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1.
Clin Nutr ; 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31685303

RESUMO

BACKGROUND & AIMS: Dietary diversity is widely advocated in national and international recommendations although whether the beneficial effects on survival or longevity still apply in the final phase of the lifespan remains understudied. We aimed to prospectively examine the association of dietary diversity, food items with all-cause mortality among the oldest old (80+) and determine whether dietary diversity recommendations were appropriate for this population. METHODS: The study included 28,790 participants aged 80+ (9957 octogenarians, 9925 nonagenarians, and 8908 centenarians). A baseline dietary diversity score (DDS) was constructed based on nine food items of a food frequency questionnaire. Cox models with penalized splines evaluated non-linear associations of DDS as continuous variable with mortality to identify cut-offs of DDS. RESULTS: We documented 23,503 deaths during 96,739 person-years of follow-up. Each one unit increase in DDS was associated with a 9% lower risk of mortality (adjusted hazard ratio (HR): 0.91; 95% confidential interval (CI): 0.90-0.92). Compared to participants whose DDS less than 2 scores, those with a DDS of 2, 3, 4, 5, and higher than 6 scores had a lower mortality risk, the HRs were 0.86 (0.82-0.89), 0.78 (0.75-0.81), 0.69 (0.66-0.72), 0.65 (0.62-0.68), and 0.56 (0.53-0.58) respectively, and a significant trend emerged (p < 0.001). Protein-rich food items were associated with prominent beneficial effects on mortality including meat (HR and 95% CI for high vs low frequency: 0.70 (0.68-0.72)), fish and sea food (HR, 0.74 (0.72-0.77)), egg (HR, 0.75 (0.73-0.77)), and bean (HR, 0.80 (0.78-0.82)). CONCLUSIONS: Even after the age of 80, the DDS tool may offer a simple and straightforward mean of identifying and screening individuals at high risk for mortality. Recommendation of dietary diversity, especially consumption of protein-rich food, may be advocated to reduce mortality risk and promote longevity in the oldest old.

2.
Pediatr Obes ; : e12584, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31689002

RESUMO

BACKGROUND: Macrosomia is associated with both neonatal complications and adult diseases (obesity, diabetes mellitus, etc.). Previous studies have reported maternal exposure to PM2.5 might influence metabolism and fetal development and cause adverse pregnancy outcomes. Studies conducted in areas with low PM2.5 concentration have found relationship between gestational PM2.5 exposure and birth weight. However, the impact of air pollution on macrosomia has not been studied, especially in highly polluted areas. OBJECTIVE: To evaluate the association between fine particulate matter (PM2.5) exposure during pregnancy and the risk of macrosomia. METHODS: Data from preconception health examination and prenatal and postnatal records were collected from 1 January 2010 to 31 December 2012 in the National Free Preconception Health Examination Project. Monthly mean of PM2.5 concentration during pregnancy was estimated from satellite data using an ensemble machine learning model. A newborn with birth weight above 4000 g was defined as macrosomia. Logistic regression models were used to examine the association between maternal exposure to PM2.5 and the risk of macrosomia, after adjusting for maternal age, pre-pregnancy body mass index, parity, neonatal sex, duration of gestation, seasonality, educational level, smoking and drinking habits, past history of diabetes mellitus and hypertension, and family history of diabetes mellitus. Restricted cubic spline models were used to evaluate the dose-response relationship between the risk of macrosomia and PM2.5 concentration. RESULTS: Of 177 841 singleton nonlow birth weight newborns included, 14 598 (8.2%) had macrosomia. The mean PM2.5 concentrations were 70.7, 71.5, and 80.9 µg/m3 in the first, second, and third trimesters. In full-adjusted logistic regression models, significant associations were found between increased risk of macrosomia and every 10 µg/m3 increase of PM2.5 concentration over the first (odds ratio [OR]: 1.045; 95% CI, 1.037-1.052), second (OR: 1.035; 95% CI, 1.028-1.043), and third (OR: 1.033; 95% CI, 1.026-1.039) trimesters. There was a nonlinear does-response association between PM2.5 concentration and the risk of macrosomia. CONCLUSIONS: Maternal exposure to PM2.5 during pregnancy was associated with an increased risk of macrosomia in China.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31603986

