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Objective To analyze the relationship between the abdominal fat and the progress of carotid atherosclerosis in the subject ageing 51-100 years.Methods 140 subjects receiving health examination in the department of health of Peking Union Medical College Hospital from 2015 to 2016 were included in the research.The abdominal fat area and distribution were calculated according to abdominal CT,and the progress of atherosclerosis in carotid artery was determined by ultrasound.Results In the population of 51-100 years old,there were no statistically significant difference in abdominal fat area and distribution among carotid artery plaque thickening group,arteriosclerosis nori-progressing group and plaque reducing group;In the population of 51-80 years old,the total abdominal fat was significantly higher in carotid artery plaque thickening group than in arteriosclerosis non-progressing group and plaque reducing group (P=0.05,P =0.03),abdominal visceral fat area also increased,but no significant difference was found (P＞0.05),and no significant differences in abdominal fat distribution was found (P＞0.05.Conclusion The less total area of abdominal fat is,the slower the progress of atherosclerosis in carotid artery is in the population of 51-80 years old.
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Objective To explore the relationship between the body weight and the structure and function of the left ventricle in the elderly inpatients,in order to emphasize the importance of body weight in the health management for elderly patients.Methods A total of 152 elderly inpatients meeting the enrollment criteria and providing informed consent were consecutively recruited.The height,body weight,body mass index (BMI),liver and kidney function,glycosylated hemoglobin,blood lipid,blood uric acid and structure and function of left ventricular were measured by anthropometry,biochemical examination and echocardiography respectively.The clinical characteristics,metabolic parameters,structure and function of left ventricular were compared among the low/normal weight,overweight and obesity groups.The correlation between left ventricular diastolic dysfunction (E/A ≤ 0.7) and the metabolic factors was analyzed.Results The incidences of lower/ normal weight,overweight and obesity in elderly inpatients were 29.6％ (45/152),52.6％ (80/152) and 17.8％ (27/152) respectively.Compared with the lower/normal weight group,the level of systolic blood pressure,glycosylated hemoglobin (P=0.005),left atrial diameter (P =0.000),left ventricular posterior wall dimension (P=0.010),left ventricular diastolic diameter (P=0.010),left ventricular mass (P=0.000),relative wall thickness and septal thickness increased significantly in overweight and obesity groups (all P＜ 0.05).A higher proportion of left ventricular diastolic dysfunction was observed in overweight and obesity groups in the patients aging 60-69 years (P=0.028).There was positive correlation between left ventricular diastolic dysfunction and BMI (P=0.022).Conclusions Overweight/obesity increases the risk of left ventricular diastolic dysfunction among elderly inpatients.The body weight management needs to be strengthened in health management for the elderly patients.
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Objective To study the rate of kidney function decline and the influencing factors in the aged population. Methods This was a prospective population-based study of 468 participants aged 65 years and older. All participants’ general health information and serum creatinine levels were collected as the baseline. After a 3-year follow-up ,the serum creatinine level of each participant was measured again.Kidney function was assessed with estimated glomerular filtration rate (eGFR) calculated using the Chronic Kidney Disease-Epidemiology Collaboration ( CKD-EPI ) equation. Outcomes of interest were mean eGFR decline and rapid decline in eGFR (annual eGFR loss≥3 ml·min－1·1.73 m －2).Risk factors were analyzed with Logistic regression. Results At baseline ,the mean age of participants was(78.4 ± 8.7)years and the mean eGFR was(74.8 ± 14.5)ml ·min－1·1.73 m －2.Annual eGFR decline was 1.5 ml·min－1·1.73 m －2,with rapid declines in 149 (32%) participants and stable kidney function in 319 (68%) individuals. The rate of kidney function loss slowed down as the age increased.Baseline eGFR was an independent predictor for rapid kidney function decline. The incidence of rapid kidney function decline in individuals with eGFR ≥ 60 ml· min－1·1.73 m －2was 2.40 times (95% CI :1.16-4.98) higher than that of participants with eGFR＜60 ml·min－1·1.73 m －2after adjustment for confounders. Conclusions Kidney function changes in the community-dwelling elderly in China are heterogeneous. Most elderly individuals do not show appreciable kidney function decline over a 3-year period.
