Number of natural teeth, denture use and mortality in Chinese elderly: a population-based prospective cohort study.

BACKGROUND: The associations between the number of natural teeth/denture use and all-cause mortality remain unclear due to lake of investigation for the potential interaction between tooth loss and denture use and for the potential changes in these exposures over time in older adults. We undertake this study to evaluate the associations of the number of natural teeth and/or denture use with mortality in Chinese elderly. METHODS: This is a prospective cohort study of 36,283 older adults (median age: 90). The number of natural teeth and denture use were collected with structured questionnaire. We evaluated hazard ratios (HRs) and confidence intervals (CIs) using a Cox proportional hazards model adjusting for demographic factors, education, income, lifestyle factors, and comorbidities. RESULTS: We documented 25,857 deaths during 145,947 person-years of observation. Compared to those with 20+ teeth, tooth loss was associated with a gradual increase in mortality, with an adjusted HR of 1.14 (95% CI, 1.06 to 1.23) for those with 10-19 teeth, 1.23 (95% CI, 1.15 to 1.31) for those with 1-9 teeth, and 1.35 (95% CI, 1.26 to 1.44) for those without natural teeth. Denture use was associated with lower risk of mortality (adjusted HR 0.81; 95% CI, 0.77 to 0.84). Subgroup analyses indicated that the benefit of denture use was greater in men than in women (P = 0.02) and tended to decrease with age (P < 0.001). The effects of denture use did not differ among various degrees of tooth loss (P = 0.17). CONCLUSIONS: Tooth loss was associated with an increased risk of mortality in older adults. Denture use provided a protective effect against death for all degrees of tooth loss however, this effect appeared to be modified by sex and age.

Plasma 25-Hydroxyvitamin D Concentrations Are Inversely Associated with All-Cause Mortality among a Prospective Cohort of Chinese Adults Aged ≥80 Years.

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.

Associations between superoxide dismutase, malondialdehyde and all-cause mortality in older adults: a community-based cohort study.

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.

The Status and Associated Factors of Successful Aging among Older Adults Residing in Longevity Areas in China.

OBJECTIVE: This study aims to assess the status of successful aging (SA) in longevity areas in China and explore multiple factors associated with SA among the young-old and oldest-old. METHODS: A total of 2296 elderly people aged 65 and older were interviewed in the longevity areas sub-sample of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2012. Baseline assessments included a researcher-administered questionnaire, physical examination, and laboratory testing. A logistic regression model was used to identify factors associated with SA. RESULTS: The prevalence of SA was 38.81% in the CLHLS in 2012. There were significant differences between ages groups, with SA compromising 56.85% among ⋝65 years group and 20.31% among ⋝100 years group (χ2trend=126.73, P<0.01). The prevalence of SA among females was 33.59%, which was significantly lower than that among males (45.58%) (χ2gender=33.65, P<0.05). In the regression analysis, having anemia (OR=0.744, 95% CI: 0.609-0.910), poor lifestyle (OR=0.697, 95% CI: 0.568-0.854), poor sleep quality (OR=0.558, 95% CI: 0.456-0.682), and central obesity (OR=0.684, 95% CI: 0.556-0.841) were the main factors associated with SA. The promoting SA rate decreased as age increased, and the group of 65-79 years had higher odds than the other age group. CONCLUSION: Preventing central obesity, improving sleep quality and promoting healthy lifestyle may contribute to achieve SA among the elderly.

Obesity is positively Associated with Depression in Older Adults: Role of Systemic Inflammation.

Objective: We aimed to explore the association between obesity and depression and the role of systemic inflammation in older adults. Methods: Adults ≥ 65 years old ( n = 1,973) were interviewed at baseline in 2018 and 1,459 were followed up in 2021. General and abdominal obesity were assessed, and serum C-reactive protein (CRP) levels were measured at baseline. Depression status was assessed at baseline and at follow-up. Logistic regression was used to analyze the relationship between obesity and the incidence of depression and worsening of depressive symptoms, as well as the relationship between obesity and CRP levels. The associations of CRP levels with the geriatric depression scale, as well as with its three dimensions, were investigated using multiple linear regressions. Results: General obesity was associated with worsening depression symptoms and incident depression, with an odds ratio ( OR) [95% confidence interval ( CI)] of 1.53 (1.13-2.12) and 1.80 (1.23-2.63), especially among old male subjects, with OR (95% CI) of 2.12 (1.25-3.58) and 2.24 (1.22-4.11), respectively; however, no significant relationship was observed between abdominal obesity and depression. In addition, general obesity was associated with high levels of CRP, with OR (95% CI) of 2.58 (1.75-3.81), especially in subjects free of depression at baseline, with OR (95% CI) of 3.15 (1.97-5.04), and CRP levels were positively correlated with a score of specific dimension (life satisfaction) of depression, P < 0.05. Conclusion: General obesity, rather than abdominal obesity, was associated with worsening depressive symptoms and incident depression, which can be partly explained by the systemic inflammatory response, and the impact of obesity on depression should be taken more seriously in the older male population.

