Sarcopenic obesity defined by the ESPEN and EASO consensus statement in older women: Risk of falls and bone mineral density implications.

PURPOSE: To apply the ESPEN-EASO diagnostic criteria for Sarcopenic Obesity (SO) in older women and to assess its association with the risk of falls, fear of falls (FOF), and bone mineral density (BMD). METHODS: After exclusion criteria, 232 women aged ≥60 years (68.2 ± 6.1) were enrolled in the study. Volunteers had handgrip strength (HGS; dynamometer) and body composition assessed by DXA before risk of falls was evaluated using the QuickScreen and FOF evaluated by the Falls Efficiency Scale. SO was defined according to the ESPEN-EASO algorithm, which includes reduced HGS and fat-free mass, and elevated fat mass. RESULTS: The prevalence of SO was 6.5 %, which was associated with a higher proportion of fallers in the previous year (X2 6.2, P = 0.04), reduced reaction time (X2 6.2, P = 0.04), reduced sit-to-stand performance (X2 6.2, P = 0.04), and a higher probability of falls [ꭓ2(6) = 17.689, p = 0.004]. FOF was lower in the eutrophic group (ꭓ2(2) = 15,662, p < 0,001) than both the obesity (p = 0.001) and SO (p = 0.05) groups. For total and femoral neck BMD, the eutrophic group presented significantly lower values (1.05 and 0.79 g/cm2) than the obesity group (1.10 and 0.87 g/cm2), but similar to the SO group (1.02 and 0.83 g/cm2). These results remained significant after adjustments for potential confounders. CONCLUSIONS: SO specified by the ESPEN-EASO framework was associated with a higher risk of falls but not with increased FOF than obesity alone. The favorable influence of overweight and obesity on BMD seems to be attenuated in individuals with SO. Our findings support the clinical significance of the ESPEN-EASO definition.

Prevalence of sarcopenia in patients with chronic kidney disease: a global systematic review and meta-analysis.

Sarcopenia is a risk factor for adverse clinical outcomes in chronic kidney disease (CKD) patients, including mortality. Diagnosis depends on adopted consensus definition and cutoff values; thus, prevalence rates are generally heterogeneous. We conducted a systematic review and meta-analysis to investigate the global prevalence of sarcopenia and its traits across the wide spectrum of CKD. A systematic search was conducted using databases, including MEDLINE and EMBASE, for observational studies reporting the prevalence of sarcopenia. We considered sarcopenia according to the consensus definition of the European Working Group on Sarcopenia in Older People (EWGSOP), the Asian Working Group for Sarcopenia, the Foundation for the National Institutes of Health Sarcopenia Project, and the International Working Group on Sarcopenia (IWGS). Subgroup analyses by CKD stages, consensus, and gender were performed. Pooled prevalence was obtained from random-effect models. A total of 140 studies (42 041 patients) across 25 countries were included in this systematic review and meta-analyses. Global prevalence of sarcopenia was 24.5% [95% confidence interval (CI): 20.9-28.3) and did not differ among stages (P = 0.33). Prevalence varied according to the consensus definition from 11% to 30%, with no significant difference (P = 0.42). Prevalence of severe sarcopenia was 21.0% (95% CI: 11.7-32.0), with higher rates for patients on dialysis (26.2%, 95% CI: 16.6-37.1) compared to non-dialysis (3.0%, 95% CI: 0-11.1; P < 0.01). Sarcopenic obesity was observed in 10.8% (95% CI: 3.5-21.2). Regarding sarcopenia traits, low muscle strength was found in 43.4% (95%CI: 35.0-51.9), low muscle mass in 29.1% (95% CI: 23.9-34.5), and low physical performance in 38.6 (95% CI: 30.9-46.6) for overall CKD. Prevalence was only higher in patients on dialysis (50.0%, 95% CI: 41.7-57.4) compared to non-dialysis (19.6%, 95% CI: 12.8-27.3; P < 0.01) for low muscle strength. We found a high global prevalence of sarcopenia in the wide spectrum of CKD. Low muscle strength, the primary sarcopenia trait, was found in almost half of the overall population with CKD. Patients on dialysis were more prevalent to low muscle strength and severe sarcopenia. Nephrology professionals should be aware of regularly assessing sarcopenia and its traits in patients with CKD, especially those on dialysis.

