The impact of dietary supplements on blood pressure in older adults: A network meta-analysis of randomized controlled trials.

Purpose: The prevalence of hypertension (HTN) increases with age and there is a need for effective, evidence-based treatments for HTN among older adults. The objective of this study was to perform a network meta-analysis to evaluate the effectiveness of different forms of nutritional supplementation on reducing blood pressure in older adults. Methods: A systematic review using PubMed and Clinical Key was performed to identify randomized controlled trials (RCTs) evaluating the effects of dietary supplements on blood pressure in adults older than 65 years of age. Network meta-analysis (NMA) was used to compare and rank the effects of different supplements on systolic (sBP), diastolic (dBP), and mean (mBP) blood pressure. Supplements were ranked according to P score. Meta-regressions were conducted to examine whether treatment effects were moderated by baseline BP and supplementation duration. Findings: We identified 144 relevant studies in the literature, twelve of which met criteria for inclusion in NMA. The included studies were published between 2003 and 2022. In reducing sBP, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), inorganic nitrates, tart cherry juice, and vitamin D supplementation were more effective than placebo, and the effect of tart cherry juice outranked that of vitamin D, vitamin E, and vitamin K2. In reducing dBP, inorganic nitrates, DHA and EPA, protein, resveratrol, and vitamin D supplementation were more effective than placebo, and the effect of resveratrol outranked that of tart cherry juice, vitamin D, vitamin E, and vitamin K2. However, the effects of tart cherry juice on sBP and resveratrol on dPB were smaller than the pooled effect of placebo, and none of the pairwise differences between the effects of examined supplements were statistically significant. Caution is needed when interpreting these results given concerns about the risk of bias assessed in seven of the twelve studies included in this analysis.

Prospective association of occupational and leisure-time physical activity with orthostatic blood pressure changes in older adults.

Orthostatic hypotension (OH) is common in older people. We examined the influence of self-reported occupational-related physical activity (PA) and leisure-time physical exercise (PE) on orthostatic response in a sample of older people over a 2 year period. Supine and orthostatic systolic blood pressure (sBP), diastolic blood pressure (dBP), and mean blood pressure (mBP) were assessed in response to Active Stand (AS) test in 205 older subjects (> 60 years old) at baseline and 2-year follow-up. OH was found in 24 subjects (11.71%) at baseline and 20 subjects (9.76%) after 2 years, with a significant degree of variability in the occurrence of OH after 2 years. Twenty-two subjects who had OH at baseline were free of it after 2 years, two subjects had persistent OH at baseline and after 2 years. After 2 years, adults with occupational PA showed no significant decrease of blood pressure in response to AS test, while lack of undertaking an occupation-related PA was significantly related with a greater decrease in sBP and mBP in response to AS testing in the 1st min. Occupation-related PA and leisure-time-related PE were related to an increase in the response of BP on AS in change between baseline and after 2 years. High between-subjects variance in OH over 2 years was noted. Occupations that involved continuous physical activity and leisure-time physical exercise in middle age were both protective for BP decline on orthostatic stress test within 2 years.

Relationship of the Behavior of Older Participants with Body Composition Change: Results of the Second Wave of the Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, and Functional Capacity Studies (COPERNICUS).

BACKGROUND: To examine the relationship between the frequency of physical activities and food product consumption with body composition change after two years in a sample of older people. METHODS: Body composition, mass change, frequency of physical activity, and food products consumption were measured. Depression severity, health self-assessment, cognitive function, and demographic data were included as confounders. RESULTS: There were no significant changes in body composition except for a reduction in visceral fat level within two years (p < 0.05). Drinking beer and eating sweets a few times per week were associated with a significant increase in body fat percentage (p < 0.05). Drinking green or white tea more frequently than a few times per year was related to an increase in body fat (3.18 to 3.88%, p < 0.05). Contrarily, daily consumption of coffee was related to a decrease in body fat (p = 0.029). Subjects who ate sweets once a week or more frequently consumed coffee more often. CONCLUSIONS: More frequent drinking of beer or of green or white tea and consumption of sweets were related to an increase in body fat percentage, while daily coffee consumption was related to a decrease in body fat percentage after two years in older, healthy subjects. Noteworthily, the frequencies of food product consumption are interrelated.

Association Between Pain and Sarcopenia Among Adults Aged ≥65 Years from Low- and Middle-Income Countries.

