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Metabolic syndrome and risk factors for cardiovascular disease: are nonagenarians protected?
Abbreviated Abstract: This study assessed cardiovascular disease risk factors in three groups of human subjects aged 20-34 [young, 20 male (M)/33 female (F)], 60-74 (aged, 29M/29F), and > 90 years (nonagenarian, 47M/50F). Components of the metabolic syndrome, cardiovascular disease, and markers of inflammation and oxidative stress were assessed. Nonagenarians weighed less than the two other groups (P < 0.001). Aged individuals had the highest prevalence of the metabolic syndrome (P < 0.001) according to the Adult Treatment Panel III classification. Both fibrinogen and homocysteine concentrations were significantly higher in the nonagenarians compared to younger groups. However, there were no significant differences between groups in fasting insulin, high sensitive C-reactive protein, and plasminogen activator inhibitor 1 concentrations. There were also no relationships between inflammation/oxidative stress and the metabolic syndrome or cardiovascular disease although nonagenarians appear to be protected from oxidative damage to DNA.
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Frisard MI, Rood JC, Fang X, Su J, Welsh DA, Jazwinski SM, Ravussin E; for the Louisiana Healthy Aging Study. Age (Dordr). 2009 Mar; 31(1):67-75. Epub 2009 Jan 31.
HDL Increases In American Women But Not In Chinese Women
High density lipoprotein-cholesterol levels increase with age in American women but not in Hong Kong Chinese women Abbreviated Abstract: OBJECTIVES: High-density lipoprotein (HDL) cholesterol is a powerful cardiovascular risk factor. Important gender and ethnic differences in plasma HDL levels exist and warrant investigation. DESIGN: Cross-sectional survey in two different general populations. Patients 7700 participants of the National Health and Nutrition Examination Survey (NHANES) 1999-2002 and 1944 participants of the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2) 2000-2004. RESULTS: Plasma HDL levels were higher in women than in men in both populations. In the United States women, it increased with age, whereas in Chinese women, it declined with age and converged with male HDL levels. In Americans, the independent predictors of low HDL levels were lower age, being non-Mexican Hispanic, waist circumference, triglycerides and not drinking alcohol in men, and lower age, being Hispanic, waist circumference, triglycerides, current smoking and not drinking alcohol in women. In Hong Kong Chinese, the independent predictors of low HDL levels were body mass index, triglycerides, current smoking and not drinking alcohol in men, and lower age, waist circumference, triglycerides, diabetes and former smoking in women. CONCLUSIONS: The decline in plasma HDL with age in Chinese women is opposite to that seen in American women. The increased cardiovascular risk in elderly Chinese women requires further study.
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Cheung BM, Li M, Ong KL, Wat NM, Tam S, Pang RW, Thomas GN, Woo J, Janus ED, Lau CP, Lam TH, Lam KS. Clin Endocrinol (Oxf). 2009 Apr; 70(4):561-8. Epub 2008 Aug 19.
Body Mass Index and Waist Circumference May Be a Mischaracterization for Patterns of Abs Fat
Patterns of abdominal fat distribution: the Framingham Heart Study
Abbreviated Abstract: OBJECTIVE: The prevalence of abdominal obesity exceeds that of general obesity. We sought to determine the prevalence of abdominal subcutaneous and visceral obesity and to characterize the different patterns of fat distribution in a community-based sample. RESULTS: The prevalence of high subcutaneous adipose tissue (SAT) was 30% (women) and 31% (men) and that for high visceral adipose statue (VAT) was 44% (women) and 42% (men). Overall, 27.8% of the sample was discordant for high SAT and high VAT: 19.9% had SAT less than but VAT equal to or greater than the 90th percentile, and 7.9% had SAT greater than but VAT less than the 90th percentile. The prevalence of metabolic syndrome was higher among women and men with SAT less than the 90th percentile and high VAT than in those with high SAT but VAT less than the 90th percentile, despite lower Body Mass Index (BMI) and waist circumference. Findings were similar for hypertension, elevated triglycerides, and low HDL cholesterol. CONCLUSIONS: Nearly one-third of our sample has abdominal subcutaneous obesity, and >40% have visceral obesity. Clinical measures of BMI and waist circumference may misclassify individuals in terms of VAT and metabolic risk.
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Pou KM, Massaro JM, Hoffmann U, Lieb K, Vasan RS, O'Donnell CJ, Fox CS. Diabetes Care. 2009 Mar; 32(3):481-5. Epub 2008 Dec 15.
Underweight Older Adults May Be Susceptible to Cardiac Events Post Op After Hip Fracture
Body mass index and risk of adverse cardiac events in elderly patients with hip fracture: a population-based study
Abbreviated Abstract: OBJECTIVES: To determine whether obesity affects cardiac complications after hip fracture repair. DESIGN: A population-based historical study using data from the Rochester Epidemiology Project. RESULTS: Hip fracture repairs were performed in 184 (15.6%) underweight, 640 (54.2%) normal-weight, 251 (21.3%) overweight, and 105 (8.9%) obese subjects (mean age 84.2 +/- 7.5; 80% female). Baseline American Society of Anesthesiologists (ASA) status was similar in all groups (ASA I/II vs. III-V, P=.14). Underweight patients had a significantly higher risk of developing myocardial infarction (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.0-2.1; P=.05) and arrhythmias (OR=1.59, 95% CI=1.0-2.4; P=.04) than normal-weight patients. Multivariate analysis demonstrated that underweight patients had a higher risk of developing an adverse cardiac event of any type (OR=1.56, 95% CI=1.22-1.98; P<.001). Overweight and obese patients with hip fracture had no excess risk of any cardiac complication. CONCLUSION: The obesity paradox and low functional reserve in underweight patients may influence the development of postoperative cardiac events in elderly people with hip fracture.
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Batsis JA, Huddleston JM, Melton LJ 4th, Huddleston PM, Lopez-Jimenez F, Larson DR, Gullerud RE, McMahon MM. J Am Geriatr Soc. 2009 Mar;57(3):419-26. Epub 2009 Jan 16.
Failure to Recognize the Immune System's Role in Chronic Heart Failure
The immune system and chronic heart failure: is the heart in control?
Abbreviated Abstract: Despite current treatment options, the clinical course of patients with chronic heart failure is notoriously difficult to predict. Among those with similar etiologies, ejection fractions, and patient demographics, our understanding of why such variations in outcomes exist remains limited. Evidence that has been progressively gathered implicates an important role of the immune system in the propagation of heart failure. This has been derived mainly from observations that cytokines are progressively elevated in patients with poor outcomes. However, attempts at introducing various immunomodulatory therapies as a new treatment strategy have been largely unsuccessful to date. This possibly reflects a failure in recognizing the complexity of the immune system's role in chronic heart failure, which has led to an oversimplified approach to treatment. This review critically analyzes the immune treatments attempted to date and hypothesizes what is required to develop a successful future treatment strategy.
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Fildes JE, Shaw SM, Yonan N, Williams SG. J Am Coll Cardiol. 2009 Mar 24;53(12):1013-20.
Abdominal Fats Is Not Impacted By Menopause
Longitudinal changes in abdominal fat distribution with menopause
Abbreviated Abstract: Increases in abdominal fat have been reported with menopause, but the impact of menopause on abdominal fat distribution (visceral vs. subcutaneous) is still unclear. The objective of the study was to determine if abdominal fat content (volume) or distribution is altered with menopause. Magnetic resonance imaging was used to quantify total abdominal, subcutaneous, and visceral fat in 8 healthy women, both in the premenopausal state and 8 years later in the postmenopausal state. Physical activity (PA) and blood lipids were also measured. Body weight and waist circumference did not change with menopause (pre- vs. postmenopause: body weight, 63.2 +/- 3.1 vs. 63.9 +/- 2.5 kg; waist circumference, 92.1 +/- 4.6 vs. 93.4 +/- 3.7 cm); however, total abdominal fat, subcutaneous fat, and visceral fat all significantly (P < .05) increased with menopause. Although absolute adiposity changed with menopause, relative fat distribution was not significantly different after menopause. Lean mass, fat mass, and PA, along with total cholesterol and triglyceride levels, did not change with menopause. High-density lipoprotein and low-density lipoprotein both increased (P < .05), and the ratio of total cholesterol to high-density lipoprotein decreased (P < .05) with menopause. As measured longitudinally with magnetic resonance imaging, total abdominal fat content increased with menopause despite no change in PA, body weight, or waist circumference; however, menopause did not affect the relative abdominal fat distribution in these women.
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Franklin RM, Ploutz-Snyder L, Kanaley JA. Metabolism. 2009 Mar; 58(3):311-5.
Viewpoint: dried plum, an emerging functional food that may effectively improve bone health
Abbreviated Abstract: Osteoporosis is a debilitating disorder that affects both female and male, albeit to a greater extent in women than men. As the demographic shift to a more aged population continues, a growing number of men and women will be afflicted with osteoporosis and a search for potential non-pharmacological alternative therapies for osteoporosis is of prime interest. Aside from existing drug therapies, certain lifestyle and nutritional factors are known to reduce the risk of osteoporosis. Among nutritional factors, recent observations suggest that dried plum, or prunes (Prunus domestica L.) is the most effective fruit in both preventing and reversing bone loss. Animal studies and a 3-month clinical trial conducted in our laboratories have shown that dried plum has positive effects on bone indices. The animal data indicate that dried plum not only protects against but more importantly reverses bone loss in two separate models of osteopenia. Dried plum as low as 5% (w/w) restored bone mineral density (BMD) to the level of intact rats. More importantly, dried plum reversed the loss of trabecular architectural properties such as trabecular number and connectivity density, and trabecular separation. We have also shown the effectiveness of dried plum in reversal of bone loss due to skeletal unloading. Analysis of BMD and trabecular bone structure by microcomputed tomography (microCT) revealed that dried plum enhanced bone recovery during reambulation following skeletal unloading and had comparable effects to parathyroid hormone. In addition to the animal studies, our 3-month clinical trial indicated that the consumption of dried plum daily by postmenopausal women significantly increased serum markers of bone formation, total alkaline phosphatase, bone-specific alkaline phosphatase and insulin-like growth factor-I by 12, 6, and 17%, respectively. This review summarizes the findings of studies published to date which examine the beneficial effects of dried plum on bone in both female and male animal models of osteoporosis as well as the only published clinical study.
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Hooshmand S, Arjmandi BH. Ageing Res Rev. 2009 Apr; 8(2):122-7.
Vitamin D Recommendations Too Low To Address Vitamin D Insufficiencies
Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004
Abbreviated Abstract: BACKGROUND: Vitamin D insufficiency is associated with suboptimal health. The prevalence of vitamin D insufficiency may be rising, but population-based trends are uncertain. We sought to evaluate US population trends in vitamin D insufficiency. CONCLUSIONS: National data demonstrate a marked decrease in serum 25(OH)D levels from the 1988-1994 to the 2001-2004 NHANES data collections. Racial/ethnic differences have persisted and may have important implications for known health disparities. Current recommendations for vitamin D supplementation are inadequate to address the growing epidemic of vitamin D insufficiency.
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Ginde AA, Liu MC, Camargo CA Jr. Arch Intern Med. 2009 Mar 23;169(6):626-32.
Social functioning and survival: A 10-year follow-up study
Abbreviated Abstract: Although otherwise extensively researched, one aspect of social functioning in older people that has received less attention is its association with staying at home for as long as possible. This 10-year follow-up examines factors of social functioning that support older people's independent living in their own homes and that reduce the risk of mortality. The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. Female gender reduced the risk of mortality. In addition, daily outdoor activities, and not needing help (from different sources) were associated with a reduced risk of mortality. No need for help and a more positive attitude towards life reduced the risk of mortality of women. There were found only non-significant trends for men. Having plans for the future also reduced the risk of mortality. The findings of this study offer useful clues for planning the services provided by home health care personnel. In planning these services it is important that home health care workers take into account the differences between women and men customers: men may need and want different things from the home health care service than women do.
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Arve S, Lavonius S, Savikko N, Lehtonen A, Isoaho H. Arch Gerontol Geriatr. 2009 Mar-Apr; 48(2):137-41. Epub 2008 Jan 18.
The Aging Population--Is There A Role For Endocrine Interventions?
The aging population--is there a role for endocrine interventions?
Abbreviated Abstract: The expected increase in the aging population will have a significant impact on society and the health system in the coming years and decades. Enhancing healthspan, "healthy aging", and thus extending the time that the elderly are able to function independently is a significant task and is imperative. Age-dependent changes such as weight loss, sarcopenia and anorexia, which contribute to the development of frailty in the elderly are discussed. The role of the age-dependent decrease in growth hormone secretion in this process and the potential benefits and risks of hormonal interventions to delay, prevent or reverse frailty in the elderly are reviewed.
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Nass R, Johannsson G, Christiansen JS, Kopchick JJ, Thorner MO. Growth Horm IGF Res. 2009 Apr;19(2):89-100. Epub 2008 Nov 1.
Oxidative And Nitrosative Are Associative Factors Of Neurodegenerative Diseases
Aging: An important factor for the pathogenesis of neurodegenerative diseases
Abbreviated Abstract: Aging is a natural process that is defined as a progressive deterioration of biological functions after the organism has attained its maximal reproductive competence. Aging leads to the accumulation of disabilities and diseases that limit normal body functions and is a major risk factor for neurodegenerative diseases. Many neurodegenerative diseases share oxidative stress and nitrosative stress as common terminal processes. According to free radical theory of aging, an elevation in reactive oxygen species (ROS) and reactive nitrogen species (RNS) damages neural membranes and induces oxidative and nitrosative stress. The increase in oxidative and nitrosative stress is accompanied by the concomitant decline in cognitive and motor performance in the elderly population, even in the absence of neurodegenerative diseases. Markedly increased rates of oxidative and nitrosative stress are the major factors associated with the pathogenesis of neurodegenerative diseases. Diet is a key environmental factor that affects the incidence of chronic neurodegenerative diseases. Dietary supplementation with polyphenols, resveratrol, ginkgo biloba, curcumin, ferulic acid, carotenoids, flavonoids, and n-3 fatty acids exerts beneficial effects not only through the scavenging of free radicals, but also by modulating signal transduction, gene expression, and restoring optimal neuronal communication.
