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Firenze, Italy

Volpato S.,University of Ferrara | Bianchi L.,University of Ferrara | Lauretani F.,University of Parma | Lauretani F.,Tuscany Regional Health Agency | And 4 more authors.
Diabetes Care

OBJECTIVE - Older people with type 2 diabetes are at high risk of mobility disability. We investigated the association of diabetes with lower-limb musclemass andmuscle quality to verify whether diabetes-related muscle impairments mediate the association between diabetes and low walking speed. RESEARCH DESIGN AND METHODS - We performed a cross-sectional analysis of 835 participants (65 years old and older) enrolled in the InCHIANTI (Invecchiare in Chianti, aging in the Chianti area) population-based study. Total,muscular, and fat cross-sectional areas of the calf and relative muscle density were measured using peripheral quantitative computerized tomography. Indicators of muscle performance included knee-extension torque, ankle plantar flexion and dorsiflexion strength, lower-extremity muscle power, and ankle muscle quality (ratio of ankle strength to the muscle area [kilograms per centimeters squared]). Gait performance was assessed by 4- and 400-m walking speed. Diabetes was ascertained by standard American Diabetes Association criteria. RESULTS - Prevalence of diabetes was 11.4%. After adjustment for age and sex, participants with diabetes had lower muscle density, knee and ankle strength, and muscle power and worse muscle quality (all P < 0.05). Diabetic participants were also slower on both 4-m (β: -0.115 ± 0.024 m/s, P < 0.001) and 400-m (β:-0.053 ± 0.023 m/s, P < 0.05) walking tests. In multivariable linear regression models, lower-limb muscle characteristics accounted for 24.3 and 15.1% of walking speed difference comparing diabetic and nondiabetic subjects in the 4- and 400-m walks, respectively. CONCLUSIONS - In older persons, diabetes is associated with reduced muscle strength and worse muscle quality. These impairments are important contributors of walking limitations related to diabetes. © 2012 by the American Diabetes Association. Source

Orsitto G.,Geriatric Unit
Journal of Nutrition, Health and Aging

Objectives: to evaluate different components of nutritional status in older patients with cognitive deficit, particularly in those with mild cognitive impairment (MCi). Design: Cross-sectional study. Setting and participants: 560 elderly subjects aged ? 65 years consecutively admitted to an acute Geriatric Unit of Apulia region of southern italy. Measurements: A standardized comprehensive geriatric assessment was used to evaluate medical, cognitive, affective and social aspects. Nutritional status was assessed using the mini nutritional assessment (MNA). the cognitive function was categorized into three levels -MCi, dementia or normal cognition (NoCi) -according to the neuropsychological test score. Results: subjects with cognitive decline had significantly lower frequency of well-nourished (MCi=10%, dementia=8%, NoCi=22%, p<0.05) and higher frequency of malnourished (MCi=47%, dementia=62%, NoCi=19%, p<0.001) than patients with normal cognition. similarly, MNA total score, MNA-3 and MNA-4 subscores were significantly lower in patients with MCi and dementia than patients with normal cognition (p<0.001). Conclusions: these results suggest that cognitive decline may be associated with malnutrition in this sample of hospitalized older patients. Dietary habits (MNA-3) and subjective assessment of self-perceived quality of health and nutrition (MNA-4) are particularly poor also in patients with MCi and could be very important variables to be considered in the multidimensional evaluation of subjects with cognitive impairment. Source

Kaiser M.J.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bandinelli S.,Geriatric Unit | Lunenfeld B.,Bar - Ilan University
Acta Biomedica

Frailty and malnutrition are both highly prevalent in the older population and have therefore become principle topics in geriatric research. Frailty is of multifactorial origin and is regarded as a fundamental risk factor for deteriorating health status and disability in older people. It is estimated that prevalence rates for frailty and pre-frailty reach as high as 27% and 51%, respectively. The role of nutritional deficiency in the development of frailty was suggested long ago, however research conducted in this area is relatively recent. The critical role of micronutrients in this context suggests the need to improve the quality of food eaten by older people - not just the quantity. This review summarizes the recent literature on the nutritional pathways to frailty with particular focus on the effect of energy, protein and micronutrients. (www.actabiomedica.it). © Mattioli 1885. Source

