Association between vitamin D status, physical performance, sex, and lifestyle factors: a cross-sectional study of community-dwelling Kosovar adults aged 40 years and older.

PURPOSE: Vitamin D status and its association with age-related decline in physical performance and strength have already been highlighted in various ways, but data on the situation in developing countries are scarce. This study aimed to investigate vitamin D status, its association with muscle mass and function, and other potential determinants such as age, sex, lifestyle factors (physical activity, dietary behavior), self-perceived health status, medication intake, education and financial situation in adults from Kosovo. METHODS: This cross-sectional study included 297 participants (54.5% women), aged ≥ 40 years. Serum 25-hydroxyvitamin D (25(OH)D) concentration, hand grip strength and physical performance tests, body composition, vitamin D dietary intake and knowledge were assessed. The interaction between serum 25(OH)D status, lifestyle factors and muscle traits was investigated. RESULTS: Vitamin D deficiency (< 50 nmol/L) was observed in 47.5% of the total population, of whom 14.7% of them were severely deficient (< 30 nmol/L). No associations were found between 25(OH)D concentration and age. Daily dietary intake of vitamin D was low (1.89 ± 0.67 µg) and 87.6% of individuals did not take vitamin D supplements. However, vitamin D supplementation was the only variable that added statistical significance (p < 0.05) to the prediction of vitamin D status (3.8%). On the other hand, age, medication intake and vitamin D level contributed significantly to the overall regression model, explaining 24.9% of the 30-s chair stand performance as an indicator of lower-body strength endurance. CONCLUSION: Vitamin D deficiency is highly prevalent among community-dwelling adults in Kosovo and low serum 25(OH)D has been associated with low muscle strength. This implies an urgent need for the development of comprehensive prevention strategies, focusing on pharmacological (supplementation) but also on non-pharmacological strategies such as education, food fortification or lifestyle advices.

Pattern and Factors Associated with Medicine Usage in Middle-aged Adults: a Population Based Cross-Sectional Study.

AIM: The present study analyzes the adherence phenomenon and possible correlations between active individuals and their educational status on the prevalence of medicine use in the population of a young and developing country such as Kosova. MATERIALS AND METHODS: This is an observational, cross-sectional, research study including a total number of 162 subjects aged 40-65 years residents of Kosova. Gender distribution was: 32.7% males and 67.3% females. Assessments of medication adherence and compliance, the level of physical activity (PA), and education were made by reliable and validated questionnaires. RESULTS: Analyzing medication compliance, of 162 interviewed subjects, 29.6% (32.1% males and 28.4% females) and 27.2% (22.6% males and 29.3% females) responded that they sometimes forget to take their medicines, or that they stop taking them for reasons other than forgetting. Meanwhile, 40.1% declared that they usually stopped the medicine only because they felt better, 38.9% claimed to have stopped the medicine because they believed they felt worse, whereas more than half of our study responders declared having problem with buying the medicine. Regarding PA, significantly better results (p<0.05) in medicine use were shown by subjects with higher PA level in our population. Additionally, higher levels of education correlated with lower amount of medication consumption. CONCLUSION: The results of this study suggest for certain lack of adherence, difficulties and information related to medicine use. Consequently this raises the need for public education on the medication adherence and life style factors such as PA for the success of the treatment.

Musculoskeletal Health of 40-65 Year Old Males and Females in Kosova and the Impact of N05B, A02B (PPI, H2RA), H02AB and Lifestyle Factors on It.

BACKGROUND: This observational, cross-sectional study investigates the impact of medication usage, physical activity (PA) and nutritional status on musculoskeletal health (MSH) in males and females aged 40-65 in the population of a post conflict, developing country. METHODS: Bone Mineral Density (BMD), T-score and Z-score at distal forearm regions (measured by DEXA scan), together with isometric hand grip strength (dynamometer) were evaluated in a total of 162 subjects (53 Males, average age 55.15±7.12 and 109 Females, 54.27±5.1). Additionally, bio-anthropometric assessments, medication usage, PA level and nutritional status were assessed. RESULTS: Significant differences (p<0.05) were found in total subjects Body Mass Index (BMI), PA, BMD, T-score and Hand grip between genders. 42% of total participants met the diagnostic criteria of, out of which 6.8% with T-score below -2, while no cases of Osteoporosis was recorded. N05B Anxiolytics and A02B Drugs for peptic ulcer and gastro-oesophageal reflux disease medication groups consumption turned to have no significant differences (p>0.05) in BMD, T-score, and hand grip in total population, except for A02B where p<0.05 were found in Hand grip, as well as between female consumers and no consumers in all variables. Meanwhile, in total subjects consuming H02AB Glucocorticoids p<0.05 were observed in BMD and T-score, but not on hand grip. CONCLUSIONS: This study shows a low risk for MSH problems amongst the studied population in Kosova, while the consumption of H02AB medication group in both genders and A02B in females only for extended periods might effect MSH, therefore appropriate benefit/risk assessment should be made before prescribing these medications, notwithstanding age, gender, PA or nutritional status.

