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Tricyclic antidepressants are effective for managing depression and other disorders. However, they can cause adverse reactions due to their anticholinergic properties, with the risk of such events increasing with age. This study identifies and describes clinical studies that evaluate associations between the use of tricyclic antidepressants and adverse health outcomes (falls, fractures, and mortality) among older people. A systematic search of the literature in English, Spanish, and French was conducted using the electronic databases PubMed, ISI Web of Science, PsycINFO, and Cochrane. The systematic review included a total of 18 studies. The meta-analysis examined the 14 studies that investigated the association between the use of tricyclic antidepressants and the risk of falls and fractures (4 of the 18 studies focused on mortality and so were excluded from the meta-analysis). The odds ratio (OR) was 1.40 (95 % CI = 1.27-1.53, p < 0.001). The Cochran Q test was significant (X2 = 79.72, p < 0.001), indicating high heterogeneity (I2 = 84.9 %). An additional meta-analysis was conducted on studies reporting hazard ratios (HRs), yielding an HR of 1.21 (95 % CI = 0.93-1.58, p = 0.16). Meta-regression analysis indicated that the years of follow-up could have a significant effect on the association studied (p = 0.008). In conclusion, enhancing our understanding of the use of antidepressants and the associated risk of adverse events in older adults will enable the identification of the most appropriate type of antidepressant for each clinical situation.
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OBJECTIVE: Falls and fear of falling (FoF) are relevant contributors to disability and institutionalization among older adults. The aim was to examine the association between multimorbidity and falls/FoF among community-dwelling older adults, exploring the mediating effect of physical function and the use of sleeping pills and pain relievers. DESING: Longitudinal analyses. SETTING AND PARTICIPANTS: A total of 1824 adults aged ≥65 years from the Seniors-ENRICA II cohort (Spain). METHODS: Multimorbidity was defined as having ≥2 diseases from a predefined list of 13 chronic conditions extracted from clinical records. Falls were self-reported and FoF was estimated using the Short Falls Efficacy Scale International. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for the association between multimorbidity/duration of multimorbidity and incident falls/FoF using logistic regression models. The mediating effects of physical function, the use of sleeping pills, and pain relievers were explored using the Karlson Holm Breen method. RESULTS: Multimorbidity was associated with a higher risk of falls (OR, 1.44; 95% CI, 1.14-1.82) and FoF (OR, 1.88; 95% CI, 1.48-2.39). Positive dose-response associations were found between the duration of multimorbidity and the risk of falls (P-trend = .003) and FoF (P-trend = .001). Physical function mediated 5.67% and 5.25% of these associations, respectively, and the use of sleeping pills explained a larger proportion of the associations (9.27% and 11.61%). Last, the mediation effect of pain relievers on the association between multimorbidity and falls was 3.05% and 9.31% in the multimorbidity-FoF association. CONCLUSIONS AND IMPLICATIONS: Multimorbidity was associated with a higher risk of falls/FoF among Spanish community-dwelling older adults. Use of sleeping pills was a relevant mediator, suggesting that interventions on sleep problems have the potential to reduce the burden of falls/FoF and their consequences among older adults with multimorbidity.
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CONTEXT: The melanocortin-4 receptor gene (MC4R) is associated with a higher risk of obesity by the presence of the C allele in rs17782313, but the mechanisms are not clear. OBJECTIVE: The present systematic review and meta-analysis aimed to explore the association between the different genotypes of MC4R rs17782313 and energy intake and appetite. DATA SOURCES: A literature search was conducted up to June 2023 in PubMed, Scopus, Web of Science, and Cochrane Collaboration databases, following PRISMA guidelines. DATA EXTRACTION: Inclusion criteria were studies in humans measuring energy intake, appetite, or satiety in all ages and physiological conditions. Studies dealing solely with body mass index were excluded. Twenty-one articles representing 48â560 participants were included in the meta-analysis. DATA ANALYSIS: According to the NHLBI (National Heart, Lung, and Blood Institute) quality-assessment criteria, all case-control studies and 6 out of 17 cohort and cross-sectional studies were classified as "good," while the rest scored as "fair." Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in a (CT+CC) vs TT dominant model, and both random-effects and fixed-effects models were used. A statistically significant association between the presence of the C allele and increased appetite was found (OR = 1.25; 95% CI: 1.01-1.49; P = .038) using the fixed-effects model, but the random-effects model proved nonsignificant. However, no association with energy intake was found. None of the variables considered (sample size, year of publication, sex, age group, type of population, origin, and quality) were identified as effect modifiers, and no publication biases were found after subgroup and meta-regression analyses. CONCLUSION: To our knowledge, this is the first systematic review and meta-analysis that has analyzed the association between rs17782313 of MC4R and energy intake and appetite. Identifying people genetically predisposed to increased appetite may be of great interest, not only to prevent obesity in younger populations but also to avoid malnutrition in elderly persons. This paper is part of the Nutrition Reviews Special Collection on Precision Nutrition. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD42023417916.