Design and methodology of the SARCopenia trajectories and associations with adverse clinical outcomes in patients on HemoDialysis: the SARC-HD study.

BACKGROUND: Sarcopenia has been associated with adverse outcomes in patients with chronic kidney disease (CKD), particularly in those undergoing hemodialysis (HD). However, the trajectories across sarcopenia stages, their determinants, and associations with adverse clinical outcomes have yet to be comprehensively examined. METHODS: The SARC-HD is a multicenter, observational prospective cohort study designed to comprehensively investigate sarcopenia in patients on HD. Eligibility criteria include adult patients undergoing HD for ≥ 3 months. The primary objective is to investigate the trajectories of sarcopenia stages and their potential determinants. Secondary objectives include evaluating the association between sarcopenia and adverse clinical outcomes (i.e., falls, hospitalization, and mortality). Sarcopenia risk will be assessed by the SARC-F and SARC-CalF questionnaire. Sarcopenia traits (i.e., low muscle strength, low muscle mass, and low physical performance) will be defined according to the revised European Working Group on Sarcopenia in Older People and will be assessed at baseline and after 12 follow-up months. Patients will be followed-up at 3 monthly intervals for adverse clinical outcomes during 24 months. DISCUSSION: Collectively, we expect to provide relevant clinical findings for healthcare professionals from nephrology on the association between sarcopenia screening tools (i.e., SARC-F and SARC-CalF) with objective sarcopenia measurements, as well as to investigate predictors of trajectories across sarcopenia stages, and the impact of sarcopenia on adverse clinical outcomes. Hence, our ambition is that the data acquired from SARC-HD study will provide novel and valuable evidence to support an adequate screening and management of sarcopenia in patients on HD.

Long-Term Lifestyle Habits and Quality of Life after Roux-in-Y Gastric Bypass in Brazilian Public versus Private Healthcare Systems: Beyond Weight Loss.

Lifestyle and health-related quality of life (HRQoL) are good markers of surgical obesity treatment. This study aimed to investigate the lifestyle and HRQoL of patients at least five years after Roux-en-Y gastric bypass in public (SUS) and private (PVT) Brazilian healthcare systems. In this cross-sectional study, weight loss (WL), % of excess WL (%EWL), diet quality, physical activity, alcohol consumption, and HRQoL were evaluated. Analysis of covariance, binary and multinomial logistic regression, adjusted for confounders, were performed. The SUS group had more vulnerable socioeconomic statuses than the PVT group. Total %WL and % EWL were 24.64 ± 0.99% and 60.46 ± 2.41%, respectively, without difference between groups. In the Pain/Discomfort and Anxiety/Depression domains of HRQoL, more than 50% reported moderate problems without differences between groups. Processed food ingestion was higher in the PVT (132.10 ± 60.15 g/1000 kcal) than in the SUS (103.43 ± 41.72 g/1000 kcal), however, without statistical significance (p = 0.093). The PVT group showed lower physical activity (OR: 0.23; 95%CI: 0.87-0.63; p = 0.004) and a higher risk of alcohol-related problems (OR: 3.23; 95%CI; 1.03-10.10; p = 0.044) compared to SUS group. Participants generally achieved satisfactory WL, regardless of healthcare systems. However, PVT participants had unfavorable lifestyle characteristics, highlighting the need for studies investigating environmental issues post-bariatric surgery.

Prevalence of low bone mineral density (T-score ≤ - 2.5) in the whole spectrum of chronic kidney disease: a systematic review and meta-analysis.