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Objective A analyze the relation between abdominal fat and diabetes mellitus in elderly person aged 51-100.Methods According to the abdominal CT scan in 2015 to 2016 of 162 patients in Peking Union Medical College Hospital,the volume and distribution of their abdominal fat were measured to analyze the relationship between abdominal fat and diabetes mellitus.Results People aged 51-75,no abnormal glucose metabolism group compare with diabetes or fast hyperglycemia group,tend to have less abdominal visceral fat [(63.61±24.95) mm3 vs.(70.39±31.33) mm3 t=-1.229,P=0.22],tend to have more abdominal subcutaneous fat [(89.03±t32.94) mm3 vs.(83.18±43.25) mm3,t=1.070,P=0.43),but both are not significant difference,total abdominal fat is similar between the two group [(152.64±46.84) mm3 vs.(151.84 ± 61.32) mm3,t =0.076,P =0.94],abdominal visceral fat percentage is significantly lower [(41.8±10.9)％ vs.(46.9±10.9)％,t=-2.346,P=0.02].People aged 76-100,no abnormal glucose metabolism group compare with diabetes or fast hyperglycemia group,tend to have more abdominal visceral fat [(68.29±39.58) mm3 vs.(51.56±25.89) mm3),abdominal subcutaneous fat [(84.65±41.30) mm3 vs.(75.29±42.04) mm3],total abdominal fat [(152.96±69.92) mm3 vs.(126.86±62.13) mm3],abdominal visceral fat percentage [(43.7±±12)％ vs.(41.1±11.8)％],all of them are not significant (t=1.885,0.839,1.479,0.810,respectively;P=0.07,0.40,0.15,0.42,respectively).Conclusions In people aged 51-75,those who had increased ratio of abdominal visceral fat to total abdominal fat were more prone to diabetes or fasting hyperglycemia.In people aged 76-100,no significant correlation was detected between abdominal fat and disorder of glucose metabolism.
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Objective To compare differences among measured rest energy expenditure (REE) by using indirect calorimetry (IC) and predictive REE from predictive equations (PE) and human body component analyzer (HBCA).Methods Young and middle-aged healthy volunteers of light manual labor were recruited in this study.REEs were obtained from IC,PE (WHO-Schofield and Harris-Benedict equations) and HBCA.Results A total of 30 healthy participants were included,of whom 12 were males (25-46 years old) with an average age of (37.8±7.4) and 18 were females (26-52 years old) with an average age of (40.4±7.8).Measured REE of the males was (1 848.33± 155.01) kcal/d,which was significantly different from the predictive REE result of H-B equation (P=0.003) but not from results of WHO-Schofield equation and HBCA.In females,however,measured REE was (1 294.44± 134.23) kcal/d,which was significantly different from predictive REE results of both equations and HBCA,P=0.002 (WHO-Schofield),P=0.031 (H-B) and P=0.002 (HBCA).Results of measured REE were related to weight (P=0.033) and percentage of body fat (P=0.036) in males,and to height and muscle mass (P=0.003) in females.Conclusion In young and middle-aged healthy females of light manual labor,IC represented a more accurate way to measure REE,while in males WHO-Schofield equation and HBCA could be considered as alternative choices to predict REE.
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Objective To analyze the effect of health check-up feedback style (HCFS) on the blood glucose level and weight of type 2 diabetes patients aged 75 years and older.Methods 120 consecutive patients with type 2 diabetes and aged 75 and older who were taking annual health check-up and receiving paper-based medical examination reports at Peking Union Medical College Hospital were enrolled into this study.The patients were randomly divided into two groups (control group and study group).All patients received annual health check-up between November 2014 and October 2015 (baseline health check-up).Patients in control group were given paperbased feedback as usual,while those in study group received feedback via face-to-face or telephone conversations.All patients received their second annual health check-up between November 2015 and October 2016.The patients' blood glucose and weight at the second health check-up were compared between the two groups.Results In baseline health check-up,the levels of HbA1c and BMI showed no difference between the two groups.In the second health check-up,HbA1c and BMI of study group were lower than control group [(7.17±0.58)％ vs.(7.44±0.72)％,P=0.027;(24.3±3.8) kg/m2 vs.(25.0±4.2) kg/m2,P=0.049].Fast blood glucose and waist circumference showed no difference between the two groups.Conclusions Combination of paper-based reports and face-to-face or telephone conversations to feedback on health check-up results led to better blood glucose and BMI control in old aged type 2 diabetes patients.HCFS is of vital importance.