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BACKGROUND: Plant-based diets have gained attention due to their beneficial effects against major chronic diseases, although their association with multimorbidity is mostly unknown. OBJECTIVES: We examined the association between the healthful (hPDI) and unhealthful plant-based diet indices (uPDI) with multimorbidity among middle-aged and older adults from the United States. METHODS: Data on 4262 adults aged >50 y was obtained from the 2012-2020 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Food consumption was collected at baseline with a food frequency questionnaire and 2 PDIs were derived: the hPDI, with positive scores for healthy plant foods and reverse scores for less healthy plant foods and animal foods; and the uPDI, with only positive scoring for less healthy plant foods. Complex multimorbidity, defined as ≥3 coexistent conditions, was ascertained from 8 self-reported conditions: hypertension, diabetes, cancer, chronic lung disease, heart disease, stroke, arthritis, and depression. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: After a median follow-up of 7.8 y, we documented 1202 incident cases of multimorbidity. Compared with the lowest quartile, higher adherence to the hPDI was inversely associated with multimorbidity (HR for quartile 3: 0.77; 95% CI: 0.62, 0.96 and HR for quartile 4: 0.79; 95% CI, 0.63, 0.98; P-trend = 0.02). In addition, a 10-point increment in the hPDI was associated with a 11% lower incidence of multimorbidity (95% CI: 1, 20%). No significant associations were found for the uPDI after adjusting for sociodemographic and lifestyle factors. CONCLUSIONS: Higher adherence to the hPDI was inversely associated with multimorbidity among middle-aged and older adults. Plant-based diets that emphasize consumption of high-quality plant foods may help prevent the development of complex multimorbidity.
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Dieta Vegetariana , Multimorbidade , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Estados Unidos/epidemiologia , Fatores de Risco , Aposentadoria , Doença Crônica/epidemiologia , Dieta Saudável/estatística & dados numéricos , Dieta Baseada em PlantasRESUMO
OBJECTIVE: To examine the association between hearing function, assessed with pure-tone average (PTA) of air conduction thresholds, and 24-hour ambulatory blood pressure (BP) in older adults. STUDY DESIGN: Cross-sectional study. SETTING: A total of 1404 community-dwelling individuals aged ≥65 years from the Seniors-ENRICA cohort were examined. METHODS: Hearing loss was defined as PTA > 40-AudCal hearing loss decibels (dB-aHL) in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz). Circadian BP patterns were calculated as the percentage decline in systolic BP during the night, and participants were classified as dipper, nondipper, and riser. Ambulatory hypertension was defined as BP ≥ 130/80 mm Hg (24 hour), ≥135/85 (daytime), and ≥120/70 (nighttime) or on antihypertensive treatment. Analyses were performed with linear- and logistic-regression models adjusted for the main confounders. RESULTS: In multivariable analyses, the PTA was associated with higher nighttime systolic BP [ß coefficient per 20 dB-aHL increment standard frequency (95% confidence interval, CI): 2.41 mm Hg (0.87, 3.95); ß (95% CI) per 20 dB-aHL increment speech frequency 2.17 mm Hg (0.70, 3.64)]. Among hypertensive patients, hearing loss at standard and high-frequency PTA was associated with the riser BP pattern [odds ratio: 2.01 (95% CI, 1.03-3.93) and 1.45 (1.00-2.09), respectively]; also, hearing loss at standard PTA was linked to uncontrolled nighttime BP [1.81 (1.01-3.24)]. CONCLUSION: PTA was associated with higher nighttime BP, and hearing loss with a riser BP pattern and uncontrolled BP in older hypertensives.