High normal plasma triglycerides are associated with preserved cognitive function in Chinese oldest-old.

OBJECTIVE: to explore the relationship between blood lipids/lipoproteins and cognitive function in the Chinese oldest-old. DESIGN: multivariate statistical analysis using cross-sectional data. SETTING: community-based setting in longevity areas in China. SUBJECTS: eight hundred and thirty-six subjects aged 80 and older were included in the sample. METHODS: plasma total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, blood pressure and fasting plasma glucose were measured and information about demographics and lifestyle was collected. Cognitive status was assessed using the Mini-Mental State Examination (MMSE). RESULTS: cumulative logit model analysis showed that triglyceride was significantly negatively associated with cognitive impairment. By general linear modelling, there was a significant linear trend of MMSE scores with the level of triglyceride, but not with levels of cholesterol after adjustment. The odds ratio (OR) of cognitive impairment (MMSE score < 18) was significantly reduced for the highest quartile of plasma triglyceride concentration (OR: 0.52, 95% CI: 0.33-0.84), but not for the second or third quartile, compared with the lowest quartile (adjusted models). There were no significant associations between cognitive impairment and cholesterol. CONCLUSION: we concluded that high normal plasma triglyceride was associated with preservation of cognitive function while lower concentrations were not in the Chinese oldest-old.

High sensitivity C-reactive protein associated with different health predictors in middle-aged and oldest old Chinese.

OBJECTIVE: To describe the distribution of plasma high sensitivity C-reactive protein (hsCRP) and explore the relationship between hsCRP and metabolic risk factors among residents living in longevity areas of China. METHODS: 268 individuals aged between 40 and 59 years and 506 individuals aged over 90 years were selected from 5 longevity areas of China to participate in a cross section longitudinal cohort study. The participants were interviewed with general health related questionnaire to collect their demographic, behavioral and lifestyle data, as well as their chronic conditions, and meanwhile their physical and biomedical parameters including waist circumference (WC), blood pressure (BP), hsCRP, plasma lipids, and fasting blood glucose (FBG) were measured. RESULTS: The median of hsCRP was 0.99 mg/L in the middle-aged group and 1.76 mg/L in the oldest old group. No significant gender difference was observed between the above two groups. Among the oldest old individuals, 36.56% had an hsCRP level >3.0 mg/L. The prevalence of high hsCRP was 16.79% in the middle-aged group. The results of stepwise multiple linear regression analyses showed that HDL-C was independently associated with ln (hsCRP) concentration in the middle-aged group, whereas ln (TG), HDL-C and FBG were correlated after adjustment for gender, study site, smoking, drinking, education and BMI in the oldest old group. CONCLUSION: HDL-C is a stronger predictor of elevated hsCRP than other metabolic factors in the middle-aged population. For the oldest old persons, high TG, low HDL-C, and FBG predict elevated plasma hsCRP.

Associations Between High-Sensitivity C-Reactive Protein and All-Cause Mortality Among Oldest-Old in Chinese Longevity Areas: A Community-Based Cohort Study.

