Central adiposity as a predictor of mortality in older adults: Identification of cutoffs using generalized additive models.

Background: Obesity is associated with premature mortality in adults; however, this association has been inconsistent in the older adult population. In addition, there is a lack of specific cutoff points for indicators of negative health outcomes in older adults. Methods: This is a prospective study with 796 non-institutionalized older adults. Data on sociodemographic characteristics, lifestyle, food consumption, and nutritional status were obtained at baseline. Generalized additive models were used to identify cutoff points for the waist circumference (WC) and waist-to-height ratio (WHtR) and Cox proportional hazards models to assess the independent association between adiposity and mortality. Results: Over the 9 years of follow-up, 197 deaths (24.7%) occurred, of which 51.8% were men, with a mean age of 76.1 ± 9.0 years. Older adults at higher risk of death had WHtR of <0.52 or ≥0.63 and WC of <83 cm or ≥101 cm. An increased risk of death was observed in older adults with high WC (HR: 2.03 95% CI: 1.20-3.41) and high WHtR (HR: 1.51 95% CI: 1.01-2.26) in the adjusted models, and an increase in WC was a risk factor for higher CVD mortality (HR: 2.09, 95% CI: 1.12-3.88) in the adjusted models. Conclusion: Adiposity was associated with an increased risk of death in older adults. In view of these results and considering the lack of cutoff points for anthropometric indices in Brazilian older adults, further studies are needed to confirm the WC and WHtR cutoff values found in this study.

Calf circumference is an independent predictor of mortality in older adults: An approach with generalized additive models.

BACKGROUND: There is a wide variation in the cutoff points of body mass index (BMI) and calf circumference (CC) , and it is necessary to assess their adequacy in predicting mortality, especially in the older adults in the community. This study aimed to investigate the association of low muscle mass and underweight with mortality in older adults, comparing different cutoff points. METHODS: This was a prospective study that included 796 older adults, not institutionalized, from a Brazilian city. Generalized additive models (GAMs) were used to identify cutoff points for CC and BMI, which were compared with values available in the literature. Survival analysis using Cox regression models was used to assess the independent association between these nutrition indicators and mortality. RESULTS: Over the 9 years of follow-up, 197 deaths (24.7%) occurred. Cutoff points established for CC and BMI as predictors of mortality were, respectively, <34.5 cm and <24.5. In the adjusted Cox models, older adults with a BMI <18.5 showed a significant increase in the risk of death (hazard ratio [HR], 2.57; 95% CI, 1.23-5.35). Higher mortality was observed among older adults with CC <34.5 cm (HR, 1.72; 95% CI, 1.27-2.33) and CC <31 cm (HR, 2.11; 95% CI, 1.44-3.10). CONCLUSION: CC was an independent predictor of mortality, and the cutoff point identified by GAMs was higher than recommended by literature (31 cm). This study suggests a review of cutoff points for CC currently adopted to assess low muscle mass in older adults.

Baixa reserva muscular em pessoas idosas e fatores associados / Low muscle reserve in older adults and associated factors

Resumo Objetivo Estimar a prevalência de baixa reserva muscular e identificar os fatores associados em pessoas idosas. Método Estudo transversal realizado com 784 idosos (60 anos ou mais) não institucionalizados, residentes em Viçosa, Minas Gerais no ano de 2009. As características de interesse foram sociodemográficas, hábitos de vida, condições de saúde e antropométricas. A baixa reserva muscular (BRM) foi definida como o perímetro da perna (PP) < 33 cm para mulheres e < 34 cm para homens. Realizou-se análise descritiva, análise bivariada e múltipla, por meio da regressão de Poisson com variância robusta, para identificar os fatores independentemente associados ao desfecho de interesse. Resultados Mais da metade da amostra era composta por mulheres (52,9%), maior frequência de idosos mais jovens (60 - 69 anos :49,5%), com no máximo quatro anos de estudo (79,9%). A prevalência de baixa reserva muscular foi de 21,7% (IC 95% 18,9%-24,7%) e os fatores independentemente associados foram a faixa etária de 70 a 79 anos (RP:1,31; IC95%: 0,96-1,795), 80 anos ou mais (RP:1,64; IC95%:1,12-2,70), histórico de internação hospitalar (RP: 1,46; IC95%: 1,02-2,09) e baixo peso (RP: 5,45; IC95%:3,77-7,88). Conclusões A prevalência da BRM na amostra é expressiva, se relaciona com a idade mais avançada, hospitalização e com o baixo peso. O monitoramento do PP mostra-se importante para o rastreamento de alterações relacionadas à baixa reserva muscular na pessoa idosa e os fatores associados devem ser considerados nas avaliações antropométricas destinadas a esta população.