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Monitorização Ambulatorial da Pressão Arterial , Perda Auditiva , Hipertensão , Humanos , Idoso , Masculino , Feminino , Estudos Transversais , Hipertensão/fisiopatologia , Perda Auditiva/fisiopatologia , Audiometria de Tons Puros , Ritmo Circadiano/fisiologia , Pressão Sanguínea/fisiologia , Idoso de 80 Anos ou maisRESUMO
OBJECTIVES: Malnutrition is a global concern in older adults, as it negatively affects morbidity and mortality. While higher animal protein intake may help prevent and treat malnutrition, it might also increase the risk of chronic diseases and death. Conversely, vegetable protein intake might have a lower anabolic effect and not be as effective to improve nutritional status. We studied whether animal and vegetable protein intake are associated with changes in nutritional status in older adults. DESIGN: We used pooled data from two Spanish cohorts: the Seniors-ENRICA 1 and Seniors-ENRICA 2. SETTINGS AND PARTICIPANTS: 2,965 community-dwelling adults aged 62-92 years. MEASUREMENTS: Protein intake was estimated at baseline via an electronic, validated diet history. Nutritional status was assessed at baseline and after 2.6 years with the GLIM (Global Leadership Initiative on Malnutrition) phenotypic criteria: weight loss, low body mass index, and reduced muscle mass. The odds of improvements in nutritional status were assessed with logistic regression models, extensively adjusted for potential confounders. RESULTS: Higher animal and vegetable protein intake were associated with improvements in nutritional status [odds ratios (95% confidence intervals) per 0.25 g/kg/day were 1.15 (1.00, 1.32) and 1.77 (1.35, 2.32), respectively]. Cereal protein intake drove most of the latter association [2.07 (1.44, 2.98)]. Replacing 0.25 g/kg/day of total animal protein, meat, or fish protein (but not dairy or egg protein) with vegetable protein was associated with improvements in nutritional status [1.54 (1.13, 2.09), 1.70 (1.20, 2.41), and 1.77 (1.18, 2.64), respectively]. CONCLUSIONS: Higher animal and, especially, vegetable protein intake were associated with improvements in nutritional status in older adults. Replacing total animal protein, meat, or fish protein with vegetable protein may help improve malnutrition.
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Desnutrição , Animais , Humanos , Idoso , Desnutrição/epidemiologia , Desnutrição/prevenção & controle , Estado Nutricional , Proteínas de Peixes , Vida Independente , Proteínas de Vegetais Comestíveis , Verduras , Redução de PesoRESUMO
The use of antidepressants with anticholinergic effects has been associated with an increased risk of dementia. However, the results published are contradictory. The aim of the study is to compare the risk of developing dementia in elderly who were prescribed tricyclic antidepressants (TCA) versus those who were prescribed selective serotonin reuptake inhibitors (SSRIs) and other antidepressants (OA). A prospective population-based cohort study was performed using the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP) data (from 2005 to 2018). The cohort study included 62,928 patients age ≥ 60 without dementia and with antidepressant long-term monotherapy. Patients were divided into exposure antidepressant groups based on ATC system [TCA, SSRIs users and OAs users]. The risk of dementia was calculated by Cox regression models, providing hazard ratios (HR) and 95 % confidence intervals. The Kaplan-Meier model was used for survival analysis. Chi2 test was used as association test. The results showed SSRI users had higher dementia risk than TCA users (HR = 1.864; 95%CI = 1.624-2.140). Moreover, OA users had also significant risk of dementia (HR = 2.103; 95%CI = 1.818-2.431). Several limitations are the variation of the trend in the prescription of antidepressants, the small number of patients that use some antidepressants, the lack of information related to the dose, or socioeconomic characteristics, the use of antidepressant drugs for other indications, or the therapeutic compliance. Our findings showed that older users of SSRI and OA have more risk of developing dementia than TCA elderly users. However, additional studies would be needed.
