Lipid risk factors among elderly with normal fasting glucose, impaired fasting glucose and type 2 diabetes mellitus. The Italian longitudinal study on aging.

BACKGROUND AND AIMS: Three groups of subjects were identified within a representative sample of older Italians: subjects with normal fasting glucose (NFG), with impaired fasting glucose (IFG) or with type 2 diabetes mellitus (T2D). The aim of the present study was to evaluate the relationship among plasma lipids, lipoproteins, other metabolic factors in the three groups, and their role in predicting total fatal events. METHODS AND RESULTS: 2422 subjects, aged 65-84 years, taking part into the Italian Longitudinal Study on Aging were included in the analyses. Factor analysis was conducted separately for men and women. Factor scores were used as independent variables in Cox Proportional Hazard models, to determine factors predicting death at the follow-up in NFG, IFG and T2D subjects. Four major factors were found for men ("insulin resistance", "body size", "total cholesterol", "HDL cholesterol") and four also for women ("insulin resistance", "total cholesterol", "body size", "HDL cholesterol"). For NFG and IFG men, and for both T2D men and women, the "HDL cholesterol" was a significant protective factor for total deaths (NFG men: HR = 0.79, 95% CI 0.67-0.93; IFG men: HR = 0.59, 95% CI 0.45-0.79; T2D men: HR = 0.55, 95% CI 0.34-0.89; T2D women: HR = 0.61, 95% CI 0.44-0.86). Among NFG women, the "body size" factor was also a protective factor with respect to total deaths (HR = 0.74, 95% CI 0.57-0.95). CONCLUSION: A factor including HDL Cholesterol and Apo A-I showed protection against all-cause mortality in older men, independently from the glycemia level, and in women only in those diagnosed with T2D.

Diabetes as a risk factor for cognitive decline in older patients.

AIMS: To assess the role of type 2 diabetes as a risk factor for cognitive decline among elderly people. METHODS: Analyses were carried out on data from the Italian Longitudinal Study on Aging, a study on 5,632 subjects aged 65-84 years, with baseline in 1992 and follow-ups in 1996 and 2000. RESULTS: At baseline, diabetic women had significantly worse scores on all cognitive tests compared to nondiabetic women, but did not show worsening over time, whereas men with diabetes did not show worse scores on cognitive tests at baseline compared to nondiabetic males; however, diabetes in men was associated with a risk of cognitive decline over time, particularly in attention. Higher levels of HbA(1c) were associated with poorer performance on memory tests at follow-up in both sexes. CONCLUSION: The impact of diabetes on cognitive status might differ in older men and women, probably because of a survival effect, with a higher mortality at a younger age among diabetic men. The metabolic and cardiovascular abnormalities associated with diabetes might be responsible for the cognitive decline, at different rates and ages, in men and women. The routine assessment of diabetes complications in the elderly should include cognitive evaluation in both sexes.

Hypersensitivity pneumonitis and alpha-chemokines.

Hypersensitivity pneumonitis (HP) is categorized as a Type-1 helper (Th1) disease. The resulting granuloma formation is dependent on T cells and the Th1 cytokine interferon (IFN)-γ. In experimental setting, the production of IFN-γ-induced protein 10 (IP-10), monokine induced by IFN-γ (MIG), IFN-inducible T-cell-alpha chemoattractant (I-TAC), has been shown (in mice exposed to the particulate antigens that cause HP) during the development of HP. The production of these chemokines was associated with an influx of chemokine (C-X-C motif) receptor (CXCR)3 CXCR3(+)/CD4(+) T cells into lungs. This suggests that IFN-γ mediates the recruitment of CXCR3(+)/CD4(+) T cells into the lung via the production of IP-10, MIG, and I-TAC, resulting in granuloma formation. In humans it has been shown that lymphocytes infiltrating lung biopsies are CD8 T cells for CXCR3. Furthermore, the T cells accumulating in the bronchoalveolar lavage (BAL) of HP were CXCR3(+)/IFN-γ(+) type 1 CD8(+) T cells (Tc1) exhibiting a strong in vitro migratory capability in response to IP-10. Alveolar macrophages express and secrete, in response to IFN-γ, high levels of IP-10, capable of inducing chemotaxis of the CXCR3(+) T-cell line. High levels of CXCR3 ligands were shown in the fluid of the BAL in HP patients. These data confirm that IFN-γ mediates the recruitment of lymphocytes into the lung via production of IP-10, resulting in Tc1-cell alveolitis and granuloma formation. It has been suggested that differences in the expression of CXC chemokines and Th1 cytokines may contribute to different immunopathogenesis, clinical course and responsiveness to treatment of HP.

