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Biomedical subjects

Anne B Newman

Publications and source records attributed to Anne B Newman.

135 records · Page 8Linked to original sources
PubMed2002

Weight-modification trials in older adults: what should the outcome measure be?

BACKGROUND: Overweight older adults are often counseled to lose weight, even though there is little evidence of excess mortality in that age group. Overweight and underweight may be more associated with health status than with mortality, but few clinical trials of any kind have been based on maximizing years of healthy life (YHL), as opposed to years of life (YOL). OBJECTIVE: This paper examines the relationship of body mass index (BMI) to both YHL and YOL. Results were used to determine whether clinical trials of weight-modification based on improving YHL would be more powerful than studies based on survival. DESIGN: We used data from a cohort of 4,878 non-smoking men and women aged 65-100 at baseline (mean age 73) and followed 7 years. We estimated mean YHL and YOL in four categories of BMI: underweight, normal, overweight, and obese. RESULTS: Subjects averaged 6.3 YOL and 4.6 YHL of a possible 7 years. Both measures were higher for women and whites. For men, none of the BMI groups was significantly different from the normal group on either YOL or YHL. For women, the obese had significantly lower YHL (but not YOL) than the normals, and the underweight had significantly lower YOL and YHL. The overweight group was not significantly different from the normal group on either measure. CONCLUSIONS: Clinical trials of weight loss interventions for obese older women would require fewer participants if YHL rather than YOL was the outcome measure. Interventions for obese men or for the merely overweight are not likely to achieve differences in either YOL or YHL. Evaluations of interventions for the underweight (which would presumably address the causes of their low weight) may be conducted efficiently using either outcome measure.

Journal Article↗
PubMed2002

Leg muscle mass and composition in relation to lower extremity performance in men and women aged 70 to 79: the health, aging and body composition study.

OBJECTIVES: The loss of muscle mass with aging, or sarcopenia, is hypothesized to be associated with the deterioration of physical function. Our aim was to determine whether low leg muscle mass and greater fat infiltration in the muscle were associated with poor lower extremity performance (LEP). DESIGN: A cross-sectional study, using baseline data of the Health, Aging and Body Composition study (1997/98). SETTING: Medicare beneficiaries residing in ZIP codes from the metropolitan areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: Three thousand seventy-five well-functioning black and white men and women aged 70 to 79. MEASUREMENTS: Two timed tests (6-meter walk and repeated chair stands) were used to measure LEP. Muscle cross-sectional area and muscle tissue attenuation (indicative of fat infiltration) were obtained from computed tomography scans at the midthigh. Body fat was assessed using dual-energy x-ray absorptiometry. RESULTS: Blacks had greater muscle mass and poorer LEP than whites. Black women had greater fat infiltration into the muscle than white women. After adjustment for clinic site, age, height, and total body fat, smaller muscle area was associated with poorer LEP in all four race-gender groups. (Regression coefficients, expressed per standard deviation (+/-55 cm2) of muscle area, were 0.658 and 0.519 in white and black men and 0.547 and 0.435 in white and black women, respectively, P <.01.) In addition, reduced muscle attenuation-indicative of greater fat infiltration into the muscle-was associated with poorer LEP, independent of total body fat and muscle area. (Regression coefficients per standard deviation (= 7 Hounsfield Units) of muscle attenuation were 0.292 and 0.224 in white and black men, and 0.193 and 0.159 in white and black women, respectively, P <.05). The most important body composition components related to LEP were muscle area in men and total body fat in women. Results were similar after additional adjustment for lifestyle factors and health status. No interactions between race and muscle area (P>.7) or between race and muscle attenuation (P>.2) were observed. CONCLUSION: Smaller midthigh muscle area and greater fat infiltration in the muscle are associated with poorer LEP in well-functioning older men and women.

Absorptiometry, Photon↗
PubMed2002

Relationship of interleukin-6 and tumor necrosis factor-alpha with muscle mass and muscle strength in elderly men and women: the Health ABC Study.