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Demência , Inibidores Seletivos de Recaptação de Serotonina , Humanos , Idoso , Estudos de Coortes , Estudos Prospectivos , Espanha/epidemiologia , Antidepressivos/efeitos adversos , Antidepressivos Tricíclicos/efeitos adversos , Demência/induzido quimicamente , Demência/epidemiologiaRESUMO
Multimorbidity is the simultaneous presence of 2 or more chronic conditions. Metabolomics could identify biomarkers potentially related to multimorbidity. We aimed to identify groups of biomarkers and their association with different multimorbidity patterns. Cross-sectional analyses were conducted within the Seniors-ENRICA-2 cohort in Spain, with information from 700 individuals aged ≥65 years. Biological samples were analyzed using high-throughput proton nuclear magnetic resonance metabolomics. Biomarker groups were identified with exploratory factor analysis, and multimorbidity was classified into 3 types: cardiometabolic, neuropsychiatric, and musculoskeletal. Logistic regression was used to estimate the association between biomarker groups and multimorbidity patterns, after adjusting for potential confounders including sociodemographics, lifestyle, and body mass index. Three factors were identified: the "lipid metabolism" mainly reflected biomarkers related to lipid metabolism, such as very-low-density lipoprotein and low-density lipoprotein cholesterol; the "high-density lipoprotein cholesterol" mainly included high-density lipoprotein cholesterol subclasses and other lipids not included in the first factor; and the "amino acid/glycolysis/ketogenesis," composed of some amino acids, glycolysis-related metabolites, and ketone bodies. Higher scores in the "lipid metabolism" factor were associated with a higher likelihood of cardiometabolic multimorbidity, odds ratio for tertile 3 versus tertile 1 was 1.79 (95% confidence interval: 1.17-2.76). The "high-density lipoprotein cholesterol" factor was associated with lower odds of cardiometabolic multimorbidity [0.51 (0.32-0.82)], and the "amino acid/glycolysis/ketogenesis" factor was associated with more frequent cardiometabolic multimorbidity [1.85 (1.18-2.90)]. Different metabolomic biomarkers are associated with different multimorbidity patterns; therefore, multiple biomarker measurements are needed for a complete picture of the molecular mechanisms of multimorbidity.
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Doenças Cardiovasculares , Multimorbidade , Humanos , Idoso , Estudos Transversais , Biomarcadores , Aminoácidos , HDL-ColesterolRESUMO
OBJECTIVE: To investigate the association between hearing function, as approached with the functional auditory capacity, and multimorbidity. STUDY DESIGN: Cross-sectional study. SETTING: The UK Biobank was established from 2006 to 2010 in the United Kingdom. This cross-sectional analysis included 165,524 participants who provided baseline information on hearing function. METHODS: Functional auditory capacity was measured with a digit triplet test. Three categories were defined according to the speech reception threshold in noise (SRTn): normal (SRTn < -5.5 dB signal-to-noise ratio [SNR]), insufficient (SRTn ≥ -5.5 to ≤ -3.5 dB SNR) and poor hearing function (SRTn > -3.5 dB SNR). To define multimorbidity, 9 chronic diseases were considered, including chronic obstructive pulmonary disease, dementia, Parkinson's disease, stroke, cancer, depression, osteoarthritis, coronary heart disease, and diabetes; multimorbidity was defined as the coexistence of 2 or more in the same individual. Analyses were conducted using logistic models adjusted for relevant confounders. RESULTS: Among the study participants, 54.5% were women, and the mean (range) age was 56.7 (39-72) years. The prevalence of insufficient and poor hearing function and multimorbidity was 13% and 13.2%, respectively. In comparison with having a normal SRTn, the odds ratio (95% confidence interval) of multimorbidity associated with insufficient SRTn was 1.13 (1.08-1.18), and with poor SRTn was 1.25 (1.14-1.37). CONCLUSION: Insufficient and poor hearing function was associated with multimorbidity. This association suggests common biological pathways for many of the considered morbidities.