Impact of Using Population-Specific Cut-Points, Self-Reported Health, and Socio-Economic Parameters to Predict Sarcopenia: A Cross-Sectional Study in Community-Dwelling Kosovans Aged 60 Years and Older.

The age-related decline of muscle strength, mass, and physical performance (sarcopenia) has been raising concerns among the scientific and healthcare communities. This decline may differ between populations, age groups, and sexes. Therefore, we aimed to explore sarcopenia together with the impact of health and socio-economic parameters in mature Kosovans. A cross-sectional study was conducted on community-dwelling adults aged ≥ 60 years (n = 240, 47.1% female) from the Prishtina region. Sarcopenia was identified using the following criteria: (i) the European Working Group in Sarcopenia for Older People (EWGSOP1), (ii) the revised EWGSOP2 algorithms, and (iii) sex-specific cut-points derived from the Kosovan population. In males, pre-sarcopenia/probable sarcopenia was detected from the EWGSOP1, EWGSOP2 and Kosovan-specific criteria at values of 3.1%, 5.5%, and 28.3%; sarcopenia was detected at 1.6%, 5.5%, and 0.0%, and severe sarcopenia was detected at 4.7%, 2.4%, and 4.7%, respectively. Pre-sarcopenia was lower in females (0.9%, 5.3%, 16.8%), with no cases of sarcopenia or severe sarcopenia detected by either algorithm. Sarcopenic males were older, had a lower weight, BMI, skeletal muscle mass, performance score, nutritional status (p < 0.001), educational level (p = 0.035), and higher malnourishment risk (p = 0.005). It is notable that high overweight and obesity levels were also detected (93.8% of females, 77.1% of males). This study highlights the importance of using population-specific cut-points when diagnosing sarcopenia, as otherwise its occurrence may be underestimated, especially in obese persons. Age, body composition, physical performance, health, and socio-economic conditions can influence the occurrence of sarcopenia.

ACTN3 Genotypes and Their Relationship with Muscle Mass and Function of Kosovan Adults.

Maintaining muscle mass and function is important throughout the lifestyle. While environmental factors such as physical activity and healthy nutrition are well investigated, the contribution of genetic factors is still controversial. Therefore, we aimed to investigate the impact of a common ACTN3 polymorphism (rs1815739) on body composition, handgrip strength, knee extensor peak torque, and physical performance (gait speed, 30-s arm curl, 30-s chair stand) in Kosovan adults. In total, 308 participants (160 females and 148 males, age range from 40 to 91 years) took part in this cross-sectional study. Genomic DNA was extracted from saliva and assessed for ACTN3 genotype distribution (41.5% of RR, 53.9% of RX and 4.6% of XX). Genotype allocation did not account for differences in any of the variables. Interestingly, female XX carriers were taller (p = 0.025) and had a higher isokinetic knee extension peak torque (p = 0.024) than the RX+RR group. In males, XX carriers were also taller (p = 0.049) and had a lower BMI (p = 0.026), but did not differ in any of the strength and performance parameters. These results indicate that the ACTN3 R577X polymorphism might exert a sex-specific impact on knee extensor peak torque and BMI.

Association between Polymorphisms in Vitamin D Pathway-Related Genes, Vitamin D Status, Muscle Mass and Function: A Systematic Review.

An association between vitamin D level and muscle-related traits has been frequently reported. Vitamin D level is dependent on various factors such as sunlight exposure and nutrition. But also on genetic factors. We, therefore, hypothesize that single nucleotide polymorphisms (SNPs) within the vitamin D pathway-related genes could contribute to muscle mass and function via an impact on vitamin D level. However, the integration of studies investigating these issues is still missing. Therefore, this review aimed to systematically identify and summarize the available evidence on the association between SNPs within vitamin D pathway-related genes and vitamin D status as well as various muscle traits in healthy adults. The review has been registered on PROSPERO and was conducted following PRISMA guidelines. In total, 77 studies investigating 497 SNPs in 13 different genes were included, with significant associations being reported for 59 different SNPs. Variations in GC, CYP2R1, VDR, and CYP24A1 genes were reported most frequently, whereby especially SNPs in the GC (rs2282679, rs4588, rs1155563, rs7041) and CYP2R1 genes (rs10741657, rs10766197, rs2060793) were confirmed to be associated with vitamin D level in more than 50% of the respective studies. Various muscle traits have been investigated only in relation to four different vitamin D receptor (VDR) polymorphisms (rs7975232, rs2228570, rs1544410, and rs731236). Interestingly, all of them showed only very low confirmation rates (6-17% of the studies). In conclusion, this systematic review presents one of the most comprehensive updates of the association of SNPs in vitamin D pathway-related genes with vitamin D status and muscle traits in healthy adults. It might be used for selecting candidate SNPs for further studies, but also for personalized strategies in identifying individuals at risk for vitamin D deficiency and eventually for determining a potential response to vitamin D supplementation.

Test-retest reliability data of functional performance, strength, peak torque and body composition assessments in two different age groups of Kosovan adults.