The prevalence of low bone mineral density (LBMD) in people with chronic kidney disease (CKD) remains unknown. We identified a high prevalence of LBMD in CKD population. Thus, public health strategies should include efforts to prevent, early detect, and manage LBMD in CKD patients, especially in patients undergoing kidney replacement therapy. Mineral and bone disorders are common among patients with CKD, which affects bone mineral density. We conducted a systematic review and meta-analysis to estimate the prevalence of low bone mineral density (LBMD) in adults with CKD. We searched MEDLINE, EMBASE, Web of Science, CINAHL, and LILACS databases from inception to February 2021. Observational studies that reported the prevalence of LBMD in adults with CKD stages 3a-5D were included. The LBMD was defined according to the World Health Organization criterion (T-score ≤ - 2.5). Random-effect model meta-analyses were used to estimate the pooled prevalence of LBMD. Meta-regressions and subgroup analyses were conducted for stages of CKD, dialysis modality, gender, bone sites and morphology, and geographical region. This study was registered in PROSPERO, number CRD42020211077. One-hundred and fifty-three studies with 78,092 patients were included. The pooled global prevalence of LBMD in CKD was 24.5% (95% CI, 21.3 - 27.8%). Subgroup analyses indicated a higher prevalence of LBMD in dialysis patients (30%, 95% CI 25 - 35%) compared with non-dialysis CKD patients (12%, 95% CI 8 - 16%), cortical bone sites (28%, 95% CI 23 - 35%) relative to trabecular sites (19%, 95% CI 14 - 24%), while similar estimates in the European and the Asiatic continents (26%, 95% CI 21 - 30% vs 25%, 95% CI 21 - 29). The prevalence of LBMD in CKD patients is high, particularly in those undergoing dialysis and in cortical bone sites. Therefore, efforts to early diagnosis and management strategies should be implemented in clinical routine for an epidemiological control of LBMD in CKD patients.

Simulated co-optimization of renewable energy and desalination systems in Neom, Saudi Arabia.

The interdependence between the water and power sectors is a growing concern as the need for desalination increases globally. Therefore, co-optimizing interdependent systems is necessary to understand the impact of one sector on another. We propose a framework to identify the optimal investment mix for a co-optimized water-power system and apply it to Neom, Saudi Arabia. Our results show that investment strategies that consider the co-optimization of both systems result in total cost savings for the power sector compared to independent approaches. Analysis results suggest that systems with higher shares of non-dispatchable renewables experience the most significant cost reductions.

Muscle strength in Brazilian firefighters with non-specific chronic low back pain: A cross-sectional study.

BACKGROUND: Imbalance between flexor and extensor muscles of the trunk could negatively influence spinal stability. OBJECTIVES: Investigate the strength balance between flexor and extensor muscles of the trunk in military firefighters with non-specific chronic low back pain (NSCLBP). METHODS: One hundred and two male firefighters were assessed in an isokinetic dynamometer at 120°/s and 60°/s to investigate the balance ratio between flexor and extensor (F/E) muscles. RESULTS: An F/E ratio of 0.72 (SD: 0.22; 95% CI: 0.67-0.76; SEM: 0.02) was observed at 60°/s and 0.94 (SD: 0.41; 95% CI: 0.85-1.03; SEM: 0.04) at 120°/s. The mean peak torque of the extensor muscles was 343.1 N.m/Kg (SD: 94.87; 95% CI: 322.8-363.5; SEM: 10.23) at 60°/s and 270.5 N.m/Kg (SD: 113; 95% CI 246.3-294.8; SEM: 12.18) at 120°/s. The mean peak torque of the flexor muscles was 232.4 N.m/Kg (SD: 53.86; 95% CI 220.8-243.9; SEM: 5.81) at 60°/s and 223.8 N.m/Kg (SD: 66.34; 95% CI 209.6-238.1; SEM: 7.15) at 120°/s. All torques generated by the extensor muscles were higher than the flexor muscles (p < 0.05). CONCLUSIONS: Firefighters with NSCLBP presented a normal F/E balance ratio and higher strength of extensor muscles of the trunk.