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Bancos de Espécimes Biológicos , Percepção da Fala , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Estudos Transversais , Multimorbidade , Fala , Biobanco do Reino Unido , Audição , Limiar AuditivoRESUMO
BACKGROUND: The role of diet quality in the accumulation of multiple chronic conditions is mostly unknown. This study examined diet quality in association with the number of chronic conditions and the rate of multimorbidity development among community-dwelling older adults. METHODS: We used data from 2 784 adults aged ≥65 years from the Seniors-ENRICA 2 cohort. Diet quality was assessed at baseline (2015-17) with the Alternate Healthy Eating Index-2010 (AHEI-2010) and the Mediterranean Diet Adherence Screener (MEDAS). Information on medical diagnoses was obtained from electronic clinical records up to 2021. RESULTS: Higher adherence to the AHEI-2010 was associated with a lower number of total chronic conditions (ß [95% CI] quartile 4 vs 1: -0.57 [-0.86 to 0.27], p trendâ <â .001] and cardiometabolic conditions (-0.30 [-0.44 to -0.17], p trendâ <â .001) at baseline, while higher adherence to the MEDAS was associated with a lower number of total chronic conditions (-0.30 [-0.58 to -0.02], p trendâ =â .01) and neuropsychiatric and neurodegenerative conditions (-0.09 [-0.17 to -0.01], p trendâ =â .01). After a median follow-up of 5.2 years (range: 0.1-6.1 years) higher adherence to the AHEI-2010 was associated with a lower increase in chronic conditions (ß [95% confidence interval] quartile 4 vs 1: -0.16 [-0.30 to -0.01], p trendâ =â .04) and with lower rate of chronic disease accumulation. CONCLUSIONS: Higher diet quality, as measured by the AHEI-2010, was associated with a lower number of chronic health conditions and a lower rate of multimorbidity development over time.
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Dieta Mediterrânea , Multimorbidade , Humanos , Idoso , Masculino , Feminino , Multimorbidade/tendências , Estudos Prospectivos , Dieta Mediterrânea/estatística & dados numéricos , Doença Crônica/epidemiologia , Vida Independente/estatística & dados numéricos , Dieta Saudável/estatística & dados numéricos , Idoso de 80 Anos ou mais , Dieta/estatística & dados numéricosRESUMO
Biological mechanisms that lead to multimorbidity are mostly unknown, and metabolomic profiles are promising to explain different pathways in the aging process. The aim of this study was to assess the prospective association between plasma fatty acids and other lipids, and multimorbidity in older adults. Data were obtained from the Spanish Seniors-ENRICA 2 cohort, comprising noninstitutionalized adults ≥65 years old. Blood samples were obtained at baseline and after a 2-year follow-up period for a total of 1 488 subjects. Morbidity was also collected at baseline and end of the follow-up from electronic health records. Multimorbidity was defined as a quantitative score, after weighting morbidities (from a list of 60 mutually exclusive chronic conditions) by their regression coefficients on physical functioning. Generalized estimating equation models were employed to assess the longitudinal association between fatty acids and other lipids, and multimorbidity, and stratified analyses by diet quality, measured with the Alternative Healthy Eating Index-2010, were also conducted. Among study participants, higher concentrations of omega-6 fatty acids [coef. per 1-SD increase (95% CI) = -0.76 (-1.23, -0.30)], phosphoglycerides [-1.26 (-1.77, -0.74)], total cholines [-1.48 (-1.99, -0.96)], phosphatidylcholines [-1.23 (-1.74, -0.71)], and sphingomyelins [-1.65 (-2.12, -1.18)], were associated with lower multimorbidity scores. The strongest associations were observed for those with a higher diet quality. Higher plasma concentrations of omega-6 fatty acids, phosphoglycerides, total cholines, phosphatidylcholines, and sphingomyelins were prospectively associated with lower multimorbidity in older adults, although diet quality could modulate the associations found. These lipids may serve as risk markers for multimorbidity.