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Farooqui T, Farooqui AA. Mech Ageing Dev. 2009 Apr;1 30(4):203-15. Epub 2008 Nov 21.
Effect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus
Abbreviated Abstract: Poor glucose control increases the risk of vascular complications and cardiovascular mortality in patients with diabetes mellitus (DM). Our aim was to evaluate the efficacy of a long-term exercise training program on metabolic control and arterial stiffness in patients with type 2 DM. Fifty men with DM (age 52.3 +/- 5.6 years) were randomly assigned to the exercise training (E) or standard treatment for DM (control [C]) group for 24 months. Supervised exercise training included both endurance and muscle strength training 4 times/week. Arterial stiffness was assessed by measuring pulse wave velocity. Body weight was not different between groups at 2 years. However, pulse wave velocity increased in both groups (E +0.600 vs. C +1.300 m/s; p = 0.27). In conclusion, long-term endurance and strength training was effective and resulted in improved metabolic control of DM compared with standard treatment. Despite significant cardiovascular risk reduction, conduit arterial elasticity did not improve.
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Loimaala A, Groundstroem K, Rinne M, Nenonen A, Huhtala H, Parkkari J, Vuori I. Am J Cardiol. 2009 Apr 1;103(7):972-7.
Usefulness of peak exercise oxygen consumption and the heart failure survival score to predict survival in patients >65 years of age with heart failure
Abbreviated Abstract: Peak exercise oxygen consumption Vo2 and the Heart Failure (HF) Survival Score (HFSS) were developed in middle-aged patient cohorts referred for heart transplantation with HF. The prognostic value of Vo2 in patients >65 years has not been well studied. Accordingly, the prognostic value of peak Vo2 was evaluated in these patients with HF. A retrospective analysis of 396 patients with HF >65 years with cardiopulmonary exercise testing was performed. Peak Vo2 and components of the HFSS (presence of coronary artery disease, left ventricular ejection fraction, heart rate, mean arterial blood pressure, presence of intraventricular conduction defects, and serum sodium) were collected. Follow-up averaged 1,038 +/- 983 days. Outcome events were defined as death, implantation of a left ventricular assist device, or urgent transplantation. Patients were divided into risk strata for peak Vo2 and HFSS based on previous cut-off points. Survival curves were derived using Kaplan-Meier analysis and compared using log-rank analysis. Survival differed markedly by Vo2 stratum (p <0.0001), with significantly better survival rates for the low- (>14 ml/kg/min) versus medium- (10 to 14 ml/kg/min), low- versus high- (<10 ml/kg/min), and medium- versus high-risk strata (all p <0.05). Survival also differed markedly by HFSS stratum (p <0.0001), with significantly better survival rates for the low- (> or =8.10) versus medium- (7.20 to 8.09), low- versus high- (< or =7.19), and medium- versus high-risk strata (all p <0.0001). In conclusion, peak Vo2 and the HFSS were both excellent parameters to predict survival in patients >65 years with HF.
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Parikh MN, Lund LH, Goda A, Mancini D. Am J Cardiol. 2009 Apr 1;103(7):998-1002. Epub 2009 Feb 7.
Volume Of Exercise And Fitness Nonresponse In Sedentary, Postmenopausal Women
Volume of exercise and fitness nonresponse in sedentary, postmenopausal women
Abbreviated Abstract: There is a wide individual heterogeneity in the maximal aerobic fitness Vo2 max response to exercise training. PURPOSE: To examine predictors of Vo2 max nonresponse after aerobic exercise training in postmenopausal women. METHODS: The Dose Response to Exercise in Women (DREW) study was a randomized, controlled trial examining the effects of incremental training doses on sedentary postmenopausal women (45-75 yr). Participants were randomized to one of three exercise treatment groups (4, 8, or 12 kcal x kg(-1) x wk(-1)) for 6 months. Participants exercised 3-4 d x wk(-1) at 50% Vo2 max. Predictors of baseline Vo2 max were determined by ANOVA. We used a logistic regression analyses with categorical (ethnicity and treatment group) and standardized continuous variables (age, body mass index [BMI], and baseline Vo2 max) to determine predictors of nonresponse (Delta
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Sisson SB, Katzmarzyk PT, Earnest CP, Bouchard C, Blair SN, Church TS. Med Sci Sports Exerc. 2009 Mar; 41(3):539-45.
Unusual Pedometers Worked Better For Step Count
Increasing our understanding of reactivity to pedometers in adults
Abbreviated Abstract: PURPOSE: To investigate the presence of reactivity, if any, to wearing sealed and unsealed pedometers, with and without step count recording. METHODS: On the first visit to the laboratory, 63 participants (41 females and 22 males; age = 23.6 +/- 9.6 yr, body mass index = 22.7 +/- 3.0 kg x m(-2)), blinded to the study aim, were provided with a sealed pedometer (New Lifestyles NL-1000) and informed that it was a "body posture monitor" (covert monitoring). Participants wore the pedometer throughout waking hours for 1 wk. On return to the laboratory, stored step counts were downloaded, and participants were informed that the device was a pedometer. Participants wore the pedometer under three more conditions-sealed, unsealed, and unsealed plus logging daily steps in an activity diary-each having a duration of 1 wk. The order of participation in each condition (sealed/unsealed/diary) was balanced across participants. Mean daily step counts recorded during the four conditions were compared using a repeated-measures ANOVA. RESULTS: There was a significant overall effect of condition (P < 0.001; covert monitoring = 8362 +/- 2600 steps per day; sealed condition = 8832 +/- 2845 steps per day; unsealed condition = 9176 +/- 3299 steps per day; diary condition = 9635 +/- 2709 steps per day), with post hoc analyses revealing that mean step counts were significantly higher in the diary condition than those reported during both the covert and sealed conditions (both P < 0.003). No significant gender effects were observed (P = 0.33). CONCLUSION: The greatest increase in step counts occurred in the diary condition, suggesting that reactivity to pedometers is greatest when participants are requested to wear an unsealed pedometer and record their step counts. This has validity implications for short-term pedometer studies investigating habitual free-living activity that require participants to provide a daily log of their step counts.
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Clemes SA, Parker RA. Med Sci Sports Exerc. 2009 Mar;41(3):674-80.
Physical Activity, Menopause, And Quality of Life: The Role of Affect and Self-Worth Across Time
Physical activity, menopause, and quality of life: the role of affect and self-worth across time
Abbreviated Abstract: OBJECTIVE: Physical activity has been shown to enhance quality of life (QOL); however, few investigations of these effects exist in women undergoing the menopausal transition. The present study examined the long-term effects of physical activity on menopause-related QOL and tested the mediating effects of physical self-worth and positive affect in this relationship. METHODS: Middle-aged women previously enrolled in a 4-month randomized controlled trial involving walking and yoga, and a control group completed a follow-up mail-in survey 2 years after the end of the trial. The survey included a battery of psychological and physical activity measures, including measures of menopausal symptoms and menopause-related QOL. Longitudinal linear panel analysis was conducted within a covariance modeling framework to test whether physical self-worth and positive affect mediated the physical activity-QOL relationship over time. RESULTS: At the end of the trial, physical activity and menopausal symptoms were related to physical self-worth and positive affect, and in turn, greater levels of physical self-worth and positive affect were associated with higher levels of menopause-related QOL. Analyses indicated that increases in physical activity and decreases in menopausal symptoms over the 2-year period were related to increases in physical self-worth (betas = 0.23 and -0.52, physical activity and menopausal symptoms, respectively) and, for symptoms, also to decreased positive affect (beta = -0.47), and both physical self-worth (beta = 0.34) and affect (beta = 0.43) directly influenced enhancements in QOL (R = 0.775). CONCLUSIONS:: The findings support the position that the effects of physical activity on QOL are mediated, in part, by intermediate psychological outcomes and that physical activity can have long-term benefits for women undergoing the menopausal transition.
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Elavsky S. Menopause. 2009 Jan 21.
Fracture Risk Increases After Diagnosis of Breast or Other Cancers In Postmenopausal Women: Results From the Women's Health Initiative
Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: results from the Women's Health Initiative
Abbreviated Abstract: SUMMARY: Risk for falls and fractures increases after breast cancer or other cancer diagnosis in postmenopausal women. Factors other than falls may be the major causes for the increased fracture risk. INTRODUCTION: Cancer treatment and prognosis may have detrimental effects on bone health. However, there is a lack of prospective investigations on fracture risk among incident cancer cases. METHODS: In this study, postmenopausal women (N = 146,959) from the Women's Health Initiative prospective cohort, who had no cancer history at baseline, were followed for up to 9 years and classified into no cancer, incident breast cancer (BC) and incident other cancer (OC) groups. The main outcomes measured were incident fractures and falls before and after cancer diagnosis. Hazards ratios (HR) and 95% confidence intervals (CI) were computed from Cox proportional hazards model. RESULTS: While hip fracture risk before a cancer diagnosis was similar between the no cancer and cancer groups, hip fracture risk was significantly higher after BC diagnosis (HR = 1.55, CI = 1.13-2.11) and the elevated risk was even more notable after OC diagnosis (HR = 2.09, CI = 1.65-2.65). Risk of falls also increased after BC (HR = 1.15, CI = 1.06-1.25) or OC diagnosis (HR = 1.27, CI = 1.18-1.36), but could not fully explain the elevated hip fracture risk. Incident clinical vertebral and total fractures were also significantly increased after OC diagnosis (p < 0.05). CONCLUSIONS: Postmenopausal women have significantly elevated risks for falls and fractures after a cancer diagnosis. The causes for this increased risk remained to be investigated.
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Chen Z, Maricic M, Aragaki AK, Mouton C, Arendell L, Lopez AM, Bassford T, Chlebowski RT. Osteoporos Int. 2009 Apr;20(4):527-36. Epub 2008 Sep 3.
Lactate Accumulation During Exercise And Increased Fatigued Resistance Caused By Aging
Evidence for differential regulation of lactate metabolic properties in aged and unloaded rat skeletal muscle
Abbreviated Abstract: Skeletal muscles of elderly individuals show fatigue resistance and reduced lactate accumulation compared with those of young subjects during activities that recruit a small amount of muscle mass. To explore the mechanism underlying the functional changes in aged muscle, we focused on lactate metabolic properties, including monocarboxylate transporter (MCT) 1 and MCT4, in muscles from old and young control rats and hindlimb-suspended young rats. MCT1 expression was lower in soleus (SOL) of old rats than in SOL of young control rats, but was similar in young control and hindlimb-suspended rats. MCT4 expression was lower in extensor digitorum longus (EDL) of old rats than in that of young control rats, but did not differ between young control and hindlimb-suspended rats. The ratio of lactate dehydrogenase to citrate synthase activities was higher in SOL of hindlimb-suspended and old rats than in SOL of young control rats, and was lower in EDL of old rats than in those of young control and hindlimb-suspended rats. Our data suggest that aging causes metabolic changes that can reduce lactate accumulation during exercise and increase fatigue resistance in skeletal muscle, and that these
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Masuda S, Hayashi T, Egawa T, Taguchi S. Exp Gerontol. 2009 Apr;44(4):280-8. Epub 2008 Dec 24.
Topical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview
Abbreviated Abstract: Vaginal atrophy, a manifestation of estrogen deprivation after the menopause, could affect up to 60% of women, with a significant impact on their quality of life. It is often under-diagnosed and inadequately treated. Symptoms are more common and severe in breast cancer survivors. Systemic estrogen replacement therapy may be unacceptable for many women because of the concerns over possible risks and may not cure vaginal symptoms in up to 45% of users. Non-medicated vaginal lubricants or moisturizers have been found to be no better than placebo and less effective than estrogen. Topical vaginal estrogen preparations reverse atrophic changes and relieve associated symptoms, while avoiding systemic effects. This article provides an up-to-date overview of the role, safety and effectiveness of topical vaginal estrogen therapy.
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Al-Baghdadi O, Ewies AA. Climacteric. 2009 Apr;12(2):91-105.
Decline in Hormone Use Over 17 Years
Continuing decline in hormone therapy use: population trends over 17 years
Abbreviated Abstract: OBJECTIVE: To describe the prevalence of menopausal hormone therapy (HT) in 2008 and trends over the last 17 years in an Australian population. METHODS: Data were obtained from nine representative population face-to-face interview surveys of the South Australian population from 1991 to 2008. The surveys used consistent method and quality control procedures. In 2008, demographic data, HT use and eight dimensions of health, using the SF-36 health survey questionnaire, were measured. Participants Over 3000 South Australian adults were interviewed in their own home by trained health interviewers in each of the surveys; in the 2008 survey, 1555 women participated, of whom 953 were over age 40. Median and mean length of conventional HT use were 10.0 and 10.5 years, respectively. HT users continued to have a demographic profile similar to those in previous surveys, i.e. they were better educated, employed, partnered, had a higher income and were less inclined to use complementary and alternative medicines. CONCLUSIONS: There has been a continuing decline in both the overall prevalence and length of use of conventional HT from 2003, probably in association with negative media about HT. Of medical concern is that about one-quarter of women using HT around menopause now chooses unregistered hormonal mixtures that are untested for long-term safety and efficacy.
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MacLennan AH, Gill TK, Broadbent JL, Taylor AW. Climacteric. 2009 Apr; 12(2):122-30.
Using A Balance Strategy Training Program
Controlling balance decline across the menopause using a balance-strategy training program: a randomized, controlled trial
Abbreviated Abstract: OBJECTIVE: To evaluate effectiveness and long-term benefits of a specific balance-strategy training program in sedentary women aged 40-60 years and whether participation leads to adoption of a more active lifestyle. METHOD: Fifty healthy women were admitted to the randomized, controlled trial on the basis of their activity level. Subjects were randomly assigned to an intervention or control group, with the former attending twice-weekly for 12 weeks. Assessments made pre- and post-intervention and at 9 months follow-up included: personal demographics, hormone replacement therapy medication, activity level, balance measures, somatosensory function, ankle flexibility and leg muscle strength. CONCLUSION: These results provide evidence that this physiotherapist-designed program preserves/reverses the balance decline associated with age and leads to adoption of a more active lifestyle.