Association between sarcopenia and clinical outcomes in chronic kidney disease patients: A systematic review and meta-analysis.

BACKGROUND & AIMS: Sarcopenia is a risk factor for adverse outcomes in older adults, but this has yet to be confirmed in chronic kidney disease (CKD). We conducted a systematic review to investigate the association between sarcopenia and its traits with mortality, hospitalization, and end-stage kidney disease (ESKD) progression in CKD patients. METHODS: Five electronic databases were searched, including MEDLINE and Embase. Observational cohort studies with CKD patients were included. The sarcopenia traits assessed were low muscle strength, low muscle mass, and low physical performance, as well as diagnosed sarcopenia (combined low muscle mass and low strength/performance). Hazard ratios (HR), risk ratios (RR), odds ratios (OR), and 95% confidence intervals (CI) were pooled using random-effect meta-analyses. RESULTS: From a total of 4922 screened studies, 50 (72,347 patients) were included in the review and 38 (59,070 patients) in the meta-analyses. Most of the included studies were in dialysis patients (n = 36, 72%). Pooled analyses showed that low muscle strength (15 studies; HR:1.99; 95%CI:1.65 to 2.41; I2:45%), low muscle mass (20 studies; HR:1.51; 95%CI:1.36 to 1.68; I2:26%) and low physical performance (five studies; HR:2.09; 95%CI:1.68 to 2.59; I2:0%) were associated with increased mortality risk in CKD patients. Diagnosed sarcopenia was also associated with the mortality risk in dialysis patients (eight studies; HR:1.87; 95%CI:1.35 to 2.59; I2:40%). On the other hand, it was uncertain whether low muscle mass was associated with hospitalization (two studies in dialysis patients; RR:1.81; 95% CI:0.78 to 4.22; I2:59%). Further, limited ESKD progression measures prevented meta-analysis for this outcome. CONCLUSIONS: Low muscle strength, low muscle mass, and low physical performance were associated with higher mortality in CKD patients. In dialysis patients, diagnosed sarcopenia also represented higher mortality risk. Evidence to conclude associations with hospitalization and ESKD progression is currently lacking. PROSPERO REGISTRATION: CRD42020192198.

SARC-F and SARC-CalF are associated with sarcopenia traits in hemodialysis patients.

BACKGROUND: The SARC-F questionnaire assesses sarcopenia risk. The addition of a calf circumference measurement, known as SARC-CalF, has been recently proposed. We investigated possible associations of SARC-F and SARC-CalF with sarcopenia traits in patients undergoing hemodialysis. METHODS: Thirty patients (17 men; 57 ± 15 years) were enrolled. Sarcopenia risk was assessed by SARC-F (≥4) and SARC-CalF (≥11). Probable (low muscle strength or low skeletal muscle mass [SMM]) and confirmed (both) sarcopenia were diagnosed as recommended by the revised European Working Group on Sarcopenia in Older People. Muscle strength was assessed by handgrip strength (HGS) and five-time sit-to-stand test (STS-5), and physical performance was evaluated by gait speed. SMM was assessed by bioelectrical impedance. RESULTS: Sarcopenia risk by the SARC-F and SARC-CalF were found in 23% (n = 7) and 40% (n = 12) patients, respectively. The SARC-F and SARC-CalF were both associated with physical function, but not with SMM. Probable sarcopenia by HGS was associated with SARC-F and SARC-CalF. Moreover, both showed moderate Kappa agreement with slowness and probable sarcopenia by HGS and/or STS-5, but only SARC-CalF with probable sarcopenia by HGS. A larger sensitivity was found for SARC-CalF than SARC-F in detecting probable sarcopenia by HGS (70% vs 30%) and by HGS and/or STS-5 (63% vs 44%). CONCLUSION: SARC-F and SARC-CalF are associated with sarcopenia traits in patients undergoing hemodialysis. SARC-CalF seems to be more strongly associated with sarcopenia traits and present a higher sensitivity for probable sarcopenia than SARC-F, as it adds a direct measurement.

