Longitudinal association of built environment pattern with DXA-derived body fat in elderly Hong Kong Chinese: a latent profile analysis.

BACKGROUND: One major limitation of prior studies regarding the associations between built environment (BE) and obesity has been the use of anthropometric indices (e.g., body mass index [BMI]) for assessing obesity status, and there has been limited evidence of associations between BE and body fat. This study aimed to explore the longitudinal association between BE and body fat in a cohort of elderly Hong Kong Chinese and examine whether the BE-body fat associations differed by BMI categories. METHODS: Between 2001 and 2003, 3944 participants aged 65-98 years were recruited and followed for a mean of 6.4 years. BE characteristics were assessed via Geographic Information System. Body fat (%) at whole body and regional areas (trunk, limbs, android, and gynoid) were assessed by dual energy X-ray absorptiometry at baseline and three follow-ups. Latent profile analysis was used to derive BE class, and linear mixed-effects models were used to investigate the associations of BE class with changes in body fat. Stratified analyses by BMI categories were also conducted. RESULTS: Three BE classes were identified. Participants in Class 2 (characterized by greater open space and proportion of residential land use) had a slower increase in whole body fat (B = -0.403, 95% confidence interval [CI]: -0.780, -0.014) and limbs fat (-0.471, 95% CI: -0.870, -0.071) compared with participants in Class 1 (characterized by high proportion of commercial land use). There were significant interactions of BE class with BMI, and participants in Class 2 had a slower increase in whole body fat and regional fat compared with participants in Class 1 (B ranging from -0.987 [limbs] to -0.523 [gynoid]) among overweight and obese participants only. CONCLUSIONS: We found that those who resided in the areas characterized by greater open space and proportion of residential land use had a slower body fat increase.

Does Low Subjective Social Status Predict Cognitive Decline in Chinese Older Adults? A 4-Year Longitudinal Study From Hong Kong.

OBJECTIVE: Subjective social status (SSS), one's self-perceived social position, encompasses not only concrete socio-economic (SES) factors (e.g., income) but also intangible aspects of status (e.g., social capital). In recent years, there has been increasing research interest in SSS as a predictor of a vast array of health outcomes but very few studies examining effects on cognitive functioning. This study's main objective was to examine the association between SSS and long-term cognitive decline in older Chinese adults. DESIGN: A 4-year longitudinal study. SETTING: Hong Kong, China. PARTICIPANTS: Chinese adults (aged ≥65) (n = 3,153). MEASUREMENTS: This study analyzed baseline SSS-Hong Kong (self-perceived social status within Hong Kong) and SSS-Community (self-perceived status within one's own social network) as predictors of long-term cognitive decline. Multiple-linear-regression was performed on 4-year follow-up Mini-Mental-Status-Examination (MMSE) cognitive function score (score range: 0-30) after adjusting for baseline MMSE scores, traditional SES indicators (e.g., education), demographic variables (e.g., sex), clinical conditions (e.g., stroke history, depression), and lifestyle variables (e.g., physical activity levels). RESULTS: Lower SSS-Community but not SSS-Hong Kong was associated with greater cognitive decline (unstandardized coefficient (95% CI) = 0.13 (0.07, 0.19) standardized ß-coefficient = 0.08, after adjusting for objective SES measures and other background and clinical factors. The standardized ß-coefficients for the SSS-Community variable were similar in magnitude to those for depression and diabetes. CONCLUSION: Cognitive decline is influenced by self-perceived rank in proximal reference groups rather than socioeconomic comparison with society at-large. SSS-Community is a useful, single-item supplementary instrument to improve prediction of cognitive decline in elderly Chinese.

Association of green space with bone mineral density change and incident fracture in elderly Hong Kong Chinese: Mr. OS and Ms. OS study.

BACKGROUND: A large body of literature has reported positive effects of green space (GS) on various aspects of health and well-being, while no studies explore the role of GS in bone health. OBJECTIVES: The present study aimed to investigate the associations of GS with bone mineral density (BMD) change and incident fracture in a prospective cohort of elderly Hong Kong Chinese. METHODS: Between 2001 and 2003, 3944 participants aged 65 years and older at baseline were recruited. GS (%) within 300-m and 500-m buffers were calculated for each participant based on the Normalized Difference Vegetation Index. BMD at whole body, lumbar spine, total hip, and femoral neck were assessed by dual energy X-ray absorptiometry at baseline and 3 follow-ups. Incident fracture cases were ascertained from the electronic database of Hospital Authority of Hong Kong. Linear mixed-effects models and Cox proportional hazards models were used to investigate the associations of GS with changes in BMD and incident fracture, respectively. RESULTS: Greater GS within 300-m and 500-m buffers were associated with a slower increase in lumbar spine BMD over 14 years. After adjustment for potential confounders, ß and 95% confidence intervals (CIs) of change in BMD across Q2-Q4 (quartiles of GS measured in a 300-m, compared with Q1) were -6.42 (-12.3, -0.59), -7.78 (-13.6, -1.97), and -7.83 (-13.7, -2.00) mg/cm3, respectively. GS was also positively associated with non-spinal fracture and major osteoporotic fracture incidence risks. Multivariable-adjusted hazard ratios (95%CIs) were 1.40 (1.09, 1.79; P-trend = 0.036) for non-spinal fracture and 1.53 (1.13, 2.07; P-trend = 0.010) for major osteoporotic fracture (Q4 compared with Q1 of GS measured in a 300-m buffer). Positive GS-fracture associations were also found for GS within a 500-m buffer. CONCLUSIONS: We found that those who lived near higher GS levels had a slower increase in lumbar spine BMD and had higher incident fracture risk.