RESUMO

BACKGROUND: Evidence of the trend of the incidence of activities of daily living (ADL) disability among Chinese older people is limited. We aimed to investigate the time trends and potential risk factors for the incidence of ADL disability among Chinese elderly (65+ years). METHODS: We established two consecutive and non-overlapping cohorts (6,857 participants in the 2002 cohort and 5,589 participants in the 2008 cohort) from the Chinese Longitudinal Healthy Longevity Survey. ADL disability was defined as the need for assistance with at least one essential activity (dressing, bathing, toileting, eating, indoor activities, and continence). Cox proportional hazards models were used to identify factors associated with the trend in the incidence of ADL disability from 2002 to 2014. RESULTS: The incidence (per 1,000 person-years) of ADL disability decreased significantly from 64.2 in the 2002 cohort to 46.6 in the 2008 cohort (P <0.001), and decreasing trends in the incidence of ADL disability were observed for all sex, age and residence subgroups (all P < 0.001), even after adjusting for multiple potential confounding factors. Moreover, we found that adjustment for sociodemographic, lifestyle information, and cardiovascular risk factors (hypertension, diabetes, heart disease and stroke) explained less of the decline in ADL disability during the period from 2002 to 2014. CONCLUSION: The incidence of ADL disability among the elderly in China appears to have decreased during the study period, and this finding cannot be explained by existing sociodemographic and lifestyle information and cardiovascular risk factors.

4.
BMJ Open ; 9(10): e026513, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31601581

RESUMO

PURPOSE: The Chinese Longitudinal Healthy Longevity Survey Biomarkers Cohort (Healthy Ageing and Biomarkers Cohort Study (HABCS)) was established to investigate the determinants of healthy aging and mortality among the oldest old in China. Besides collecting health status, behavioural and sociodemographic circumstances, the present study also gathers comprehensive data for the elderly by simultaneously collecting, detecting, analysing blood and urine, respectively. PARTICIPANTS: HABCS is a community-based longitudinal multiwave study of older men and women aged 65 or above. Baseline survey and the follow-up surveys with replacement for deceased elderly were conducted in eight longevity areas in China, which cover the northern, middle and southern parts of China. Between 2008 and 2017, 6333 participants were included in HABCS, comprising 1385 centenarians, 1350 nonagenarians, 1294 octogenarians, 1577 younger elderly (aged 65-79). FINDINGS TO DATE: We have found that higher baseline levels of (1) total cholesterol, (2) low-density lipoprotein cholesterol (LDL-C) and (3) superoxide dismutase activity were associated with greater cognitive decline. While (4) higher LDL-C level was associated with lower risk of all-cause mortality. There was a reverse association between (5) plasma vitamin D and cognitive impairment in cross-sectional and prospective study. FUTURE PLANS: We are currently exploring the relationships between various biomarkers and different outcomes such as cognitive function and mortality. This longitudinal cohort study will be continued in the future.

5.
J Am Med Dir Assoc ; 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31588027

RESUMO

OBJECTIVE: To investigate associations between leisure activities, examining each activity separately and in combination, and all-cause mortality among the Chinese oldest-old (≥80 years) population. DESIGN: Prospective cohort study. SETTING: Community-living, the oldest-old from 22 provinces in China. PARTICIPANTS: We included 30,070 Chinese individuals aged ≥80 years (mean age: 92.7 years) from the Chinese Longitudinal Healthy Longevity Survey from 1998 to 2014. MEASUREMENTS: Cox proportional hazards models were used to estimate relationships between leisure activities and all-cause mortality, adjusting for covariates including sociodemographic and lifestyle factors, self-reported medical history, and other potential confounders. RESULTS: During 110,278 person-years of follow-up, 23,661 deaths were documented. Participants who engaged in watching TV or listening to the radio, playing cards or mah-jong, reading books or newspapers, gardening, keeping domestic animals or pets, or attending religious activities "almost every day" had a significantly lower mortality risk (adjusted hazard ratios ranged from 0.82 to 0.89; P < .01 for all) than did participants who "never" engaged in those activities. Furthermore, engagement in multiple leisure activities was associated with a reduced risk of all-cause mortality (P for the trend < .001). CONCLUSIONS AND IMPLICATIONS: Frequent participation in leisure activities might help decrease the risk of death in the Chinese oldest-old population. This finding has important implications for public health policy and encourages the incorporation of a broad range of leisure activities into the daily lives of oldest-old individuals.

