Low holotranscobalamin and cobalamins predict incident fractures in elderly men: the MrOS Sweden.

UNLABELLED: In a population-based study on cobalamin status and incident fractures in elderly men (n = 790) with an average follow-up of 5.9 years, we found that low levels of metabolically active and total cobalamins predict incident fractures, independently of body mass index (BMI), bone mineral density (BMD), plasma total homocysteine (tHcy), and cystatin C. INTRODUCTION: Cobalamin deficiency in elderlies may affect bone metabolism. This study aims to determine whether serum cobalamins or holotranscobalamin (holoTC; the metabolic active cobalamin) predict incident fractures in old men. METHODS: Men participating in the Gothenburg part of the population-based Osteoporotic Fractures in Men (MrOS) Sweden cohort and without ongoing vitamin B medication were included in the present study (n = 790; age range, 70-81 years). RESULTS: During an average follow-up of 5.9 years, 110 men sustained X-ray-verified fractures including 45 men with clinical vertebral fractures. The risk of fracture (adjusted for age, smoking, BMI, BMD, falls, prevalent fracture, tHcy, cystatin C, 25-OH-vitamin D, intake of calcium, and physical activity (fully adjusted)), increased per each standard deviation decrease in cobalamins (hazard ratio (HR), 1.38; 95% confidence intervals (CI), 1.11-1.72) and holoTC (HR, 1.26; 95% CI, 1.03-1.54), respectively. Men in the lowest quartile of cobalamins and holoTC (fully adjusted) had an increased risk of all fracture (cobalamins, HR = 1.67 (95% CI, 1.06-2.62); holoTC, HR = 1.74 (95% CI, 1.12-2.69)) compared with quartiles 2-4. No associations between folate or tHcy and incident fractures were seen. CONCLUSIONS: We present novel data showing that low levels of holoTC and cobalamins predicting incident fracture in elderly men. This association remained after adjustment for BMI, BMD, tHcy, and cystatin C. However, any causal relationship between low cobalamin status and fractures should be explored in a prospective treatment study.

Physical activity is the strongest predictor of calcaneal peak bone mass in young Swedish men.

SUMMARY: In a highly representative sample of young adult Swedish men (n = 2,384), we demonstrate that physical activity during childhood and adolescence was the strongest predictor of calcaneal bone mineral density (BMD), and that peak bone mass was reached at this site at the age of 18 years. INTRODUCTION: The purpose of the present study was to determine if physical activity during growth is associated with peak calcaneal BMD in a large, highly representative cohort of young Swedish men. METHODS: In this study, 2,384 men, 18.3 +/- 0.3 (mean +/- SD) years old, were included from a population attending the mandatory tests for selection to compulsory military service in Sweden. BMD (g/cm(2)) of the calcaneus was measured using dual-energy X-ray absorptiometry. Training habits were investigated using a standardized questionnaire. RESULTS: Regression analysis (with age, height, weight, smoking, and calcium intake as covariates) demonstrated that history of regular physical activity was the strongest predictor and could explain 10.1% of the variation in BMD (standardized beta = 0.31, p < 0.001). A regression model with quadratic age effect revealed maximum BMD at 18.4 years. CONCLUSIONS: We found that history of physical activity during growth was the strongest predictor of peak calcaneal BMD in young men.

Performance of the SF-36 health survey in screening for depressive and anxiety disorders in an elderly female Swedish population.

OBJECTIVE: To assess the sensitivity, specificity and predictive validity of suggested cut-off scores in the SF-36 mental health (MH) and mental component summary (MCS) in screening for depressive and anxiety disorders in a population sample of older Swedish women. METHOD: The sample comprised 586 randomly selected females aged 70-84 years who took part in an in-depth psychiatric examination. This provided the 'gold standard' against which the usefulness of SF-36 recommended thresholds for screening for depressive and anxiety disorders in older Swedish women was examined. RESULTS: Based on DSM-III-R criteria, 69 women (12%) were diagnosed with depression (major depression, dysthymia and/or depression NOS) and 49 (8%) with generalised anxiety and panic disorders. The previously recommended MH and MCS cut-offs (i.e. 52 and 42) gave a specificity for diagnosis of depression of 92 and 82% and sensitivity of 58 and 71%, respectively. Both the MH and MCS were good predictors of depressive disorders but poor predictors of anxiety disorders. CONCLUSION: The study supports the predictive validity of suggested SF-36 MH and MCS cut-off scores in screening for depressive disorder but not for anxiety disorder in older women in Sweden.