Physical activity is associated with nutritional biomarkers in hemodialysis patients: A cross-sectional study.

OBJECTIVE: To explore the association between physical activity levels and nutritional biomarkers in hemodialysis patients. METHODS: Eighty-six patients responded to the short version of the International Physical Activity Questionnaire to estimate the metabolic equivalent of tasks (MET) per week. A MET-min per week <600 was considered as sedentary. The nutritional biomarkers (i.e., albumin, globulin, and albumin/globulin ratio) were collected. RESULTS: Sixty-five patients (75.6%) were sedentary. Binary logistic regression showed that patients with low albumin levels had an 89% lower chance to be physically active (p = 0.037), but it was not significant in the adjusted analysis (p = 0.052). Albumin and albumin/globulin ratio levels were correlated with MET-min per week (r = 0.34 and 0.30; both p < 0.05). Additionally, lower median albumin and albumin/globulin ratio levels were found in the sedentary patients (p = 0.021 and p = 0.031), respectively. CONCLUSION: The physical activity levels were associated with albumin and albumin/globulin ratio, surrogates of nutritional status in hemodialysis patients. These nutritional biomarkers were lower in sedentary patients.

Poor handgrip strength determined clinically is associated with falls in older women.

OBJECTIVES: To assess the association between poor handgrip strength (HGS) determined by clinical criterion and incidence of falls in older women. METHODS: The cohort included 195 women (68.1±6.2 years) who were assessed for HGS (Jamar Dynamometer) at baseline and were prospectively followed for 18 months. FNIH Sarcopenia threshold of HGS adjusted for body mass index (<0.56) was used for clinical determination of poor HGS. Association between poor HGS and incidence of falls was analyzed using Cox hazard models in the total cohort and in a stratified analysis by balance status. RESULTS: During the follow-up, 53 (27%) women experienced at least one fall. In a multivariable model, poor HGS was associated with approximately 3-fold increased risk for falls [Hazard Ratio (HR)=2.73, 95% Confidence Interval (CI)=1.28-5.82, p=0.009]. In a stratified analysis, women with impaired balance exhibited even greater risk for falls (HR=3.85, 95%CI=1.47-10.12, p=0.011), although no association was found in women with normal balance (p=0.459). CONCLUSIONS: Poor HGS based on clinical criterion is independently associated with higher risk of falls in older women, particularly in those with impaired balance. These results suggest potential prognostic value of FNIH Sarcopenia threshold for risk stratification and referring high-risk individuals to fall prevention programs.

The Influence of Body Fat Distribution on Postural Balance and Muscle Quality in Women Aged 60 Years and Over.

The aim of this study was to investigate the influence of body fat distribution on postural balance and lower-limb muscle quality in women aged 60 years and over. Two hundred and twenty-two volunteers took part in this cross-sectional analysis. Participants underwent body fat distribution assessment using dual-energy x-ray absorptiometry and were classified as nonobese, gynoid obese, or android obese. Postural balance was assessed during quiet standing, with and without vision restriction, using a force platform. Specific torque was defined as the ratio of knee extensors peak torque (evaluated by an isokinetic dynamometer) to the lean mass of the same limb (evaluated by dual-energy x-ray absorptiometry). Compared with nonobese participants, both obese groups exhibited higher range of postural sway along the anteroposterior and mediolateral axes (P < .05). However, there were no differences between participants with gynoid and android obesity. The android obese group exhibited greater speed of postural sway in the condition without vision restriction than both nonobese (P = .040) and gynoid obese (P = .004) groups. Regarding muscle quality, only participants with gynoid obesity (P = .004) presented lower specific torque than their nonobese peers. These results may be clinically useful when designing falls prevention exercises targeting the obese population.