6.
Chemosphere ; 237: 124412, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31376695

RESUMO

BACKGROUND: The association between multiple metal concentrations and gestational diabetes mellitus (GDM) is poorly understood. METHODS: A total of 776 women with GDM and an equal number of controls were included in the study. Concentrations of metals in participants' blood (nickel (Ni), arsenic (As), cadmium (Cd), antimony (Sb), thallium (Tl), mercury (Hg), lead (Pb)) were measured using inductively coupled plasma-mass. We used unconditional logistical regression models to estimate the associations between metals and GDM. We also employed weighted quantile sum (WQS) regression and principal components analysis (PCA) to examine metal mixtures in relation to GDM. RESULTS: An increased risk of GDM was associated with As (OR = 1.49, 95% CI: 1.11, 2.01 for the 2nd tertile vs. the 1st tertile) and Hg (OR = 1.43, 95% CI: 1.09, 1.88 for the 3rd tertile vs. the 1st tertile). In WQS analysis, the WQS index was significantly associated with GDM (OR = 1.20, 95% CI: 1.02, 1.41). The major contributor to the metal mixture index was Hg (69.2%), followed by Pb (12.8%), and As (11.3%). Based on PCA, the second principal component, which was characterized by Hg, Ni, and Pb, was associated with an increased risk of GDM (OR = 1.46, 95% CI: 1.02, 2.08 for the highest quartile vs. the lowest quartile). CONCLUSIONS: Our study results suggest that high metal levels are associated with an increased risk of GDM, and this increased risk is mainly driven by Hg and, to a lesser extent, by Ni, Pb, and As.

7.
Artigo em Inglês | MEDLINE | ID: mdl-31435643

RESUMO

BACKGROUND: The aim of this study was to examine the trends in impairment regarding activities of daily living (ADL), physical performance and cognitive function among the oldest-old (those aged ≥80 years) in China between 1998 and 2014. METHODS: We used data on 34,297 oldest-old individuals from the seven waves of the Chinese Longitudinal Healthy Longevity Study. We estimated age, period and cohort effects on the prevalence of self-reported ADL impairment, tested physical performance and cognitive function impairment using the age-period-cohort (APC) model. RESULTS: Regarding age, the prevalence of ADL, physical and cognitive impairment were highest in the centenarians, but they did not increase with age in this population. Among the literate subgroup, the prevalence of cognitive impairment increased more rapidly with age than that in the illiterate subgroup. Regarding period, the prevalence of self-reported and tested physical impairment slowly increased between 1998 and 2014, but cognitive impairment remained stable. Regarding cohort, ADL impairment continuously decreased. However, physical and cognitive impairment remained stable after a brief decline in the early birth cohorts. CONCLUSIONS: The results suggest that the age effect is still the most obvious effect regarding several types of functional impairment. The likelihood of a younger person experiencing functional impairment may not change significantly, but ADL is likely to be amenable to improvement resulting from improved medical and social care. Therefore, increased care for the elderly may considerably improve their quality of life, particularly regarding their basic activities of daily living.