Height and body weight in elderly adults: a 21-year population study on secular trends and related factors in 70-year-olds.

BACKGROUND: Body size in elderly adults is partly due to aging and partly to secular trends. This study describes secular trends in three anthropometric measures (i.e., height, body weight [BW], and body mass index [BMI]) of 70-year-olds over a period of 21 years and their relation to social and lifestyle factors. METHODS: A total of 3128 70-year-olds from four birth cohorts born between 1901 and 1922 in Gothenburg, Sweden, were examined between 1971 and 1992 in the Geriatric Medicine Department, Göteborg University. Trends in anthropometric measures were examined by permutation test. Influence of the subjects' birth year, physical activity, smoking habits, and education on anthropometric measures were investigated by multiple linear regression. RESULTS: Individuals in later-born cohorts were found to be 1 to 2 cm taller and 1.5 to 6.3 kg heavier than earlier-born cohorts. For BMI, a positive trend was significant only in 70-year-old male participants. "Year of birth" was a positive predictor for BW (p <.001) and BMI (p <.001) in male participants and for height (p <.05) and BW (p <.01) in female participants. Physical inactivity was a positive (p <.01) and "current smoking" a negative (p <.001) predictor for BMI in both sexes. "More than basic education" was a positive predictor for height (p <.001) in both sexes and a negative predictor for body weight (p <.01) and BMI (p <.001) in female participants only. CONCLUSIONS: Trends of increasing height, BW, and BMI were found among the Swedish elderly participants. This may be partly due to differences in smoking habits, physical activity, education, food habits, childhood nutrition, and living conditions between the cohorts.

A population-based study on brain atrophy and motor performance in elderly women.

BACKGROUND: Brain atrophy is a common neuroimaging finding in healthy elderly individuals as well as in patients with movement-related disorders. The relationship between brain atrophy and motor changes has not been frequently reported. This study investigates this relationship. METHODS: A population-based sample of women (N = 238), aged 70, 74, and 78 years, living in Göteborg, Sweden, participated in this study. Motor performance was measured by a laboratory test, the Postural-Locomotion-Manual test, which precisely measures the subject's mobility of lower and upper extremities using an optoelectronic technique. Cortical and central atrophy were rated on computerized tomographic (CT) scans of the brain. RESULTS: In bivariate analysis, temporal lobe atrophy, high sylvian fissure ratio, and high bicaudate ratio were correlated with impaired mobility. The association between temporal lobe atrophy and high sylvian fissure ratio and poor mobility remained after controlling for age, smoking, coronary heart disease, diabetes mellitus, hypertension, and white matter lesions on CT scans. CONCLUSIONS: Our results suggest that temporal lobe atrophy, which is often seen on brain imaging in elderly persons, might be an important brain abnormality related to motor impairments in elderly women. Further studies to investigate this relationship and its underlying mechanisms are needed.

Body mass index, weight change and mortality in the elderly. A 15 y longitudinal population study of 70 y olds.

OBJECTIVE: To examine the relationship between body mass index (BMI) at age 70, weight change between age 70 and 75, and 15 y mortality. DESIGN: Cohort study of 70-y-olds. SETTING: Geriatric Medicine Department, Göteborg University, Sweden. SUBJECTS: A total of 2628 (1225 males and 1403 females) 70-y-olds examined in 1971--1981 in Gothenburg, Sweden. RESULTS: The relative risks (RRs) for 15 y mortality were highest in the lowest BMI quintiles of males 1.20 (95% CI 0.96--1.51) and females 1.49 (95% CI 1.14--1.96). In non-smoking males, no significant differences were observed across the quintiles for 5, 10 and 15 y mortality. In non-smoking females, the highest RR (1.58, 95% CI 1.15--2.16) for 15 y mortality was in the lowest quintile. After exclusion of first 5 y death, no excess risks were found in males for following 5 and 10 y mortality across the quintiles. In females, a U-shaped relation was observed after such exclusions. BMI ranges with lowest 15 y mortality were 27--29 and 25--27 kg/m(2) in non-smoking males and females, respectively. A weight loss of > or = 10% between age 70 and 75 meant a significantly higher risk for subsequent 5 and 10 y mortality in both sexes relative to individuals with 'stable' weights. CONCLUSION: Low BMI and weight loss are risk factors for mortality in the elderly and smoking habits did not significantly modify that relationship. The BMI ranges with lowest risks for 15 y mortality are relatively higher in elderly. Exclusion of early deaths from the analysis modified the weight-mortality relationship in elderly males but not in females.