Adherence to the Mediterranean Diet and All-Cause Mortality Risk in an Elderly Italian Population: Data from the ILSA Study.

OBJECTIVE: The aim of this study was to evaluate adherence to the Mediterranean Diet (MD) and its association with all-cause mortality in an elderly Italian population. DESIGN: Data analysis of a longitudinal study of a representative, age stratified, population sample. SETTING: Study data is based upon the Italian Longitudinal Study on Aging (ILSA) a prospective, community-based cohort study. The baseline evaluation was carried out in 1992 and the follow-up in 1996 and 2000. PARTICIPANT: Participant food intake assessment was available at baseline for 4,232 subjects; information on survival was available for 2,665 at the 2000 follow-up. MEASUREMENTS: Adherence to the MD was evaluated with an a priori score based on the Mediterranean pyramid components. Cox proportional hazard models were used to assess the relationship between the MD score and all-cause mortality. Six hundred and sixty five subjects had died at the second follow-up (identified up to the first and second follow-up together; mean follow-up: 7.1±2.6 years). RESULTS: At the 2000 follow-up, adjusting for other confounding factors, participants with a high adherence to MD (highest tertile of the MD score distribution) had an all-cause mortality risk that was of 34% lower with respect to the subjects with low adherence (Hazard Ratio=0.66; 95% CI: 0.49-0.90; p=0.0144). CONCLUSION: According to study results, a higher adherence to the MD was associated with a low all-cause mortality risk in an elderly Italian population.

The CXCR3 chemokines in inflammatory myopathies.

The α-chemokines (C-X-C motif) ligand 9 (CXCL9) and interferon γ-induced protein 10 (IP-10) are expressed in idiopathic inflammatory myopathies muscle. Abundant expression of IP-10 was observed on macrophages and T cells surrounding and invading non-necrotic muscle fibers in polymyositis and sporadic inclusion body myositis and in T cells in perimysial infiltrates of dermatomyositis. IP-10 was also localized to blood vessel endothelial cells in all inflammatory and normal muscle tissues. Serum IP-10 is high in patients with inflammatory myopathies. Human skeletal muscle cells might actively self-promote muscular inflammation by eliciting IP-10 secretion, under the influence of cytokines [Interferon (IFN-γ), Tumor Necrosis Factor (TNF-α)], which can amplify T helper (Th)1 cell tissue infiltration in vivo. It has been shown that drugs able to block the IP-10/chemokine (C-X-C motif) receptor 3 (CXCR3) axis can suppress inflammation in muscle.

Th1 cytokines and chemokines in primary biliary cirrhosis.

T- helper 1 (Th1) cytokines and chemokines in primary biliary cirrhosis (PBC) has been investigated in several studies. The involvement of (C-X-C motif) receptor 3 (CXCR3) and its ligands in the pathogenesis of PBC was studied in autoimmune cholangitis animal models suggesting that CXCR3 chemokines contribute to the development of PBC. In humans with PBC, interferon (IFN)γ-induced protein 10 (IP-10) and chemokine (C-X-C motif) ligand 9 (MIG) expressions, and CXCR3-positive cells were present in the portal areas of diseased livers. MIG and IP-10 were positively associated with the severity of liver fibrosis. Circulating IP-10 and MIG levels, and CXCR3-expressing cells, in PBC were increased significantly compared to controls and appeared to increase with disease progression. Furthermore, a significant reduction of these chemokines in PBC patients' serum after ursodeoxycholic acid (UDCA) treatment has been shown.