Influence of the ACTN3 Genotype and the Exercise Intensity on the Respiratory Exchange Ratio and Excess Oxygen Consumption After Exercise.

ABSTRACT: de L. Corrêa, H, Ribeiro, HS, Maya, ÁTD, Neves, RP, de Moraes, MR, Lima, RM, Nóbrega, OT, and Ferreira, AP. Influence of the ACTN3 genotype and the exercise intensity on the respiratory exchange ratio and excess oxygen consumption after exercise. J Strength Cond Res 35(5): 1380-1388, 2021-This study aimed to assess the respiratory exchange ratio (RER) and excess postexercise oxygen consumption (EPOC) after high-intensity interval training and continuous moderate-intensity aerobic training in accordance with the ACTN3 genotype. A cross-sectional study with 30 physically active individuals who participated in 3 experimental sessions, as follows: a high-intensity interval aerobic exercise, for 3 minutes at 115% anaerobic threshold, with 90 seconds of passive recovery; a continuous moderate-intensity aerobic exercise at 85% anaerobic threshold; and a control session. Respiratory exchange ratio and V̇o2 were obtained through an indirect, calorimetry-based gas analysis method, using a breath-by-breath approach, assessed at baseline, during the trials, and at 1, 2, 3, and 4 hours after exercise. We found that lower postexercise RER values were observed only in subjects with the X allele, in both the high- and the moderate-intensity training protocols. Homozygous RR subjects showed no differences in postexercise RER compared with the scores at the control day. After both sessions of exercise, EPOC levels were higher compared with scores at the control day for 2 hours among X allele carriers, and only in the first hour among RR homozygous. Thus, the RER and EPOC presented different responses after moderate and intense exercise according to the ACTN3 genotype. Moreover, individuals with the X allele of the ACTN3 gene show a higher oxidation of fats in the postexercise period.

Resistance Training Improves Muscle Strength and Function, Regardless of Protein Supplementation, in the Mid- to Long-Term Period after Gastric Bypass.

Inadequate protein intake and low levels of physical activity are common long-term sequelae after bariatric surgery and can negatively affect muscle strength (MS) and physical function (PF). The study investigated the effects of resistance training with or without protein supplementation on MS and PF. The study, which involved a 12-week controlled trial (n = 61) of individuals 2-7 years post-Roux-en-Y gastric bypass (RYGB), comprised four groups: whey protein supplementation (PRO; n = 18), maltodextrin placebo (control [CON]; n = 17), resistance training combined with placebo (RTP; n = 11), and resistance training combined with whey protein supplementation (RTP+PRO; n = 15). An isokinetic dynamometer was used to measure MS (peak torque at 60°/s and 180°/s). PF was measured with the 30-s sit-to-stand (30-STS), 6-min walk (6-MWT), and timed up-and-go (TUG) tests. There were improvements in the absolute and relative-to-bodyweight peak torque at 60°/s and 180°/s, TUG, 6-MWT and 30-STS in the RTP and RTP+PRO groups, but not in the CON and PRO groups. Changes in MS were significantly correlated with changes in PF between the pre- and post-intervention periods. A supervised resistance training program, regardless of protein supplementation, improved MS and PF in the mid-to-long-term period after RYGB and can lead to clinical benefits and improved quality of life.

Effects of Extra Virgin Olive Oil (EVOO) and the Traditional Brazilian Diet on Sarcopenia in Severe Obesity: A Randomized Clinical Trial.