BACKGROUND: Pain may increase the risk for sarcopenia, but existing literature is only from high-income countries, while the mediators of this association are largely unknown. Thus, we aimed to investigate the association between pain and sarcopenia using nationally representative samples of older adults from 6 low- and middle-income countries (LMICs), and to identify potential mediators. METHODS: Cross-sectional data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. Sarcopenia was defined as having low skeletal muscle mass and weak handgrip strength, while the presence and severity of pain in the last 30 days were self-reported. Multivariable logistic regression and mediation analyses were performed. The control variables included age, sex, education, wealth, and chronic conditions, while affect, sleep/energy, disability, social participation, sedentary behavior, and mobility were considered potential mediators. RESULTS: Data on 14,585 adults aged ≥65 years were analyzed (mean [SD] age 72.6 [11.5] years; 55.0% females). Compared to no pain, mild, moderate, severe, and extreme pain were associated with 1.42 (95% confidence interval [CI] = 1.05-1.94), 1.43 (95%CI = 1.02-2.00), 1.92 (95%CI = 1.09-3.37), and 2.88 (95%CI = 1.10-7.54) times higher odds for sarcopenia, respectively. Disability (mediated percentage 18.0%), sedentary behavior (12.9%), and low mobility (56.1%) were significant mediators in the association between increasing levels of pain and sarcopenia. CONCLUSIONS: Higher levels of pain were associated with higher odds for sarcopenia among adults aged ≥65 years in 6 LMICs. Disability, sedentary behavior, and mobility problems were identified as potential mediators. Targeting these factors in people with pain may decrease the future risk of sarcopenia onset, pending future longitudinal research.

Effects of Sitting Callisthenic Balance and Resistance Exercise Programs on Cognitive Function in Older Participants.

BACKGROUND: Exercise training programs have the potential to improve cognitive function in older subjects. However, the majority of training programs are based on aerobic modality. In the current study, the influence of 3 months programs of sitting callisthenic balance (SCB) and resistance training (RT) on cognitive functioning and the mediating role that a change in the level of neurotrophic factors and strength in older, healthy participants plays were examined. MATERIAL AND METHODS: Global cognitive function was examined using MoCA, short-term memory using Digit Span and Delayed Matching to Sample, set shifting using Trial Making Test Part B, speed of processing simple visual stimuli using Simple Reaction Time, decision making using Choice Reaction Time, visual attention with Visual Attention Test (VAT), tests. Strength of lower and upper limbs, neurotrophin level (irisin, brain-derived neurotrophic factor (BDNF), neurotrophin 3 (NT-3), neurotrophin 4/5 (NT 4/5) were examined. RESULTS: Improved scores in RT vs. SCB were noted in MoCA (p = 0.02), reaction time in SRT (p = 0.02), TMT B (p = 0.03), errors committed in CRT (p = 0.04) and VAT (p = 0.02) were observed. No significant changes in the level of neurotrophic factors were observed. Changes in upper limb strength were related to changes in the number of errors committed in the SRT (p = 0.03). Lower limb strength changes explained the dynamics of the number of correct answers (p = 0.002) and errors committed (p = 0.006) in VAT. CONCLUSIONS: Both SCB and RT influenced multiple cognitive domains. The RT program improved global cognitive functioning, while no improvement was noticed in the SCB group. Decision making, visual attention and global cognitive function were improved after the RT program. Set-shifting, short-term visual memory processing speed of simple visual stimuli were improved after the SCB program, while a decrease in the processing speed of simple visual stimuli was noted in the RT group. Changes in irisin were related to set-shifting and short-term memory, while in BDNF to an improvement in the processing speed of simple visual stimuli. Resistance exercise training programs could be applied to prevent age related declines of cognitive function in healthy older subjects.

Adipokines Level and Cognitive Function-Disturbance in Homeostasis in Older People with Poorly Managed Hypertension: A Pilot Study.

