Adipose tissue infiltration in skeletal muscle: age patterns and association with diabetes among men of African ancestry

BACKGROUND: Although obesity is strongly associated with diabetes, the greater prevalence of diabetes in persons of African ancestry than in those of other ancestries cannot be explained simply by differences in total or central adiposity. OBJECTIVE: We examined whether skeletal muscle composition is associated with diabetes in 1249 men of African ancestry aged >or=40 y. DESIGN: Anthropometry and fasting serum glucose were measured, and lower-leg skeletal muscle composition was assessed with peripheral quantitative computerized tomography (pQCT). RESULTS: The prevalence of diabetes in this population was high (21%). We observed an age-associated adipose tissue remodeling in skeletal muscle and greater intermuscular (IMAT) and lesser subcutaneous (SAT) adipose tissue area with advancing age (P < 0.0001). Multivariate stepwise logistic regression identified more IMAT and less SAT to be significantly associated with a greater prevalence of diabetes. Even among normal-weight men [body mass index (BMI; in kg/m(2)) < 25], diabetic men had significantly (P = 0.01) more IMAT than did those without diabetes. Greater IMAT was also associated with a greater prevalence of hyperglycemia in men with a family history of diabetes than in those without such history (P for interaction = 0.02). CONCLUSIONS: These findings underscore the independent associations of subcutaneous and intermuscular fat among men of African ancestry, an effect that may be modified by a family history of diabetes. Further studies are needed to identify the genetic and physiologic mechanisms that influence the distribution and remodeling of adipose tissue in skeletal muscle with aging.'

Enfermedades cronicas y limitacion funcional en adultos mayores: estudio comparitivo en siete ciudades de America Latina y el Caribe / Chronic diseases and functional limitation in older adults: a comparative study in seven cities of Latin America and the Caribbean

OBJECTIVE. To identify the relationship between selected chronic diseases and the presence of disability in inhabitants 60 years old or older in seven cities of Latin America and the Caribbean. METHODS. In 2000 and 2001 a descriptive cross-sectional study was conducted with a sample of 10 891 persons 60 or older in seven cities: Bridgetown, Barbados; Buenos Aires, Argentina; Havana, Cuba; Mexico City, Mexico; Montevideo, Uruguay; Santiago, Chile; and Sao Paulo, Brazil. This research was part of the Salud, Bienstar y Envejecimiento (Health , Well-Being, and Aging) project (known as the "SABE project"). The dependent variables in the study were difficulty in performing basic activities of daily living, and difficulty in performing instrumental activities of daily living. Compiled from self-reports, the independent variables were : age, sex, educational level, living alone or with other person (s), self-assesed health, and the presence or not of hypertension, diabetes mellitus, cancer, chronic obstructive pilmonary disease, ischemic heart disease, cerebrovascular diseases, and osteoarthritis. The presence of depression and cognitive impairment in the participants was evaluated, and body mass index was also calculated. To compare the degree of influence of the different variables on disability, a standardized coefficient for each association was calculated. RESULTS. In the seven cities studied, the variables that showed a direct association with difficulty in carrying out basic activities of daily living and instrumental activities of daily living were: suffering from a higher number of noncommunicable diseases, from cerebrovascular diseases, from osteoarthritis, or from depression; being older; being female; rating one's own health as bad, and the presence of cerebrovascular diseases, osteoarthritis, or cognitive impairment. CONCLUSIONS. Our research provides the first systematized description of the associations between disability and chronic noncommunicable diseases in older adults in Latin America and the Caribbean. Difficulties that older adults have in carrying out instrumental activities of daily living are the first ones to appear. Therefore, follow-up mechanisms should be established that make possible the early detection of this disability (AU)

National policy on ageing for Trinidad and Tobago.

The needs of older persons must be assessed against the rapid demographic changes society is undergoing. Such changes may impact differently on the situation of older persons, unless effective countervailing measures are instituted. If mechanisms for treating with ageing issues in Trinidad and Tobago are to be effective, they must be located within a comprehensive policy framework. It is on this basis that the Government of Trinidad and Tobago has sought to develop a national policy on ageing. The overall goal of this policy is to promote the well being of older persons in a sustainable manner and provide older persons with the opportunity to be integrated into the mainstream of society.