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Fu S, Choy NL, Nitz J. Climacteric. 2009 Apr;12(2):165-76.
Low Testosterone And Anaemia In Men with Type 2 Diabetes
Low testosterone and anaemia in men with type 2 diabetes
Abbreviated Abstract: OBJECTIVE: Anaemia is frequently found in patients with diabetes, in whom it is associated with increased morbidity and mortality. Low testosterone levels are also common in men with type 2 diabetes. We hypothesized that low testosterone levels are also associated with anaemia in men with type 2 diabetes, over the effects of chronic kidney disease. DESIGN: Cross-sectional cohort study, performed in 2005 in a tertiary diabetes clinic. Patients 464 men with type 2 diabetes. CONCLUSIONS: These findings suggest that testosterone deficiency may contribute to the increased frequency of anaemia in men with type 2 diabetes. However, the appropriate clinical response to testosterone deficiency in anaemic patients remains to be established by prospective clinical trials.
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Grossmann M, Panagiotopolous S, Sharpe K, MacIsaac RJ, Clarke S, Zajac JD, Jerums G, Thomas MC. Clin Endocrinol (Oxf). 2009 Apr;70(4):547-53. Epub 2008 Aug 13.
Androgen Deprivation Therapy
Hot flashes during androgen deprivation therapy with luteinizing hormone-releasing hormone agonist combined with steroidal or nonsteroidal antiandrogen for prostate cancer
Abbreviated Abstract: OBJECTIVES: To investigate hot flashes and quality of life during combined androgen blockade (CAB) therapy using steroidal or nonsteroidal antiandrogens. METHODS: A total of 151 patients with prostate cancer, who were enrolled into this study from May 2001 to June 2003, were randomized to receive CAB therapy using a luteinizing hormone-releasing hormone agonist (leuprorelin) combined with a steroidal antiandrogen (chlormadinone) or a nonsteroidal antiandrogen (bicalutamide). The incidence of, frequency of, and distress due to hot flashes were evaluated with a self-administered questionnaire during a 2-year period. The general and disease-specific quality-of-life outcomes were also measured using the Functional Assessment of Cancer Therapy-Prostate questionnaire. CONCLUSIONS: Our results suggest that CAB using a steroidal antiandrogen such as chlormadinone might induce fewer and less-distressing hot flashes than CAB with bicalutamide.
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Sakai H, Igawa T, Tsurusaki T, Yura M, Kusaba Y, Hayashi M, Iwasaki S, Hakariya H, Hara T, Kanetake H. Urology. 2009 Mar;73(3):635-40. Epub 2008 Nov 26.
Growth Hormone Deficient Adults
Ten years of growth hormone (GH) replacement normalizes muscle strength in GH-deficient adults
Abbreviated Abstract: CONTEXT: GH replacement for 1-5 yr improves, but does not fully normalize, muscle strength. OBJECTIVE, DESIGN, AND PATIENTS: In this single-center, open-labeled, prospective study, the effects of 10 yr of GH replacement on muscle strength and neuromuscular function were followed in 109 consecutive adults (61 men; mean age 50.0 yr; range 22-74 yr) with adult-onset GH deficiency. RESULTS: The mean initial GH dose of 0.88 mg/d was gradually lowered to 0.47 mg/d. The mean IGF-I sd score increased from -1.54 at baseline to 1.12 at study end. GH replacement induced a sustained increase in lean mass and isometric knee flexor strength (60 degrees). In most other measures of upper leg and handgrip strength, there were transient increases during the first half of the study (0-5 yr), whereas during the second half (5-10 yr), the absolute values of muscle strength decreased and returned to or even below the baseline values. However, after correction for age and gender using observed/predicted value ratios, there were sustained and, until 7 yr, even progressive increases in the measures of muscle strength. At study end, knee flexor strength had increased to 104-110% of predicted, knee extensor strength to 93-108%, and handgrip strength to 88-93%. Measurements of neuromuscular function showed reduced voluntary motor unit activation after 10 yr. CONCLUSIONS: Ten years of GH replacement therapy increased muscle strength during the first half of the study and thereafter partly protected against the normal age-related decline in muscle strength and neuromuscular function, resulting in approximately normalized muscle strength after 10 yr.
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Götherström G, Elbornsson M, Stibrant-Sunnerhagen K, Bengtsson BA, Johannsson G, Svensson J. J Clin Endocrinol Metab. 2009 Mar; 94(3):809-16. Epub 2008 Dec 16.
Estrogen and Glucose Intolerance
Estrogens protect against high-fat diet-induced insulin resistance and glucose intolerance in mice
Abbreviated Abstract: Although corroborating data indicate that estrogens influence glucose metabolism through the activation of the estrogen receptor alpha (ERalpha), it has not been established whether this pathway could represent an effective therapeutic target to fight against metabolic disturbances induced by a high-fat diet. To this end, we first evaluated the influence of chronic 17beta-estradiol (E2) administration in wild type ovariectomized mice submitted to either a normal chow diet (NCD) or a high-fat diet (HFD). Whereas only a modest effect was observed in NCD fed mice, E2 administration exerted a protective effect against HFD-induced glucose intolerance, and this beneficial action was abolished in ERalpha-deficient mice. Furthermore, E2 treatment reduced HFD-induced insulin resistance by 50% during hyperinsulinemic euglycemic clamp studies, and improved insulin signalling (Akt phosphorylation) in insulin-stimulated skeletal muscles. Unexpectedly, we found that E2 treatment enhanced cytokine (IL-6, TNF-alpha) and PAI-1 mRNA expression induced by HFD in the liver and visceral adipose tissue. Interestingly, although the pro-inflammatory effect of E2 was abolished in visceral adipose tissue from chimeric mice grafted with bone marrow cells from ERalpha-deficient mice, the beneficial effect of the hormone on glucose tolerance was not altered, suggesting that the metabolic and inflammatory effects of estrogens can be dissociated. Eventually, comparison of sham-operated with ovariectomized HFD-fed mice, demonstrated that endogenous estrogens levels are sufficient to exert a full protective effect against insulin resistance and glucose intolerance. In conclusion, the regulation of the ERalpha pathway could represent an effective strategy to reduce the impact of high-fat diet-induced type 2 diabetes.
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Riant E, Waget A, Cogo H, Arnal JF, Burcelin R, Gourdy P. Endocrinology. 2009 Jan 22.
Psychological Symptoms in Surgically Induced Menopausal Women
Do different delivery systems of hormone therapy have different effects on psychological symptoms in surgically menopausal women? A randomized controlled trial
Abbreviated Abstract: OBJECTIVE: To compare the influence of different delivery forms of estrogen therapy on menopausal and psychological symptoms in surgically menopausal women. STUDY DESIGN: Surgically menopausal women were assigned to a 1-year-therapy with oral conjugated estrogen 0.625mg/day (n=35), intranasal 300microg/day estradiol hemihidrate (n=33), percutaneous gel 1.5mg/day estradiol hemihidrate (n=32) or no treatment (control group, n=32). Serum E(2) and FSH levels, Kupperman's Scale used to assess climacteric symptoms, Hamilton Depression Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores were assessed before and after 1-year-therapy. RESULTS: After 1 year, the greatest increase in E(2) was in the oral group, followed by the transdermal gel, and then the intranasal group (oral vs. transdermal gel: p=0.022: oral vs. intranasal: p=0.0001; transdermal gel vs. intranasal: p=0.0001). All treatment groups improved significantly in total Kupperman index score and HARS (p<0.05) with no difference between the groups. With regard to HDRS, all treatment groups improved significantly (p<0.05) with the greatest improvement in the oral group, and no difference between transdermal gel and intranasal groups (oral vs. transdermal gel: p=0.015; oral vs. intranasal: p=0.001; transdermal gel vs. intranasal: p=0.735). Control group scored worse in all tests after study (p<0.05). All scores correlated significantly with post-treatment serum E(2) and FSH levels (p<0.001). CONCLUSION: Oral, intranasal and percutaneous gel estradiol therapies significantly improve menopausal and psychological symptoms in surgically menopausal women with oral route better than transdermal gel and intranasal modalities against depressive mood.
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Baksu B, Baksu A, Göker N, Citak S. Maturitas. 2009 Feb 20; 62(2):140-5.
Hot Flashes Impacts Women's Quality of Life
Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life
Abbreviated Abstract: OBJECTIVE: To use the Menopause-Specific Quality of Life Questionnaire (MENQOL) to assess the impact of menopausal symptoms on health-related quality of life in a large US population-based study. METHODS: Participants were recruited from the US population through random-digit-dialing and probability sampling. Analyses included 2703 postmenopausal women 40-65 years old in our Menopause Epidemiology Study. Respondents answered a 30-min questionnaire, including the MENQOL. CONCLUSION: Symptoms experienced during menopause and socio-demographic characteristics affect the quality of life in postmenopausal women. Hot flashes impact the daily activities of most postmenopausal women, especially those with more frequent/severe symptoms. Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women.
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Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV. Maturitas. 2009 Feb 20;62(2):153-9. Epub 2009 Jan 21.
Sexual Experience and Estrogen
A randomized study of low-dose conjugated estrogens on sexual function and quality of life in postmenopausal women
Abbreviated Abstract: OBJECTIVE: To evaluate the effects of combined vaginal and oral low-dose estrogen plus progestogen therapy (EPT) on the frequency and severity of dyspareunia, sexual function, and quality of life in recently postmenopausal women. DESIGN:: This outpatient, double-blind, randomized, placebo-controlled trial enrolled 285 healthy, sexually active postmenopausal women aged 45 to 65 years. Women received either one daily oral low-dose conjugated estrogens (0.45 mg)/medroxyprogesterone (1.5 mg) tablet for six 28-day cycles along with 1 g conjugated estrogens vaginal cream (0.625 mg), intravaginally for the first 6 weeks of the trial or a placebo cream and placebo tablet. Efficacy was evaluated using the McCoy Female Sexuality Questionnaire, self-reported daily diary cards, the Brief Index of Sexual Functioning-Women (BISF-W), and the Women's Health Questionnaire. RESULTS:: The EPT group had a significant decrease in the frequency of dyspareunia compared with baseline and placebo in an analysis of responses to the McCoy Female Sexuality Questionnaire. Also, EPT was associated with a significant improvement in a woman's level of sexual interest, frequency of orgasm, and pleasure of orgasm. There was no effect of EPT use on coital frequency. The EPT group had significant improvement in receptivity/initiation and relationship satisfaction, although not in other BISF-W domains, versus placebo (BISF-W analysis) and significant improvement versus placebo on most Women's Health Questionnaire responses. CONCLUSIONS:: EPT provided a statistically significant improvement compared with placebo in dyspareunia, sexual experience, and quality of life as measured in this study. In general, EPT also improved self-reported sexual perception and enjoyment significantly compared with placebo.
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Gast MJ, Freedman MA, Vieweg AJ, De Melo NR, Girão MJ, Zinaman MJ; The Dyspareunia Study Group. Menopause. 2008 Nov 20.
Nonhormonal Therapies Used For Menopausal Symptoms
Replacing hormone therapy is the decline in prescribing sustained, and are nonhormonal drugs substituted?
Abbreviated Abstract: OBJECTIVES: After two cautioning landmark studies in 2002 and 2003, a dramatic decrease in hormonal therapy (HT) prescribing for menopausal symptoms was seen. Our objectives were to (1) determine whether this decline in HT prescribing sustained until 2007 and (2) investigate nonhormonal drug prescribing for women who stopped HT. METHODS:: We analyzed drug dispensing data from community pharmacies in The Netherlands. For the first objective, we analyzed exposure prevalence of HT. For our second objective, we selected all women who were dispensed HT prescriptions between August 2002 and August 2003. From this study cohort, we defined our index group as all women who stopped HT shortly after the studies (n = 1,254) and a reference group as all women who continued HT (n = 839). We calculated the incidence of nonhormonal therapies for both groups, reporting risk ratio (RR) and 95% CI. Kaplan-Meier curves were also constructed. RESULTS: Mean exposure prevalence of HT (per 1,000 women) pre 2002 versus post 2004 was 30.6 versus 15.3 (50.0% decline) for 40 to 49 years, 79.2 versus 25.5 (67.7% decline) for 50 to 59 years, and 28.4 versus 11.6 (59.1% decline) for 60 to 69 years. HT exposure remained low until 2007. HT stoppers receive more clonidine, RR 3.48 (2.36-5.13); anxiolytics or sedatives, RR 1.46 (1.15-1.87); and osteoporosis prophylaxis and treatment, RR 2.04 (1.14-3.66). Young stoppers (40-49 y) received more antidepressants, RR 2.70 (1.41-5.11), whereas older stoppers (60-69 y) received less antidepressants, RR 0.43 (0.18-1.05). Kaplan-Meier curves showed that nonhormonal drug prescribing occurred soon after HT was stopped. CONCLUSIONS:: This study shows the dramatic and sustained impact of the cautioning landmark studies on HT prescribing. HT stoppers received more nonhormonal therapies for menopausal symptoms compared with those who continued HT.
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Vegter S, Kölling P, Töben M, Visser ST, de Jong-van den Berg LT. Menopause. 2009 Feb 2.