Socioeconomic status as an effect modifier of the association between built environment and mortality in elderly Hong Kong Chinese: A latent profile analysis.

BACKGROUND: Previous studies have focused on associations between individual built environment (BE) characteristics and mortality, and found the BE-mortality associations differed by socioeconomic status (SES). Different individual BE characteristics may have different impacts on health and thus could interact. Combinations of BE characteristics may be a better approach to explore the BE-mortality associations. OBJECTIVES: This study aimed to investigate the associations of BE pattern with mortality in a prospective cohort of elderly Hong Kong Chinese (Mr. OS and Ms. OS Study), and assess whether the BE-mortality association differed by SES. METHODS: Between 2001 and 2003, 3944 participants aged 65-98 years at baseline were included in the present analysis. BE characteristics were assessed via Geographic Information System. Data on all-cause and cause-specific mortality were obtained from the Hong Kong Government Death Registry. Latent profile analysis was used to derive BE class, and the Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Three BE classes were identified. During a total of 53276 person-years of follow-up, 1632 deaths were observed. There were no significant associations of BE class with all-cause and cause-specific mortality. However, we found the associations of BE class with all-cause mortality were modified by SES. In comparison with Class 3 (characterized by greater green space), HRs (95%CIs) were 0.72 (0.54, 0.97) for Class 1 (characterized by greater commercial land use) and 0.77 (0.64, 0.94) for Class 2 (characterized by greater residential land use) among low-SES participants. The associations were stronger among high-SES participants, with 0.55 (0.33, 0.89) for Class 1 and 0.68 (0.48, 0.97) for Class 2. In contrast, Class 2 (HR 1.18, 95%CI 1.01-1.39) had a higher mortality risk compared with Class 3 among middle-SES participants. CONCLUSIONS: Our findings provide new evidence on the role of SES as an effect modifier of BE pattern and mortality. BE pattern has a varied effect on mortality risk for different SES groups.

Schmorl's nodes are associated with prevalent osteoporotic vertebral fracture and low bone mineral density: a population-based thoracic spine MRI study in older men and women.

Background: Schmorl's node (SN) corresponds to nucleus pulposus herniation into the vertebral spongy bone with thickened trabeculae around the formed node. We hypothesize that a pathway may exist that: osteoporosis → weakened endplate → SN development ↔ endplate fracture of an osteoporotic vertebra. Methods: For osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong studies, at 14-year follow-up, thoracic spine magnetic resonance imaging (MRI) was sampled in 270 males (mean: 82.9±3.7 years) and 150 females (mean: 81.5±4.3 years). SN and Modic change were assessed as existed or not existed. For posterior disc protrusion, ligamentum flavum ossification, and spinal canal stenosis, semi-quantitative gradings were applied. For each vertebra in women, a score of 0, 0.5, 1, 1.5, 2, 2.5, 3 was assigned for no osteoporotic vertebral fracture (OVF) or OVF of <1/5, ≥1/5-1/4, ≥1/4-1/3, ≥1/3-2/5, ≥2/5-2/3, and ≥2/3 vertebral height loss, respectively, and a summed score was calculated by summing up the scores of vertebrae T1 to T12. For men, those of minimal grade were not considered as OVF and assigned a '0' score. Results: SN prevalence in women (55.5%) almost doubled that in men (25.9%). SN was statistically significantly correlated with lower bone mineral density (BMD) derived femoral neck T-score, while the other four spine degeneration changes were not statistically significantly correlated with the T-score. SN were statistically significantly correlated with OVF score. Subjects with SN were more likely to have OVF, with odds ratio for men of 4.32 [95% confidence interval (CI): 1.70-11.00, P=0.002] and odds ratio for women of 3.28 (95% CI: 1.23-8.74, P=0.018). Conclusions: Among older population, many features of SN parallel those of OVF.

'Healthier Chinese spine': an update of osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong spine radiograph studies.

