Body Composition Changes and 10-Year Mortality Risk in Older Brazilian Adults: Analysis of Prospective Data from the SABE Study.

INTRODUCTION: Aging related alterations in body composition are associated with higher all-cause mortality risk. OBJECTIVE: To examine the associations between 10-year mortality risk with both BMI and body composition, as well as to establish whether these relationships are modified by age and gender, using data from community-dwelling older Brazilian adults. METHODS: We used data from two waves i.e., 2000 and 2010 of the SABE (Health, Well-being, and Aging) study conducted in São Paulo, Brazil, involving a probabilistic sample of community-dwelling older adults aged 60 years and older. The variables of the study were: mortality (in 10-year follow-up period), body mass index (BMI), body composition (waist circumference, waist hip ratio, triceps skinfold thickness, mid-upper arm circumference, calf circumference, and arm muscle area) and covariables (sociodemographic characteristics, life style, self-reported health conditions, number of chronic diseases, Mini mental state exam, and Geriatric depression scale). Poisson regression estimates with STATA statistical software were used for statistical analyses, considering all p-values < 0.05. RESULTS: Over the 10-year follow-up period, there were 769 deaths (40.2%). The mortality rate was 61.0 for men and 111.8 for the ≥80 age group. In the fully adjusted model, statistically significant hazard ratios were found for low muscle mass (IRR: 1.33), underweight (IRR: 1.29), and low fat mass (IRR: 1.31) with mortality. Men in extreme BMI categories (underweight - IRR: 1.47; obesity I - IRR: 1.66; and obesity II - IRR: 1.91) and women with low muscle and low fat mass were significantly associated with mortality risk. In the ≥80 age group it was observed that low muscle mass (IRR: 168.7), inadequate body reserves (IRR: 1.63), low fat mass (IRR: 140.7), and underweight (IRR: 142.9) were associated with mortality risk. Waist circumference demonstrated protection for mortality in the high-risk categorization for the ≥80 age group. CONCLUSION: Our results showed that underweight, low fat mass, and low muscle mass were associated with mortality risk, presenting different roles considering gender and age in older Brazilian adults over a 10-year follow-up period.

Effects of walking and strength training on resting and exercise cardiovascular responses in patients with intermittent claudication.

BACKGROUND: Exercise training is recommended as the first-line therapy for intermittent claudication patients. However, the effects of exercise therapy on cardiovascular function of these patients have been poorly studied. The aim of this study is to compare the effects of walking and strength training on cardiovascular responses assessed at rest and during exercise in patients with intermittent claudication. PATIENTS AND METHODS: Thirty-four patients with stable symptoms of intermittent claudication were randomized into two groups: strength training (ST) consisting of eight exercises, three sets of 10 repetitions, intensity of 11 - 13 on 15-grade Borg scale, 2-min interval between sets; and walking training (WT) consisting of walking on a treadmill, 15 bouts of 2-min, intensity of 11 - 13 on 15-grade Borg scale, with a 2-min interval between bouts. Before and after 12 weeks, blood pressure, heart rate and rate pressure product were measured at rest and during a progressive treadmill test until maximal claudication pain. RESULTS: Fifteen patients in each group completed the training program. After the training programs, resting systolic blood pressure (ST:-6 ± 13 mmHg and WT:-3 ± 18 mmHg, P = .04), heart rate (ST: -6 ± 10 bpm and WT:-2 ± 9 bpm, P = .03), and rate pressure product (ST:-1485 ± 1442 mmHg*bpm and WT:- 605 ± 2145 mmHg*bpm, P = .01) decreased significantly and similarly in both groups. Submaximal systolic blood pressure (ST: -14 ± 23 mmHg and WT:-6 ± 23 mmHg, P = .02), and rate pressure product (ST:-1579 ± 3444 mmHg*bpm and WT: -1264 ± 3005 mmHg*bpm, P = .04) decreased significantly and similarly in both groups. There were no changes in submaximal heart rate after ST and WT. Maximal systolic blood pressure, heart rate, and rate pressure product did not change in either group, although maximal exercise time increased similarly in the ST and WT groups (+31 ± 19 %, and +31 ± 32 %, respectively, P < .01). CONCLUSIONS: Strength and walking trainings promoted similar increases in walking capacity and decreases in resting and submaximal exercise cardiovascular load.

Nutritional intervention improves the caloric and proteic ingestion of head and neck cancer patients under radiotherapy.

Malnutrition is commonly associated with head and neck cancer, due especially to anorexia, which is aggravated by radiotherapy. The objective of this study was to evaluate modifications to nutritional ingestion following three types of nutritional intervention. Sixty-four male out-patients (62.1 +/- 1.5 years) were divided into three groups: oral group, (n=32) that received an adapted oral diet; feeding tube group, (n=16) under home enteral nutrition via a nasoenteral feeding tube (6x/day); and supplement group, (n=16) with oral diet associated to oral alimentary supplement between meals (3x/day). The groups were homogeneous and counseled to maintain a caloric ingestion of 40 kcal/kg. The diet for the oral group was adapted to the age and to the side effects of radiotherapyThe nutritional state of the three groups was evaluated for the caloric-proteic ingestion, anthropometric indicators (body weight, body mass index, triceps skinfold thickness, midarm muscle area), laboratorial indicators (total proteins, albumin, hematocrit, hemoglobin and total lymphocytes count), The results showed that all of the groups presented an increase in the ingestion of calories and proteins (p < 0.001). The nutritional therapy support for patients with head and neck cancer under radiotherapy, whether exclusive oral diet, enteral through a feeding tube, or with alimentary supplement associated to an oral diet achieved a significant increase in the total caloric ingestion. It is recommended that programs be implemented-to improve the ingestion of foods among these patients.