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Diabet. Med. 29, 742-747 (2012) Abstract Background HbA1c is currently being introduced for diagnostic purpose in diabetes. Previous studies have, however, indicated that patients with liver disease have false low HbA1c levels. We therefore investigated the correlation between HbA1c and plasma glucose in patients with different levels of increased liver enzyme concentrations. Methods Data from 10 065 patients with simultaneous measurement of HbA1c, venous fasting plasma glucose, alanine aminotransferase and γ-glutamyl transferase were extracted from our laboratory database. Correlations were investigated in four patient groups divided according to their liver enzyme concentrations. Results The correlation between HbA1c and plasma glucose was high in all groups, with r = 0.77 for men and r = 0.78 for women ( P < 0.001), a correlation confirmed with multiple regression analysis ( P < 0.001). However, interaction analysis revealed that linear regression lines were significantly different for men and women, with increase of both liver enzyme measurements and also, for women, with increased alanine aminotransferase. When compared with biological variation for HbA1c, only men with increased measurements of both liver enzymes had a clinically important decrease in HbA1c. Conclusions Increased liver enzyme concentrations do not bias the correlation between HbA1c and fasting plasma glucose. However, men with low plasma glucose and increased concentrations of both liver enzymes do have a slightly decreased HbA1c and, if the clinical suspicion is strong enough, one should consider supplement testing. [ABSTRACT FROM AUTHOR]

OBJECTIVES: : To elucidate whether well-known predictions of mortality are reduced or even reversed, or whether mortality is a stochastic process in the oldest old. DESIGN: : A multidimensional survey of the Danish 1905 cohort conducted in 1998 with follow-up of vital status after 15 months. SETTING: : Denmark. PARTICIPANTS: : All Danes born in 1905, irrespective of physical and mental status were approached. Two thousand two hundred sixty-two persons of 3,600 participated in this survey. MEASUREMENTS: : Professional interviewers collected data concerning sociodemographic factors, smoking, alcohol consumption, body mass index, physical and cognitive performance, and health during a visit at the participant's residency. Cox regression models were used to evaluate predictors of mortality. RESULTS: : Five hundred seventy-nine (25.7%) of the 2,249 participants eligible for the analysis died during the 15 months follow-up. Multivariate analyses showed that marital status, education, smoking, obesity, consumption of alcohol, and number of self-reported diseases were not associated with mortality. Disability and cognitive impairment were significant risk factors in men and women. In addition poor self-rated health was associated with an increase in mortality in women. CONCLUSION: : In the oldest old, several known predictors of mortality, such as sociodemographic factors, smoking, and obesity, have lost their importance, but a high disability level, poor physical and cognitive performance, and self-rated health (women only), predict mortality, which shows that mortality in the oldest old is not a stochastic process. [ABSTRACT FROM AUTHOR]

Objective: Hyponatraemia is one of the major problems in geriatric inpatients. However, in nonhospitalised elderly, the preponderance of hyponatraemia and the importance of the effect of drug intake on serum sodium concentrations are little known. This study investigated the prevalence of hyponatraemia in very old nonhospitalised people, controlling for factors that may induce hyponatraemia (especially drug use). Methods: Data on serum sodium concentration, health and drug use were retrieved for 185 persons aged 92 to 93 years (the 1905 cohort) and 147 persons aged 100 years (the centenarian cohort) participating in two major population-based studies of elderly people in Denmark. Data were analysed by comparing median serum sodium concentrations between users and nonusers of various drugs after controlling for the influence of age, sex, cancer, heart failure, hypothyroidism, renal failure and smoking. Furthermore, the preponderance of drug use in the patients with clinically relevant hyponatraemia was compared with that in persons with normal serum sodium concentrations. Results: Median serum sodium concentration was 140 mmol/L for the centenarians and 141 mmol/L for the 1905 cohort. In total, 19 persons had hyponatraemia (serum sodium concentration ≤134 mmol/L). There was no association between median serum sodium concentration and any of the above-mentioned diseases, or sex or smoking. Of the drugs generally known to cause hyponatraemia, only omeprazole and oral antidiabetic agents were associated with significantly lower median serum sodium concentrations (difference 3 mmol/L). Use of thiazide diuretics was significantly more common than expected in persons with hyponatraemia compared with persons with a normal serum sodium concentration (7 of 19 vs 46 of 270 individuals). Furthermore, the results suggested that digoxin and lactulose might be associated with a lowered median serum sodium concentration. Conclusion: This study demonstrates that severe hyponatraemia was rarely seen in a population-based sample of very old persons and that drugs have only a limited influence on serum sodium concentration. The only drug class associated with clinically relevant hyponatraemia was thiazide diuretics, which were used by significantly more persons with hyponatraemia. Furthermore, this study suggests that digoxin and lactulose use is associated with lower serum sodium concentrations in the elderly. [ABSTRACT FROM AUTHOR]