8.
J Cell Biochem ; 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31385350

RESUMO

Small for gestational age (SGA) has a high risk of mortality and morbidity and is common in obstetrics. To date, no effective prediction and treatment tools are available. Acting as microRNA (miRNA) sponges and disease biomarkers are clear functions of circular RNAs (circRNAs). However, it is still unknown what role circRNAs act in SGA. To explore the role of circRNAs in SGA, circRNA expression patterns of the umbilical cord and maternal plasma in SGA was assessed. We first evaluated circRNAs in umbilical cord blood of the SGA and appropriate for gestational age (AGA) groups by microarray sequencing. In total, 170 340 circRNAs were sequenced, and 144 circRNAs were significantly upregulated while 977 were markedly downregulated. Has_circRNA15994-13, has_circ_0001359, and has_circ_0001360 were abundant and differentially expressed between the SGA and AGA groups, and confirmed in the umbilical cord and maternal blood specimens by reverse transcription polymerase chain reaction. By combining miRNA microarray data of the SGA placenta tissue in NCBI, it was found that two miRNAs were both hsa_circRNA15994-13 targets and differentially expressed, including hsa-miR-3619-5p and hsa-miR-4741. Further KEEG analysis revealed that the most significant pathway enriched by hsa-miR-3619-5p was Wnt signaling that is closely related to SGA; meanwhile, previous reports demonstrated that hsa-miR-3619-5p directly binds to ß-catenin to accommodate the Wnt/ß-catenin pathway, whereby the suggestive hsa_circRNA15994-13 → hsa-miR-3619-5p → ß-catenin signaling pathway may play an important part in SGA.

9.
Nutrients ; 11(7)2019 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-31262080

RESUMO

In vitro and in vivo experimental studies have shown garlic has protective effects on the aging process; however, there is no evidence that garlic consumption is associated with all-cause mortality among oldest-old individuals (≥80 years). From 1998 to 2011, 27,437 oldest-old participants (mean age: 92.9 years) were recruited from 23 provinces in China. The frequencies of garlic consumption at baseline and at age 60 were collected. Cox proportional hazards models adjusted for potential covariates were constructed to estimate hazard ratios (HRs) relating garlic consumption to all-cause mortality. Among 92,505 person-years of follow-up from baseline to September 1, 2014, 22,321 participants died. Participants who often (≥5 times/week) or occasionally (1-4 times/week) consumed garlic survived longer than those who rarely (less than once/week) consumed it (p < 0.001). Participants who consumed garlic occasionally or often had a lower risk for mortality than those who rarely consumed garlic at baseline; the adjusted HRs for mortality were 0.92(0.89-0.94) and 0.89(0.85-0.92), respectively. The inverse associations between garlic consumption and all-cause mortality were robust in sensitivity analyses and subgroup analyses. In this study, habitual consumption of garlic was associated with a lower all-cause mortality risk; this advocates further investigation into garlic consumption for promoting longevity.

10.
Ann Vasc Surg ; 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31201972

RESUMO

BACKGROUND: Despite aggressive limb salvage attempts, military popliteal artery injuries are associated with high amputation rates. Combined arterial and venous injuries present a management dilemma for military surgeons in austere settings, and the impact of vein injury management strategy on limb outcomes is not clear. METHODS: Military casualties sustaining combined ipsilateral popliteal artery and vein injuries from 2003 to 2016 were identified from a military vascular injury database. Limbs were grouped based on whether venous ligation or repair was initially performed. The primary outcome was secondary amputation; the secondary outcomes included limb and vascular/graft complications. RESULTS: Fifty-six limbs were included; of which, 27 (48%) were managed with vein ligation and 29 (52%) with repair. Veins were repaired primarily in 13 (45%) cases with the remainder being treated with interposition grafts. Median injury severity score was higher in the ligation group (19 vs 15, P = 0.09), but vascular and concomitant limb injury characteristics were similar. Amputation rates did not differ by vein treatment (45% repair vs. 41% ligation, P = 0.76), and this held with injuries above and below the knee considered independently. Most (71%) amputations were performed <30 days from injury. Amputation was indicated more frequently for vascular repair failure in the ligated group (55% vs 15%, P = 0.04). Four graft infections were all in the repair group (P = 0.07 vs ligation). Arterial graft complications were more frequent with vein repair (45%) than ligation (30%), but this did not reach significance (P = 0.24). Only one deep vein thrombosis was diagnosed in each group (P = 0.96). CONCLUSIONS: Type of management of concomitant popliteal vein injury was not associated with early or late amputation in this series of military popliteal artery injuries. Vein injury management may have had implications for the development of arterial graft and limb complications, however. Surgical decision-making regarding popliteal vein treatment should balance short-term contingencies with long-term limb salvage issues.