Ageing - A new challenge to health care in the new millennium [editorial]

The Caribbean region is experiencing a demographic transition in terms of ageing of its population in both numbers and life expectancy. Thirty-five years of life have been added to the life span since 1950. This calls for adequate arrangement to meet the social, economic and health needs.(AU)

Active aging: a medical student's perspective

This presentation aims to look at promoting active aging from a life course perspective. The study is based on literature review and incorporates views from the World Health Organisation Aging and Health Policy, other experts in the field and from the authors. Stastitics indicate that the year 2025 over 10 percent of the population of most Caribbean countries will be over 70 years old. The current life expectancy at birth in Jamaica and most Caribbean countries is over 72 years for both males and females. This increase in life expectancy has occurred largely due to increased access to, and qualify of, medical care, the increased use of antibiotics, better environmental health, and education. These have all significantly contributed to a decrease in the spread of communicable diseases. The present and future health care professional must understand that active aging is the only way to improve the quality of longevity. This presentation looks at strategies to promote active aging from a life course perspective. This is based on a proactive approach which incorporates educational programmes which focus on all aspects of life and encourage the individual to realize that healthy lifestyles from an early age have lifetime benefits. The teachings of geriatic medicine in medical schools, as well as social and corporate policy and community involvement, are also important aspects of the active aging approach. CONCLUSION: Healthy children have a much greater probability of becoming healthy adults, and healthy older people. It is imperative that this life course perspective of aging be encouraged so that life can be added to the years, even as years are being added to life.(Au)

Report on the conference on ageing: maturing at a healthy pace: appreciating the older years, March 31-April 1, 1999, Eric Williams' Medical Sciences Complex, Mt. Hope

The conference organizers, ... had the following as the main conference objectives: (i) the formulation of strategies which would positively influence the main factors impacting on the life of older persons (ii) the dissemination of information about positive ways in which the needs of the elderly are being approached (iii) the creation of a policy on ageing which would embrace a gender-sensitive approach to the delivery of services (Executive Summary)

Anti-ageing medicine - growth hormone therapy

Anti-ageing medicine is now recognised by the American Medical Association as a bona fide medical speciality. An Academy has been established and board certification is now available. With the prospect of an older population and increase life expectancy, anti-ageing medicine aims to prescribe a proactive, preventative course of medicine that will lead to longer, healthier, human lives, free of the disease processes now synonymous with advanced age. Technology exists today that can slow, stop and even reverse much of the deterioration and disease that typically accompanies the ageing process. Hormone replacement therapy (HRT) is one such technology. Perhaps the most exciting agent in HRT is human growth hormone (hGH). In 1990 Rudman et al, in their pioneering study published in the New England Journal of Medicine, demonstrated the age-reversal effects of hGH. Since then a number of studies have confirmed their findings and refined the technique. The use of hGH as an anti-ageing therapy is reviewed and the author's clinical experience is presented.(AU)

For cognitive enhancement provider system (FORCEPS) preventive geriatrics: our cardinal challenge

Recent revelations restoring telomeres and using citicoline to rejuvenate cerebral function post-stroke make it highly probable that human lifespan (with acceptable cerebration) can be extended to a theoretical limit of 120-140 years. However, millions of people are already taking anti-aging products of uncertain quality and quantity without any objective measurements of their effectiveness, such as on short-term memory loss. No drug company will undertake these very expensive studies on nonpatentable products. FORCEPS was designed to evaluate anti-aging and SMART drugs, herbs and supplements through a network of practitioners in preventive geriatrics, communicating through weekly telephone conference and a FORCEPS newsletter. Currently, the focus is on acetyl-carnitine coenzyme 0-10, deprenyl (selegiline), gingko bilboa, phosphatidyl serine and piracetam. For prescription medicine such as deprenyl and piracetam. FORCEPS maintain alist od compounding mail-order pharmacies to facilitate in-office physician dispensing for non-FDA approved uses. The non-prescription items are available through the FORCEPS multi-level marketing (MLM) network, whereby the customers (including providers) can purchase the products wholesale and also derive income by sponsoring new customers who maintain monthly product purchase levels for self use and resale. The major incentives for customers to purchase through FORCEPS would be the motoring and advice in anti-ageing therapy, and the potential for income through sponsoring new participants in the MLM network. By providing products of pharmaceutical-grade quality and standardized protocols to experienced geriatricians, FORCEPS will coordinate and communicate the evaluation of these products among thousands of customers in the only way possible - applied real life research analysis to determine what really works.(AU)

Incidence of hypertension and non-insulin dependent diabetes mellitus and associated risk factors in a rapidly developing Caribbean community: the St. James survey, Trinidad