Some Herbal Formulas Did Not Impact Menopausal Symptoms
A randomized placebo-controlled trial on the effectiveness of an herbal formula to alleviate menopausal vasomotor symptoms
Abbreviated Abstract: OBJECTIVE: To evaluate the effectiveness of a formula containing Chinese herbs and Cimicifuga racemosa in alleviating vasomotor symptoms and improving quality of life. DESIGN: Between September 2004 and October 2005, 93 healthy women aged 45 to 65 years who reported six or more vasomotor symptoms per 24 hours were recruited into a 20-week randomized, double-blind, placebo-controlled trial. Women were consulted in clinics conducted within the Sydney metropolitan area. After a 4-week baseline period, women were randomly allocated to receive herbal (equivalent to 3,150 mg dry herb) or identical placebo tablets for 16 weeks. Women recorded the number and severity (1 = mild to 4 = very severe) of vasomotor symptoms in a daily hot flash diary and completed the Greene Climacteric and Hot Flash Related Daily Interference scales at each monthly consultation. RESULTS:: Intention-to-treat and per-protocol analyses found no statistically significant differences in mean hot flash scores (product of frequency and intensity), Greene Climacteric Scale scores, and Hot Flash Related Daily Interference Scale scores between the placebo and herbal treatment groups after 16 weeks of intervention. CONCLUSIONS: This herbal formula containing Chinese herbs and Cimicifuga cannot be recommended to alleviate menopausal vasomotor symptoms or improve quality of life.
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van der Sluijs CP, Bensoussan A, Chang S, Baber R. Menopause. 2008 Dec 4.
Risk of dementia in older breast cancer survivors: a population-based cohort study of the association with adjuvant chemotherapy
Abbreviated Abstract: OBJECTIVES: To assess whether there is an association between delivery of adjuvant chemotherapy to older women with breast cancer and development of dementia over time. DESIGN: Retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare claims data. SETTING: Women residing in geographic areas included in the SEER registry. PARTICIPANTS: Women aged 66 to 80 diagnosed with non-metastatic invasive breast cancer from 1992 to 1999 were included. It was determined whether patients had undergone chemotherapy within 6 months of diagnosis. MEASUREMENTS: Whether women developed dementia over time was determined using diagnostic codes. The effect of adjuvant chemotherapy on development of dementia was evaluated, adjusting for confounders using a proportional hazards model stratified for age. RESULTS: Twenty-one thousand three hundred sixty-two women met selection criteria; 2,913 received chemotherapy, and 18,449 did not. Women who received chemotherapy were younger than those who did not (median aged 70 vs. 73; P<.001). Median follow-up time was 59 months. After controlling for other factors, it was found that chemotherapy was not associated with a greater risk of development of dementia over time for any age group (hazard ratio for dementia in women receiving chemotherapy: aged 66-70=0.83, 95% confidence interval (CI)=0.48-1.45, P=.5; aged 71-75=0.74, 95% CI=0.46-1.18, P=.2; aged 76-80=0.49, 95% CI=0.28-0.88, P=.02). CONCLUSION: Receipt of chemotherapy in older women with breast cancer was not associated with a greater risk of dementia diagnosis over time; very elderly women who undergo chemotherapy may be at lower baseline risk. The use of a claims-based definition of dementia limited the study.
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Baxter NN, Durham SB, Phillips KA, Habermann EB, Virning BA. J Am Geriatr Soc. 2009 Mar; 57(3):403-11.
Metabolic syndrome in older subjects: coincidence or clustering?
Abbreviated Abstract: The prevalence of the metabolic syndrome (MS) increases with advancing age. However, aging per se is associated with increased prevalence of most of the abnormalities contributing to the MS. Whether MS in older people consistently identifies a true pathophysiological entity or a casual aggregation of aging-associated metabolic abnormalities, remains to be fully elucidated. In the present study, we aimed to evaluate whether in older subjects the aggregation of metabolic components of the MS, as defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), is consistent with a single latent variable. Age, waist circumference, systolic and diastolic blood pressure, metabolic variables were determined in 152 older (>70 years), non-diabetic, healthy men. Cronbach alpha was used to assess the internal consistency of the components contributing to the MS. Structural equation modeling, using the Normed Fit Index (NFI), the Root Mean Square Error of Approximation (RMSEA), the Comparative Fit Index (CFI), and the Tucker-Lewis Index (TLI) was used to assess the fit to a model with a single latent variable. The Cronbach alpha test showed low internal consistency among the metabolic variables (alpha=0.31). The calculated chi(2) values were 28.31 and 32.52 for model entering hypertension as dichotomous variable and for model entering blood pressure values, respectively, both expressing low fit to a model with a single latent variable. In both models, CFI (0.41 and 0.55), NFI (0.59 and 0.55), RMSEA (0.25 and 0.22) and TLI (-0.31 and -0.12) scores showed a low fit of the metabolic alterations to a single latent variable. These findings suggest caution in making diagnosis of MS at older ages, since metabolic and cardiovascular abnormalities being per se extremely common in elderly people, do not appear to cluster together under a single common factor.
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Bo M, Sona A, Astengo M, Fiandra U, Quagliotti E, Brescianini A, Fonte G. Arch Gerontol Geriatr. 2009 Mar-Apr;48(2):146-50. Epub 2008 Feb 19.
The Value of Family History As A Risk Indicator For Venous Thrombosis
The value of family history as a risk indicator for venous thrombosis
Abbreviated Abstract: BACKGROUND: A positive family history of venous thrombosis may reflect the presence of genetic risk factors. Once a risk factor has been identified, it is not known whether family history is of additional value in predicting an individual's risk. We studied the contribution of family history to the risk of venous thrombosis in relation to known risk factors. METHODS: In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis, a population-based case-control study, we collected blood samples and information about family history and environmental triggers from 1605 patients with a first venous thrombosis and 2159 control subjects. RESULTS: A total of 505 patients (31.5%) and 373 controls (17.3%) reported having 1 or more first-degree relatives with a history of venous thrombosis. A positive family history increased the risk of venous thrombosis more than 2-fold (odds ratio [95% confidence interval], 2.2 [1.9-2.6]) and up to 4-fold (3.9 [2.7-5.7]) when more than 1 relative was affected. Family history corresponded poorly with known genetic risk factors. Both in those with and without genetic or environmental risk factors, family history remained associated with venous thrombosis. The risk increased with the number of factors identified; for those with a genetic and environmental risk factor and a positive family history, the risk was about 64-fold higher than for those with no known risk factor and a negative family history. CONCLUSIONS: Family history is a risk indicator for a first venous thrombosis, regardless of the other risk factors identified. In clinical practice, family history may be more useful for risk assessment than thrombophilia testing.
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Bezemer ID, van der Meer FJ, Eikenboom JC, Rosendaal FR, Doggen CJ. Arch Intern Med. 2009 Mar 23; 169(6):610-5.
Metabolic Syndrome and Obesity Potential Predictors of Depressive Symptoms
Association between metabolic syndrome and depressive symptoms in middle-aged adults: results from the Whitehall II study
Abbreviated Abstract: OBJECTIVE: Although it is possible that the association between depression and the metabolic syndrome is a "two-way street," the metabolic syndrome as a predictor of depression has been little investigated. We examined whether the metabolic syndrome is associated with the onset of depressive symptoms in a cohort of middle-aged British civil servants. RESEARCH DESIGN AND METHODS: Analyses included 5,232 participants (41-61 years of age) from the Whitehall II prospective cohort study. Depressive symptoms were assessed in 1991-1993 and again 6 years later using the depression subscale from the 30-item General Health Questionnaire. Metabolic syndrome was assessed in 1991-1993, according to National Cholesterol Education Program criteria. RESULTS: Presence of the metabolic syndrome was associated with an increased risk of future depressive symptoms, odds ratio 1.38 (95% CI 1.02-1.96) after adjustment for potential confounders. Of the five components, only central obesity, high triglyceride levels, and low HDL cholesterol levels predicted depressive symptoms. These components explained most of the association between the metabolic syndrome and the onset of depressive symptoms. CONCLUSIONS: Our results suggest that the metabolic syndrome, in particular the obesity and dyslipidemia components, is predictive of depressive symptoms.
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Akbaraly TN, Kivimäki M, Brunner EJ, Chandola T, Marmot MG, Singh-Manoux A, Ferrie JE. Diabetes Care. 2009 Mar;32(3):499-504. Epub 2008 Dec 23.
Hysterectomy Is More Likely To Be Performed In Heavier Women
Hysterectomy and weight gain
Abbreviated Abstract: OBJECTIVE: To investigate whether overweight women are more likely to have a hysterectomy and whether hysterectomy leads to increased weight gain. DESIGN:: Survey data of middle-aged women participating in the Australian Longitudinal Study on Women's health in 1996 (ages 45-50 y; n = 13,125), 1998 (n = 10,612), 2001 (n = 10,293), and 2004 (n = 9309) included self-reported height, weight, and hysterectomy. First, we conducted a cohort analysis, comparing body mass index (BMI) of women categorized according to hysterectomy status. Second, we used a nested case-control analysis to compare weight gain between women who underwent hysterectomy and women who did not have a hysterectomy, matched for prehysterectomy weight, height, menopause status, and educational level. RESULTS:: At survey 1, the mean BMI of women who subsequently had a hysterectomy was greater than that of women without a hysterectomy by survey 2 (difference, 1.1 kg/m; 95% CI, 0.5-1.6). Results were similar for surveys 2 to 3 (BMI difference, 0.8 kg/m; 95% CI, 0.3-1.3) and surveys 3 to 4 (BMI difference, 0.8 kg/m; 95% CI, 0.1-1.4).Having a hysterectomy between surveys 1 and 2 was not associated with percentage of weight gain over the 3 or 6 years after survey 2 (odds ratio, 0.98 [95% CI, 0.96-1.01] and 0.99 [95% CI, 0.97-1.01], respectively). Having a hysterectomy between surveys 2 and 3 was weakly associated with percentage of weight gain over 3 years (odds ratio, 1.03 [95% CI, 1.00-1.05]). CONCLUSIONS:: Among women older than 45 to 50 years, hysterectomy did not lead to greater weight gain but was more likely to be performed in heavier women.
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Fitzgerald DM, Berecki-Gisolf J, Hockey RL, Dobson AJ. Menopause. 2008 Oct 27.
Moderate Alcoholic Beverage Consumption Had Minimal Impact on Insulin Sensitivity
Effect of moderate alcoholic beverage consumption on insulin sensitivity in insulin-resistant, nondiabetic individuals
Abbreviated Abstract: Although moderate alcohol consumption has been associated with a decrease in plasma insulin concentrations, relatively few studies have been conducted to evaluate the effect of alcohol on insulin sensitivity, particularly in nondiabetic, insulin-resistant individuals. Because enhanced insulin sensitivity could contribute to the reported association between moderate alcohol consumption and reduced risk of heart disease and diabetes, we believed it is important to address this issue. Consequently, we evaluated the ability of moderate alcohol consumption to improve insulin sensitivity, as measured by determining the steady-state plasma glucose (SSPG) concentration during the insulin suppression test, in 20 nondiabetic, insulin-resistant individuals. Measurements were made of SSPG, glucose, insulin, and lipoprotein concentrations before and after consuming 30 g of alcohol for 8 weeks, either as vodka (n = 9) or red wine (n = 11). The SSPG concentrations (insulin resistance) decreased by approximately 8% in the total group (P = .08), and high-density lipoprotein cholesterol concentration increased by a mean of 0.09 mmol/L (P = .02). Trends were similar in individuals who consumed vodka or red wine. Men tended to have greater decline in SSPG and increase in high-density lipoprotein cholesterol compared with women. There were no other metabolic changes in fasting plasma glucose, insulin, and triglyceride concentrations. These data demonstrate that 8 weeks of moderate alcohol consumption had minimal impact on enhancing insulin sensitivity in nondiabetic, insulin-resistant individuals, raising questions as to the role, if any, of improved insulin sensitivity in the purported clinical benefits associated with moderate alcohol consumption.
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Kim SH, Abbasi F, Lamendola C, Reaven GM. Metabolism. 2009 Mar;58(3):387-92.
Telomerase Insufficiency In Rheumatoid Arthritis
Telomerase insufficiency in rheumatoid arthritis
Abbreviated Abstract: In rheumatoid arthritis (RA), chronically stimulated T lymphocytes sustain tissue-destructive joint inflammation. Both naïve and memory T cells in RA are prematurely aged with accelerated loss of telomeres suggesting excessive proliferative pressure or inadequate telomeric maintenance. Upon stimulation, RA naïve CD4 T cells are defective in up-regulating telomerase activity (P < 0.0001) due to insufficient induction of the telomerase component human telomerase reverse transcriptase (hTERT); T cell activation and cell cycle progression are intact. Telomerase insufficiency does not affect memory T cells or CD34 hematopoietic stem cells and is present in untreated patients and independent from disease activity. Knockdown of hTERT in primary human T cells increases apoptotic propensity (P = 0.00005) and limits clonal burst (P = 0.0001) revealing a direct involvement of telomerase in T cell fate decisions. Naïve RA CD4 T cells stimulated through the T cell receptor are highly susceptible to apoptosis, expanding to smaller clonal size. Overexpression of ectopic hTERT in naïve RA T cells conveys apoptotic resistance (P = 0.008) and restores proliferative expansion (P < 0.0001). Telomerase insufficiency in RA results in excessive T cell loss, undermining homeostatic control of the naive T cell compartment and setting the stage for lymphopenia-induced T cell repertoire remodeling. Restoring defective telomerase activity emerges as a therapeutic target in resetting immune abnormalities in RA.
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Fujii H, Shao L, Colmegna I, Goronzy JJ, Weyand CM. Proc Natl Acad Sci U S A. 2009 Mar 17;106(11):4360-5. Epub 2009 Mar 2.
Volume 2 - 2009
Topics
Cardiovascular
Nutrition
Aging
Diabetes
Exercise and Physiology
Hormones
Cognitive
Other
Cardiovascular
Older Adults Have the Highest Prevalence of Metabolic SyndromeMetabolic syndrome and risk factors for cardiovascular disease: are nonagenarians protected?