11.
Artigo em Inglês | MEDLINE | ID: mdl-30946444

RESUMO

Little is known about the role of specific leisure activities in affecting cognitive functions. We aim to examine the associations of specific leisure activities with the risk of cognitive impairment among oldest-old people in China. This community-based prospective cohort study included 10,741 cognitively normal Chinese individuals aged 80 years or older (median age 88 years) from the Chinese Longitudinal Healthy Longevity Survey. Cognitive function was assessed using the Mini-mental State Examination (MMSE). Cox proportional hazards models were utilized to estimate the effects of specific leisure activities on cognitive impairment outcome. During a median follow-up time of 3.4 years (41,760 person-years), 2,894 participants developed cognitive impairment. Compared to those who 'never' engaged in watching TV or listening to radio, reading books or newspapers, and playing cards or mah-jong, those who engaged in such activities 'almost every day' reduced their risk of cognitive impairment, the fully adjusted HRs were 0.56 (0.51-0.61), 0.64 (0.53-0.78), and 0.70 (0.56-0.86), respectively. The association between the risk of cognitive impairment and watching TV and listening to the radio, playing cards or mah-jong, and reading books or newspapers were stronger among those who had 2 or more years of education. Moreover, the association between risk of cognitive impairment and watching TV and listening to radio was stronger in men than in women. In conclusion, a greater frequency of TV watching or radio listening, reading books or newspapers and playing cards or mah-jong may decrease the risk of cognitive impairment among the oldest-old.

12.
BMC Geriatr ; 19(1): 104, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30987591

RESUMO

BACKGROUND: Oxidative stress is an important theory of aging but population-based evidence has been lacking. This study aimed to evaluate the associations between biomarkers of oxidative stress, including plasma superoxide dismutase (SOD) activity and malondialdehyde (MDA), with all-cause mortality in older adults. METHODS: This is a community-based cohort study of 2224 participants (women:1227, median age: 86 years). We included individuals aged 65 or above and with plasma SOD activity and/or MDA tests at baseline. We evaluated the hazard ratios (HRs) and 95% confidence intervals (CIs) by multivariable Cox models. RESULTS: We documented 858 deaths during six years of follow-up. There was a significant interaction effect of sex with the association between SOD activity and mortality (P < 0.001). Compared with the lowest quintile, the risk of all-cause mortality was inversely associated with increasing quintiles of plasma SOD activity in women(P-trend< 0.001), with adjusted HRs for the second through fifth quintiles of 0.73 (95% CI 0.53-1.02), 0.52(95% CI 0.38-0.72), 0.53(95% CI 0.39-0.73), and 0.48(95% CI 0.35-0.66). There were no significant associations between SOD activity and mortality in men (P-trend = 0.64), and between MDA and mortality in all participants (P-trend = 0.79). CONCLUSIONS: Increased activity of SOD was independently associated with lower all-cause mortality in older women but not in men. This epidemiological study lent support for the free radical/oxidative stress theory of aging.