For the MrOS (Hong Kong) and MsOS (Hong Kong) baseline (BL) studies, community-dwelling 2,000 Chinese men (mean age: 72.3 years) and 2,000 Chinese women (mean age: 72.5 years) were recruited from 2001 to 2003. These two studies have spanned two decades till now. This review summarizes our spine radiograph results. Senile and post-menopausal osteoporosis were associated with intervertebral disc volume reduction; and in women, menopause accelerates disc degeneration. Elderly women's osteoporotic vertebral fracture (OVF) prevalence was double of that of elderly men. For year-4 follow-up (FU), male participants with BL OVF had little increased risk for further OVF. In our study comparing OVF rates in age-matched Hong Kong Chinese women and Italian Caucasian women (mean age: 74.1 years), endplate and/or cortex fracture (ECF) prevalence was 26% for Chinese and 47% for Italian. OVF with ≥40% vertebral height loss was recorded among 9.5% of the Chinese subjects while among 26% of the Italian subjects. OVFs in Italian subjects were more likely to be multiple and generally severer. Clinical spine fractures were recorded 133 cases/100,000 person-years in MrOS (Hong Kong) participants and 273 cases/100,000 person-years in MsOS (Hong Kong) participants. Literature review suggests the clinical vertebral fracture rates among elderly Hong Kong Chinese subjects are approximately half of those of American, Australian, and Canadian subjects. Data synthesis suggests elderly Caucasians have a higher degenerative spondylolisthesis prevalence, being approximately 70% higher than that of elderly Hong Kong Chinese. Literature review of other authors' publications shows, compared with Caucasians, Chinese have a much lower incident rate of back pain. We conclude that elderly Chinese have a generally healthier spine relative to elderly Caucasians.

Longitudinal Association of Built Environment Pattern with Physical Activity in a Community-Based Cohort of Elderly Hong Kong Chinese: A Latent Profile Analysis.

A large number of studies have focused on the associations between single built environment (BE) characteristics and physical activity (PA). Combinations of BE characteristics offer a more comprehensive approach to identify the BE-PA associations. We aimed to examine the BE-PA associations in a cohort of elderly Hong Kong Chinese. Between 2001 and 2003, 3944 participants (65-98 years of age) were recruited and followed for a mean of 7.8 years. BE characteristics were assessed via geographic information system. PA levels were obtained using the Physical Activity Scale for the Elderly questionnaire at baseline and three follow-ups. Latent profile analysis was first conducted to classify the BE characteristics, and linear mixed-effects models were then used to explore the longitudinal associations between the BE classes and changes in the PA levels. Three classes of BE were identified. Class 3 (characterized by greater green space and sky view factor) demonstrated a significant decline in household PA (ß = -1.26, 95% confidence interval: -2.20, -0.33) during the study period, and a slower decline in walking PA (1.19 (0.42, 1.95)) compared with Class 2 (characterized by a greater proportion of residential land use). Our results indicate that BE patterns characterized by high green space and a sky view factor may help promote the walking PA level.

Elderly men have much lower vertebral fracture risk than elderly women even at advanced age: the MrOS and MsOS (Hong Kong) year 14 follow-up radiology results.

MrOS MsOS (Hong Kong) studies year 14 follow-up shows for subjects without baseline osteoporotic vertebral deformity, women's incident vertebral fracture (VF) rate was twice that of men. For subjects with vertebral deformity of baseline ≥ 20% height loss, counting subject, women's incident VF rate was three times higher than that of men. INTRODUCTION: For MrOS MsOS (Hong Kong) baseline (BL) studies, 2000 men and 2000 women ≥ 65 years were recruited during 2001 to 2003. This study presents the year 14 follow-up (FU). MATERIALS: Whole spine MRI was performed in 271 males (mean, 82.8 ± 3.6 years) and 150 females (mean, 82.0 ± 4.29 years). Osteoporotic vertebral deformity (OVD) classification included no OVD (grade 0), and OVDs with < 20%, 20~25%, > 25%~1/3, > 1/3~40%, > 40%~2/3, and > 2/3 height loss (grade 1~6). With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade 0 to ≥ grade 2 or to grade 1 with ≥ 10% height loss. OVD progression and new incident OVD were considered incident VF. RESULTS: The proportion of osteoporotic subjects only slightly increased during FU for men but doubled for women. Groupwise, OVD was not associated with back pain in men; but OVD with > 1/3 height loss was associated with back pain in women. For subjects without BL OVD, 7.9% of men and 14.6% of women had incident VF. For subjects with BL OVD of ≥ 20% height loss, men's and women's incident VF were 17.6% and 52.6%, respectively, counting subject and 1.68% and 7.89%, respectively, counting vertebra. CONCLUSION: Elderly men with or without existing osteoporotic VD have much lower future VF risk than elderly women.