Objective: To describe the prevalence of urinary incontinence and to find characteristics useful in general practice for identifying middle-aged and elderly women with the problem., Design: Cross-sectional interview study., Setting: Population-based samples of Danes., Subjects: A total of 5795 women older than 45 years (46+ years)., Main Outcome Measures: Prevalence of incontinence and clinical characteristics assessed by standardized interview questions., Results: The overall prevalence of urinary incontinence was 20% among women less than 60 years of age and 44% among those older than 80 years. Increasing age was highly associated with both forms of incontinence (stress and urge). High body mass index (BMI), chronic lung disease, and stroke were also associated with both forms, while number of children was associated with stress incontinence only. Predictive models show that 56% of women characterized by high age (older than 80 years) and overweight (BMI higher than 30) will suffer from urinary incontinence. The low-risk group defined by these two parameters (aged 46-60 years and not overweight) still had a 19% prevalence in the last month., Conclusion: The prevalence of urinary incontinence increased with age. Even in the low-risk groups the problem was very common in old age. Questions about incontinence should, therefore, be asked in relevant consultations with all elderly female patients.

Introduction: Long-lived individuals are rare and may be selected in part for the genetic factors that promote successful ageing. The children of long-lived parents may therefore age more successfully than the children of short-lived parents., Material and Methods: We used three major cross-sectional, population-based surveys to study the association of parental longevity with successful ageing in offspring. The measures of ageing were hand-grip strength, cognitive performance (mini mental state examination (MMSE) and a cognitive composite score), self-reported diseases, and self-rated health., Results: For every additional ten years the parents lived, grip strength increased by 0.32 kg (95% CI = 0.00-0.63), the MMSE score by 0.20 points (95% CI = 0.03-0.37), and cognitive composite score by 0.24 points (95% CI = 0.07-0.40). A ten-year increment of parental life was associated with a reduction by approximately 0.20 in the adjusted OR for having each of the following conditions: diabetes, hypertension, ischaemic heart disease, heart failure, stroke, or fair, poor or very poor self-rated health. Almost all the effects were seen solely in the cohort of 70+ year-olds, but not in the middle-aged or nonagenarians., Discussion: Parental life span is positively associated with physical and cognitive functioning and avoidance of some of the common chronic diseases. However, overall the effects are small and are seen in the elderly, but not in the middle-aged or the very old.

Cognitive impairment has been associated with increased mortality. Most studies, however, have only included small numbers, if at all, of the very old. In a large nationwide survey of all Danes born in 1905 and still alive in 1998, where the baseline examination was conducted, we examined the impact of cognitive impairment on mortality over a 2-year period. No cognitive impairment was defined as a score of 24-30 points on the Mini Mental State Examination, mild cognitive impairment was defined as a score of 18-23 points, and severe impairment was defined as a score of 0-17 points. Cox regression analysis was applied to adjust for a number of known and suspected factors known or suspected of being associated with cognition and mortality (e.g. sociodemographic factors, sex, smoking, alcohol consumption, depressive symptoms, and physical abilities), and yielded hazard ratios (95% confidence interval) of 1.24 (1.00-1.55) for mildly impaired and 1.73 (1.37-2.20) for severely impaired Danes compared to individuals with no impairment. Cognitive impairment predicts mortality among the very old, even after controlling for most known predictors of mortality., (Copyright 2002 S. Karger AG, Basel)