13.
J Nutr ; 149(6): 1056-1064, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30949685

RESUMO

BACKGROUND: High concentrations of plasma 25-hydroxyvitamin D [25(OH)D], a marker of circulating vitamin D, have been associated with a lower risk of mortality in epidemiologic studies of multiple populations, but the association for Chinese adults aged ≥80 y (oldest old) remains unclear. OBJECTIVE: We investigated the association between plasma [25(OH)D] concentration and all-cause mortality among Chinese adults aged ≥80 y. DESIGN: The present study is a prospective cohort study of 2185 Chinese older adults (median age: 93 y). Prospective all-cause mortality data were analyzed for survival in relation to plasma 25(OH)D using Cox proportional hazards regression models, with adjustments for potential sociodemographic and lifestyle confounders and biomarkers. The associations were measured with HR and 95% CIs. RESULTS: The median plasma 25(OH)D concentration was 34.4 nmol/L at baseline. Over the 5466 person-year follow-up period, 1100 deaths were identified. Men and women were analyzed together as no effect modification by sex was found. After adjusting for multiple potential confounders, the risk of all-cause mortality decreased as the plasma 25(OH)D concentration increased (P-trend <0.01). Compared with the lowest age-specific quartile of plasma 25(OH)D, the adjusted HRs for mortality for the second, third, and fourth age-specific quartiles were 0.72 (95% CI: 0.57, 0.90), 0.73 (95% CI: 0.58, 0.93), and 0.61 (95% CI: 0.47, 0.81), respectively. The observed associations were broadly consistent across age and other subgroups. Sensitivity analyses generated similar results after excluding participants who died within 2 y of follow-up or after further adjustment for ethnicity and chronic diseases. CONCLUSIONS: A higher plasma 25-hydroxyvitamin D concentration was associated with a reduced risk of all-cause mortality among Chinese adults aged ≥80 y. This observed inverse association warrants further investigation in randomized controlled trials testing vitamin D supplementation in this age group.

14.
J Clin Endocrinol Metab ; 104(8): 3370-3378, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30869791

RESUMO

CONTEXT: The patterns of the association between high-density lipoprotein cholesterol (HDL-C) concentrations and mortality among the elderly are still unclear. OBJECTIVE: To examine the association of HDL-C concentrations with mortality and to identify the optimal HDL-C concentration range that predicts the lowest risk of all-cause mortality among the elderly. DESIGN: This was a nationwide, community-based, prospective cohort study. PARTICIPANTS: This study included 7766 elderly individuals (aged ≥65 years; mean age: 74.4 years) from the Health and Retirement Study. Cox proportional hazards models and Cox models with penalized smoothing splines were used to estimate hazard ratios (HRs) with 95% CI for all-cause and cause-specific mortality. RESULTS: During a median follow-up of 5.9 years, 1921 deaths occurred. After a full adjustment for covariates, a nonlinear (P < 0.001 for nonlinearity) association was found between HDL-C and all-cause mortality [minimum mortality risk at 71 mg/dL (1.84 mM)]; the risk for all-cause mortality was significantly higher in the groups with HDL-C concentration <61 mg/dL (1.58 mM; HR: 1.18; 95% CI: 1.05 to 1.33) and with HDL-C concentration >87 mg/dL (2.25 mM; HR: 1.56; 95% CI: 1.17 to 2.07) than in the group with HDL-C concentrations ranging from 61 to 87 mg/dL (1.58 to 2.25 mM). Nonlinear associations of HDL-C concentrations with both cardiovascular and noncardiovascular mortality were also observed (both P < 0.001 for nonlinearity). CONCLUSIONS: Among the elderly, nonlinear associations were found between HDL-C and all-cause and cardiovascular mortality. The single optimal HDL-C concentration and range were 71 mg/dL and 61 to 87 mg/dL, respectively.

15.
J Clin Endocrinol Metab ; 104(8): 3345-3354, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30896760

RESUMO

CONTEXT: The patterns of associations between glycated Hb (HbA1c) and mortality are still unclear. OBJECTIVE: To explore the extent to which ranges of HbA1c levels are associated with the risk of mortality among participants with and without diabetes. DESIGN, SETTING, AND PATIENTS: This was a nationwide, community-based prospective cohort study. Included were 15,869 participants (median age 64 years) of the Health and Retirement Study, with available HbA1c data and without a history of cancer. Cox proportional hazards regression models were used to estimate hazard ratios with 95% CIs for mortality. RESULTS: A total of 2133 participants died during a median follow-up of 5.8 years. In participants with diabetes, those with an HbA1c level of 6.5% were at the lowest risk of all-cause mortality. When HbA1c level was <5.6% or >7.4%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 6.5%. As for participants without diabetes, those with an HbA1c level of 5.4% were at the lowest risk of all-cause mortality. When the HbA1c level was <5.0%, the increased all-cause mortality risk became statistically significant as compared with an HbA1c level of 5.4%. However, we did not observe a statistically significant elevated risk of all-cause mortality above an HbA1c level of 5.4%. CONCLUSIONS: A U-shaped and reverse J-shaped association for all-cause mortality was found among participants with and without diabetes. The corresponding optimal ranges for overall survival are predicted to be 5.6% and 7.4% and 5.0% and 6.5%, respectively.