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Ácidos Graxos , Multimorbidade , Humanos , Idoso , Esfingomielinas , Estudos Prospectivos , Ácidos Graxos Ômega-6 , Glicerofosfolipídeos , Fosfatidilcolinas , Doença CrônicaRESUMO
BACKGROUND: Multimorbidity refers to the coexistence of multiple chronic health conditions. The effect of nutritional adequacy on multimorbidity is mostly unknown. OBJECTIVE: The aim of this study was to assess the prospective association between dietary micronutrient adequacy and multimorbidity among community-dwelling older adults. METHODS: This cohort study included 1461 adults aged ≥65 y from the Seniors-ENRICA II cohort. Habitual diet was assessed at baseline (2015-2017) with a validated computerized diet history. The intakes of 10 micronutrients (calcium, magnesium, potassium, vitamins A, C, D, E, zinc, iodine, and folate) were expressed as percentages relative to the dietary reference intakes, with higher scores indicating greater adequacy. Dietary micronutrient adequacy was computed as the average of all the nutrient scores. Information on medical diagnosis was obtained from the electronic health records up to December 2021. Conditions were grouped into a comprehensive list of 60 categories and occurrence of multimorbidity was defined as having ≥6 chronic conditions. Analyses were conducted using Cox proportional hazard models adjusted for relevant confounders. RESULTS: The mean age was 71.0 y (SD: 4.2) and 57.8% of participants were males. During a median follow-up of 4.79 y, we documented 561 incident cases of multimorbidity. Participants in the highest (85.8%-97.7%) versus the lowest tertile (40.1%-78.7%) of dietary micronutrient adequacy had a low risk of multimorbidity [fully adjusted hazard ratio (95% confidence interval): 0.75 (0.59-0.95); P-trend: 0.02]. A 1-SD increment in minerals and vitamins adequacy was associated with a low risk of multimorbidity, although estimates were attenuated after additional adjustment for the opposite subindex [minerals subindex: 0.86 (0.74-1.00); vitamins subindex: 0.89 (0.76-1.04)]. No differences were observed by strata of sociodemographic and lifestyle factors. CONCLUSION: A high micronutrient index score was associated with low risk of multimorbidity. Improving the dietary micronutrient adequacy could prevent multimorbidity among older adults. CLINICAL TRIAL REGISTRY: clinicaltrials.govNCT03541135.
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Vida Independente , Multimorbidade , Masculino , Humanos , Idoso , Feminino , Estudos de Coortes , Dieta , Vitaminas , Micronutrientes , Vitamina ARESUMO
OBJECTIVE: The duration and quality of sleep have been associated with multiple health conditions in adults. However, whether sleep duration and quality are associated with hearing loss (HL) is uncertain. The present study investigates the prospective association between duration and quality of sleep and HL. DESIGN: This longitudinal analysis included 231,650 participants aged 38 to 72 years from the UK Biobank cohort, established in 2006-2010 in the United Kingdom. Duration and sleep complaints (snoring at night, daytime sleepiness, sleeplessness, difficulty getting up in the morning, and eveningness preference) were self-reported. HL was self-reported at baseline and during the follow-up. RESULTS: Over a median follow-up of 4.19 (SD: 2.15) years, 6436 participants reported incident HL. In fully adjusted models, in comparison with sleeping between 7 and 8 hours a day, the adjusted hazard ratio (HR) (95% CI) associated with sleeping <7 hours a day was 1.01 (0.95 to 1.07), and for sleeping >8 hours a day was 0.98 (0.88 to 1.08). After adjustment for potential confounders, the HRs (95% confidence interval) of HL associated with having 1, 2, 3, and 4 to 5 vs. 0 sleep complaints were: 1.15 (1.05 to 1.27), 1.16 (1.05 to 1.28), 1.32 (1.19 to 1.47), and 1.49 (1.31 to 1.69), respectively; p for trend: <0.001. An increase in the number of sleep complaints was associated with higher risk of HL among participants with non-optimal sleep duration than among participants with optimal sleep duration. CONCLUSION: In this large population-based study, poor sleep quality was associated with an increased risk of HL; however, sleep duration was not associated with risk.
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Surdez , Perda Auditiva , Distúrbios do Início e da Manutenção do Sono , Adulto , Humanos , Autorrelato , Qualidade do Sono , Estudos Transversais , Bancos de Espécimes Biológicos , Multimorbidade , Sono , Perda Auditiva/epidemiologia , Fatores de RiscoRESUMO
INTRODUCTION: While some condition clusters represent the chance co-occurrence of common individual conditions, others may represent shared causal factors. The aims of this study were to identify multimorbidity patterns in older adults and to explore the relationship between social variables, lifestyle behaviors, and the multimorbidity patterns identified. METHODS: This was a cross-sectional design. Data came from 3,273 individuals aged ≥65 from the Seniors-ENRICA-2 cohort; information on 60 chronic disease categories, categorized according to the 2nd edition of the International Classification of Primary Care and the 10th edition of the International Classification of Diseases, was obtained from clinical record linkage. To identify multimorbidity patterns, an exploratory factor analysis was conducted over chronic disease categories with a prevalence >5%, using Oblimin rotation and Kaiser's eigenvalues-greater-than-one rule. The association between multimorbidity patterns and their potential determinants was assessed with multivariable linear regression. RESULTS: The three-factor solution (Musculoskeletal diseases and mental disorders, Cardiometabolic diseases, and Cardiopulmonary diseases) explained 64.5% of the total variance. Being older, lower occupational category, higher levels of loneliness, lower levels of physical activity, and higher body mass index were associated with higher scores in the multimorbidity patterns identified. Female sex was linked to the Musculoskeletal diseases and mental disorders pattern, while being male was revealed to the two remaining multimorbidity patterns. A high diet quality was inversely related to Cardiometabolic diseases, while optimal sleep duration was inversely related to Cardiopulmonary diseases. CONCLUSION: Three multimorbidity patterns were identified in older adults. Multimorbidity patterns were differently associated with social variables and lifestyles behavioral factors.