Prevalence of diabetes and depressive symptomatology and their effect on mortality risk in elderly Italians: The Italian Longitudinal Study on Aging.

AIM: This study assessed the prevalence of depressive symptomatology (DS) in older individuals with diabetes to determine whether diabetes and DS are independent predictors of mortality, and if their coexistence is associated with an increased mortality risk. METHODS: Analyses were based on data from the Italian Longitudinal Study on Aging (ILSA), a prospective community-based cohort study in which 5632 individuals aged 65-84years were enrolled. The role of diabetes and DS in all-cause mortality was evaluated using the Cox model, adjusted for possible confounders, for four groups: 1) those with neither diabetes nor DS (reference group); 2) those with DS but without diabetes; 3) those with diabetes but no DS; and 4) those with both diabetes and DS. RESULTS: Type 2 diabetes mellitus (T2DM) was present in 13.8% of the participants; they presented with higher baseline rates of DS compared with the non-diabetic controls. During the first follow-up period, participants with DS but not diabetes had a 42% higher risk of all-cause mortality compared with the reference control group (HR=1.42; 95% CI: 1.02-1.96), while participants with diabetes but not DS had an 83% higher risk of death than the reference group (HR=1.83; 95% CI: 1.19-2.80). The risk of death for those with both disorders was more than twice that for the reference group (HR=2.58; 95% CI: 1.55-4.29). Analyses of deaths from baseline to the second follow-up substantially confirmed these results. CONCLUSION: The prevalence rate of DS is higher in elderly people with diabetes and their coexistence is associated with an increased mortality risk.

The metabolic syndrome, incidence of diabetes and mortality among the elderly: the Italian Longitudinal Study of Ageing.

AIM: To investigate whether or not the metabolic syndrome (MetS) can predict the incidence of diabetes and all-cause mortality among elderly subjects. METHODS: Analyses were based on data collected by the Italian Longitudinal Study on Aging (ILSA) that, between 1992 and 1996, enrolled 5632 participants aged 65 to 84 years. The analyses included 3081 participants for whom complete data were available. Logistic-regression models were designed to study the influence of the MetS on the incidence of diabetes, adjusting for individual MetS components and possible confounders. Data on mortality collected between baseline and the 1996 follow-up were also considered, and Cox's proportional hazards models were used to determine the death risk attributable to the synergistic relationship between the MetS and diabetes. RESULTS: The MetS was strongly associated with an increased risk of diabetes (OR: 5.53, 95% CI: 2.89-10.60). After adjusting for its individual components and possible confounders, the MetS maintained an important role in predicting the incidence of diabetes (OR: 2.65, 95% CI: 0.97-7.24) together with the fasting glucose component (OR: 5.89, 95% CI: 2.89-11.98). Over the 4-year follow-up, participants with diabetes, but without the MetS, and subjects with the MetS, but without diabetes, had no significant risk of death compared with the reference group. Elderly subjects who had both the MetS and diabetes had almost double the risk of death vs the reference group (HR: 1.80, 95% CI: 1.04-3.12). CONCLUSION: The MetS is associated with the incidence of diabetes, and the synergy between the MetS and diabetes is an important risk factor for all-cause mortality in elderly subjects.

Identification of factorial structure of MMSE based on elderly cognitive destiny: the Italian Longitudinal Study on Aging.

The Mini-Mental State Examination (MMSE) is one of the most commonly used instruments in the evaluation of global cognitive status, but only few studies have investigated the relationship among its components in terms of factorial structure. We have considered data from the Italian Longitudinal Study on Aging (ILSA), carried out in Italy in 1992 on a sample of 5,632 subjects aged 65-84 years, and followed up in 1996. The aim of our study was to investigate static factorial structure in three groups of elderly (subjects with a diagnosis of dementia at baseline; subjects free of dementia at baseline, but incident cases at follow-up; subjects who never developed dementia during the 4-year follow-up). Considering our results, we could hypothesize that MMSE static structure reflects the cognitive profile of elderly, and is thus influenced by subjects' potential to develop dementia.