Background: To investigate whether the frequency of carriers of mutations in the HFE gene associated with hereditary hemochromatosis diminishes with age as an indication that HFE mutations are associated with increased mortality. It is of value in the debate concerning screening for hereditary hemochromatosis to determine the significance of heterozygosity., Methods: Genotyping for mutations in exons 2 and 4 of the HFE gene using denaturing gradient gel electrophoresis in 1784 participants aged 45 to 100 years from 4 population-based studies: all 183 centenarians from the Danish Centenarian Study, 601 people aged 92 to 93 years from the Danish 1905 Cohort, 400 aged 70 to 94 years from the Longitudinal Study of Aging Danish Twins, and 600 aged 45 to 67 years from a study of middle-aged Danish twins., Results: All participants (N=1784) were screened for mutations in exon 4, and a trend toward fewer heterozygotes for the C282Y mutation-the mutation most often associated with hereditary hemochromatosis-was found. This was significant for the whole population (P=.005) and for women (P=.004) but not for men (P=.26). A group of 599 participants was screened for mutations in exon 2, and there was no variation in the distribution of mutations in exon 2 in the different age groups., Conclusions: In a high-carrier frequency population like Denmark, mutations in HFE show an age-related reduction in the frequency of heterozygotes for C282Y, which suggests that carrier status is associated with shorter life expectancy.

Objectives: The authors studied nonagenarians, a rapidly growing age group whose cognitive and physical abilities have yet to be investigated systematically., Methods: All Danes born in 1905 were invited to participate in a home-based 2-hour multidimensional interview, including cognitive and physical performance tests and collection of DNA, carried out by lay interviewers. Population-based registers were used to evaluate representativeness., Results: There were 2,262 participants. A total of 1,632 (72%) gave a DNA sample. Participants and nonparticipants were highly comparable with regard to marital status, institutionalization, and hospitalization patterns, but men and rural area residents were more likely to participate. Six months after the survey began, 7.2% of the participants and 11.8% of the nonparticipants had died., Discussion: Despite the known difficulties of conducting surveys among the extremely old, it was possible to conduct a nationwide survey, including collection of DNA, among more than 2,000 fairly nonselected nonagenarians using lay interviewers.

We developed a method to estimate genotype-specific average relative mortality risk, R, from genotype distributions in cross-sectional studies of people belonging to different age-groups, and applied the method to new data from a study of apolipoprotein E genotypes (apoE) in 177 Danish centenarians and data from a study of 40-year-old Danish men. Twenty-one percent of the centenarians were epsilon 2-carriers (genotypes epsilon 2 epsilon 2 and epsilon 3 epsilon 2) and 15% were epsilon 4-carriers (genotypes epsilon 4 epsilon 4 and epsilon 4 epsilon 3) compared to 13 and 29%, respectively, of the young men. The R-values were 0.95 (95% CI 0.88 to 1.02) for epsilon 2-carriers and 1.13 (95% CI 1.05 to 1.22) for epsilon 4-carriers, using epsilon 3 epsilon 3- and epsilon 4 epsilon 2 genotypes as reference. Corresponding values for epsilon 4-carriers were obtained by using published data from a French and a Finnish study of centenarians, whereas the values for epsilon 2-carriers were about 0.90 with these data. The method to estimate mortality risk and the results associate with the view that the apoE gene is a "frailty gene." On the other hand, if odds ratios are used to summarize data from studies of this kind, they are more impressive and may propagate the misconception that apoE is a "longevity gene"., (Copyright 2000 Wiley-Liss, Inc.)

Objective: to compare the activities of antioxidative enzymes in erythrocytes between centenarians and a younger group of elderly subjects., Design: cross-sectional study., Setting: county of Funen, Denmark., Subjects: 41 centenarians aged between 100 and 105 years and 52 community control subjects aged between 60 and 79 years., Measurements: enzyme activities of superoxide dismutase (CuZn-SOD), glutathione peroxidase, catalase and glutathione reductase (GR) in erythrocytes. Functional capacity among the centenarians was evaluated by Katz' index of activities of daily living, the Physical Performance Test and Mini-Mental State Examination., Results: the mean CuZn-SOD activity was significantly lower and the mean GR activity was significantly higher in centenarians than in the group of elderly people. The centenarians with the lowest cognitive and physical functional capacity and who did not survive at least 1 year after blood sampling tended to have the lowest CuZn-SOD activities. The range of GR activity was shifted toward higher values in the centenarian group than in the younger group and those centenarians having the best functional capacity tended to have the highest GR activity., Conclusions: CuZn-SOD activity is decreased in centenarians, probably because of reduced demand for the enzyme at lower metabolic rate and oxygen consumption. Subjects with high GR activity occur more frequently among centenarians than expected, possibly due to their better survival. The role of GR in disease prevention and as a predictor for longevity deserves to be further explored.