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Doenças Cardiovasculares , Doenças Musculoesqueléticas , Humanos , Masculino , Feminino , Idoso , Multimorbidade , Estudos Transversais , Estilo de Vida , Doença Crônica , Prevalência , Doenças Cardiovasculares/epidemiologia , Doenças Musculoesqueléticas/complicaçõesRESUMO
Recent findings suggest that the distribution of protein intake throughout the day has an impact on various health outcomes in older adults, independently of the amount consumed. We evaluated the association between the distribution of dietary protein intake across meals and all-cause mortality in community-dwelling older adults. Data from 3225 older adults aged ≥ 60 years from the Seniors-ENRICA-1 cohort were examined. Habitual dietary protein consumption was collected in 2008-2010 and in 2012 through a validated diet history. Protein distribution across meals was calculated for each participant as the coefficient of variation (CV) of protein intake per meal, in sex-specific tertiles. Vital status was obtained from the National Death Index up to 30 January 2020. Cox proportional hazards regression was performed to determine the hazard ratios (HR) and their 95 % CI for the association between the distribution of daily protein intake across meals and all-cause mortality. Over a median follow-up of 10·6 years, 591 deaths occurred. After adjustment for potential confounders, the CV of total protein intake was not associated with all-cause mortality (HR and 95 % CI in the second and third tertile v. the lowest tertile: 0·94 (0·77, 1·15) and 0·88 (0·72, 1·08); Ptrend = 0·22). Similarly, the HR of all-cause mortality when comparing extreme tertiles of CV for types of protein were 0·89 (0·73, 1·10) for animal-protein intake and 1·02 (0·82, 1·25) for plant-protein intake. Dietary protein distribution across meals was not associated with all-cause mortality, regardless of protein source and amount, among older adults. Further studies should investigate whether this picture holds for specific causes of death.
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Proteínas Alimentares , Vida Independente , Masculino , Feminino , Humanos , Dieta , RefeiçõesRESUMO
BACKGROUND: Leucine is suggested to play a central role in age-related physical decline, but the effect of dietary leucine intake on physical functioning is uncertain. We examined the prospective association between dietary leucine intake and impaired lower-extremity function (ILEF) and frailty in older adults. METHODS: We used data from 2 956 adults aged ≥60 and older from the Seniors-ENRICA cohort. At baseline (2008-2010) and in 2012, dietary information was obtained with a validated computerized face-to-face diet history, from which energy-adjusted cumulative leucine intake per body weight was calculated. Participants were followed up through 2017 to assess incident ILEF, ascertained with the Short Physical Performance Battery, and incident frailty, according to the Fried phenotype criteria. Statistical analysis was performed with Cox models adjusted for the main potential confounders. RESULTS: During follow-up, we identified 515 incident cases of ILEF and 241 of frailty. Compared with participants in the lowest tertile of leucine intake (35.5-89.0 mg/kg/d), those in the highest tertile (107.4-372.5 mg/kg/d) had a lower risk of ILEF (fully adjusted hazard ratio [95% confidence interval]: 0.70 [0.53-0.93], p trend: .01) and of frailty (0.63 [0.41-0.96], p trend: .03]. A higher consumption of important sources of leucine in this population, including unprocessed beef, oily and white fish, and bread, were also associated with a lower risk of incident ILEF and frailty. CONCLUSIONS: Higher leucine intake was associated with reduced risk of ILEF and frailty. Dietary leucine, obtained from foods rich in high-quality protein, could be a key nutrient to prevent age-related physical function decline in older adults.