BACKGROUND: The association between high-sensitivity C-reactive protein (hsCRP) levels and all-cause mortality for the oldest-old (aged 80 years or older) remains unclear. We aimed to investigate the associations between hsCRP concentrations and the risks of all-cause mortality, and further identify the potential modifying factors affecting these associations among the oldest-old. METHODS: This prospective, community-based cohort study included 2,206 participants aged 80 years or older (median age 93.0 years) from the Healthy Aging and Biomarkers Cohort Study. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (95% CIs) for all-cause mortality according to hsCRP quartiles and recommendation for relative risk categories of hsCRP levels (< 1.0, 1.0-3.0, and > 3.0 mg/L), with adjustment for sociodemographic information, lifestyle, physical examination, medical history, and other potential confounders. RESULTS: During a median follow-up period of 3.1 years (IQR: 1.6-3.9 years), 1,106 deaths were verified. After full adjustment for potential confounders, a higher hsCRP concentration was positively associated with an increased risk of all-cause mortality (P for trend < 0.001). Compared with the lowest quartile, the fully adjusted HRs of the second, third, and fourth quartiles were 1.17 (95% CI: 0.94, 1.46), 1.28 (95% CI: 1.01, 1.61), and 1.49 (95% CI: 1.20, 1.87), respectively. The association of hsCRP with all-cause mortality was modified by smoking status (P for interaction = 0.011), an increased risk of hsCRP with all-cause mortality showed among non-current smokers (HR: 1.17; 95% CI: 1.07, 1.28), but no significance was observed in current smokers (HR: 0.83; 95% CI: 0.66, 1.18). CONCLUSIONS: Our study indicated that elevated hsCRP concentrations were associated with a higher risk of all-cause mortality among Chinese oldest-old. Future studies investigating additional factors of disease and aging processes are needed to obtain a better understanding of the mechanisms.

[Association of anemia with cognition among senior female in China].

OBJECTIVE: To explore the relationship between anemia and cognitive function among senior female aged 90 years old and above in longevity regions in China. METHODS: 383 senior female in 5 longevity areas from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008 - 2009 were included in the study. The cognitive function was assessed by mini mental state examination (MMSE) scale. All subjects were administered the physical examinations and biochemical testing of blood, including the hemoglobin. The difference of cognitive function between those with and without anemia was analyzed. Logistic regression was used to analyze the relationship between anemia and cognitive function. RESULTS: The 383 subjects were divided into two groups, 141 in anemia group and 242 in group without anemia. The total score of cognitive function was 9.65 ± 9.32 in anemia group, and 13.06 ± 10.25 in group without anemia (χ(2) = 5.59, P < 0.05). The percentage of cognition impairment was 84.4% (119/141) in anemia group, and 72.3% (175/242) in group without anemia (χ(2) = 8.08, P < 0.05). In the multivariable logistic regressions, after adjustment for age, education, marital status, smoking and alcohol drinking, the risk for cognition impairment in anemia group was about twice of that in group without anemia (OR = 2.016, 95%CI: 1.185 - 3.431, P = 0.010). CONCLUSION: Anemia increases the risk of cognition impairment among senior female in Chinese longevity areas.

Alcohol Cessation in Late Life is Associated with Lower Risk of Cognitive Impairment among the Older Adults in China.

OBJECTIVE: Evidence regarding alcohol consumption and cognitive impairment is controversial. Whether cessation of drinking alcohol by non-dependent drinkers alters the risk of cognitive impairment remains unknown. This study prospectively evaluated the potential association between the history of lifetime alcohol cessation and risk of cognitive impairment. METHODS: This study included 15,758 participants age 65 years or older, selected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) that covered 23 provinces in China. Current alcohol use status, duration of alcohol cessation, and alcohol consumption before abstinence were self-reported by participants; cognitive function was evaluated using Mini-mental State Examination (MMSE). Cause-specific hazard models and restricted cubic splines were applied to estimate the effect of alcohol use on cognitive impairment. RESULTS: Among the 15,758 participants, mean (± SD) age was 82.8 years (± 11.9 years), and 7,199 (45.7%) were males. During a mean of 3.9 years of follow-up, 3,404 cases were identified as cognitive impairment. Compared with current drinkers, alcohol cessation of five to nine years [adjusted HR, 0.79 (95% CI: 0.66-0.96)] and more than nine years [adjusted HR, 0.82 (95% CI: 0.69-0.98)] were associated with lower risk of cognitive impairment. CONCLUSION: A longer duration of alcohol cessation was associated with a lower risk of cognitive impairment assessed by MMSE. Alcohol cessation is never late for older adults to prevent cognitive impairment.

Association Between Plasma 25-hydroxyvitamin D Concentrations and Incident Activities of Daily Living Disability: A Longitudinal Community-Based Cohort Study.