AIM: To explore the network relationship between cognitive function, depressive symptom intensity, body composition, proxies of cognitive reserve, trophic factor, adipokines and myokines, physical performance and blood pressure in a group of older people with poorly managed hypertension (PMHTN) compared to a normotensive (NTN) group. MATERIALS AND METHODS: History of hypertension and blood pressure level were examined in older participants. Thirty-one subjects diagnosed with PMHTN (history of hypertension diagnosis and values of sBP or dBP over 140/90 mmHg) and eighteen NTN (lack of history of hypertension and sBP and dBP lower than 140/90 mmHg) participated. Participants completed physical and cognitive function assessments: including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and its two subtests Delayed Recall (DR) and Verbal Fluency (VF) and Trail Making Test Part B (TMT B). Factors associated with cognitive functioning: age, years of education, cognitive and travel activity were assessed using a questionnaire. Visceral fat was determined by bioimpedance testing and gait velocity and agility assessed using an Up and Go test. To summarize the strength and direction (negative or positive) of a relationship between two variables, Spearman's rank correlation coefficient was used. Then, network graphs were created to illustrate the relationship between variables. Node strength (number of edges per node), neighbourhood connectivity (the average connectivity of all the neighbours of a node), stress (the number of shortest paths passing through each node) were compared in network from PMHTN group to network from NTN group. RESULTS: Neighbourhood connectivity and stress were significantly higher in of the PMHTN network compared to NTN (6.03 ± 1.5 vs. 4.23 ± 2.5, p = 0.005 and 118.21 ± 137.6 vs. 56.87 ± 101.5, p = 0.02, accordingly). CONCLUSION: In older subjects with poorly managed hypertension, dyshomeostasis was observed, compared to normotensive subjects.

Assessment of the Development of Poverty in EU Countries.

The aim of the article is to assess of development of poverty in EU countries in 2010 and 2019. The study used the model method of the linear ordering of objects-TOPSIS, considering the distance of each object from both the pattern and the non-pattern development. The originality of the work consists in the use of primary data obtained from the Eurostat database and the winsorized data that were created on the basis of outliers. The indicators characterizing the first goal of sustainable development-"No poverty" were used. The results of the research indicate that the inhabitants of western Europe and Scandinavia are less affected by poverty than the population of eastern and southern Europe. The division of countries according to the scale of poverty is reflected in the level of GDP per capita.

Coffee Consumption and Blood Pressure: Results of the Second Wave of the Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, and Functional Capacity Studies (COPERNICUS).

This study examined the relationship between the frequency of coffee consumption and blood pressure over a two year follow up of a cohort of elderly people. Healthy, older people (N = 205) were examined at baseline and at two years. Participants completed physical and behavioural assessments, which included body composition, current pharmacological treatment, and frequency of coffee consumption grouped into three categories: "never to a few times per month", "once a week to a few times per week", and "every day". Blood pressure (systolic (sBP), diastolic (dBP), mean (mBP), and pulse pressure (PP)) was measured at baseline and after two years. After adjusting for body composition, smoking status, age, sex, heart rate, and number of antihypertensive agents taken, participants who drank coffee everyday had a significant increase in sBP, with a mean of 8.63 (1.27; 15.77) and an mBP, with a mean of 5.55 mmHg (0.52; 10.37) after two years (t = 2.37, p = 0.02 and t = 2.17, p = 0.03, respectively) compared to participants who never or very rarely (up to a few times per month) drank coffee. DBP and PP were not affected by coffee consumption frequency in a statistically significant manner.

Cognitive Function Changes in Older People. Results of Second Wave of Cognition of Older People, Education, Recreational Activities, NutritIon, Comorbidities, fUnctional Capacity Studies (COPERNICUS).

BACKGROUND: Cognitive reserve explains why subjects with more years of education, professional achievement, or participation in recreational activities show less cognitive decline with aging. We hypothesize that levels of recreational travel, education, occupation, systemic health, physical performance, and current cognitive activity levels affect the trajectory of cognitive function in older, healthy people in Poland. MATERIALS AND METHODS: Healthy, older people (N = 205) were examined and followed-up at 2 years. Participants completed physical and cognitive function assessments: including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA) and its two subtests Delayed Recall (DR) and Verbal Fluency (VF), and Trail Making Test Part B (TMT B). Factors associated with cognitive functioning were also examined. RESULTS: The MMSE result significantly decreased over 2 years. No significant decrease in other cognitive tests was noted. However, the trajectory of cognitive tests results varied between individual participants. Percentage of variance of change was explained by the following predictors: 21 in MMSE, 24 in MoCA, 8 in DR, 25 in VF, and 24 in TMT B. Age and the presence of varicose veins were significantly linked to negative changes in MMSE and MoCA scores, while working in a professional occupational status associated with a higher score. The subgroup with varicose veins did worse on the Delayed Recall subtest of MoCA. CONCLUSION: Cognitive reserve could be extended by proxies of reserve that are related to systemic health and travel activity. The latter is a combination of social, physical, and cognitive activity and potentially might serve as an intervention to improve cognitive function in older people. However, due to the limitations of this study, results should be interpreted with caution and needs to be replicated in the further studies.