Abstract Objective To estimate the prevalence of low muscle reserve and identify associated factors in older people. Method Cross-sectional study carried out with 784 non-institutionalized older people (60 years or older), living in Viçosa, Minas Gerais, in 2009. The characteristics of interest were sociodemographic, life habits, health and anthropometric conditions. Low muscle reserve (LMR) was defined as leg circumference (LC) < 33 cm for women and < 34 cm for men. Descriptive analysis, bivariate and multiple analysis were performed, using Poisson regression with robust variance, to identify the factors independently associated with the outcome of interest. Results More than half of the sample consisted of women (52.9%), more frequently younger seniors (60 - 69 years old :49.5%), with a maximum of four years of study (79.9%). The prevalence of low muscle reserve was 21.7% (95%CI 18.9%-24.7%) and the independently associated factors were the age group from 70 to 79 years (PR:1.31; 95%CI: 0.96-1.795), 80 years or older (PR:1.64; 95%CI:1.12-2.70), history of hospitalization (PR: 1.46; 95%CI: 1.02-2.09) and low weight (PR: 5.45; 95%CI: 3.77-7.88). Conclusions The prevalence of LMR in the sample is expressive, it is related to older age, hospitalization and low weight. LC monitoring is important for tracking changes related to low muscle reserve in older people and associated factors should be considered in anthropometric assessments for this population.

Qualidade da alimentação de idosos longevos e doenças crônicas não transmissíveis / Food quality of long elderly and non-communicable chronic diseases

Avaliou-se a qualidade da alimentação de idosos longevos e sua relação com doenças crônicas não transmissíveis. Foi um estudo transversal, de base populacional, realizado em Viçosa, Minas Gerais, Brasil, o qual integra um projeto maior intitulado "Condições de saúde, nutrição e uso de medicamentos por idosos do município de Viçosa (MG): um inquérito de base populacional". As entrevistas com os idosos foram realizadas por meio de questionário semiestruturado, com a maioria das questões fechadas e pré-codificadas. Os dados do consumo alimentar foram obtidos por recordatório de ingestão habitual e a qualidade da dieta avaliada por meio do Índice de Alimentação Saudável Revisado (IAS-R), validado para a população brasileira. A amostra foi composta por 94 idosos longevos, a maioria do sexo feminino. Os mesmos apresentaram alta ingestão de sódio, baixa ingestão de cereais integrais e IAS-R = 62,22. Idosos diabéticos apresentaram maior ingestão de frutas totais, baixa ingestão de Gord_AA (açúcares, gorduras sólidas e álcool) e IAS-R total maior em comparação aos não diabéticos. As presenças de dislipidemia e hipertensão não alteraram o consumo de nenhum dos componentes. Os resultados indicaram a necessidade de adequação na ingestão alimentar. Assim, intervenções e orientações nutricionais específicas destinadas à promoção da saúde devem ser incentivadas.

The quality of the food of long-lived elderly and its relationship with non-communicable chronic diseases was evaluated. This a cross-sectional study with a population basis that was conducted in Viçosa, Minas Gerais, Brazil, which is part of a larger project entitled "Health, nutrition and drug use by older people in Viçosa (MG): a population-based survey". The interviews with the elderly was conducted through a semi-structured questionnaire, with most questions closed and pre-coded. Food intake data were obtained from the usual intake recall and the quality of the diet was assessed using the Revised Healthy Eating Index (HEI-R), validated for the Brazilian population. The sample consisted of 94 long-lived elderly, most of them female. They presented high sodium intake, low whole grains intake and HEI-R = 62.22. Diabetic older adults had higher total fruit intake, lower intake of Gord_AA (sugars, solid fats, and alcohol) and higher total HEI-R compared to non-diabetics. The presences of dyslipidemia and hypertension did not alter the consumption of any of the components. The results indicated the need for adequacy in food intake. Thus, specific nutritional interventions and guidelines for health promotion should be encouraged.

Healthy Eating Index: Assessment of the Diet Quality of a Brazilian Elderly Population.