OBJECTIVES: A few studies of Western populations have found inconsistent results regarding the associations between vitamin D status and physical function. We explored the association between circulating vitamin D status [plasma 25-hydroxyvitamin D, 25(OH)D] and incident activities of daily living (ADL) disability among Chinese older adults. DESIGN: Community-based longitudinal cohort study. SETTING AND PARTICIPANTS: A total of 2453 men and women (median age 84.0 years) in 7 Chinese longevity areas were included. MEASURES: Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident ADL, with adjustments for potential sociodemographic, and lifestyle confounders and biomarkers. Because there was a statistically significant interaction between plasma 25(OH)D and sex in relation to incident ADL, men and women were analyzed separately. RESULTS: The median concentrations of plasma 25(OH)D were 46.6 nmol/L and 36.4 nmol/L for men and women, respectively. Compared with the lowest quartile in the fully adjusted model, the HR for incident ADL disability for the highest quartile was 0.55 (95% CI 0.36-0.85) for women; for men, a null association was indicated (HRhighest vs lowest 0.61, 95% CI 0.37-1.00). However, when using the recommended circulating 25(OH)D thresholds by the US Institute of Medicine, those with vitamin D sufficiency (≥50 nmol/L) had better ADL disability prognoses than those with vitamin D deficiency (<30 nmol/L) in both sexes (men HR 0.45, 95% CI 0.28-0.72; women HR 0.58, 95% CI 0.37-0.90). CONCLUSIONS AND IMPLICATIONS: The relationship between plasma 25(OH)D concentration and incident ADL disability was sex-specific among Chinese older adults. However, participants with recommended vitamin D sufficiency may have better disability prognoses in both sexes, suggesting that the recommended 25(OH)D concentration for bone health may extend to functional outcomes such as ADL disability in Chinese older adults.

[A study on chronic diseases and other related health indicators of centenarians in longevity areas in China].

OBJECTIVE: To describe chronic diseases and other related health indicators of centenarians, compare these health indicators with other age groups in longevity areas in China. METHODS: Residents who participated in the project of Chinese Longitudinal Healthy Longevity Survey (CLHLS) conducted in 2008 - 2009 were selected from 7 Longevity Areas.2029 people aged 40 and over attended the study from March to June, 2009, including 469 aged 40 and over, 436 aged 60 and over, 346 aged 80 and over, 380 aged 90 and over, 398 centenarians. Information, including socio-demographic, were collected by self-designed questionnaire. Calibrated instruments were used by the clinical personnel who had worked over 3 years to manually check subjects' health. Venous blood and urine samples were collected for blood and urine routine test, plasma macro and trace elements test, plasma biological test, using standard methods such as instrument analysis, atomic absorption spectrometry. Data analysis was conducted using descriptive statistical methods. RESULTS: In the groups aged 40 and over, 60 and over, 80 and over, 90 and over, 100 and over, the body mass index (BMI) were (23.2 +/- 4.6), (22.1 +/- 3.7), (20.2 +/- 3.4), (20.2 +/- 3.9) and (19.1 +/- 5.0) kg/m(2) in males (F = 22.78, P < 0.01) and (23.3 +/- 4.0), (21.6 +/- 3.5), (19.7 +/- 3.9), (19.0 +/- 4.8), (18.4 +/- 3.8) kg/m(2) in females (F = 51.84, P < 0.01); the prevalence of hypertension were 38.3% (80/209), 60.8% (166/273), 63.5% (106/167), 61.8% (68/110), 54.8% (34/62) in males (chi(2) = 34.26, P < 0.01) and 32.3% (84/260), 60.1% (98/163), 69.8% (125/179), 61.5% (166/270), 58.9% (198/336) in females (chi(2) = 78.45, P < 0.01); the prevalence of diabetes were 10.5% (22/209), 12.5% (34/273), 9.0% (15/167), 18.2% (20/110), 12.9% (8/62) in males (chi(2) = 5.92, P = 0.20) and 4.2% (11/260), 15.3% (25/163), 10.1% (18/179), 12.2% (33/270), 7.4% (25/336) in females (chi(2) = 19.25, P < 0.01). In groups aged 40 and over, 90 and over, 100 and over, the superoxide dismutase (SOD) activity were (29.03 +/- 5.79), (30.93 +/- 5.39), (31.63 +/- 5.92) U/ml in males (F = 4.40, P < 0.05) and (28.27 +/- 6.25), (30.86 +/- 5.72), (31.55 +/- 5.25) U/ml in females (F = 13.13, P < 0.05); levels of plasma calcium were (3.63 +/- 1.08), (3.09 +/- 0.91), (3.34 +/- 1.07) mmol/L in males (F = 5.71, P < 0.01) and (3.84 +/- 1.02), (3.19 +/- 1.16), (3.38 +/- 1.16) mmol/L in females (F = 11.61, P < 0.01); levels of selenium were (1.44 +/- 0.86), (1.28 +/- 0.60), (1.75 +/- 0.57)micromol/L in males (F = 3.79, P < 0.05) and (1.44 +/- 0.80), (1.48 +/- 0.81), (1.78 +/- 0.80) micromol/L in females (F = 8.69, P < 0.01); levels of iron were (63.25 +/- 49.05), (71.86 +/- 54.16), (138.36 +/- 77.60) micromol/L in males (F = 22.78, P < 0.01) and (64.86 +/- 57.72), (74.56 +/- 56.93), (106.56 +/- 74.08) micromol/L in females (F = 17.88, P < 0.01); levels of copper were (23.49 +/- 12.85), (17.96 +/- 7.57), (22.33 +/- 6.89) micromol/L in males (F = 5.18, P < 0.01) and (21.52 +/- 10.63), (19.60 +/- 9.57), (22.99 +/- 8.71) micromol/L in females (F = 5.68, P < 0.01); positive rates of high-sensitivity c-reactive protein (hsCRP) were 5.5% (8/146), 24.0% (18/75), 31.3% (10/32) in males (chi(2) = 22.62, P < 0.01) and 9.8% (12/122), 19.6% (40/204), 25.1% (49/195) in females (chi(2) = 11.24, P < 0.01). CONCLUSION: The results indicate that the centenarians have lower chronic diseases risks and higher anti-oxidants activity compared with other age groups, and have a high level of nutritional elements compared with those aged 90 and over. However, it is more common for them suffering from inflammation.