16.
Nutrients ; 11(3)2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30889808

RESUMO

The association between dietary diversity (DD) and psychological resilience among older people is an underdeveloped area of research. This cross-sectional study explored the associations of DD with psychological resilience among 8571 community-based elderly individuals. The intake frequencies of food groups were collected, and dietary diversity was assessed based on the mean DD score. Psychological resilience was assessed using a simplified resilience score (SRS). Data were analyzed using multiple linear regression and logistic regression models. Poor DD was significantly associated with psychological resilience, with a ß (95% CI) of -0.94 (-1.07, -0.81) for the SRS (p < 0.01) and an odds ratio (95% CI) of 1.83 (1.66, 2.01) for low SRS status. The interaction effects of age with DD were observed for the SRS (p < 0.001) and low SRS status (p < 0.001). Based on separate analyses by age group, the association of a low SRS with poor DD was more prominent in the younger elderly than the oldest old, with OR (95% CI) 2.32 (1.96, 2.74) and 1.61 (1.43, 1.82), respectively. Compared with younger participants with good DD, the risk of a low SRS was greater for younger participants with poor DD, the oldest old with good DD, and the oldest old with poor DD, with OR (95% CI) 2.39 (2.02, 2.81), 1.28 (1.09, 1.51), and 2.03 (1.72, 2.39), respectively. The greatest contribution to DD was from a high consumption of vegetables, fruits, and nuts. Our study suggested that poor DD was associated with a low psychological resilience among the Chinese elderly, especially the younger elderly. These findings suggest that augmentation of DD might promote psychological resilience.


Assuntos
Adaptação Psicológica , Dieta/psicologia , Comportamento Alimentar/psicologia , Avaliação Geriátrica , Resiliência Psicológica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Razão de Chances
17.
Environ Int ; 125: 245-251, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30731374

RESUMO

Studies worldwide have estimated the number of deaths attributable to long-term exposure to fine airborne particles (PM2.5), but limited information is available on short-term exposure, particularly in China. In addition, most existing studies have assumed that short-term PM2.5-mortality associations were linear. For this reason, the use of linear exposure-response functions for calculating disease burden of short-term exposure to PM2.5 in China may not be appropriate. There is an urgent need for a comprehensive, evidence-based assessment of the disease burden related to short-term PM2.5 exposure in China. Here, we explored the non-linear association between short-term PM2.5 exposure and all-cause mortality in 104 counties in China; estimated county-specific mortality burdens attributable to short-term PM2.5 exposure for all counties in the country and analyzed spatial characteristics of the mortality burden due to short-term PM2.5 exposure in China. The pooled PM2.5-mortality association was non-linear, with a reversed J-shape. We found an approximately linear increased risk of mortality from 0 to 62 µg/m3 and decreased risk from 62 to 250 µg/m3. We estimated a total of 169,862 additional deaths from short-term PM2.5 exposure throughout China in 2015. Models using linear exposure-response functions for the PM2.5-mortality association estimated 32,186 deaths attributable to PM2.5 exposure, which is 5.3 times lower than estimates from the non-linear effect model. Short-term PM2.5 exposure contributed greatly to the death burden in China, approximately one seventh of the estimates from the chronic effect. It is essential and crucial to incorporate short-term PM2.5-related mortality estimations when considering the disease burden attributable to PM2.5 in developing countries such as China. Traditional linear effect models likely underestimated the mortality burden due to short-term exposure to PM2.5.