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Fragilidade , Animais , Bovinos , Humanos , Idoso , Fragilidade/epidemiologia , Leucina , Estudos Prospectivos , Dieta , Ingestão de Energia , Idoso FragilizadoRESUMO
BACKGROUND: Some amino acids have been associated with aging-related disorders and risk of physical impairment. The aim of this study was to assess the association between plasma concentrations of 9 amino acids, including branched-chain and aromatic amino acids, and multimorbidity. METHODS: This research uses longitudinal data from the Seniors-ENRICA 2 study, a population-based cohort from Spain that comprises noninstitutionalized adults older than 65. Blood samples were extracted at baseline and after a follow-up period of 2 years for a total of 1 488 subjects. Participants' information was linked with electronic health records. Chronic diseases were grouped into a list of 60 mutually exclusive conditions. A quantitative measure of multimorbidity, weighting morbidities by their regression coefficients on physical functioning, was employed and ranged from 0 to 100. Generalized estimating equation models were used to explore the relationship between plasma amino acids and multimorbidity, adjusting for sociodemographics, socioeconomic status, and lifestyle behaviors. RESULTS: The mean age of participants at baseline was 73.6 (SD = 4.2) years, 49.6% were women. Higher concentrations of glutamine (coef. per mmol/l [95% confidence interval] = 10.1 [3.7, 16.6]), isoleucine (50.3 [21.7, 78.9]), and valine (15.5 [3.1, 28.0]) were significantly associated with higher multimorbidity scores, after adjusting for potential confounders. Body mass index could have influenced the relationship between isoleucine and multimorbidity (p = .016). CONCLUSIONS: Amino acids could play a role in regulating aging-related diseases. Glutamine and branched-chain amino acids as isoleucine and valine are prospectively associated and could serve as risk markers for multimorbidity in older adults.
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Aminoácidos , Isoleucina , Humanos , Feminino , Idoso , Masculino , Glutamina , Multimorbidade , Valina , Doença CrônicaRESUMO
BACKGROUND: Prevalence of dementia and cognitive impairment increase creating the need for identifying modifiable risk factors to reduce their burden. The aim of this study was to identify latent groups following similar trajectories in cognitive performance assessed with the verbal fluency test, as well as their determinants. METHODS: Data from English Longitudinal Study of Aging (ELSA) were studied. Latent groups of similar course through a 6-year period in the outcome variable (verbal fluency) were investigated, along with their determinants, using Group Based Trajectory Modeling (GBTM). RESULTS: Four latent groups of verbal fluency trajectories were revealed. Education was the strongest predictor for a favorable trajectory, while cardiovascular disease and depression symptoms were associated with lower within each trajectory. CONCLUSION: Cardiovascular diseases and depressive symptoms are associated with a worse course of verbal fluency through aging, implying that they might serve as targets for interventions to prevent cognitive decline in the aging population. Contrarily, higher level of education is associated with a more favorable course through aging.
Assuntos
Envelhecimento , Disfunção Cognitiva , Humanos , Idoso , Estudos Longitudinais , Envelhecimento/psicologia , Disfunção Cognitiva/epidemiologia , Fatores de Risco , EscolaridadeRESUMO
OBJECTIVE: To examine the combined association of five healthy lifestyle behaviors with hearing loss (HL) in the UK Biobank cohort, established between 2006 and 2010 in the United Kingdom. METHODS: This longitudinal analysis included 61,958 participants aged 40 to 70 years from April 2007 to December 2016. The healthy behaviors examined were: never smoking, high level of physical activity, high diet quality, moderate alcohol intake, and optimal sleep. Hearing loss was self-reported at baseline and in any physical exam during the follow-up. RESULTS: Over a median follow-up of 3.9±2.5 years, 3072 (5.0%) participants reported incident HL. After adjustment for potential confounders, including age, social factors, exposure to high-intensity noise, ototoxic medication, and comorbidity, the HRs of HL associated with having 1, 2, 3, and 4 to 5 vs 0 behaviors were: 0.85 (95% CI, 0.75 to 0.96), 0.85 (95% CI, 0.75 to 0.96), 0.82 (95% CI, 0.71 to 0.94), and 0.80 (95% CI, 0.67 to 0.97), respectively (P for trend, 0.02). We estimated that the population attributable risk percent for not adhering to any five low-risk lifestyle behaviors was 15.6%. CONCLUSION: In this large study, an increasing number of healthy behaviors was associated with decreased risk of HL.