BACKGROUND: The food consumption assessment is necessary to monitor elderly's nutritional status because it allows detecting nutrition deficits and guiding the elaboration of effective conducts. OBJECTIVE: The objective of this study is to assess the global quality of the elderly's diet in Viçosa-MG, Brazil. METHODS: This is a population-based cross-sectional study, involving noninstitutionalized elderly. Diet quality was assessed through the Brazilian Healthy Eating Index-Revised (BHEI-R) validated to the Brazilian population. RESULTS: The study comprised 620 elderly individuals. The mean total BHEI-R score was 64.28. The worse consumption scores concerned the components Whole grains, Milk and derivatives, Sodium, Total fruit, and Whole fruit. Approximately 82% scored zero (0%) for Whole grains and 67% for Sodium. Men presented significantly lower scores than women, who have presented maximal score in the same items. Women's scores were not only significantly higher for Total fruit, Whole fruit, Milk and derivatives, but also significantly lower for Saturated fat. DISCUSSION: Most elderly need to improve their diet quality. Strategies heading toward the improvement of diet quality must be priority in policies to health promotion toward the healthy and active aging.

Ingestão de açúcar de adição por estudantes daárea da saúde em uma instituição de ensino de Viçosa, Brasil / Added sugar intake of health area students in an educationalinstitution of Viçosa, Brazil

Evidências mostram que o consumo excessivo de açúcares, pode comprometer a qualidade da alimentação impactandonegativamente na saúde. Assim, o objetivo do presente estudo foi avaliar o consumo de macronutrientes e adequaçãodo consumo de açúcar por estudantes da área da saúde da Universidade Federal de Viçosa, Brasil. Participaram desteestudo 157 mulheres e 30 homens, com faixa etária de 21,3 ± 3,4 anos, apresentando IMC e CC médios de 22,03 ±4,03 kg.m-2 e 72,95 ± 8,96 cm, respectivamente. Foram aplicados questionários semiestruturados e procedeu-se àsavaliações antropométricas e dietéticas dos indivíduos. Os resultados revelaram alta ingestão média diária de açúcarde adição (69,21 ± 5,25 g) que, consequentemente, aumentou o teor de frutose da alimentação (36,22 ± 29,78 g),além de uma baixa ingestão de fibras (15,51 ± 7,30 g). Verificou-se que a ingestão média de açúcar de adição estevesignificativamente (p<0,05) associada ao peso corporal (0,172; p=0,041), IMC (0,181; p=0,031) e consumo dosmacronutrientes e cálcio (0,247; p=0,003). Deve-se considerar a necessidade de implementação de medidas que visempromover mudanças comportamentais importantes no que diz respeito à alimentação de graduandos dos cursos desaúde.

Evidence shows that excessive sugar consumption may impair the quality of feeding affecting negatively on health. Theobjective of this study was evaluated the intake of macronutrients and adequacy of sugar consumption by healthcarestudents of Federal University of Viçosa, Brazil. The study included 157 women and 30 men, aged 21.3 ± 3.4 years,with mean body mass index (BMI) of 22.03 ± 4.03 kg m-2 and waist circumference (WC) of 72.95 ± 8.96 cm. Semistructuredquestionnaires were administered and proceeded to anthropometric and dietary assessments of individuals.The results revealed high average daily intake of added sugar (69.21 ± 5.25 g) which consequently increased the fructosecontent of feeding (36.22 ± 29.78 g), and a low intake of fiber (15.51 ± 7.30 g). It was found that the average intakeof added sugar was significantly (p <0.05) associated to body weight (0.172, p = 0.041), BMI (0.181, p = 0.031) andconsumption of macronutrients and calcium (0.247; p = 0.003). Should consider the need to implement measures topromote significant behavioral changes with regard to the supply of undergraduate health courses.

Systematic review of healthy eating indexes in adults and elderly: applicability and validity / Revisión sistemática de los índices de alimentación saludable de adultos y ancianos: aplicabilidad y validez

Introduction: The Healthy Eating Index (HEI) assesses a combination of different types of foods, nutrients and dietary components. It has been adapted in some countries, considering the local dietary habits. Objective: in this article, the Healthy Eating Indexes published to date were identified by means of a systematic review. Besides, issues relating to their validity, applicability and limitations were discussed. Methods: an electronic search was performed in the PUBMED, SCIENCE DIRECT, BVS and SciELO data base containing studies on the adaptation, review, update or validation of the HEI. The descriptors Healthy Eating Index, Index of Diet Quality, Quality of diet, Diet surveys were used, in different combinations. Results: a total of 11 studies were described and critically analyzed. One of the studies dealt with the development of the index; six proposed adjustments; two assessed validity and reliability of the index, and the other two proposed revision and update. The Healthy Eating Indexes reveal the actual quality of the diet, but the absence of a methodological standard hinders the comparison of the results found in different populations (AU)