This article reports test-retest reliability data of laboratory- and field-based performance tests as well as body composition analyses of younger and older Kosovan adults. In total, 57 healthy young (18-35 years) and 61 older (>60 years) participants took part in two identical test sessions, with a median [25th - 75th percentile] of 14 [13-21] days in between. Functional performance tests included 30-s chair stand test (CST), 30-s arm curl test (ACT), six-minutes walking test (6MWT), sit and reach test, timed up and go test (TUG), as well as the assessment of gait speed (GS) at normal and fast pace. Isometric handgrip strength (HGS) was used to estimate strength of the dominant hand. Isokinetic peak torque (PT) and average power (AvgP) for knee extension and flexion were determined at velocities of 60°/s and 120°/s. Body composition assessments included body fat percentage, skeletal muscle mass (SMM) and index (SMI) as well as appendicular skeletal muscle mass (ASMM) and index. Secondary endpoints included self-perceived health status and potential co-morbidities. All performance test outcomes as well as body fat percentage, SMM, ASMM, and self-perceived health were significantly better in young as compared to older participants (p < 0.001). Improvements from test to retest were observed for CST (p < 0.001), PTflexion (60°/s: p = 0.001, 120°/s: p = 0.041), AvgPflexion (60°/s: p < 0.001, 120°/s: p < 0.001), AvgPextension (120°/s: p = 0.050), but also for SMM (p = 0.021) and SMI (p = 0.021). Only for CST and HGS a time x age group interaction was detected (p < 0.05). Acceptable reliability (ICC > 0.7) was observed for all parameters in both age groups, except for some of the measures from the isokinetic dynamometry, where ICCs were generally lower in older participants, but fell below 0.7 for AvgPflexion at 60°/s (ICC = 0.6) and at 120°/s (ICC = 0.67) as well as for PTflexion at 120°/s (ICC = 0.69). These data's importance lay upon their potential use in epidemiological studies observing muscle strength, peak torque, power, physical performance and body composition over various age groups, either in the same or similar populations, or for comparison to other populations.

SIDE TO SIDE DIFFERENCES BETWEEN DOMINANT AND NON-DOMINANT ARM'S BONE DENSITY AND ISOMETRIC HANDGRIP STRENGTH IN MALES AND FEMALES AGED 40-65 YEARS OLD.

OBJECTIVE: This observational, cross-sectional study, investigates and compares the differences of BMD, T-score, Z-score and isometric strength between dominant (D) versus non-dominant (ND) arms of 162 subjects aged 40-65 in a developing, low income country (Kosova). MATERIAL AND METHODS: Bone Mineral Density (BMD), T-score and Z-score at distal forearm regions of both arms (measured by DXA scan), together with the Handgrip Isometric Strength (HIS) (by handgrip) were evaluated in a total subjects (53 Males and 109 Females). Additionally, General Healthcare Status Questionnaire together with self-administrated International Physical Activity Questionnaire (IPAQ) were filled. RESULTS: Significant differences (p<0.05) between arms were found in BMD, T-score, and Z-score in total subjects and in females, whereas not significant differences (p>0.05) were observed in Males BMD comparing to significantly higher results (p<0.05) in T-score and Z-score. Significant differences (p<0.05) were also found in total subjects and in females handgrip, but not (p>0.05) in males. When comparing the total subject's BMD, T-score, Z-score and Handgrip based on the PA levels (1 to 3 according to IPAQ scoring) no significant differences (p>0.05) were found between PA1, as well as PA3 whereas significantly differences (p<0.05) were found in D arms of PA2 level. CONCLUSION: The study analyses side-to-side differences in bone density and muscular force between D and ND arms amongst a population which is frequently exposed to diagnostic screenings for age related osteomuscular conditions (aged 40-60), and demonstrates that these differences should be in consideration amongst clinicians, but not in the way it is done right now.

Effect of sport training on forearm bone sites in female handball and soccer players.

BACKGROUND: The objective of this study was to evaluate the bone mineral density (BMD) and Z-score of a skeletal region, considered as weight-bearing site in trained handball players (HP), but as non-weight-bearing site in trained soccer players (SP). The bone health status of the same site was also analyzed in an untrained group (CG). METHODS: BMD and Z-score at distal forearm regions (dominant, D; non-dominant, ND) were evaluated in 30 female HP and in 30 female SP, who have been training for 7.7±3.8 years, 17 hours per week, as well as in 30 females CG. RESULTS: Playing handball was associated with higher BMD of the skeleton at both measured sites than in CG. Also in comparison with SP, HPs' arms showed a significant increase in BMD. On the other hand, female SP have been reported to exhibit an enhanced ND arm BMD compared with controls. The benefits of exercise appeared to be significantly improved only in SP sub-group who started sport activity before or at menarche. These athletes showed at ND forearm a BMD 4% greater than those SP who started later, reaching a BMD of 11.6% higher than CG, a value similar to the corresponding in HP sub-group. Moreover, their D arm BMD was 7.1% higher compared with CG. CONCLUSIONS: This study indicates that, compared with non-trained subjects, long-term high-impact sport participation is associated with an higher bone health state, especially if the playing careers were started before or at menarche. This effect was observed at level of both forearms in HP, which are considered as weight-bearing sites for this discipline but also on the same skeletal regions of SP, which are not directly loaded by sport-related regular training.