BACKGROUND: Nutritional interventions may have positive effects on sarcopenia and body composition. OBJECTIVE: to evaluate the effectiveness of extra virgin olive oil (EVOO) consumption and a healthy traditional Brazilian diet (DieTBra) on improving sarcopenia indicators and reducing total body fat in severe obesity. METHODS: A randomized controlled trial registered at ClinicalTrials.gov (NCT02463435) conducted with 111 severely obese participants randomized into three treatment groups-(1) EVOO (52 mL/day), (2) DieTBra, (3) DieTBra + EVOO (52 mL/day)-for 12 weeks. Body composition was assessed by dual-energy X-ray absorptiometry and sarcopenia by walking speed and handgrip strength. RESULTS: Significant reductions in total body fat (p = 0.041) and body weight (p = 0.003) were observed in the DieTBra group. In the DietBra + olive oil group there was also a significant reduction in body weight (0.001) compared to the olive oil-only group. ANCOVA analyses showed reductions in total body fat in the DieTBra (p = 0.016) and DieTBra + olive oil (p = 0.004) groups. Individuals in the DieTBra group had significant improvements in their walking speed (p = 0.042) and handgrip strength (p = 0.044). CONCLUSIONS: DieTBra contributes to improvements in handgrip strength, walking speed, and total body fat in severely obese adults. The major study was registered at ClinicalTrials.gov (NCT02463435).

Obesity and falls in older women: Mediating effects of muscle quality, foot loads and postural control.

BACKGROUND: Obesity is associated with an increased risk of falls in older women. However, it is not certain whether factors commonly associated with obesity and falls mediate this risk. RESEARCH QUESTION: Do lower-limb muscle quality, foot loads and postural control mediate the relationship between obesity and falls in women aged 60 years and older? METHODS: At baseline, 246 female participants underwent obesity screening (BMI≥30 kg/m²), and measurements of muscle quality (isokinetic dynamometer and dual-energy X-ray absorptiometry), foot loads (pressure platform) and postural balance (force platform). Incident falls were recorded at the end of the 18-month follow-up period via participant recall. To test whether, and to what extent, biomechanical factors mediated the relationship between obesity and falls, the Natural Indirect Effects (NIE), Natural Direct Effect (NDE) and proportion mediated were calculated using the counterfactual approach. Significance level was set at p < .05. RESULTS: 204 participants (83 %) completed the follow-up. As expected, obesity was associated with a higher risk of being a faller (RR: 2.13, 95 % CI: 1.39-3.27). Using the counterfactual approach, only specific torque (NIE: 1.11, 95 % CI: 1.01-1.38) and flatfoot (NIE: 1.10, 95 % CI: 1.01-1.32) were significant mediators of the relationship between obesity and falls. Specific torque and flatfoot mediated 19 % and 21 % of the relationship, respectively. SIGNIFICANCE: Lower-limb muscle quality (specific torque) and foot loads (flatfoot) mediate the relationship between obesity and falls in older women. The inclusion of muscle strengthening and podiatry interventions as part of a fall prevention program may benefit this population.

Dynapenic abdominal obesity and the incidence of falls in older women: a prospective study.

BACKGROUND: Dynapenic abdominal obesity (D/AO) has been associated with negative outcomes in older people, including trait of falls. AIMS: To assess the association between D/AO and the incidence of falls over 18 months in older community-dwelling women. METHODS: A total of 201 older women (67.97 ± 6.02 years; 27.70 kg/m2) underwent waist circumference measurement, and had handgrip strength assessed using a hydraulic dynamometer. Dynapenia was classified using the lower tertile of handgrip strength, while abdominal obesity was considered as a waist circumference > 88 cm. D/AO was the combination of both aforementioned criteria. Volunteers were classified into four groups: normal, abdominal obesity, dynapenic, and D/AO. Participants were then tracked by phone calls for ascertainment of falls during a follow-up period of 18 months. Chi-square and multivariable Cox proportional regressions were conducted. RESULTS: The overall incidence of falls over the follow-up was 27.5%; and for normal, dynapenic, abdominal obesity, and D/AO were 14.7%, 17.2%, 27.5%, and 40.4% (X2 = 8.341; P = 0.039), respectively. D/AO was associated with a higher risk of falls (hazard ratio: 3.595 [95% CI: 1.317-9.815], even after adjustments for age, body mass index, physical activity level, regular use of medications, peripheral sensation, chronic diseases, and history of lower-limbs pain. CONCLUSIONS: D/AO is more closely related to falls than either dynapenia or abdominal obesity alone, and is independently associated with an increased incidence of falls in older women. These results provide support for the concept that the combined evaluation of muscle strength and central obesity may be clinically relevant in this population.