Abbreviated Abstract: This study assessed cardiovascular disease risk factors in three groups of human subjects aged 20-34 [young, 20 male (M)/33 female (F)], 60-74 (aged, 29M/29F), and > 90 years (nonagenarian, 47M/50F). Components of the metabolic syndrome, cardiovascular disease, and markers of inflammation and oxidative stress were assessed. Nonagenarians weighed less than the two other groups (P < 0.001). Aged individuals had the highest prevalence of the metabolic syndrome (P < 0.001) according to the Adult Treatment Panel III classification. Both fibrinogen and homocysteine concentrations were significantly higher in the nonagenarians compared to younger groups. However, there were no significant differences between groups in fasting insulin, high sensitive C-reactive protein, and plasminogen activator inhibitor 1 concentrations. There were also no relationships between inflammation/oxidative stress and the metabolic syndrome or cardiovascular disease although nonagenarians appear to be protected from oxidative damage to DNA.
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Frisard MI, Rood JC, Fang X, Su J, Welsh DA, Jazwinski SM, Ravussin E; for the Louisiana Healthy Aging Study. Age (Dordr). 2009 Mar; 31(1):67-75. Epub 2009 Jan 31.
HDL Increases In American Women But Not In Chinese Women
High density lipoprotein-cholesterol levels increase with age in American women but not in Hong Kong Chinese women Abbreviated Abstract: OBJECTIVES: High-density lipoprotein (HDL) cholesterol is a powerful cardiovascular risk factor. Important gender and ethnic differences in plasma HDL levels exist and warrant investigation. DESIGN: Cross-sectional survey in two different general populations. Patients 7700 participants of the National Health and Nutrition Examination Survey (NHANES) 1999-2002 and 1944 participants of the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS2) 2000-2004. RESULTS: Plasma HDL levels were higher in women than in men in both populations. In the United States women, it increased with age, whereas in Chinese women, it declined with age and converged with male HDL levels. In Americans, the independent predictors of low HDL levels were lower age, being non-Mexican Hispanic, waist circumference, triglycerides and not drinking alcohol in men, and lower age, being Hispanic, waist circumference, triglycerides, current smoking and not drinking alcohol in women. In Hong Kong Chinese, the independent predictors of low HDL levels were body mass index, triglycerides, current smoking and not drinking alcohol in men, and lower age, waist circumference, triglycerides, diabetes and former smoking in women. CONCLUSIONS: The decline in plasma HDL with age in Chinese women is opposite to that seen in American women. The increased cardiovascular risk in elderly Chinese women requires further study.
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Cheung BM, Li M, Ong KL, Wat NM, Tam S, Pang RW, Thomas GN, Woo J, Janus ED, Lau CP, Lam TH, Lam KS. Clin Endocrinol (Oxf). 2009 Apr; 70(4):561-8. Epub 2008 Aug 19.
Body Mass Index and Waist Circumference May Be a Mischaracterization for Patterns of Abs Fat
Patterns of abdominal fat distribution: the Framingham Heart Study
Abbreviated Abstract: OBJECTIVE: The prevalence of abdominal obesity exceeds that of general obesity. We sought to determine the prevalence of abdominal subcutaneous and visceral obesity and to characterize the different patterns of fat distribution in a community-based sample. RESULTS: The prevalence of high subcutaneous adipose tissue (SAT) was 30% (women) and 31% (men) and that for high visceral adipose statue (VAT) was 44% (women) and 42% (men). Overall, 27.8% of the sample was discordant for high SAT and high VAT: 19.9% had SAT less than but VAT equal to or greater than the 90th percentile, and 7.9% had SAT greater than but VAT less than the 90th percentile. The prevalence of metabolic syndrome was higher among women and men with SAT less than the 90th percentile and high VAT than in those with high SAT but VAT less than the 90th percentile, despite lower Body Mass Index (BMI) and waist circumference. Findings were similar for hypertension, elevated triglycerides, and low HDL cholesterol. CONCLUSIONS: Nearly one-third of our sample has abdominal subcutaneous obesity, and >40% have visceral obesity. Clinical measures of BMI and waist circumference may misclassify individuals in terms of VAT and metabolic risk.
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Pou KM, Massaro JM, Hoffmann U, Lieb K, Vasan RS, O'Donnell CJ, Fox CS. Diabetes Care. 2009 Mar; 32(3):481-5. Epub 2008 Dec 15.
Underweight Older Adults May Be Susceptible to Cardiac Events Post Op After Hip Fracture
Body mass index and risk of adverse cardiac events in elderly patients with hip fracture: a population-based study
Abbreviated Abstract: OBJECTIVES: To determine whether obesity affects cardiac complications after hip fracture repair. DESIGN: A population-based historical study using data from the Rochester Epidemiology Project. RESULTS: Hip fracture repairs were performed in 184 (15.6%) underweight, 640 (54.2%) normal-weight, 251 (21.3%) overweight, and 105 (8.9%) obese subjects (mean age 84.2 +/- 7.5; 80% female). Baseline American Society of Anesthesiologists (ASA) status was similar in all groups (ASA I/II vs. III-V, P=.14). Underweight patients had a significantly higher risk of developing myocardial infarction (odds ratio (OR) 1.44, 95% confidence interval (CI)=1.0-2.1; P=.05) and arrhythmias (OR=1.59, 95% CI=1.0-2.4; P=.04) than normal-weight patients. Multivariate analysis demonstrated that underweight patients had a higher risk of developing an adverse cardiac event of any type (OR=1.56, 95% CI=1.22-1.98; P<.001). Overweight and obese patients with hip fracture had no excess risk of any cardiac complication. CONCLUSION: The obesity paradox and low functional reserve in underweight patients may influence the development of postoperative cardiac events in elderly people with hip fracture.
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Batsis JA, Huddleston JM, Melton LJ 4th, Huddleston PM, Lopez-Jimenez F, Larson DR, Gullerud RE, McMahon MM. J Am Geriatr Soc. 2009 Mar;57(3):419-26. Epub 2009 Jan 16.
Failure to Recognize the Immune System's Role in Chronic Heart Failure
The immune system and chronic heart failure: is the heart in control?
Abbreviated Abstract: Despite current treatment options, the clinical course of patients with chronic heart failure is notoriously difficult to predict. Among those with similar etiologies, ejection fractions, and patient demographics, our understanding of why such variations in outcomes exist remains limited. Evidence that has been progressively gathered implicates an important role of the immune system in the propagation of heart failure. This has been derived mainly from observations that cytokines are progressively elevated in patients with poor outcomes. However, attempts at introducing various immunomodulatory therapies as a new treatment strategy have been largely unsuccessful to date. This possibly reflects a failure in recognizing the complexity of the immune system's role in chronic heart failure, which has led to an oversimplified approach to treatment. This review critically analyzes the immune treatments attempted to date and hypothesizes what is required to develop a successful future treatment strategy.
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Fildes JE, Shaw SM, Yonan N, Williams SG. J Am Coll Cardiol. 2009 Mar 24;53(12):1013-20.
Abdominal Fats Is Not Impacted By Menopause
Longitudinal changes in abdominal fat distribution with menopause
Abbreviated Abstract: Increases in abdominal fat have been reported with menopause, but the impact of menopause on abdominal fat distribution (visceral vs. subcutaneous) is still unclear. The objective of the study was to determine if abdominal fat content (volume) or distribution is altered with menopause. Magnetic resonance imaging was used to quantify total abdominal, subcutaneous, and visceral fat in 8 healthy women, both in the premenopausal state and 8 years later in the postmenopausal state. Physical activity (PA) and blood lipids were also measured. Body weight and waist circumference did not change with menopause (pre- vs. postmenopause: body weight, 63.2 +/- 3.1 vs. 63.9 +/- 2.5 kg; waist circumference, 92.1 +/- 4.6 vs. 93.4 +/- 3.7 cm); however, total abdominal fat, subcutaneous fat, and visceral fat all significantly (P < .05) increased with menopause. Although absolute adiposity changed with menopause, relative fat distribution was not significantly different after menopause. Lean mass, fat mass, and PA, along with total cholesterol and triglyceride levels, did not change with menopause. High-density lipoprotein and low-density lipoprotein both increased (P < .05), and the ratio of total cholesterol to high-density lipoprotein decreased (P < .05) with menopause. As measured longitudinally with magnetic resonance imaging, total abdominal fat content increased with menopause despite no change in PA, body weight, or waist circumference; however, menopause did not affect the relative abdominal fat distribution in these women.
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Franklin RM, Ploutz-Snyder L, Kanaley JA. Metabolism. 2009 Mar; 58(3):311-5.
Nutrition
Dried Plums May Restore Bone Mineral DensityViewpoint: dried plum, an emerging functional food that may effectively improve bone health
Abbreviated Abstract: Osteoporosis is a debilitating disorder that affects both female and male, albeit to a greater extent in women than men. As the demographic shift to a more aged population continues, a growing number of men and women will be afflicted with osteoporosis and a search for potential non-pharmacological alternative therapies for osteoporosis is of prime interest. Aside from existing drug therapies, certain lifestyle and nutritional factors are known to reduce the risk of osteoporosis. Among nutritional factors, recent observations suggest that dried plum, or prunes (Prunus domestica L.) is the most effective fruit in both preventing and reversing bone loss. Animal studies and a 3-month clinical trial conducted in our laboratories have shown that dried plum has positive effects on bone indices. The animal data indicate that dried plum not only protects against but more importantly reverses bone loss in two separate models of osteopenia. Dried plum as low as 5% (w/w) restored bone mineral density (BMD) to the level of intact rats. More importantly, dried plum reversed the loss of trabecular architectural properties such as trabecular number and connectivity density, and trabecular separation. We have also shown the effectiveness of dried plum in reversal of bone loss due to skeletal unloading. Analysis of BMD and trabecular bone structure by microcomputed tomography (microCT) revealed that dried plum enhanced bone recovery during reambulation following skeletal unloading and had comparable effects to parathyroid hormone. In addition to the animal studies, our 3-month clinical trial indicated that the consumption of dried plum daily by postmenopausal women significantly increased serum markers of bone formation, total alkaline phosphatase, bone-specific alkaline phosphatase and insulin-like growth factor-I by 12, 6, and 17%, respectively. This review summarizes the findings of studies published to date which examine the beneficial effects of dried plum on bone in both female and male animal models of osteoporosis as well as the only published clinical study.
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Hooshmand S, Arjmandi BH. Ageing Res Rev. 2009 Apr; 8(2):122-7.
Vitamin D Recommendations Too Low To Address Vitamin D Insufficiencies
Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004
Abbreviated Abstract: BACKGROUND: Vitamin D insufficiency is associated with suboptimal health. The prevalence of vitamin D insufficiency may be rising, but population-based trends are uncertain. We sought to evaluate US population trends in vitamin D insufficiency. CONCLUSIONS: National data demonstrate a marked decrease in serum 25(OH)D levels from the 1988-1994 to the 2001-2004 NHANES data collections. Racial/ethnic differences have persisted and may have important implications for known health disparities. Current recommendations for vitamin D supplementation are inadequate to address the growing epidemic of vitamin D insufficiency.
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Ginde AA, Liu MC, Camargo CA Jr. Arch Intern Med. 2009 Mar 23;169(6):626-32.
Aging
Men And Women Needs And Wants Differ During Home Health Care ServicesSocial functioning and survival: A 10-year follow-up study
Abbreviated Abstract: Although otherwise extensively researched, one aspect of social functioning in older people that has received less attention is its association with staying at home for as long as possible. This 10-year follow-up examines factors of social functioning that support older people's independent living in their own homes and that reduce the risk of mortality. The data were collected in 1991 by a postal questionnaire that was sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. Female gender reduced the risk of mortality. In addition, daily outdoor activities, and not needing help (from different sources) were associated with a reduced risk of mortality. No need for help and a more positive attitude towards life reduced the risk of mortality of women. There were found only non-significant trends for men. Having plans for the future also reduced the risk of mortality. The findings of this study offer useful clues for planning the services provided by home health care personnel. In planning these services it is important that home health care workers take into account the differences between women and men customers: men may need and want different things from the home health care service than women do.
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Arve S, Lavonius S, Savikko N, Lehtonen A, Isoaho H. Arch Gerontol Geriatr. 2009 Mar-Apr; 48(2):137-41. Epub 2008 Jan 18.
The Aging Population--Is There A Role For Endocrine Interventions?
The aging population--is there a role for endocrine interventions?
Abbreviated Abstract: The expected increase in the aging population will have a significant impact on society and the health system in the coming years and decades. Enhancing healthspan, "healthy aging", and thus extending the time that the elderly are able to function independently is a significant task and is imperative. Age-dependent changes such as weight loss, sarcopenia and anorexia, which contribute to the development of frailty in the elderly are discussed. The role of the age-dependent decrease in growth hormone secretion in this process and the potential benefits and risks of hormonal interventions to delay, prevent or reverse frailty in the elderly are reviewed.
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Nass R, Johannsson G, Christiansen JS, Kopchick JJ, Thorner MO. Growth Horm IGF Res. 2009 Apr;19(2):89-100. Epub 2008 Nov 1.
Oxidative And Nitrosative Are Associative Factors Of Neurodegenerative Diseases
Aging: An important factor for the pathogenesis of neurodegenerative diseases
Abbreviated Abstract: Aging is a natural process that is defined as a progressive deterioration of biological functions after the organism has attained its maximal reproductive competence. Aging leads to the accumulation of disabilities and diseases that limit normal body functions and is a major risk factor for neurodegenerative diseases. Many neurodegenerative diseases share oxidative stress and nitrosative stress as common terminal processes. According to free radical theory of aging, an elevation in reactive oxygen species (ROS) and reactive nitrogen species (RNS) damages neural membranes and induces oxidative and nitrosative stress. The increase in oxidative and nitrosative stress is accompanied by the concomitant decline in cognitive and motor performance in the elderly population, even in the absence of neurodegenerative diseases. Markedly increased rates of oxidative and nitrosative stress are the major factors associated with the pathogenesis of neurodegenerative diseases. Diet is a key environmental factor that affects the incidence of chronic neurodegenerative diseases. Dietary supplementation with polyphenols, resveratrol, ginkgo biloba, curcumin, ferulic acid, carotenoids, flavonoids, and n-3 fatty acids exerts beneficial effects not only through the scavenging of free radicals, but also by modulating signal transduction, gene expression, and restoring optimal neuronal communication.