Assuntos
Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Mortalidade , Material Particulado/toxicidade , China , Humanos , Material Particulado/análise , Análise Espacial
18.
J Am Geriatr Soc ; 67(4): 741-748, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30628728

RESUMO

OBJECTIVES: Currently, most treatment guidelines suggest lowering hypertriglyceridemia of any severity, even in elderly individuals. However associations of serum triglycerides (TGs) with adverse health and mortality risk decrease with age, it remains unclear among the oldest old (aged 80 years and older). The study was to investigate the relationship of serum TG concentrations with cognitive function, activities of daily living (ADLs), frailty, and mortality among the oldest old in a prospective cohort study. DESIGN: Longitudinal prospective cohort study. SETTING: Community-based setting in longevity areas in China. PARTICIPANTS: A total of 930 (mean age = 94.0 years) Chinese oldest old. MEASUREMENTS: The TG concentrations were measured at baseline survey in 2009. Cognitive function, ADLs, frailty, and mortality were determined over 5 years of follow-up. Cox proportional hazards models and competing risk models were performed to explore the association, adjusting for potential confounders. RESULTS: Each 1-mmol/L increase in TGs was associated with a nearly 20% lower risk of cognitive decline, ADL decline, and frailty aggravation during the 5 years of follow-up. Consistently, higher TGs (each 1 mmol/L) was associated with lower 5-year all-cause mortality after fully adjustment (hazard ratio [HR] = 0.79; 95% confidence interval [CI] = 0.69-0.89). Nonelevated TG concentrations (less than 2.26 mmol/L) were associated with higher mortality risk (HR = 1.72; 95% CI = 1.22-2.44), relative to TGs of 2.26 mmol/L or more. We observed similar results regarding TG concentrations and mortality in 1-year lag analysis and when excluding participants with identified chronic disease. CONCLUSION: In the oldest old, a higher concentration of TGs was associated with a lower risk of cognitive decline, ADL decline, frailty aggravation, and mortality. This paradox suggests the clinical importance of revisiting the concept of "the lower the better" for the oldest old. J Am Geriatr Soc 67:741-748, 2019.

20.
Lancet Public Health ; 3(10): e470-e477, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30314593

RESUMO

BACKGROUND: Evidence from cohort studies in North America and Europe indicates that long-term exposure to fine particulate matter (PM2·5) is associated with an increased mortality risk. However, this association has rarely been quantified at higher ambient concentrations. We estimated the hazard ratio (HR) for all-cause mortality from long-term exposure to PM2·5 in a well established Chinese cohort of older adults. METHODS: The Chinese Longitudinal Healthy Longevity Survey (CLHLS) is a prospective cohort study of men and women aged 65 years and older enrolled in 2008 and followed up through 2014 for mortality events. We studied individuals for whom residential locations were available in 2008 for linkage to 1 km grids of PM2·5 concentrations, derived from satellite remote sensing. Cox proportional hazards models were used to estimate the effect of long-term exposure to PM2·5 on all-cause mortality, controlling for age, sex, smoking status, drinking status, physical activity, body-mass index, household income, marital status, and education. We then used our results to estimate premature mortality related to PM2·5 exposure in the population aged 65 years and older in China in 2010. FINDINGS: 13 344 individuals in the CLHLS cohort had data for all timepoints, yielding follow-up data for 49 440 person-years. In a 3-year window, these individuals were exposed to a median PM2·5 concentration of 50·7 µg/m3 (range 6·7-113·3). The overall HR for a 10 µg/m3 increase in this value was 1·08 (95% CI 1·06-1·09). In stratified analyses, HRs were higher in rural than in urban locations, in southern versus northern regions, and with exposure to lower versus higher PM2·5 concentrations. Based on the overall HR, we estimated that 1 765 820 people aged 65 years and older in China in 2010 had premature mortality related to PM2·5 exposure. INTERPRETATION: Long-term exposure to PM2·5 is associated with an increased risk of all-cause mortality among adults aged 65 years and older in China, but the magnitude of the risk declines as the concentration of PM2·5 increases. FUNDING: National Natural Science Foundation of China, National High-Level Talents Special Support Plan of China for Young Talents, US National Aeronautics and Space Administration, and the Columbia University Global Policy Initiative.

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