Cardiorespiratory Fitness, Smoking Status, and Risk of Incidence and Mortality From Cancer: Findings From the Veterans Exercise Testing Study.

BACKGROUND: To assess the joint and stratified associations between cardiorespiratory fitness (CRF), incidence, and mortality from cancer in never, former, and current male smokers. METHODS: CRF (treadmill exercise test) was assessed in 4694 men (never smokers [n = 1715]; former smokers [n = 1602], 32.4 [30.5] pack-years; and current smokers [n = 1377], 40.3 [26] pack-years) aged 58.1 (17.3) years, and prospectively followed for 12.7 (7.5) years. Multivariable Cox hazard models were analyzed. RESULTS: In joint analyses, where high CRF in never smokers was used as a reference, hazard ratios and 95% (confidence intervals) for cancer incidence and cancer mortality were as follows: moderate CRF 1.41 (1.0-1.9) and 3.0 (1.7-5.5) in never smokers, 1.65 (1.3-2.2) and 3.7 (2.1-6.6) in former smokers, and 1.3 (0.9-1.7) and 3.4 (1.9-6.1) in current smokers, respectively. The corresponding values for low CRF were 1.53 (1.1-2.2) and 5.1 (2.7-9.5), 1.84 (1.3-2.5) and 6.6 (3.7-11.8), and 1.5 (1.1-2.2) and 5 (2.7-9.3), respectively. In stratified analyses by smoking status, compared with low CRF, moderate and high CRF were associated with a 32% to 78% reduction in cancer mortality risk (P trend for all <.001). CONCLUSION: Higher CRF is associated with lower risk of incidence and mortality from cancer regardless of smoking status, supporting the potential preventive benefits for public health.

Cardiorespiratory Fitness, Lung Cancer Incidence, and Cancer Mortality in Male Smokers.

INTRODUCTION: The preventive role of cardiorespiratory fitness in lung cancer among smokers is unknown. This study aims to evaluate the association between cardiorespiratory fitness and lung cancer incidence and cancer mortality in former and current male smokers. METHODS: From 1987 to 2014, cardiorespiratory fitness (quantified from treadmill exercise testing) was assessed in 2,979 men (former smokers, n=1,602; current smokers, n=1,377) aged 59.1 (SD=17.4) years and prospectively followed up for 11.6 (SD=7) years. Multivariable Cox hazard models and population attributable fraction of low cardiorespiratory fitness (<5 METs) for cancer outcomes were analyzed during 2018. RESULTS: Of the 99 case patients diagnosed with lung cancer, 79 died of cancer 3.6 (SD=4.6) years after diagnosis. Among former smokers, 1-MET increase and categories of moderate and high cardiorespiratory fitness were associated with 13% (p=0.016), 51%, and 77% (p-trend=0.015) reductions in lung cancer incidence, respectively. Among current smokers who were later diagnosed with lung cancer, 1-MET increase and categories of moderate and high cardiorespiratory fitness were associated with 18% (p=0.008), 84%, and 85% (p-trend<0.001) reductions in cancer mortality, respectively. The population attributable fraction for lung cancer incidence was 10.8% among former smokers and 22.3% for cancer mortality among current smokers. CONCLUSIONS: Higher cardiorespiratory fitness is associated with lower risk of lung cancer incidence in former smokers and reduced risk of cancer mortality in current smokers who were diagnosed with lung cancer. Screening for low cardiorespiratory fitness and achieving at least moderate cardiorespiratory fitness could potentially reduce lung cancer morbidity and mortality, providing a preventive strategy for smokers.