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Farooqui T, Farooqui AA. Mech Ageing Dev. 2009 Apr;1 30(4):203-15. Epub 2008 Nov 21.
Diabetes
Long-term Endurance Positively Effective In Patients With Type 2 Diabetes MellitusEffect of long-term endurance and strength training on metabolic control and arterial elasticity in patients with type 2 diabetes mellitus
Abbreviated Abstract: Poor glucose control increases the risk of vascular complications and cardiovascular mortality in patients with diabetes mellitus (DM). Our aim was to evaluate the efficacy of a long-term exercise training program on metabolic control and arterial stiffness in patients with type 2 DM. Fifty men with DM (age 52.3 +/- 5.6 years) were randomly assigned to the exercise training (E) or standard treatment for DM (control [C]) group for 24 months. Supervised exercise training included both endurance and muscle strength training 4 times/week. Arterial stiffness was assessed by measuring pulse wave velocity. Body weight was not different between groups at 2 years. However, pulse wave velocity increased in both groups (E +0.600 vs. C +1.300 m/s; p = 0.27). In conclusion, long-term endurance and strength training was effective and resulted in improved metabolic control of DM compared with standard treatment. Despite significant cardiovascular risk reduction, conduit arterial elasticity did not improve.
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Loimaala A, Groundstroem K, Rinne M, Nenonen A, Huhtala H, Parkkari J, Vuori I. Am J Cardiol. 2009 Apr 1;103(7):972-7.
Exercise and Physiology
Peak Exercise Oxygen Consumption and Heart Failure Survival Score Predict Survival in Heart Failure PatientsUsefulness of peak exercise oxygen consumption and the heart failure survival score to predict survival in patients >65 years of age with heart failure
Abbreviated Abstract: Peak exercise oxygen consumption Vo2 and the Heart Failure (HF) Survival Score (HFSS) were developed in middle-aged patient cohorts referred for heart transplantation with HF. The prognostic value of Vo2 in patients >65 years has not been well studied. Accordingly, the prognostic value of peak Vo2 was evaluated in these patients with HF. A retrospective analysis of 396 patients with HF >65 years with cardiopulmonary exercise testing was performed. Peak Vo2 and components of the HFSS (presence of coronary artery disease, left ventricular ejection fraction, heart rate, mean arterial blood pressure, presence of intraventricular conduction defects, and serum sodium) were collected. Follow-up averaged 1,038 +/- 983 days. Outcome events were defined as death, implantation of a left ventricular assist device, or urgent transplantation. Patients were divided into risk strata for peak Vo2 and HFSS based on previous cut-off points. Survival curves were derived using Kaplan-Meier analysis and compared using log-rank analysis. Survival differed markedly by Vo2 stratum (p <0.0001), with significantly better survival rates for the low- (>14 ml/kg/min) versus medium- (10 to 14 ml/kg/min), low- versus high- (<10 ml/kg/min), and medium- versus high-risk strata (all p <0.05). Survival also differed markedly by HFSS stratum (p <0.0001), with significantly better survival rates for the low- (> or =8.10) versus medium- (7.20 to 8.09), low- versus high- (< or =7.19), and medium- versus high-risk strata (all p <0.0001). In conclusion, peak Vo2 and the HFSS were both excellent parameters to predict survival in patients >65 years with HF.
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Parikh MN, Lund LH, Goda A, Mancini D. Am J Cardiol. 2009 Apr 1;103(7):998-1002. Epub 2009 Feb 7.
Volume Of Exercise And Fitness Nonresponse In Sedentary, Postmenopausal Women
Volume of exercise and fitness nonresponse in sedentary, postmenopausal women
Abbreviated Abstract: There is a wide individual heterogeneity in the maximal aerobic fitness Vo2 max response to exercise training. PURPOSE: To examine predictors of Vo2 max nonresponse after aerobic exercise training in postmenopausal women. METHODS: The Dose Response to Exercise in Women (DREW) study was a randomized, controlled trial examining the effects of incremental training doses on sedentary postmenopausal women (45-75 yr). Participants were randomized to one of three exercise treatment groups (4, 8, or 12 kcal x kg(-1) x wk(-1)) for 6 months. Participants exercised 3-4 d x wk(-1) at 50% Vo2 max. Predictors of baseline Vo2 max were determined by ANOVA. We used a logistic regression analyses with categorical (ethnicity and treatment group) and standardized continuous variables (age, body mass index [BMI], and baseline Vo2 max) to determine predictors of nonresponse (Delta
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Sisson SB, Katzmarzyk PT, Earnest CP, Bouchard C, Blair SN, Church TS. Med Sci Sports Exerc. 2009 Mar; 41(3):539-45.
Unusual Pedometers Worked Better For Step Count
Increasing our understanding of reactivity to pedometers in adults
Abbreviated Abstract: PURPOSE: To investigate the presence of reactivity, if any, to wearing sealed and unsealed pedometers, with and without step count recording. METHODS: On the first visit to the laboratory, 63 participants (41 females and 22 males; age = 23.6 +/- 9.6 yr, body mass index = 22.7 +/- 3.0 kg x m(-2)), blinded to the study aim, were provided with a sealed pedometer (New Lifestyles NL-1000) and informed that it was a "body posture monitor" (covert monitoring). Participants wore the pedometer throughout waking hours for 1 wk. On return to the laboratory, stored step counts were downloaded, and participants were informed that the device was a pedometer. Participants wore the pedometer under three more conditions-sealed, unsealed, and unsealed plus logging daily steps in an activity diary-each having a duration of 1 wk. The order of participation in each condition (sealed/unsealed/diary) was balanced across participants. Mean daily step counts recorded during the four conditions were compared using a repeated-measures ANOVA. RESULTS: There was a significant overall effect of condition (P < 0.001; covert monitoring = 8362 +/- 2600 steps per day; sealed condition = 8832 +/- 2845 steps per day; unsealed condition = 9176 +/- 3299 steps per day; diary condition = 9635 +/- 2709 steps per day), with post hoc analyses revealing that mean step counts were significantly higher in the diary condition than those reported during both the covert and sealed conditions (both P < 0.003). No significant gender effects were observed (P = 0.33). CONCLUSION: The greatest increase in step counts occurred in the diary condition, suggesting that reactivity to pedometers is greatest when participants are requested to wear an unsealed pedometer and record their step counts. This has validity implications for short-term pedometer studies investigating habitual free-living activity that require participants to provide a daily log of their step counts.
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Clemes SA, Parker RA. Med Sci Sports Exerc. 2009 Mar;41(3):674-80.
Physical Activity, Menopause, And Quality of Life: The Role of Affect and Self-Worth Across Time
Physical activity, menopause, and quality of life: the role of affect and self-worth across time
Abbreviated Abstract: OBJECTIVE: Physical activity has been shown to enhance quality of life (QOL); however, few investigations of these effects exist in women undergoing the menopausal transition. The present study examined the long-term effects of physical activity on menopause-related QOL and tested the mediating effects of physical self-worth and positive affect in this relationship. METHODS: Middle-aged women previously enrolled in a 4-month randomized controlled trial involving walking and yoga, and a control group completed a follow-up mail-in survey 2 years after the end of the trial. The survey included a battery of psychological and physical activity measures, including measures of menopausal symptoms and menopause-related QOL. Longitudinal linear panel analysis was conducted within a covariance modeling framework to test whether physical self-worth and positive affect mediated the physical activity-QOL relationship over time. RESULTS: At the end of the trial, physical activity and menopausal symptoms were related to physical self-worth and positive affect, and in turn, greater levels of physical self-worth and positive affect were associated with higher levels of menopause-related QOL. Analyses indicated that increases in physical activity and decreases in menopausal symptoms over the 2-year period were related to increases in physical self-worth (betas = 0.23 and -0.52, physical activity and menopausal symptoms, respectively) and, for symptoms, also to decreased positive affect (beta = -0.47), and both physical self-worth (beta = 0.34) and affect (beta = 0.43) directly influenced enhancements in QOL (R = 0.775). CONCLUSIONS:: The findings support the position that the effects of physical activity on QOL are mediated, in part, by intermediate psychological outcomes and that physical activity can have long-term benefits for women undergoing the menopausal transition.
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Elavsky S. Menopause. 2009 Jan 21.
Fracture Risk Increases After Diagnosis of Breast or Other Cancers In Postmenopausal Women: Results From the Women's Health Initiative
Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: results from the Women's Health Initiative
Abbreviated Abstract: SUMMARY: Risk for falls and fractures increases after breast cancer or other cancer diagnosis in postmenopausal women. Factors other than falls may be the major causes for the increased fracture risk. INTRODUCTION: Cancer treatment and prognosis may have detrimental effects on bone health. However, there is a lack of prospective investigations on fracture risk among incident cancer cases. METHODS: In this study, postmenopausal women (N = 146,959) from the Women's Health Initiative prospective cohort, who had no cancer history at baseline, were followed for up to 9 years and classified into no cancer, incident breast cancer (BC) and incident other cancer (OC) groups. The main outcomes measured were incident fractures and falls before and after cancer diagnosis. Hazards ratios (HR) and 95% confidence intervals (CI) were computed from Cox proportional hazards model. RESULTS: While hip fracture risk before a cancer diagnosis was similar between the no cancer and cancer groups, hip fracture risk was significantly higher after BC diagnosis (HR = 1.55, CI = 1.13-2.11) and the elevated risk was even more notable after OC diagnosis (HR = 2.09, CI = 1.65-2.65). Risk of falls also increased after BC (HR = 1.15, CI = 1.06-1.25) or OC diagnosis (HR = 1.27, CI = 1.18-1.36), but could not fully explain the elevated hip fracture risk. Incident clinical vertebral and total fractures were also significantly increased after OC diagnosis (p < 0.05). CONCLUSIONS: Postmenopausal women have significantly elevated risks for falls and fractures after a cancer diagnosis. The causes for this increased risk remained to be investigated.
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Chen Z, Maricic M, Aragaki AK, Mouton C, Arendell L, Lopez AM, Bassford T, Chlebowski RT. Osteoporos Int. 2009 Apr;20(4):527-36. Epub 2008 Sep 3.
Lactate Accumulation During Exercise And Increased Fatigued Resistance Caused By Aging
Evidence for differential regulation of lactate metabolic properties in aged and unloaded rat skeletal muscle
Abbreviated Abstract: Skeletal muscles of elderly individuals show fatigue resistance and reduced lactate accumulation compared with those of young subjects during activities that recruit a small amount of muscle mass. To explore the mechanism underlying the functional changes in aged muscle, we focused on lactate metabolic properties, including monocarboxylate transporter (MCT) 1 and MCT4, in muscles from old and young control rats and hindlimb-suspended young rats. MCT1 expression was lower in soleus (SOL) of old rats than in SOL of young control rats, but was similar in young control and hindlimb-suspended rats. MCT4 expression was lower in extensor digitorum longus (EDL) of old rats than in that of young control rats, but did not differ between young control and hindlimb-suspended rats. The ratio of lactate dehydrogenase to citrate synthase activities was higher in SOL of hindlimb-suspended and old rats than in SOL of young control rats, and was lower in EDL of old rats than in those of young control and hindlimb-suspended rats. Our data suggest that aging causes metabolic changes that can reduce lactate accumulation during exercise and increase fatigue resistance in skeletal muscle, and that these
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Masuda S, Hayashi T, Egawa T, Taguchi S. Exp Gerontol. 2009 Apr;44(4):280-8. Epub 2008 Dec 24.
Hormones
Topical Estrogen Therapy Relieves Vaginal Atrophy SymptomsTopical estrogen therapy in the management of postmenopausal vaginal atrophy: an up-to-date overview
Abbreviated Abstract: Vaginal atrophy, a manifestation of estrogen deprivation after the menopause, could affect up to 60% of women, with a significant impact on their quality of life. It is often under-diagnosed and inadequately treated. Symptoms are more common and severe in breast cancer survivors. Systemic estrogen replacement therapy may be unacceptable for many women because of the concerns over possible risks and may not cure vaginal symptoms in up to 45% of users. Non-medicated vaginal lubricants or moisturizers have been found to be no better than placebo and less effective than estrogen. Topical vaginal estrogen preparations reverse atrophic changes and relieve associated symptoms, while avoiding systemic effects. This article provides an up-to-date overview of the role, safety and effectiveness of topical vaginal estrogen therapy.
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Al-Baghdadi O, Ewies AA. Climacteric. 2009 Apr;12(2):91-105.
Decline in Hormone Use Over 17 Years
Continuing decline in hormone therapy use: population trends over 17 years
Abbreviated Abstract: OBJECTIVE: To describe the prevalence of menopausal hormone therapy (HT) in 2008 and trends over the last 17 years in an Australian population. METHODS: Data were obtained from nine representative population face-to-face interview surveys of the South Australian population from 1991 to 2008. The surveys used consistent method and quality control procedures. In 2008, demographic data, HT use and eight dimensions of health, using the SF-36 health survey questionnaire, were measured. Participants Over 3000 South Australian adults were interviewed in their own home by trained health interviewers in each of the surveys; in the 2008 survey, 1555 women participated, of whom 953 were over age 40. Median and mean length of conventional HT use were 10.0 and 10.5 years, respectively. HT users continued to have a demographic profile similar to those in previous surveys, i.e. they were better educated, employed, partnered, had a higher income and were less inclined to use complementary and alternative medicines. CONCLUSIONS: There has been a continuing decline in both the overall prevalence and length of use of conventional HT from 2003, probably in association with negative media about HT. Of medical concern is that about one-quarter of women using HT around menopause now chooses unregistered hormonal mixtures that are untested for long-term safety and efficacy.
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MacLennan AH, Gill TK, Broadbent JL, Taylor AW. Climacteric. 2009 Apr; 12(2):122-30.