[Anemia status and its relevant factors among elderly people aged above 80 years old in longevity areas in China].

OBJECTIVE: To describe the epidemiological characteristics of anemia among elderly people aged 80 years old and above in longevity areas in China and to analyze its relevant factors to the health effects. METHODS: The data used in this study came from the Chinese Longitudinal Healthy Longevity Survey, including all centenarians in 7 longevity areas, as well as randomly selected population aged 40-, 60-, 80- and 90- in the same 7 areas. A total of 1980 subjects enrolled in the study. The data of general information, eating habits and diseases history was collected by questionnaire survey. Hemoglobin, plasma macro and trace elements were gained by biochemical test. Logistic regression was used to analyze the anemia and its relevant factors. RESULTS: The prevalence of anemia of elderly people aged 40-, 60-, 80-, 90-, 100- were 16.1% (75/465), 19.1% (82/429), 41.1% (141/343), 46.2% (171/370) and 57.1% (213/373) in 7 longevity areas, which kept on a rise with the increasing of age (z = 14.7, P < 0.05). The prevalence of anemia of male aged 100 years old and above was 66.7% (38/57), which was the highest one among all elderly. Plasma Ca (2.96 mmol/L), Fe (58.22 micromol/L), Zn (28.84 micromol/L) and Cu (19.56 micromol/L) of the elderly people aged 90 years old and above in anemia group, and in control group they were 3.30 mmol/L, 78.26 micromol/L, 33.66 micromol/L, 20.62 micromol/L, respectively. The significant differences were observed between the two groups (z values were -2.95, -3.07, -2.23 and -2.16, P < 0.05). The main risk factors related to anemia were age (OR = 1.675, 95%CI: 1.554 - 1.807), followed by frequency of beans and their products intake (OR = 0.545, 95%CI: 0.435 - 0.682), waist circumference (OR = 0.567, 95%CI: 0.456 - 0.705) and frequency of meat intake (OR = 1.608, 95%CI: 1.303 - 1.983). CONCLUSION: The anemia status of oldest old people in longevity areas was severe. Higher frequency of beans and their products intake and maintaining well nutritional condition benefit for the prevention of anemia.

[Investigation and analysis of plasma trace elements of oldest elderly in longevity areas in China].