Stenholm S.,Finnish National Institute for Health and Welfare | Kronholm E.,Finnish National Institute for Health and Welfare | Bandinelli S.,Geriatric Unit | Guralnik J.M.,U.S. National Institute on Aging | Ferrucci L.,U.S. National Institute on Aging

Study Objectives: To characterize elderly persons into sleep/rest groups based on their self-reported habitual total sleeping time (TST) and habitual time in bed (TIB) and to examine the prospective association between sleep/rest behavior on physical function decline. Design: Population-based InCHIANTI study with 6 years follow-up (Tuscany, Italy). Setting: Community. Participants: Men and women aged ≥ 65 years (n = 751). Measurements and Results: At baseline, participants were categorized into 5 sleep/rest behavior groups according to their self-reported TST and TIB, computed from bedtime and wake-up time. Physical function was assessed at baseline and at 3- and 6-year follow-ups as walking speed, the Short Physical Performance Battery (SPPB), and self-reported mobility disability (ability to walk 400 m or climb one flight of stairs). Both long (≥ 9 h) TST and long TIB predicted accelerated decline in objectively measured physical performance and greater incidence in subjectively assessed mobility disability, but short (≤ 6 h) TST did not. After combining TST and TIB, long sleepers (TST and TIB ≥ 9 h) experienced the greatest decline in physical performance and had the highest risk for incident mobility disability in comparison to mid-range sleepers with 7-8 h TST and TIB. Subjective short sleepers reporting short (≤ 6 h) TST but long (≥ 9 h) TIB showed a greater decline in SPPB score and had a higher risk of incident mobility disability than true short sleepers with short (≤ 6 h) TST and TIB ≤ 8 hours. Conclusions: Extended time in bed as well as long total sleeping time is associated with greater physical function decline than mid-range or short sleep. TIB offers important additive information to the self-reported sleep duration when evaluating the consequences of sleep duration on health and functional status. Source

Milaneschi Y.,U.S. National Institute on Aging | Shardell M.,University of Maryland Baltimore County | Maria Corsi A.,Tuscany Health Regional Agency | Vazzana R.,University of Chieti Pescara | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism

Context: Hypovitaminosis D and depressive symptoms are common conditions in older adults. Objective: We examined the relationship between 25-hydroxyvitamin D [25(OH)D] and depressive symptoms over a 6-yr follow-up in a sample of older adults. Design and Setting: This research is part of a population-based cohort study (InCHIANTI Study) in Tuscany, Italy. Participants: A total of 531 women and 423 men aged 65 yr and older participated. Main Outcome Measure: Serum 25(OH)D was measured at baseline. Depressive symptoms were assessed at baseline and at 3- and 6-yr follow-ups using the Center for Epidemiological Studies-Depression Scale (CES-D). Depressed mood was defined as CES-D of 16 or higher. Analyses were stratified by sex and adjusted for relevant biomarkers and variables related to sociodemographics, somatic health, and functional status. Results: Women with 25(OH)D less than 50 nmol/liter compared with those with higher levels experienced increases in CES-D scores of 2.1 (P = 0.02) and 2.2 (P = 0.04) points higher at, respectively, 3- and 6-yr follow-up. Women with low vitamin D (Vit-D) had also significantly higher risk of developing depressive mood over the follow-up (hazard ratio = 2.0; 95% confidence interval = 1.2-3.2; P = 0.005). In parallel models, men with 25(OH)D less than 50 nmol/liter compared with those with higher levels experienced increases in CES-D scores of 1.9 (P = 0.01) and 1.1 (P = 0.20) points higher at 3- and 6-yr follow-up.Menwith low Vit-Dtended to have higher risk of developing depressed mood (hazard ratio = 1.6; 95% confidence interval = 0.9 -2.8; P = 0.1). Conclusion: Our findings suggest that hypovitaminosis D is a risk factor for the development of depressive symptoms in older persons. The strength of the prospective association is higher in women than in men. Understanding the potential causal pathway between Vit- D deficiency and depression requires further research. Copyright © 2010 by The Endocrine Society. Source

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