Using A Balance Strategy Training Program
Controlling balance decline across the menopause using a balance-strategy training program: a randomized, controlled trial
Abbreviated Abstract: OBJECTIVE: To evaluate effectiveness and long-term benefits of a specific balance-strategy training program in sedentary women aged 40-60 years and whether participation leads to adoption of a more active lifestyle. METHOD: Fifty healthy women were admitted to the randomized, controlled trial on the basis of their activity level. Subjects were randomly assigned to an intervention or control group, with the former attending twice-weekly for 12 weeks. Assessments made pre- and post-intervention and at 9 months follow-up included: personal demographics, hormone replacement therapy medication, activity level, balance measures, somatosensory function, ankle flexibility and leg muscle strength. CONCLUSION: These results provide evidence that this physiotherapist-designed program preserves/reverses the balance decline associated with age and leads to adoption of a more active lifestyle.
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Fu S, Choy NL, Nitz J. Climacteric. 2009 Apr;12(2):165-76.
Low Testosterone And Anaemia In Men with Type 2 Diabetes
Low testosterone and anaemia in men with type 2 diabetes
Abbreviated Abstract: OBJECTIVE: Anaemia is frequently found in patients with diabetes, in whom it is associated with increased morbidity and mortality. Low testosterone levels are also common in men with type 2 diabetes. We hypothesized that low testosterone levels are also associated with anaemia in men with type 2 diabetes, over the effects of chronic kidney disease. DESIGN: Cross-sectional cohort study, performed in 2005 in a tertiary diabetes clinic. Patients 464 men with type 2 diabetes. CONCLUSIONS: These findings suggest that testosterone deficiency may contribute to the increased frequency of anaemia in men with type 2 diabetes. However, the appropriate clinical response to testosterone deficiency in anaemic patients remains to be established by prospective clinical trials.
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Grossmann M, Panagiotopolous S, Sharpe K, MacIsaac RJ, Clarke S, Zajac JD, Jerums G, Thomas MC. Clin Endocrinol (Oxf). 2009 Apr;70(4):547-53. Epub 2008 Aug 13.
Androgen Deprivation Therapy
Hot flashes during androgen deprivation therapy with luteinizing hormone-releasing hormone agonist combined with steroidal or nonsteroidal antiandrogen for prostate cancer
Abbreviated Abstract: OBJECTIVES: To investigate hot flashes and quality of life during combined androgen blockade (CAB) therapy using steroidal or nonsteroidal antiandrogens. METHODS: A total of 151 patients with prostate cancer, who were enrolled into this study from May 2001 to June 2003, were randomized to receive CAB therapy using a luteinizing hormone-releasing hormone agonist (leuprorelin) combined with a steroidal antiandrogen (chlormadinone) or a nonsteroidal antiandrogen (bicalutamide). The incidence of, frequency of, and distress due to hot flashes were evaluated with a self-administered questionnaire during a 2-year period. The general and disease-specific quality-of-life outcomes were also measured using the Functional Assessment of Cancer Therapy-Prostate questionnaire. CONCLUSIONS: Our results suggest that CAB using a steroidal antiandrogen such as chlormadinone might induce fewer and less-distressing hot flashes than CAB with bicalutamide.
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Sakai H, Igawa T, Tsurusaki T, Yura M, Kusaba Y, Hayashi M, Iwasaki S, Hakariya H, Hara T, Kanetake H. Urology. 2009 Mar;73(3):635-40. Epub 2008 Nov 26.
Growth Hormone Deficient Adults
Ten years of growth hormone (GH) replacement normalizes muscle strength in GH-deficient adults
Abbreviated Abstract: CONTEXT: GH replacement for 1-5 yr improves, but does not fully normalize, muscle strength. OBJECTIVE, DESIGN, AND PATIENTS: In this single-center, open-labeled, prospective study, the effects of 10 yr of GH replacement on muscle strength and neuromuscular function were followed in 109 consecutive adults (61 men; mean age 50.0 yr; range 22-74 yr) with adult-onset GH deficiency. RESULTS: The mean initial GH dose of 0.88 mg/d was gradually lowered to 0.47 mg/d. The mean IGF-I sd score increased from -1.54 at baseline to 1.12 at study end. GH replacement induced a sustained increase in lean mass and isometric knee flexor strength (60 degrees). In most other measures of upper leg and handgrip strength, there were transient increases during the first half of the study (0-5 yr), whereas during the second half (5-10 yr), the absolute values of muscle strength decreased and returned to or even below the baseline values. However, after correction for age and gender using observed/predicted value ratios, there were sustained and, until 7 yr, even progressive increases in the measures of muscle strength. At study end, knee flexor strength had increased to 104-110% of predicted, knee extensor strength to 93-108%, and handgrip strength to 88-93%. Measurements of neuromuscular function showed reduced voluntary motor unit activation after 10 yr. CONCLUSIONS: Ten years of GH replacement therapy increased muscle strength during the first half of the study and thereafter partly protected against the normal age-related decline in muscle strength and neuromuscular function, resulting in approximately normalized muscle strength after 10 yr.
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Götherström G, Elbornsson M, Stibrant-Sunnerhagen K, Bengtsson BA, Johannsson G, Svensson J. J Clin Endocrinol Metab. 2009 Mar; 94(3):809-16. Epub 2008 Dec 16.
Estrogen and Glucose Intolerance
Estrogens protect against high-fat diet-induced insulin resistance and glucose intolerance in mice
Abbreviated Abstract: Although corroborating data indicate that estrogens influence glucose metabolism through the activation of the estrogen receptor alpha (ERalpha), it has not been established whether this pathway could represent an effective therapeutic target to fight against metabolic disturbances induced by a high-fat diet. To this end, we first evaluated the influence of chronic 17beta-estradiol (E2) administration in wild type ovariectomized mice submitted to either a normal chow diet (NCD) or a high-fat diet (HFD). Whereas only a modest effect was observed in NCD fed mice, E2 administration exerted a protective effect against HFD-induced glucose intolerance, and this beneficial action was abolished in ERalpha-deficient mice. Furthermore, E2 treatment reduced HFD-induced insulin resistance by 50% during hyperinsulinemic euglycemic clamp studies, and improved insulin signalling (Akt phosphorylation) in insulin-stimulated skeletal muscles. Unexpectedly, we found that E2 treatment enhanced cytokine (IL-6, TNF-alpha) and PAI-1 mRNA expression induced by HFD in the liver and visceral adipose tissue. Interestingly, although the pro-inflammatory effect of E2 was abolished in visceral adipose tissue from chimeric mice grafted with bone marrow cells from ERalpha-deficient mice, the beneficial effect of the hormone on glucose tolerance was not altered, suggesting that the metabolic and inflammatory effects of estrogens can be dissociated. Eventually, comparison of sham-operated with ovariectomized HFD-fed mice, demonstrated that endogenous estrogens levels are sufficient to exert a full protective effect against insulin resistance and glucose intolerance. In conclusion, the regulation of the ERalpha pathway could represent an effective strategy to reduce the impact of high-fat diet-induced type 2 diabetes.
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Riant E, Waget A, Cogo H, Arnal JF, Burcelin R, Gourdy P. Endocrinology. 2009 Jan 22.
Psychological Symptoms in Surgically Induced Menopausal Women
Do different delivery systems of hormone therapy have different effects on psychological symptoms in surgically menopausal women? A randomized controlled trial
Abbreviated Abstract: OBJECTIVE: To compare the influence of different delivery forms of estrogen therapy on menopausal and psychological symptoms in surgically menopausal women. STUDY DESIGN: Surgically menopausal women were assigned to a 1-year-therapy with oral conjugated estrogen 0.625mg/day (n=35), intranasal 300microg/day estradiol hemihidrate (n=33), percutaneous gel 1.5mg/day estradiol hemihidrate (n=32) or no treatment (control group, n=32). Serum E(2) and FSH levels, Kupperman's Scale used to assess climacteric symptoms, Hamilton Depression Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) scores were assessed before and after 1-year-therapy. RESULTS: After 1 year, the greatest increase in E(2) was in the oral group, followed by the transdermal gel, and then the intranasal group (oral vs. transdermal gel: p=0.022: oral vs. intranasal: p=0.0001; transdermal gel vs. intranasal: p=0.0001). All treatment groups improved significantly in total Kupperman index score and HARS (p<0.05) with no difference between the groups. With regard to HDRS, all treatment groups improved significantly (p<0.05) with the greatest improvement in the oral group, and no difference between transdermal gel and intranasal groups (oral vs. transdermal gel: p=0.015; oral vs. intranasal: p=0.001; transdermal gel vs. intranasal: p=0.735). Control group scored worse in all tests after study (p<0.05). All scores correlated significantly with post-treatment serum E(2) and FSH levels (p<0.001). CONCLUSION: Oral, intranasal and percutaneous gel estradiol therapies significantly improve menopausal and psychological symptoms in surgically menopausal women with oral route better than transdermal gel and intranasal modalities against depressive mood.
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Baksu B, Baksu A, Göker N, Citak S. Maturitas. 2009 Feb 20; 62(2):140-5.
Hot Flashes Impacts Women's Quality of Life
Menopause-specific questionnaire assessment in US population-based study shows negative impact on health-related quality of life
Abbreviated Abstract: OBJECTIVE: To use the Menopause-Specific Quality of Life Questionnaire (MENQOL) to assess the impact of menopausal symptoms on health-related quality of life in a large US population-based study. METHODS: Participants were recruited from the US population through random-digit-dialing and probability sampling. Analyses included 2703 postmenopausal women 40-65 years old in our Menopause Epidemiology Study. Respondents answered a 30-min questionnaire, including the MENQOL. CONCLUSION: Symptoms experienced during menopause and socio-demographic characteristics affect the quality of life in postmenopausal women. Hot flashes impact the daily activities of most postmenopausal women, especially those with more frequent/severe symptoms. Treatments that safely and effectively treat these symptoms could improve quality of life among postmenopausal women.
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Williams RE, Levine KB, Kalilani L, Lewis J, Clark RV. Maturitas. 2009 Feb 20;62(2):153-9. Epub 2009 Jan 21.
Sexual Experience and Estrogen
A randomized study of low-dose conjugated estrogens on sexual function and quality of life in postmenopausal women
Abbreviated Abstract: OBJECTIVE: To evaluate the effects of combined vaginal and oral low-dose estrogen plus progestogen therapy (EPT) on the frequency and severity of dyspareunia, sexual function, and quality of life in recently postmenopausal women. DESIGN:: This outpatient, double-blind, randomized, placebo-controlled trial enrolled 285 healthy, sexually active postmenopausal women aged 45 to 65 years. Women received either one daily oral low-dose conjugated estrogens (0.45 mg)/medroxyprogesterone (1.5 mg) tablet for six 28-day cycles along with 1 g conjugated estrogens vaginal cream (0.625 mg), intravaginally for the first 6 weeks of the trial or a placebo cream and placebo tablet. Efficacy was evaluated using the McCoy Female Sexuality Questionnaire, self-reported daily diary cards, the Brief Index of Sexual Functioning-Women (BISF-W), and the Women's Health Questionnaire. RESULTS:: The EPT group had a significant decrease in the frequency of dyspareunia compared with baseline and placebo in an analysis of responses to the McCoy Female Sexuality Questionnaire. Also, EPT was associated with a significant improvement in a woman's level of sexual interest, frequency of orgasm, and pleasure of orgasm. There was no effect of EPT use on coital frequency. The EPT group had significant improvement in receptivity/initiation and relationship satisfaction, although not in other BISF-W domains, versus placebo (BISF-W analysis) and significant improvement versus placebo on most Women's Health Questionnaire responses. CONCLUSIONS:: EPT provided a statistically significant improvement compared with placebo in dyspareunia, sexual experience, and quality of life as measured in this study. In general, EPT also improved self-reported sexual perception and enjoyment significantly compared with placebo.
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Gast MJ, Freedman MA, Vieweg AJ, De Melo NR, Girão MJ, Zinaman MJ; The Dyspareunia Study Group. Menopause. 2008 Nov 20.
Nonhormonal Therapies Used For Menopausal Symptoms
Replacing hormone therapy is the decline in prescribing sustained, and are nonhormonal drugs substituted?
Abbreviated Abstract: OBJECTIVES: After two cautioning landmark studies in 2002 and 2003, a dramatic decrease in hormonal therapy (HT) prescribing for menopausal symptoms was seen. Our objectives were to (1) determine whether this decline in HT prescribing sustained until 2007 and (2) investigate nonhormonal drug prescribing for women who stopped HT. METHODS:: We analyzed drug dispensing data from community pharmacies in The Netherlands. For the first objective, we analyzed exposure prevalence of HT. For our second objective, we selected all women who were dispensed HT prescriptions between August 2002 and August 2003. From this study cohort, we defined our index group as all women who stopped HT shortly after the studies (n = 1,254) and a reference group as all women who continued HT (n = 839). We calculated the incidence of nonhormonal therapies for both groups, reporting risk ratio (RR) and 95% CI. Kaplan-Meier curves were also constructed. RESULTS: Mean exposure prevalence of HT (per 1,000 women) pre 2002 versus post 2004 was 30.6 versus 15.3 (50.0% decline) for 40 to 49 years, 79.2 versus 25.5 (67.7% decline) for 50 to 59 years, and 28.4 versus 11.6 (59.1% decline) for 60 to 69 years. HT exposure remained low until 2007. HT stoppers receive more clonidine, RR 3.48 (2.36-5.13); anxiolytics or sedatives, RR 1.46 (1.15-1.87); and osteoporosis prophylaxis and treatment, RR 2.04 (1.14-3.66). Young stoppers (40-49 y) received more antidepressants, RR 2.70 (1.41-5.11), whereas older stoppers (60-69 y) received less antidepressants, RR 0.43 (0.18-1.05). Kaplan-Meier curves showed that nonhormonal drug prescribing occurred soon after HT was stopped. CONCLUSIONS:: This study shows the dramatic and sustained impact of the cautioning landmark studies on HT prescribing. HT stoppers received more nonhormonal therapies for menopausal symptoms compared with those who continued HT.
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Vegter S, Kölling P, Töben M, Visser ST, de Jong-van den Berg LT. Menopause. 2009 Feb 2.