BACKGROUND: A decline in muscle mass and muscle strength characterizes normal aging. As clinical and animal studies show a relationship between higher cytokine levels and low muscle mass, the aim of this study was to investigate whether markers of inflammation are associated with muscle mass and strength in well-functioning elderly persons. METHODS: We used baseline data (1997-1998) of the Health, Aging, and Body Composition (Health ABC) Study on 3075 black and white men and women aged 70-79 years. Midthigh muscle cross-sectional area (computed tomography), appendicular muscle mass (dual-energy x-ray absorptiometry), isokinetic knee extensor strength (KinCom), and isometric grip strength were measured. Plasma levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were assessed by enzyme-linked immunosorbent assay (ELISA). RESULTS: Higher cytokine levels were generally associated with lower muscle mass and lower muscle strength. The most consistent relationship across the gender and race groups was observed for IL-6 and grip strength: per SD increase in IL-6, grip strength was 1.1 to 2.4 kg lower (p <.05) after adjustment for age, clinic site, health status, medications, physical activity, smoking, height, and body fat. An overall measure of elevated cytokine level was created by combining the levels of IL-6 and TNF-alpha. With the exception of white men, elderly persons having high levels of IL-6 (>1.80 pg/ml) as well as high levels of TNF-alpha (>3.20 pg/ml) had a smaller muscle area, less appendicular muscle mass, a lower knee extensor strength, and a lower grip strength compared to those with low levels of both cytokines. CONCLUSIONS: Higher plasma concentrations of IL-6 and TNF-alpha are associated with lower muscle mass and lower muscle strength in well-functioning older men and women. Higher cytokine levels, as often observed in healthy older persons, may contribute to the loss of muscle mass and strength that accompanies aging.

Aged↗
PubMed2002

Identifying early decline of physical function in community-dwelling older women: performance-based and self-report measures.

BACKGROUND AND PURPOSE: The ability to identify early decline in physical function is important, but older people experiencing decline may fail to report the early changes in physical function. The purpose of this study was to compare the descriptions of physical function in community-dwelling older women obtained using performance-based and self-report measures. SUBJECTS AND METHODS: One hundred seventy community-dwelling women with a mean age of 74.3 years (SD=4.3, range=56.6-83.6) completed the activities of daily living (ADL), instrumental activities of daily living (IADL) and social activity (SA) sections of the Functional Status Questionnaire (FSQ). They also completed performance-based measures of gait speed and the 7-item Physical Performance Test (PPT). RESULTS: The majority of the women scored at the ceiling for the self-report measures of function (ADL=77%, IADL=61%, SA=94%), whereas only 7% scored at the ceiling for the PPT and 30% scored at the ceiling for gait speed (defined as >1.2 m/s). For 2 items of the FSQ, sensitivity was low (8% and 9%) and specificity was high (97% and 98%) compared with performance on the PPT. DISCUSSION AND CONCLUSION: In this sample of community-dwelling older women, performance-based measures identified more limitations in physical function than did self-report measures.

Activities of Daily Living↗
PubMedDate not supplied

Cystatin C and incident peripheral arterial disease events in the elderly: results from the Cardiovascular Health Study.

BACKGROUND: The association of cystatin C, a novel marker of renal function, with risk for developing complications related to peripheral arterial disease (PAD) has not been examined. METHODS: We evaluated the hypothesis that a high cystatin C concentration is independently associated with future PAD events among 4025 participants in the Cardiovascular Health Study who underwent serum cystatin C measurement at the 1992-1993 visit and who did not have PAD at baseline. The association of cystatin C quintiles with time to first lower-extremity PAD procedure (bypass surgery, angioplasty, or amputation) was evaluated using multivariable proportional hazards models. Secondary analyses were conducted using quintiles of serum creatinine level and estimated glomerular filtration rate (eGFR). RESULTS: The annualized risk of undergoing a procedure for PAD was 0.43% per year among participants in the highest cystatin C quintile (>1.27 mg/L) compared with 0.21% per year or less in all other quintiles. After multivariable adjustment for known risk factors for PAD, elevated cystatin C levels remained associated with the outcome (hazard ratio, 2.5 for highest vs lowest quintile of cystatin C, 95% confidence interval, 1.2-5.1). The highest quintiles of serum creatinine level and eGFR were not associated with future PAD events in either unadjusted or adjusted analyses. CONCLUSION: Elevated concentrations of cystatin C were independently predictive of incident PAD events among community-dwelling elderly patients.

