Clinical trial on the effects of oral magnesium supplementation in stable-phase COPD patients.

BACKGROUND AND AIMS: COPD is a common chronic condition in older age that impacts on daily activities and quality of life. Previous studies suggest that magnesium deficit in COPD patients affects bronco-obstruction, inflammation, and physical performance. We investigated whether oral magnesium supplementation in stable-phase COPD patients improves lung function, physical performance, and quality of life. METHODS: We conducted a double-blind randomized-controlled clinical study with 49 participants divided into two groups: one given 300 mg/day of magnesium citrate (n = 25) and the other one sachet/day of a placebo (n = 24). The following parameters were assessed at baseline and after 3 and 6 months: lung function (spirometry), physical performance (handgrip strength, lower limb strength, six-minute walk test), inflammation (e.g., C-reactive protein, CRP), disease-related symptoms, and quality of life (St George's Respiratory Questionnaire, EuroQoL-5D, the Modified British Medical Research Council Questionnaire). RESULTS: Linear mixed models revealed significantly lower CRP values in the intervention group than in the placebo group at the 6 month follow-up (ß = - 3.2, 95% CI - 6.0, - 0.4, p = 0.03). Moreover, the maximum work for flexion tended to increase in both groups between the 3 and the 6 month assessments, especially in the placebo group. No significant differences within and between groups over the study period were observed for the other parameters tested. CONCLUSIONS: Although the established minimum sample size was not reached, our results suggests that oral magnesium supplementation may have a potential anti-inflammatory role. On the other hand, it does not seem to substantially influence lung function, physical performance, and quality of life in COPD patients. TRIAL REGISTRATION: The study is registered in clinicaltrial.gov (Trial Registration: NCT02680769, 13 June 2016, retrospectively registered).

The Impact of Smoking on Bone Metabolism, Bone Mineral Density and Vertebral Fractures in Postmenopausal Women.

BACKGROUND: Smoking is recognized among the risk factors for osteoporosis, but only few studies have comprehensively explored its influence on bone metabolism and strength. We aimed to evaluate smoking effects on calcium-phosphate metabolism, bone mineral density (BMD) and fracture risk in postmenopausal women. METHODS: Our sample included 1067 postmenopausal women who arrived to our osteoporosis outpatient clinic. Anamnestic data, smoking habits (categorized as never, former, and current; and by smoking intensity and duration), biochemical parameters, lumbar/femoral BMD, and presence of vertebral fractures were recorded. In a subsample of 357 women, the changes in BMD after a 2-yr follow-up period were also assessed. RESULTS: Current smokers had shorter reproductive age, lower body mass index, and higher prevalence of heavy alcohol consumption than former/never smokers. They also had lower PTH values and weaker linear association between serum vitamin D and parathyroid hormone (current ß = -0.11[SE = 0.004]; former ß = -0.14[SE = 0.01]; never ß = -0.20[SE = 0.003]; p < 0.01 for all). Baseline BMD did not reflect differences based on smoking habits, duration or intensity. However, after 2 years, only current smokers significantly worsened in femural BMD. After adjustment for confounders, the chance of having sustained vertebral fractures at the first evaluation increased by 74% (95% confidence interval:1.07-2.83) in current compared with never smokers, especially among heavy smokers. CONCLUSIONS: Smoking may negatively affect bone by inhibiting vitamin D-parathyroid hormone axis, reducing estrogen exposure, promoting risky health behaviors, and accelerating bone loss, especially at the femur. No significant differences were observed in these outcomes among former smokers, suggesting that quitting smoking has beneficial effects on bone health.

Dietary inflammatory index is associated with lung function in healthy older adults.

OBJECTIVES: Aging is associated with low-grade chronic inflammation contributing to a decline in lung performance. The Dietary Inflammatory Index (DII) has been introduced to evaluate the inflammatory potential of different diets, which may further affect individuals' respiratory function. This study investigates the association between DII and lung performance in older adults. METHODS: This cross-sectional study included 155 adults aged ≥65 y recruited at public gyms in Padua, Italy. Participants were assessed on medical history, biochemical parameters, body composition (through dual energy x-ray absorptiometry), anthropometry, and lung function (by spirometry). Based on individuals' dietary habits, we computed their DII and categorized participants in the lower DII (comprising those in the lowest DII tertile) or the higher DII (comprising those in the highest DII tertiles) groups. The association of DII with forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) was tested through multivariable linear regression analyses in the total sample and stratified by body mass index (<25 kg/m2 versus ≥25 kg/m2). RESULTS: The mean age of the sample was 71.2 y and 80% were women. Individuals in the higher DII group had FEV1 and FVC values reduced by 0.15 L (95% CI, -0.29 to -0.01 L) and 0.25 L (95% CI, -0.43 to -0.07 L), respectively, as compared with those in the lower DII group. Results seemed to be more marked among participants with excess weight conditions. CONCLUSIONS: Pro-inflammatory diets may affect lung function in fit older people, and this effect may be exacerbated in overweight or obese individuals.