Some Herbal Formulas Did Not Impact Menopausal Symptoms
A randomized placebo-controlled trial on the effectiveness of an herbal formula to alleviate menopausal vasomotor symptoms
Abbreviated Abstract: OBJECTIVE: To evaluate the effectiveness of a formula containing Chinese herbs and Cimicifuga racemosa in alleviating vasomotor symptoms and improving quality of life. DESIGN: Between September 2004 and October 2005, 93 healthy women aged 45 to 65 years who reported six or more vasomotor symptoms per 24 hours were recruited into a 20-week randomized, double-blind, placebo-controlled trial. Women were consulted in clinics conducted within the Sydney metropolitan area. After a 4-week baseline period, women were randomly allocated to receive herbal (equivalent to 3,150 mg dry herb) or identical placebo tablets for 16 weeks. Women recorded the number and severity (1 = mild to 4 = very severe) of vasomotor symptoms in a daily hot flash diary and completed the Greene Climacteric and Hot Flash Related Daily Interference scales at each monthly consultation. RESULTS:: Intention-to-treat and per-protocol analyses found no statistically significant differences in mean hot flash scores (product of frequency and intensity), Greene Climacteric Scale scores, and Hot Flash Related Daily Interference Scale scores between the placebo and herbal treatment groups after 16 weeks of intervention. CONCLUSIONS: This herbal formula containing Chinese herbs and Cimicifuga cannot be recommended to alleviate menopausal vasomotor symptoms or improve quality of life.
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van der Sluijs CP, Bensoussan A, Chang S, Baber R. Menopause. 2008 Dec 4.
Cognitive
Chemotherapy For Breast Cancer Did Not Increase Older Women's Chance of Getting DementiaRisk of dementia in older breast cancer survivors: a population-based cohort study of the association with adjuvant chemotherapy
Abbreviated Abstract: OBJECTIVES: To assess whether there is an association between delivery of adjuvant chemotherapy to older women with breast cancer and development of dementia over time. DESIGN: Retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare claims data. SETTING: Women residing in geographic areas included in the SEER registry. PARTICIPANTS: Women aged 66 to 80 diagnosed with non-metastatic invasive breast cancer from 1992 to 1999 were included. It was determined whether patients had undergone chemotherapy within 6 months of diagnosis. MEASUREMENTS: Whether women developed dementia over time was determined using diagnostic codes. The effect of adjuvant chemotherapy on development of dementia was evaluated, adjusting for confounders using a proportional hazards model stratified for age. RESULTS: Twenty-one thousand three hundred sixty-two women met selection criteria; 2,913 received chemotherapy, and 18,449 did not. Women who received chemotherapy were younger than those who did not (median aged 70 vs. 73; P<.001). Median follow-up time was 59 months. After controlling for other factors, it was found that chemotherapy was not associated with a greater risk of development of dementia over time for any age group (hazard ratio for dementia in women receiving chemotherapy: aged 66-70=0.83, 95% confidence interval (CI)=0.48-1.45, P=.5; aged 71-75=0.74, 95% CI=0.46-1.18, P=.2; aged 76-80=0.49, 95% CI=0.28-0.88, P=.02). CONCLUSION: Receipt of chemotherapy in older women with breast cancer was not associated with a greater risk of dementia diagnosis over time; very elderly women who undergo chemotherapy may be at lower baseline risk. The use of a claims-based definition of dementia limited the study.
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Baxter NN, Durham SB, Phillips KA, Habermann EB, Virning BA. J Am Geriatr Soc. 2009 Mar; 57(3):403-11.
Other
Study Suggests Caution When Diagnosing Metabolic SyndromeMetabolic syndrome in older subjects: coincidence or clustering?
Abbreviated Abstract: The prevalence of the metabolic syndrome (MS) increases with advancing age. However, aging per se is associated with increased prevalence of most of the abnormalities contributing to the MS. Whether MS in older people consistently identifies a true pathophysiological entity or a casual aggregation of aging-associated metabolic abnormalities, remains to be fully elucidated. In the present study, we aimed to evaluate whether in older subjects the aggregation of metabolic components of the MS, as defined by the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), is consistent with a single latent variable. Age, waist circumference, systolic and diastolic blood pressure, metabolic variables were determined in 152 older (>70 years), non-diabetic, healthy men. Cronbach alpha was used to assess the internal consistency of the components contributing to the MS. Structural equation modeling, using the Normed Fit Index (NFI), the Root Mean Square Error of Approximation (RMSEA), the Comparative Fit Index (CFI), and the Tucker-Lewis Index (TLI) was used to assess the fit to a model with a single latent variable. The Cronbach alpha test showed low internal consistency among the metabolic variables (alpha=0.31). The calculated chi(2) values were 28.31 and 32.52 for model entering hypertension as dichotomous variable and for model entering blood pressure values, respectively, both expressing low fit to a model with a single latent variable. In both models, CFI (0.41 and 0.55), NFI (0.59 and 0.55), RMSEA (0.25 and 0.22) and TLI (-0.31 and -0.12) scores showed a low fit of the metabolic alterations to a single latent variable. These findings suggest caution in making diagnosis of MS at older ages, since metabolic and cardiovascular abnormalities being per se extremely common in elderly people, do not appear to cluster together under a single common factor.
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Bo M, Sona A, Astengo M, Fiandra U, Quagliotti E, Brescianini A, Fonte G. Arch Gerontol Geriatr. 2009 Mar-Apr;48(2):146-50. Epub 2008 Feb 19.
The Value of Family History As A Risk Indicator For Venous Thrombosis
The value of family history as a risk indicator for venous thrombosis
Abbreviated Abstract: BACKGROUND: A positive family history of venous thrombosis may reflect the presence of genetic risk factors. Once a risk factor has been identified, it is not known whether family history is of additional value in predicting an individual's risk. We studied the contribution of family history to the risk of venous thrombosis in relation to known risk factors. METHODS: In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis, a population-based case-control study, we collected blood samples and information about family history and environmental triggers from 1605 patients with a first venous thrombosis and 2159 control subjects. RESULTS: A total of 505 patients (31.5%) and 373 controls (17.3%) reported having 1 or more first-degree relatives with a history of venous thrombosis. A positive family history increased the risk of venous thrombosis more than 2-fold (odds ratio [95% confidence interval], 2.2 [1.9-2.6]) and up to 4-fold (3.9 [2.7-5.7]) when more than 1 relative was affected. Family history corresponded poorly with known genetic risk factors. Both in those with and without genetic or environmental risk factors, family history remained associated with venous thrombosis. The risk increased with the number of factors identified; for those with a genetic and environmental risk factor and a positive family history, the risk was about 64-fold higher than for those with no known risk factor and a negative family history. CONCLUSIONS: Family history is a risk indicator for a first venous thrombosis, regardless of the other risk factors identified. In clinical practice, family history may be more useful for risk assessment than thrombophilia testing.
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Bezemer ID, van der Meer FJ, Eikenboom JC, Rosendaal FR, Doggen CJ. Arch Intern Med. 2009 Mar 23; 169(6):610-5.
Metabolic Syndrome and Obesity Potential Predictors of Depressive Symptoms
Association between metabolic syndrome and depressive symptoms in middle-aged adults: results from the Whitehall II study
Abbreviated Abstract: OBJECTIVE: Although it is possible that the association between depression and the metabolic syndrome is a "two-way street," the metabolic syndrome as a predictor of depression has been little investigated. We examined whether the metabolic syndrome is associated with the onset of depressive symptoms in a cohort of middle-aged British civil servants. RESEARCH DESIGN AND METHODS: Analyses included 5,232 participants (41-61 years of age) from the Whitehall II prospective cohort study. Depressive symptoms were assessed in 1991-1993 and again 6 years later using the depression subscale from the 30-item General Health Questionnaire. Metabolic syndrome was assessed in 1991-1993, according to National Cholesterol Education Program criteria. RESULTS: Presence of the metabolic syndrome was associated with an increased risk of future depressive symptoms, odds ratio 1.38 (95% CI 1.02-1.96) after adjustment for potential confounders. Of the five components, only central obesity, high triglyceride levels, and low HDL cholesterol levels predicted depressive symptoms. These components explained most of the association between the metabolic syndrome and the onset of depressive symptoms. CONCLUSIONS: Our results suggest that the metabolic syndrome, in particular the obesity and dyslipidemia components, is predictive of depressive symptoms.
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Akbaraly TN, Kivimäki M, Brunner EJ, Chandola T, Marmot MG, Singh-Manoux A, Ferrie JE. Diabetes Care. 2009 Mar;32(3):499-504. Epub 2008 Dec 23.
Hysterectomy Is More Likely To Be Performed In Heavier Women
Hysterectomy and weight gain
Abbreviated Abstract: OBJECTIVE: To investigate whether overweight women are more likely to have a hysterectomy and whether hysterectomy leads to increased weight gain. DESIGN:: Survey data of middle-aged women participating in the Australian Longitudinal Study on Women's health in 1996 (ages 45-50 y; n = 13,125), 1998 (n = 10,612), 2001 (n = 10,293), and 2004 (n = 9309) included self-reported height, weight, and hysterectomy. First, we conducted a cohort analysis, comparing body mass index (BMI) of women categorized according to hysterectomy status. Second, we used a nested case-control analysis to compare weight gain between women who underwent hysterectomy and women who did not have a hysterectomy, matched for prehysterectomy weight, height, menopause status, and educational level. RESULTS:: At survey 1, the mean BMI of women who subsequently had a hysterectomy was greater than that of women without a hysterectomy by survey 2 (difference, 1.1 kg/m; 95% CI, 0.5-1.6). Results were similar for surveys 2 to 3 (BMI difference, 0.8 kg/m; 95% CI, 0.3-1.3) and surveys 3 to 4 (BMI difference, 0.8 kg/m; 95% CI, 0.1-1.4).Having a hysterectomy between surveys 1 and 2 was not associated with percentage of weight gain over the 3 or 6 years after survey 2 (odds ratio, 0.98 [95% CI, 0.96-1.01] and 0.99 [95% CI, 0.97-1.01], respectively). Having a hysterectomy between surveys 2 and 3 was weakly associated with percentage of weight gain over 3 years (odds ratio, 1.03 [95% CI, 1.00-1.05]). CONCLUSIONS:: Among women older than 45 to 50 years, hysterectomy did not lead to greater weight gain but was more likely to be performed in heavier women.
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Fitzgerald DM, Berecki-Gisolf J, Hockey RL, Dobson AJ. Menopause. 2008 Oct 27.
Moderate Alcoholic Beverage Consumption Had Minimal Impact on Insulin Sensitivity
Effect of moderate alcoholic beverage consumption on insulin sensitivity in insulin-resistant, nondiabetic individuals
Abbreviated Abstract: Although moderate alcohol consumption has been associated with a decrease in plasma insulin concentrations, relatively few studies have been conducted to evaluate the effect of alcohol on insulin sensitivity, particularly in nondiabetic, insulin-resistant individuals. Because enhanced insulin sensitivity could contribute to the reported association between moderate alcohol consumption and reduced risk of heart disease and diabetes, we believed it is important to address this issue. Consequently, we evaluated the ability of moderate alcohol consumption to improve insulin sensitivity, as measured by determining the steady-state plasma glucose (SSPG) concentration during the insulin suppression test, in 20 nondiabetic, insulin-resistant individuals. Measurements were made of SSPG, glucose, insulin, and lipoprotein concentrations before and after consuming 30 g of alcohol for 8 weeks, either as vodka (n = 9) or red wine (n = 11). The SSPG concentrations (insulin resistance) decreased by approximately 8% in the total group (P = .08), and high-density lipoprotein cholesterol concentration increased by a mean of 0.09 mmol/L (P = .02). Trends were similar in individuals who consumed vodka or red wine. Men tended to have greater decline in SSPG and increase in high-density lipoprotein cholesterol compared with women. There were no other metabolic changes in fasting plasma glucose, insulin, and triglyceride concentrations. These data demonstrate that 8 weeks of moderate alcohol consumption had minimal impact on enhancing insulin sensitivity in nondiabetic, insulin-resistant individuals, raising questions as to the role, if any, of improved insulin sensitivity in the purported clinical benefits associated with moderate alcohol consumption.
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Kim SH, Abbasi F, Lamendola C, Reaven GM. Metabolism. 2009 Mar;58(3):387-92.
Telomerase Insufficiency In Rheumatoid Arthritis
Telomerase insufficiency in rheumatoid arthritis
Abbreviated Abstract: In rheumatoid arthritis (RA), chronically stimulated T lymphocytes sustain tissue-destructive joint inflammation. Both naïve and memory T cells in RA are prematurely aged with accelerated loss of telomeres suggesting excessive proliferative pressure or inadequate telomeric maintenance. Upon stimulation, RA naïve CD4 T cells are defective in up-regulating telomerase activity (P < 0.0001) due to insufficient induction of the telomerase component human telomerase reverse transcriptase (hTERT); T cell activation and cell cycle progression are intact. Telomerase insufficiency does not affect memory T cells or CD34 hematopoietic stem cells and is present in untreated patients and independent from disease activity. Knockdown of hTERT in primary human T cells increases apoptotic propensity (P = 0.00005) and limits clonal burst (P = 0.0001) revealing a direct involvement of telomerase in T cell fate decisions. Naïve RA CD4 T cells stimulated through the T cell receptor are highly susceptible to apoptosis, expanding to smaller clonal size. Overexpression of ectopic hTERT in naïve RA T cells conveys apoptotic resistance (P = 0.008) and restores proliferative expansion (P < 0.0001). Telomerase insufficiency in RA results in excessive T cell loss, undermining homeostatic control of the naive T cell compartment and setting the stage for lymphopenia-induced T cell repertoire remodeling. Restoring defective telomerase activity emerges as a therapeutic target in resetting immune abnormalities in RA.
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Fujii H, Shao L, Colmegna I, Goronzy JJ, Weyand CM. Proc Natl Acad Sci U S A. 2009 Mar 17;106(11):4360-5. Epub 2009 Mar 2.
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