Interaction between Subjective Memory Decline and Depression Symptom Intensity in Older People. Results of the Second Wave of Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, and Functional Capacity Studies (COPERNICUS).

BACKGROUND: Prevalence of subjective memory impairment (SMC), with or without objective memory impairment, and the mediating role of depression symptom intensity was examined in older people. METHODS: n = 205 subjects (60 years old and older) were examined and followed up at two years. Cognitive function was examined using the Montreal Cognitive Assessment (MoCA) Delayed Recall (DR) subtest. Geriatric Depression Scale (GDS) was used as a screening tool for depression. Statistical analysis was performed using linear mixed models. RESULTS: A total of 144 subjects (70.24%) had SMC. MoCA Delayed Recall scores were not significantly changed in relation to time and SMC. Dynamics of SMC significantly influenced changes in GDS score (p = 0.008). CONCLUSIONS: SMC and objective memory impairment do not fully overlap each other. Subjects without SMC for longer than two years noted less intensity of depression symptoms in comparison to subgroup with SMC. However, occurrence of SMC in subjects who were previously free of SMC, was not related to increase in depression symptom intensity.

Effects of 3-months sitting callisthenic balance and resistance exercise on aerobic capacity, aortic stiffness and body composition in healthy older participants. Randomized Controlled Trial.

BACKGROUND: Arterial stiffness (AS) is a reduction in the ability of large arteries to readily accommodate the increase in blood ejected from the heart during systole related with aging. Physical exercise is associated with AS reduction. However, it remains controversial as to which modality and intensity (resistance vs aerobic, high vs low) would be the most effective. The aim of these studies is to examine the effects of 3-months sitting callisthenic balance (SCB) and resistance exercise (RET) on aerobic capacity, aortic stiffness and body composition in older participants. MATERIAL AND METHODS: Aortic pulse wave velocity (PWVao), return time (RT), diastolic reflection area (DRA) and blood pressure (BP) level changes were measured with Arteriograph. Aerobic capacity was examined with 6-min walk test (6-MWT) and spiroergometry (VO2max). Body composition was analyzed by Bioelectric Impedance Analysis using Tanita. RESULTS: Significant improvements of BP, PWVao, RT and DRA were observed in the SCB group (p = 0.018, p = 0.017 and p = 0.012, respectively). % of fat mass improved in RET and SCB group (p = 0.003, p = 0.012, respectively). Visceral fat significantly improved in SCB group (p = 0.03). CONCLUSIONS: Despite no significant changes in indicators of aerobic capacity (VO2max and 6MWT result) in both groups, significant improvement in all measures of AS, except SBPao were observed in the SCB group, while no AS improvement in the RET group was noted. There were some differences in pattern of body compositions improvement between two groups.

Cognitive Functioning in Older People. Results of the First Wave of Cognition of Older People, Education, Recreational Activities, Nutrition, Comorbidities, Functional Capacity Studies (COPERNICUS).

Background: Cognitive reserve is a way of explaining why some individuals with a high degree of brain pathology are without clinical manifestations. In this study, factors related to systemic diseases, body composition, aerobic capacity, past and current behavior were examined and included as predictors of cognitive function. Materials and Methods: 407 subjects (60-88 years old) underwent physical examination and cognitive function assessment [Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Trail Making Test Part B (TMT B)]. Predictors of cognitive functioning were evaluated: occupational status (OS), diet, mental and touristic activities were assessed using an ad hoc questionnaire. Aerobic capacity was measured using a six-minute walk test (6MWT). Results: With each year of age there is a decrease in MMSE score by 0.18 points. Varicose veins on lower extremities and low OS were also significantly associated with MMSE result. For every year of having hypertension, low OS and not being abroad in the last 3 years, there was 0.17, 0.30, and 0.16 less points, respectively, and 0.15 more point per one additional meter walked in 6MWT in the MoCA score. With each year of age and for low OS there was there were 0.31 and 0.21 s more to complete TMT B, respectively. Conclusion: Education, OS, presence of systemic diseases and social and tourist activities, aerobic capacity and body composition could be considered as factors contributing to cognitive functioning in older people. However, the relationship of above mentioned factors with education level and cognitive function may be not fully orthogonal.