing. Conclusion. Elevation of BP is associated with a selective impairment in executive function in otherwise healthy community-dwelling elders.

Although outpatient Comprehensive Geriatric Assessment (CGA) has shown certain benefits in functional status and quality of life by many randomized controlled trials, no survival benefit has been reported. We hypothesized that the lack of survival benefit may be due to insufficient power of individual trials. In order to assess the influence of outpatient CGA on survival of older persons, we performed a meta-analysis of all randomized controlled trials of outpatient CGA. Nine studies consisting of 3750 subjects fulfilled the predetermined eligible criteria and were included in the meta-analysis. Combined mortality risk ratio with outpatient CGA intervention compared to usual care group was 0.95 (95% confidence interval, CI 0.82–1.12, P = 0.62). Treatment effects were homogeneous across the trials. This meta-analysis did not demonstrate survival benefit for outpatient CGA. Inadequate statistical power is unlikely to explain the results. Future researches of outpatient CGA should focus on coordinated and standardized measurement of outcomes related to functional status, institutionalization rate, and quality of life.