Health related quality of life in adults with repaired tetralogy of Fallot: psychosocial and cognitive outcomes.

OBJECTIVE: To assess the health related quality of life of patients who were operated on during childhood for total correction of tetralogy of Fallot, focusing on the psychosocial and cognitive outcomes. PATIENTS: 54 patients (24 men and 30 women, mean (SD) age 32 (4) years), operated on for total correction of tetralogy of Fallot at mean age of 8.2 years, underwent a cardiological examination, psychological assessment (semistructured interview, Minnesota multiphasic personality inventory), evaluation of quality of life (36 item short form health survey), and neuropsychological assessment with an extensive neuropsychological battery of tests. RESULTS: Psychological characteristics-(1) a lower than normal academic level, (2) a job inadequate for educational level, (3) a preference for an overprotective familiar setting, and (4) a difficulty communicating own corporal image. Denial of the cardiopathy was found to be a common behaviour to normalise functioning. Very few patients had a deficit in memory, learning, or attention functions; rather, patients had a deficit in the executive functions, problem solving, and planning strategies. CONCLUSIONS: Despite a satisfactory health related quality of life, there are residual psychological and social problems in addition to impaired cognitive outcomes in the presence of a normal intelligence quotient.

Physical disability among older Italians with diabetes. The ILSA study.

AIMS/HYPOTHESIS: We studied the role of diabetic complications and comorbidity in the association between diabetes and disability in the elderly. METHODS: Data were from a nationally representative sample of 5632 older Italians, aged 65 years and older, and who participated in the Italian Longitudinal Study on Aging. Clinical diagnoses of diabetes and other major chronic conditions were made by a physician, while disability was assessed by self-reported information on activities of daily living and physical performance tests. RESULTS: After adjusting for age, education and BMI, disability on the basis of activities of daily living was associated with diabetes in women, but not in men (odds ratio [OR] 1.65, CI: 1.22-2.23 and OR 1.21, CI: 0.84-1.75 respectively). In contrast, the association between severe and/or total disability on the basis of physical performance tests and diabetes was strong in both sexes (OR 2.81, CI: 1.44-5.41 and OR 2.16, CI: 1.25-3.73 respectively). Adjusting for traditional complications and comorbidity reduced the excess odds of disability by 38% in women and by 16% in men. CONCLUSIONS/INTERPRETATION: Disability in older Italians with diabetes is frequent and only partially attributable to traditional diabetic complications and comorbidity.

[Use of polyethylene glycol in the treatment of puerperal constipation]. / Uso del Polietilen Glicol como tratamiento del estreñimiento asociado al puerperio.

We evaluated the efficiency of polyethylene glycol at low dosage as a treatment for constipation in the puerperium. A prospective, open label and control study was performed in 225 puerpery patients. We observed a 94.7% of study group patients and a 10.7% of a control group patients had a evacuation in the first 48 hours, (p < 0.01). Decreased consistency of the stools was seen in the PEG group (74.3%). According to our findings, low doses of PEG were useful and safe as a treatment for constipation in the puerperium, without side effects.

Preeclampsia and calcium adenosine triphosphatase activity of red blood cell ghosts.

OBJECTIVE: The current work was undertaken to study the calcium adenosine triphosphatase activity of red blood cell membranes from pregnant women with preeclampsia. STUDY DESIGN: Six normotensive and six preeclamptic pregnant women at 38 to 39 weeks of gestation were studied. The diagnosis of preeclampsia was made on the basis of blood pressure (> 140/90 mm Hg), proteinuria (> 0.5 gm of urinary protein per day), or edema. Hemoglobin-free red blood cell ghosts were prepared from the heparinized blood samples and were used to determine the calcium adenosine triphosphatase activity. RESULTS: It was found that the calcium adenosine triphosphatase activity of preeclamptic women is diminished by about 50% compared with that of normotensive pregnant women. CONCLUSION: A diminution of the calcium adenosine triphosphatase activity of erythrocytes in preeclampsia might be an indication that the in vivo activity of the calcium pump of these cells is diminished, which could, in turn, drive the cells to increase their cytoplasmic free calcium concentration.