Association of body surface area with fat mass, free fat mass and total weight in healthy individuals, and implications for the dosage of cytotoxic drugs.

BACKGROUND & AIMS: In oncology, the dosage of anti-neoplastic drugs is generally adapted to the patient's body surface area (BSA). We investigated the potential differences between BSA and body weight (BW) in estimating the variability in body composition among individuals, especially older adults. MATERIALS AND METHODS: The study population included 322 community-dwelling individuals with different age and sex: 45 adult men (AM, age 18-65 years), 86 older men (OM, age >65 years), 54 adult women (AW, age 18-65 years), and 137 older women (OW, age >65 years). For each participant, we estimated the body composition with dual-energy X-ray absorptiometry, and we calculated the BSA using the DuBois and DuBois formula. The strength of relationships between fat free mass (FFM) and fat mass (FM) with BSA, BW, and BMI were expressed as correlation (r) and determination coefficients (R2). RESULTS: Most of the included sample was normal weight (45.7%) or overweight (41.9%). FFM demonstrated a stronger association with BSA than with BW or BMI in all age/sex groups, with r ranging from 0.831 to 0.924 (p < 0.001 for all) and R2 from 0.691 to 0.853. Conversely, BW and BMI were more strongly related to FM than BSA, especially in women. For such relationship, BW, in particular, showed r ranging from 0.793 to 0.924 (p < 0.001 for all). CONCLUSIONS: This study suggests that BSA may be more appropriately used to estimate FFM, compared with BW. Instead, alternative parameters should be considered to estimate FM in patients at risk for adverse effects of lipophilic drugs, especially in older age.

Efficacy of an interdisciplinary pathway in a first level trauma center orthopaedic unit: A prospective study of a cohort of elderly patients with hip fractures.

BACKGROUND: hip fracture has negative consequences for elderly people. Alternative models of care, with respect to traditional model, were developed to minimize complications and improve functional outcomes. The interdisciplinary model in orthopaedic wards has less evidence of efficacy compared to orthogeriatric units. OBJECTIVE: to compare the efficacy (in-hospital outcomes, mortality, functional status at 6 months after discharge) of an interdisciplinary pathway, based on comprehensive geriatric assessment, compared to a traditional model of care, in hip-fractured elderly patients. DESIGN: prospective study with retrospective control group conducted in a first-level trauma center Orthopaedic Unit. SUBJECTS: 97 patients treated with the traditional model and 127 with an interdisciplinary pathway (mean age 83.9 ±â€¯7.4 vs 84 ±â€¯6.7 years, p = 0.89). METHODS: in all participants we assessed: clinical history, functional pre-fracture status utilising Activities of Daily Living (ADL), in-hospital details. At 6 months after discharge, we evaluated functional status, place of residence, hospital readmissions, mortality. RESULTS: during hospital stay, significant differences emerged in mortality and in external visits. A higher proportion of patients of the orthogeriatric group lived alone at home at 6 months and showed a lower functional decline. Comprehensive geriatric assessment was associated with the ADL score (partial R2: 0.08, p < 0.001) and with a higher probability of independent walking ability ([OR] 3.89 95% [CI] 1.73-8.74, p = 0.001). CONCLUSIONS: an interdisciplinary pathway in hip-fractured elderly patients, could reduce in-hospital mortality, improve functional recovery and increase the probability of living alone at home, at 6 months.

Phase angle and metabolic equivalents as predictors of frailty transitions in advanced age.

OBJECTIVES: The aim of this prospective study was to investigate whether two cellular and metabolic health indices, phase angle (PhA) and metabolic equivalents (METs), can predict changes in frailty states in fit community-dwelling older people. METHODS: A sample of 118 individuals aged ≥65 years who attended a twice-weekly mild fitness program of aerobic and/or resistance exercises was enrolled in the study. At baseline and after three years, individuals underwent a clinical examination, biochemical determinations, bioelectrical impedance analysis, body composition assessment with dual energy X-ray absorptiometry, physical performance tests, and frailty and sarcopenia assessment. In 78 participants was executed indirect calorimetry, too. Based on frailty transitions during the follow-up between non-frailty, pre-frailty and frailty, participants were categorized as improved, stable (non-frail or pre-frail), and worsened or remaining frail. The chances to experience different frailty changes by baseline PhA and METs were explored through multinomial regression analysis and expressed as odds ratios (OR) and 95% Confidence intervals (95%CI). RESULTS: During the follow-up, 8 participants improved in frailty status, 84 were stable and 26 worsened or remained frail. For each one-unit increase in PhA, the odds of improving in frailty increased by 4.53 times (95%CI:1.18-17.46); while for each one-unit increase in METs, the odds of worsening in frailty decreased by 65% (95%CI:0.16-0.79). CONCLUSIONS: PhA and METs may be indirect measures of functional reserve, with lower values being potential biomarkers of evolving frailty.