The Role of Dietary Patterns in the Contribution of Cardiorespiratory Fitness in Community-Dwelling Older Chinese Adults in Hong Kong.

OBJECTIVE: We examined the influence of various dietary patterns on cardiorespiratory fitness (CRF) expressed as peak oxygen uptake (VO2peak), taking into account demographics and lifestyle risk factors. DESIGN: Prospective cohort study. PARTICIPANTS AND METHODS: We conducted multivariate linear regression analyses using available data from a cohort of community-dwelling older Chinese adults (752 men, 483 women) in Hong Kong. Baseline interviewer-administered questionnaires covered dietary intake estimation and dietary pattern generation from the food frequency questionnaire, demographic and lifestyle factors, self-reported medical history, as well as frailty status. VO2peak at the 7-year follow-up was measured using symptom-limited maximal exercise testing on an electrically braked bicycle ergometer. RESULTS: In men, baseline Diet Quality Index-International (DQI-I) score (ß = 0.044, P = .013) and Okinawan diet score (ß = 0.265, P = .014) was independently associated with age-adjusted VO2peak at the 7-year follow-up. The significant association was only retained for the Okinawan diet score in the multivariate adjusted model (ß = 0.227, P = .039). Dietary pattern scores including the Dietary Approaches to Stop Hypertension (DASH) score, Mediterranean-DASH Intervention for Neurodegenerative Delay Diet score, Mediterranean Diet Score, and 3 other pattern scores derived by factor analysis were not associated with VO2peak. In women, none of the dietary pattern scores at baseline was associated with VO2peak in both the age-adjusted and multivariate-adjusted models. CONCLUSIONS/IMPLICATIONS: A higher Okinawan diet score was associated with a higher 7-year CRF in community-dwelling Chinese older men. Further studies are warranted to examine the underlying mechanisms on how the Okinawan diet influences CRF.

Association of dietary patterns with serum high-sensitivity C-reactive protein level in community-dwelling older adults.

INTRODUCTION: Studies examining the association between dietary patterns and inflammatory markers are limited, in particular among Chinese older adults. OBJECTIVE: We examined the association of various dietary patterns with serum high-sensitivity C-reactive protein (hsCRP) level in community-dwelling Chinese older adults, taking into account demographics and other lifestyle factors. METHODS: We conducted ordinal regression analyses using baseline data based on 1332 older men and 1314 older women of Chinese origin from a cohort study of bone health in Hong Kong. Baseline interviewer administered questionnaires included dietary intake estimation and dietary pattern generation from the food frequency questionnaire, as well as demographic and lifestyle factors. Serum hsCRP was measured using a commercially available enzyme-linked immunosorbent assay. RESULTS: In men, higher serum hsCRP level was associated with lower Diet Quality Index-International (DQI-I) score, the Mediterranean-DASH Intervention for Neurodegenerative Delay diet (MIND) score, Okinawan diet score, "vegetables-fruits" pattern score, and lower adherence to the Mediterranean diet. In women, serum hsCRP level was not associated with any dietary patterns. CONCLUSION: Our cross-sectional analyses suggest that various dietary patterns were associated with a lower serum hsCRP level in community-dwelling Chinese older adults, and these associations were only observed in older men.

Prevalence of cervical spine degenerative changes in elderly population and its weak association with aging, neck pain, and osteoporosis.

BACKGROUND: To investigate the prevalence of MRI degenerative findings of cervical spine in elderly Chinese males and females. METHODS: From a general population sample, cervical spine T2 weighted sagittal MR images were acquired in 272 males (mean age: 82.9±3.83) and 150 females (mean age: 81.5±4.27). Images were interpreted and degenerative changes were classified. Study subjects were divided into younger group (group A, ≤81 years) and older group (group B, >81 years). For neck pain, question was structured as 'during the past 12 months, have you had any neck pain?'. Two hundred and fifty-two males and 134 females also had hip bone mineral density (BMD) measured. RESULTS: 98.1% subjects exhibited at least one degenerative change at one or more vertebral levels. The C5/6 level had the highest overall frequency for degenerative changes. Most of the degenerative changes were more common in females. The older female group had higher prevalence or higher severity of degenerative findings than the younger group. Eleven point four percent of the males and 20.6% of the females reported neck pain, and male subjects with neck pain tended to have slightly higher prevalence of cervical degenerative changes. There was a weak trend that osteoporosis was associated with a higher prevalence of spinal cord high signal and a higher prevalence of spinal canal stenosis. CONCLUSIONS: The age-dependence of cervical spine degenerative changes was more notable in females. Subjects with neck pain and subjects with osteoporosis were weakly associated with higher prevalence of cervical degenerative changes.