OBJECTIVE: To investigate the levels and differences of plasma selenium, manganese, iron, copper, zinc among oldest elderly in longevity areas in China. METHODS: 446 oldest elderly including 208 centenarians, 238 aged 90 and over, who lived in Xiayi county of Henan province (110 persons), Zhongxiang city of Hubei province (111 persons), Mayang county of Hunan province (60 persons), Sanshui district of Guangdong province (113 persons), Yongfu county of Guangxi Zhuang autonomous region (52 persons) in China, were selected. The contents of plasma selenium, manganese, iron, copper, zinc were detected and compared among these elderly who were classified into different genders, different regions and different age groups. RESULTS: In oldest elderly, the median (inter-quartile range) of content of plasma selenium was 1.44 (0.91) micromol/L, content of manganese was 0.54 (0.94) micromol/L, content of iron was 69.17 (102.85) micromol/L, content of copper was 20.19 (8.73) micromol/L, content of zinc was 31.66 (32.51) micromol/L. Contents of plasma selenium of oldest elderly in Xiayi, Zhongxiang, Mayang, Sanshui, Yongfu region were 1.46 (0.66), 1.30 (0.80), 1.06 (0.51), 2.39 (1.53) and 1.35(0.55) micromol/L; contents of plasma manganese were 0.56 (0.51), 1.40 (1.11), 0.35 (0.71), 0.44 (0.55) and 0.15 (0.21) micromol/L; contents of plasma iron were 86.77 (86.87), 141.42 (101.83), 38.88 (36.28), 31.38 (46.19) and 79.64 (75.34) micromol/L; contents of plasma copper were 22.16 (8.11), 19.46 (9.26), 21.36 (12.38), 18.12 (6.74) and 21.47 (7.85) micromol/L; contents of plasma zinc were 36.85 (26.18), 36.59 (35.94), 39.98 (56.91), 25.05 (24.92) and 16.74 (16.81) micromol/L. Contents of plasma trace elements among oldest elderly in different longevity areas were significantly different (F values were 29.76, 38.75, 47.18, 11.51 and 13.47, P values were all less than 0.05). Contents of plasma trace elements in different gender groups (contents of plasma selenium were 1.38 (0.83) micromol/L in male and 1.45 (0.91) micromol/L in female; contents of plasma manganese were 0.52 (0.95) and 0.54 (0.91) micromol/L; contents of plasma iron were 69.23 (104.06) and 69.11 (101.05) micromol/L; contents of plasma copper were 20.28 (8.72) and 20.06 (8.76) micromol/L; contents of plasma zinc were 28.39 (32.58) and 31.85 (34.26) micromol/L) were not significantly different (t(Se) = -1.82, P = 0.07; t(Mn) = 0.64, P = 0.52; t(Fe) = 0.65, P = 0.52; t(Cu) = -1.90, P = 0.06; t(Zn) = -0.96, P = 0.34). The contents of plasma selenium, iron, copper in centenarians were higher than those aged 90 and over (contents of plasma selenium were 1.63 (0.94) micromol/L and 1.30 (0.82) micromol/L, contents of plasma iron were 112.63 (119.78) and 60.13 (58.43) micromol/L, contents of plasma copper were 21.07 (9.03) and 18.81 (8.86) micromol/L, F value were 41.99, 27.32, 24.45, P values were less than 0.01). Content of plasma manganese in centenarians was lower than those aged 90 and over (0.44 (0.76) and 0.64 (0.93) micromol/L, F = 10.76, P < 0.01). No significant differences were detected in plasma zinc between concentration and those aged 90 and over (31.78 (34.06) and 31.11 (33.85) micromol/L; F = 1.32, P = 0.25). CONCLUSION: The concentrations of plasma selenium, manganese, iron, copper and zinc were high in oldest elderly in the longevity areas. The contents of plasma selenium, iron, copper increased with age.

[Level and effect factors of superoxide dismutase and malondialchehyche of the old people aged 90 and over in longevity regions, China].