OBJECTIVE: To compare the incidence rates of hypertension and non-insulin dependent diabetes mellitus in relation to ethnicity and other characteristics in a rapidly developing community. DESIGN: Prospective surveillance of a total community for five years. SUBJECTS: Cohort of 2491 men and women aged 35 to 69 years (79 percent response), of African, Indian and other (mainly Afro-European) descent. RESULTS: During surveillance, secular increases ocurred in fasting blood glucose concentrations in both sexes and in Body Mass Index (BMI) in men with apparent secular reductions in systolic blood pressure in both sexes. Incidence rates of hypertension did not differ significantly with ethnicity, ranging between 31 and 41 per 1000 person-years in men and between 27 and 32 person-years in women. In men, the incidence of diabetes (per 1000 persons-years) in Indians (24) was significantly higher than in Africans (13) and others (11). In women the diabetic incidence was similar to that for men in Indians (23) and Africans 914), but in others was twice that in men 921). In both sexes, weight gain was an important risk factor for hypertension, whereas risk for diabetes increased with BMI at baseline. The increased risk of diabetes in Indians among men was independent baseline BMI and blood glucose. CONCLUSION: Apart from the increased risk of diabetes in Indians, ethnicity had no significant influence on incidence rates hypertension and diabetes in Trinidad. Secular increases in blood glucose in both sexes and in BMI in men probably contributed to the concurrent increase in mortality from coronary heart disease in this community (AU).

Adolescent blood pressure in a cohort study of sickle cell disease

BACKGROUND: Previous studies on low blood pressure in patients with homozygous sickle cell (SS) disease have sought new hypothesis on the mechanism of low blood pressure but have not analyzed the role of known determinants such as weight. METHODS: Blood pressure has been measured by an automated oscillometric method in 220 patients with SS disease, 144 with sickle cell-hemoglobin C disease (both groups aged, 9.5 to 18.5 years) and 122 control subjects with a normal hemoglobin genotype (aged 16.0 to 18.5 years) participating in a cohort study from birth. RESULTS: Significant age-related increases in systolic and mean arterial pressure occurred in sickle cell-hemoglobin C disease but not in SS disease. Further analysis were confined to a subgroup of 51 patients with SS, 41 patients with sickle cell-hemoglobin C, and 97 subjects with normal hemoglobin, aged 16.0 to 18.5 years in whom simultaneous measurements of height, weight, arm circumference, and hematologic test results were also available. Crude analysis showed significantly lower systolic, diastolic, and mean arterial pressure in SS disease compared with control subjects with normal hemaglobin, but further analysis showed the systolic difference to be confined to males and all differences disapperared after ajustment for weight. No difference occurred in sickle cell-hemoglobin C disease. CONCLUSIONS: These results suggest that the lower blood pressure in SS disease is attributable to low weight and that no further mechanisms need be postulated (AU)

Serum immunoglobulin levels in children with homozygous sickle cell disease

Serum immunoglobulin levels (IgA, IgG, and IgM) have been assayed in a representative sample of children (aged 1-7 years) with homozygous sickle cell disease and in age/sex-matched control children with a normal haemoglobin genotype, followed from birth in a prospective cohort study. In SS disease, significant elevation of IgA occurred from the age of two years and of IgG from the age of six years. IgM levels were not significantly different in the two genotypes. The mechanisms contributing to these changes in immunoglobulins are currently unclear as is their clinical significance.(AU)

Environmental factors affecting paracetamol metabolism in London factory and office workers

Paracetamol elimination was measured, using serial saliva samples, in 114 London factory and office workers, 76 whites and 38 Asian immigrants. Use of social drugs such as alcohol, tobacco and the oral contraceptive varied considerably within the sample, being appreciably greater in white subjects. Paracetamol clearance was 21 percent slower in Asians than in whites and half-life 18 percent longer. The total range of clearance was 1.86-6.78 ml/min/kg. Clearance was slower in women than in men, increased with increasing alcohol intake and cigarette consumption, and was more rapid in those women using the oral contraceptive. The effects of alcohol and the oral contraceptive were also found in white subjects alone. The variable found to correlate independently with paracetamol clearance accounted for only 27 percent of the total sample variance, however, and are unlikely to be the major determinants of paracetamol elimination in man (AU)

Cholelithiasis in Jamaican patients with homozygous sickle cell disease

The prevalence of cholelithiasis in Jamaican adults with SS disease was studied by plain abdominal radiograph in 206 patients and by oral cholecystogram in 126 (61 percent) of these patients. Gallstones were found in 57 (28 percent of patients, were more common in females than males, and increased with age and hemolytic rate. The majority of gallstones were visible on the plain abdominal radiograph, only 17 percent of patients with gallstones having only radiolucent stones. Nonfunctioning oral cholecystograms were common (10 percent) in agreement with observations by previous workers. Gallstones were noted in the common bile duct in 2 patients. In general there was no clear relationship between the presence of cholelithiasis and clinical symptomatology. Complications, such as pancreatitis and malignant change in the gall bladder, recognized to be associated with cholelithiasis in the general population, have not been clearly related to cholelithiasis in SS disease. More information is needed before a logical policy can be evolved for surgical intervention in cholelithiasis in SS disease. (AU)