A population-based study on motor performance and white matter lesions in older women.

OBJECTIVE: To investigate the relationship between motor performance and white matter lesions (WMLs) on computed tomography (CT) of the brain in older women. DESIGN: Cross-sectional study. SETTING: Population-based study in Göteborg, Sweden. PARTICIPANTS: A total of 248 women aged 70, 74, and 78 years. MEASUREMENTS: Motor performance was measured by a Postural-Locomotion-Manual (PLM) test using an optoelectronic technique. WMLs on CT scans were rated as no, mild, moderate, or severe. RESULTS: White matter lesions were associated with impaired mobility of the lower extremities, that is, prolonged locomotion phase in the PLM test. This association was also present after controlling for age, hypertension, coronary heart disease, stroke, diabetes mellitus, chronic bronchitis, intermittent claudication, and smoking. CONCLUSIONS: Cerebral white matter lesions may contribute to motor impairments in older adults.

Utilization of dental services in relation to socioeconomic and health factors in the middle-aged and elderly Swedish population.

The aims of this study were to describe the change in reported time since the latest visit to a dentist between the years 1980/81 and 1988/89 and the reported use of dental services in relation to age, dental state, and socioeconomic and health characteristics in a sample of the Swedish population in 1988/89. The studies are based on interviews by Statistics Sweden about the living conditions. In the investigations in 1980/81, 14,964 inhabitants between 16 and 84 years of age participated, and in 1988/89, 13,309 inhabitants. In all age groups there was a significantly higher frequency of reported visits to a dentist last year in 1988/89 than in 1980/81. In the age group 50-64 years old this figure increased from 54% to 75%, and in the age group 65-84 years old it increased from 26% to 39%. In the investigation in 1988/89 about 75% of the dentulous women in all age groups up to 75 years reported visiting a dentist last year. The relative risk for not visiting a dentist last year, adjusted for age, gender, and dental state, was higher in dentulous subjects with low income and education, not married, not native-born, living in rural areas, smoking, and low social and physical activity. The results of the logistic regression analysis showed that, among the elderly, functional ability and general health factors have lower significance for time since last visit to a dentist than socioeconomic, social support, and life-style factors.

Associations between self-assessed masticatory ability and some general health factors in a Swedish population.

OBJECTIVES: The aims of this study were 1) to describe changes in self-assessed masticatory ability over a 14 year period (1975-89); and 2) to describe associations between self-assessed masticatory ability and age, dental state and some other background factors in a sample of the Swedish population in 1988/89. DESIGN: The Swedish National Central Bureau of Statistics investigates annually the living conditions of the Swedish population by means of interviews by trained persons. The data were analysed by means of stepwise logistic regression and calculation of adjusted relative risks. SUBJECTS: In the investigation in 1988/89, 12,901 people above 16 years of age participated and the response rate was 80%. RESULTS: In comparison between the investigations, the prevalence of reported impairment was lower in 1988/89 than in 1975 and 1980/81. Prevalence of reported impairment of chewing ability increased with ageing from 2% in young adults (16-34 years old) to 44% in older elderly (> 85 years old). In most age groups, edentulous people reported the highest prevalence, and dentate people the lowest. Relative risks for impaired masticatory ability, independent of age, gender and dental state, were higher for people in rural areas, with low income and living single, as well as for those with skeletal, gastrointestinal, psychiatric and tumour diseases. In the elderly, results from the logistic regression showed that some disability and psychosocial factors were also associated with masticatory ability. CONCLUSIONS: The results indicated that there was a group of elderly people who reported several functional and health problems including impaired masticatory ability.