Aged↗
PubMedDate not supplied

Neck and shoulder pain in 70- to 79-year-old men and women: findings from the Health, Aging and Body Composition Study.

BACKGROUND CONTEXT: Musculoskeletal pain in the cervicobrachial region is considered a major health problem among adults of working age, but little is known about the impact of this pain in the elderly. PURPOSE: Determine the prevalence of neck and shoulder pain in a well-functioning cohort, identify factors associated with this pain, assess the pattern of coexisting joint pain and evaluate the impact of this pain on physical functioning. STUDY DESIGN: Cross-sectional study. PATIENT SAMPLE: Black and white men and women, aged 70 to 79 years, participating in the Health, Aging and Body Composition (Health ABC) study. OUTCOME MEASURES: Not applicable. METHODS: Between April 1997 and June 1998, 3,075 men and women participating in Health ABC study completed the initial home interview and clinical examination. Information was collected on musculoskeletal pain, medical history, depressive symptomatology and physical function. Physical performance measures were obtained. RESULTS: A total of 11.9% of participants reported neck pain of one month or more in duration and 18.9% reported shoulder pain. White women had the highest prevalence of neck pain (15.4%) and black women the highest prevalence of shoulder pain (24.3%). The correlates of both neck and shoulder pain were female gender, no education beyond high school, poorer self-rated health, depressive symptomatology and a medical history of arthritis, heart attack, angina. Increasing severity of both neck and shoulder pain was associated with an increased prevalence of joint pain at other body sites and with poor functional capacity. Measures of physical performance involving the upper extremity were also decreased. CONCLUSIONS: Neck and shoulder pain, either alone or in conjunction with pain in other joints, has a substantial impact on the function and well-being of the older adults in this cohort.

Age Distribution↗
PubMedDate not supplied

Subclinical cardiovascular disease in older adults: insights from the Cardiovascular Health Study.

Knowledge about the epidemiology of subclinical cardiovascular disease (SCVD) in older adults may hold the key for improved opportunities for primary prevention of cardiovascular disease (CVD), a top clinical and public health priority. This review reports findings on the prevalence of SCVD and the ability of SCVD measures to predict incident and adverse outcomes from one of the largest (N=5888) and most comprehensive prospective observational studies on SCVD in older adults, the Cardiovascular Health Study. According to a composite index that combined SCVD measures from different vascular beds, the overall prevalence of SCVD was 37%, making it as common as clinically overt CVD in older adults. SCVD measures strongly predicted incident CVD, stroke, mortality, frailty, and physical and cognitive decline, even after adjustment for traditional CVD risk factors. Ongoing research will address the potential use of SCVD for clinical decision making in older adults.

Aged↗
PubMedDate not supplied

Chronic renal insufficiency and cardiovascular events in the elderly: findings from the Cardiovascular Health Study.

In the Cardiovascular Health Study, the authors sought to evaluate the impact of chronic renal insufficiency (CRI) on cardiovascular risk status and outcomes in a representative sample of community-dwelling elderly adults. Defined as a serum creatinine level > or =1.3 mg/dL in women and > or =1.5 mg/dL in men, CRI was present in 647 (11%) of 5808 participants. At baseline, the prevalence of clinical or subclinical cardiovascular disease was 64% in participants with CRI and 43% in those without CRI (odds ratio, 2.34; 95% confidence interval, 1.96-2.80). The incidence of cardiovascular disease events during follow-up was 3% per year in participants with creatinine levels <1.10 mg/dL and increased steadily to reach 7% per year in those with creatinine > or =1.70 mg/dL. Among the possible mediators for the association between CRI and cardiovascular morbidity are inflammatory (C-reactive protein, fibrinogen, and interleukin-6) and hemostatic (factor VII, factor VIII, plasmin-antiplasmin product, and D-dimer) biomarkers, all of which were significantly elevated in Cardiovascular Health Study participants with CRI. Future studies should evaluate the contribution of novel and traditional cardiovascular risk factors to the cardiovascular risk of elderly persons with CRI. The identification of CRI in the elderly and the use of cardiovascular prevention therapies represent a major opportunity to reduce their burden of cardiovascular morbidity.

Aged↗