OBJECTIVE: To explore the level and effect factors of superoxide dismutase (SOD) and malondialchelyche (MDA) of the people aged 90 years old and above in longevity regions in China. METHODS: From Xiayi county (Henan province), Zhongxiang county (Hubei province), Mayang county (Hunan province), Foshan county Sanshui district (Guangdong province) and Yongfu county (Guangxi province), the people of hundred-year were selected and numbered. The old people aged 90 - 99 according to the age and sex were appointed by the centenarians' code and 496 people were selected in total. Questionnaire investigation was conducted on nationality, education, nutrition, smoking, alcohol drinking, tea drinking and physical activities.436 blood sampling (4 ml Per sampling) were conducted and the level of triglyceride (TG), SOD, MDA, Ca, Mg, and some microelements were determined. Non-conditional logistic regression analysis was conducted to explore the effect factors of SOD and MDA in plasma. RESULTS: Analysis showed that the activity of plasma SOD was (31.19 +/- 5.51) U/ml, and the content of MDA was (4.68 +/- 1.98) micromol/L. The SOD level of minority people of 90 years old and over was (27.55 +/- 4.97) U/ml, lower than that of Han nationality ((31.73 +/- 5.39) U/ml; t = 5.85, P < 0.01); the MDA level of minority people of 90 years old and over was (5.58 +/- 1.95) micromol/L, higher than that of Han nationality ((4.54 +/- 1.95) micromol/L; t = -3.94, P < 0.01). logistic regression showed, comparing with the Han nationality, the minority had lower level of SOD (OR = 0.493), and higher level of MDA (OR = 5.412, P < 0.05). Beside nationality, the factors significantly affecting the activity of SOD included the intake frequency of meat, intake frequency of eggs and plasma concentration of Se (OR values were 0.388, 2.260 and 1.906, P < 0.05). The factors significantly affecting the level of MDA included the intake frequency of milk, physical activity and the level of TG (OR values were 0.435, 1.850 and 1.647, P < 0.05). CONCLUSION: The level of SOD of the oldest-old people aged 90 years old and over is relatively higher than the younger ones, and the level of MDA is relatively lower in longevity region, China. The effect factors of SOD are nationality, meat intake frequency, eggs intake frequency and the level of Se in plasma. The effect factors of MDA are nationality, milk intake frequency, physical activity and the level of TG in plasma.

Abdominal Obesity and Its Attribution to All-cause Mortality in the General Population with 14 Years Follow-up: Findings from Shanxi Cohort in China.

OBJECTIVE: This study aimed to assess the association of waist circumference (WC) with all-cause mortality among Chinese adults. METHODS: The baseline data were from Shanxi Province of 2002 China Nutrition and Health Survey. The death investigation and follow-up visit were conducted from December 2015 to March 2016. The visits covered up to 5,360 of 7,007 participants, representing a response rate of 76.5%. The Cox regression model and floating absolute risk were used to estimate hazard ratio and 95% floating CI of death by gender and age groups (≥ 60 and < 60 years old). Sensitivity analysis was performed by excluding current smokers; participants with stroke, hypertension, and diabetes; participants who accidentally died; and participants who died during the first 2 years of follow-up. RESULTS: This study followed 67,129 person-years for 12.5 years on average, including 615 deaths. The mortality density was 916 per 100,000 person-years. Low WC was associated with all-cause mortality among men. Multifactor-adjusted hazard ratios ( HR) were 1.60 (1.35-1.90) for WC < 75.0 cm and 1.40 (1.11-1.76) for WC ranging from 75.0 cm to 79.9 cm. Low WC (< 70.0 cm and 70.0-74.9 cm) and high WC (≥ 95.0 cm) groups had a high risk of mortality among women. The adjusted HRs of death were 1.43 (1.11-1.83), 1.39 (1.05-1.84), and 1.91 (1.13-3.22). CONCLUSION: WC was an important predictor of death independent of body mass index (BMI). WC should be used as a simple rapid screening and predictive indicator of the risk of death.

Age, Period, and Cohort Effects on Activities of Daily Living, Physical Performance, and Cognitive Functioning Impairment Among the Oldest-Old in China.

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 and older) 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 model. RESULTS: Regarding age, the prevalence of ADL, physical performance, and cognitive function 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 oldest-old may considerably improve their quality of life, particularly regarding their basic ADL.

Specific Leisure Activities and Cognitive Functions Among the Oldest-Old: The Chinese Longitudinal Healthy Longevity Survey.

BACKGROUND: 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. METHODS: 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. RESULTS: 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 hazard ratios 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 two 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. CONCLUSIONS: 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.

Trends in the Incidence of Activities of Daily Living Disability Among Chinese Older Adults From 2002 to 2014.

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 older people (≥65 years). METHODS: We established two consecutive and nonoverlapping 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 < .001), and decreasing trends in the incidence of ADL disability were observed for all sex, age, and residence subgroups (all p < .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 older adults 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.

Triglycerides Paradox Among the Oldest Old: "The Lower the Better?"

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.