Correlations between presbyacusis and extrinsic noxious factors.

As part of the longitudinal gerontological and geriatric population study of 70-year-olds in Göteborg, Sweden, the possible correlation between presbyacusis and extrinsic factors affecting health in elderly persons was investigated. Participants from one cohort (F 01) were studied longitudinally at ages 70, 75, 79 and 85 years, and from another cohort (F 06) at age 70 years. A weak correlation between hearing loss and smoking, alcohol abuse and head trauma was found for men and between hearing loss and intake of pharmaceutical agents (especially salicylates) for women.

Dental health and functional ageing. A study of 70-year-old people.

Functional ageing, including dental health, was studied in the gerontological population study in Gothenburg. This study was based on three 70-yr-old cohorts, born in 1901-2, 1906-7, and 1911-12 (n = 1380). The Eichner index was used as a measurement of deterioration in dental state and dental functional impairment. This impairment was significantly associated with a lower capacity in cognition, visual ability, hearing ability, lung volume, heart volume, muscle strength, and bone mineral content as well as a lower self-assessment of health. A multiple regression model showed that an index of seven functional capacities was the most predictive factor for dental status independent of confounding factors such as socioeconomic factors, tobacco smoking, and the most incapacitating diseases. These associations were more marked in men and the survival rate between 70 and 79 years of age was higher among men with a well preserved dental state of the age of 70. The co-variation between impairment in dental function and other functional variables and survival indicate a common functional ageing.

Bacteriuria in representative population samples of persons aged 72-79 years.

Screening for bacteriuria was performed between 1984 and 1988 in persons aged 72-79 years representative of the general population in Göteborg, Sweden. The frequency of bacteriuria (greater than or equal to 10(5)/ml) at a single screening was 6% and 16% at age 72 years and 6% and 14% at age 79 years for the screened men (n = 235 and 259) and women (n = 259 and 297), respectively. By repeated screening after one month and 30 months of those previously negative at age 72 years, an additional 4% and 3% of men and 3% and 7% of women with bacteriuria were detected. Bacteriuric persons were excluded from further screening and controlled by frequent cultures during several years, with careful monitoring of clinical interventions. The persistence of untreated bacteriuria was analyzed in relation to bacterial species and number in the untreated subgroup of bacteriuric individuals. Nine of 10 Escherichia coli (E. coli) with less than 10(6)/ml and 22/22 non-E. coli strains disappeared spontaneously. In contrast, 20/26 (77%, p less than 0.01) with greater than or equal to 10(6) E. coli/ml persisted. Of 17 persons with bacteriuria persisting at least 12 months, 16 were women and 16 had E. coli. Of 201 E. coli cultures obtained from this group, 94% had greater than or equal to 10(6)/ml, and 99% had greater than or equal to 5 x 10(5)/ml. The results indicate that screening for high counts (greater than 10(6)/ml) of E. coli most effectively detects persisting bacteriuria in the general elderly population.

Blood pressure and mortality in old age. Eleven years' follow-up of a 70-year-old population.

The association between blood pressure levels and mortality up to 11 years has been studied in two representative samples of men and women (1951 people in total) from the longitudinal population study 'seventy-year-old people in Göteborg, Sweden'. We found a significant association between systolic blood pressure (SBP) and mean arterial pressures (MAP) and mortality after 6 years when data from both sexes were pooled. After 11 years, the mortality in the 10% of subjects who had the highest blood pressures at the age of 70 (greater than or equal to 190/105 for men and greater than or equal to 200/105 for women) was 30% higher among the men and 50-60% higher among the women than in the 75% of subjects with the lowest blood pressures. There was no difference between SBP and diastolic blood pressure (DBP) in this respect. A significant association between blood pressure and mortality remained when background factors such as treatment for hypertension, heart failure, coronary heart disease (CHD), diabetes, cholesterol, body mass index (BMI) and smoking habits were kept constant.