Introducción: los índices de alimentación saludable evalúan la combinación de diferentes tipos de alimentos, nutrientes y componentes de la dieta. Estos indicadores han sido adaptados en algunos países considerando las directrices dietéticas locales. Objetivo: esta revisión sistemática identifica todos los índices de alimentación saludable publicados hasta el momento; así mismo, discute la validez, aplicabilidad y limitaciones de los mismos. Métodos: para ello se realizó una búsqueda electrónica en PubMed, Science Direct, BVS y SciELO utilizando los siguientes términos: Healthy Eating Index, Index of Diet Quality, Quality of diet y Diet surveys con diferentes combinaciones e idiomas. Resultados: un total de 11 estudios fueron seleccionados y analizados críticamente: entre ellos, un estudio que desarrolla el primer índice, seis estudios en los que se proponen ajustes en la metodología utilizada, dos estudios que evaluan la validez y la fiabilidade, así como dos de revisión y actualización. Los datos muestran que los índices de alimentación saludable son buenas herramientas para valorar la calidad de la dieta, pero la falta de estandarización en la metodología hace difícil la comparación entre los resultados de las diferentes poblaciones (AU)

Effect of eicosapentaenoic acid and docosahexaenoic acid supplementations to control cognitive decline in dementia and Alzheimer’s disease: a systematic review / Efecto de la suplementación del ácido eicosapentaenoico y ácido docosahexaenoico para controlar el deterioro cognitivo en la demencia y enfermedad de alzheimer: una revisión sistemática

Introduction: there is a lack of consensus on the benefits of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) supplementations on cognition in dementia and/or Alzheimer’s disease (AD) elderly. Objective: this study presents a systematic review of the results of randomized clinical trials about this topic. The adopted search criteria were randomized clinical trials involving elderly over 65 years of age with no limit to the year of publication of the study. Results: we identified 139 articles, and from the eligible ones a reverse search was conducted. The quality of the trials was assessed using the Jadad scale. Of the four selected studies, three were related to mild to moderate AD elderly, of both genders. Mini Mental State Examination, Alzheimer’s Disease Assessment Scale Cognitive, and Clinical Dementia Rate were the main tests used to assess cognitive performance. Conclusion: EPA and/or DHA supplementations did not affect scores obtained on the cognitive tests. However, supplementation with EPA and/or DHA improved verbal fluency and attention in patients who had only very mild dementia or AD or presented APOEε4 negative genotype. In case of advanced AD elderly patients, EPA and/or DHA supplementations did not reduce cognitive decline rates (AU)

Introducción: no existe consenso sobre los beneficios de la suplementación con ácido eicosapentaenoico (EPA) y ácido docosahexaenoico (DHA) sobre la cognición de las personas mayores con demencia y/o Alzheimer. Objetivo: esta revisión sistemática muestra los resultados de ensayos clínicos randomizados al respecto. Métodos: se realizó una búsqueda de ensayos clínicos randomizados llevados a cabo en personas mayores de 65 años, sin estabelecer límites en cuanto al año de publicación. Resultados: se identificaron 139 artículos y a partir de los artículos candidatos se llevó a cabo una búsqueda inversa. La calidad de los ensayos clínicos aleatorios se evaluó mediante la escala de Jadad. De los cuatro estudios seleccionados, tres valoraban ancianos, con diagnóstico de enfermedad de Alzheimer de leve a moderada, en ambos sexos. Mini Examen del Estado Mental, Enfermedad de Alzheimer, Escala de Evaluación Cognitiva y Tasa Clí- nica de Demencia fueron los principales test utilizados para estudiar el rendimiento cognitivo. Conclusión: la suplementación de EPA y/o DHA no afectó las puntuaciones en las pruebas cognitivas. Sin embargo, la suplementación con EPA y/o DHA mejoró la cognición en los dominios de fluidez y de atención verbales en pacientes que únicamente presentaban demencia leve o enfermedad de Alzheimer o el genotipo APOEε4 negativo. En los pacientes ancianos con enfermedad de Alzheimer avanzada, la suplementación con EPA y/o DHA no redujo las tasas de deterioro cognitivo (AU)