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Objective To investigate the differences of four equations to estimate glomerular filtration rate (GFR) and their impacts on chronic kidney disease (CKD) prevalence in communitydwelling elderly people in Beijing.Methods A total of 489 participants aged above 70 years were enrolled.The GFR was estimated using the Cockcroft Gault (CG) equation,Chronic Kidney DiseaseEpidemiology Collaboration (CKD-EPI) equation,Modification of Diet in Renal Disease (MDRD) equation and Berlin Initiative Study (BIS) equation respectively.The internal-consistency check was made on the four equations for the GFR (ml min 1 1.73m 2) estimates.Results The mean age of participants was (81.8±7.6) years.The mean GFR estimated using the CG,CKD-EPI,MDRD and BIS equation was 58.4± 17.2,71.9± 15.3,76.7± 19.1 and 62.7± 12.7,respectively.And the prevalence of CKD was 56.2％,22.7％,17.8％ and 41.7％,respectively.The greatest differences of equations to estimate GFR were seen in elderly people aged 90 and above,and those with body mass index＜ 20.0 kg/m2 or serum creatinine concentration＜ 88.4 μmol/L.Conclusions The GFR estimated using different equations has a large difference which has a significant effect on CKD classification in elderly people.The equation to estimate GFR for the elderly is urgently needed.Until then,the eGFR and CKD classification estimated using different equations should be regarded with caution.
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With the emerging of aging society and advances of information sciences, telemedicine has gradually become a new medical model.Telemedicine can be used in health monitoring, disease diagnosis, counseling, education, chronic disease management and long-term care in elderly population;particularly in management of chronic heart failure, diabetes and other chronic diseases, as well as in referral and continuous medical care.To promote telemedicine in the elderly population can break the physical limitations of different health care settings, so that geriatrician and the allied team members are enable to maximize their values in providing corresponding health services.This article reviews the progress of telemedicine in foreign countries, which would be of reference value for development of telemedicine for elderly people in China.
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As the basis of the health management of the elderly, weight management should receive attention from medical practitioners.However, there is an ongoing debate on the ideal range of body mass index for elderly in China.This article aimed to find the suitable body mass index for Chinese old people by reviewing the literature regarding the body mass and obesity of the elderly.Lots of evidence show that overweight and mild obesity appear to be the optimal weight status for the elderly.
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Objective To summarize the progress of research on the influence of nutrition support on quality adjusted life year (QALY) in elderly patients with nutritional risk, and to evaluate the feasibility of QALY as an outcome indicator.Methods Literature in Chinese, English and Japanese relating to the feasibility of QALY and cost-utility in evaluating the influence of nutrition support on the outcomes of patients with nutritional risk published from 1980 to 2013 were searched in Wanfang, China National Knowledge Infrastructure,PubMed, Nature databases.The methodological quality of randomized controlled trials was assessed using Jadad scale combined with Schulz allocation concealment, and the quality of cohort studies with Newcastle-Ottawa scale.Results Totally 10 articles were fotnd, in which 8 were selected, including 6 randomized controlled trial and 2 cohort studies, covering 1 130 patients;the other 2 were excluded for not conforming to inclusion criteria.Four of the 6 randomized controlled trial indicate that QALY is higher and all-cost is lower in the treatment group compared with the control group (or cost-utility is higher in the treatment group).The 2 cohort studies indicate that total parenteral nutrition support at home could improve the QALY of malnourished patients and could save cost compared with nutrition support at hospital when necessary.Conclusions Nutrition support for patients with nutritional risk can improve prognosis, reduce cost, and increase QALY.More large-scale, high-quality randomized controlled trials are needed to evaluate the effect of nutrition support on the QALY of elderly patients with nutritional risk.
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Objective To explore the image quality of coronary artery imaging with dual source computed tomography (DSCT) and analyze the coronary artery lesions. Methods Two hundred cases with clinically suspected coronary heart disease, who underwent plain and enhanced DSCT coronary artery imaging without oral Betaloc preparation were retrospectively analyzed. The patients were divided into two groups: the senile group of 126 cases with the average age of (71.3±7.7) years old and the control group of 74 cases with the average age of (50.4±6.2) years old. The clinical characteristics, the average heart rate and breath-holding time for plain and enhanced scan, the average calcium score, the image quality evaluation and the coronary stenosis were compared between the two groups. Results Compared with the control group, the incidences of chest pain or discomfort, hypertension, diabetes mellitus, hypercholesterolemia and old myocardial infarction were significantly higher in the senile group. The average calcium score and the numbers of <50% and ≥50% stenosis were also significantly higher in the senile group than those in the control group (364.9±442.6)points vs. (44.8±106.9)points, 159 vs. 45 branches, 212 vs. 32 branches, respectively, all P<0.01). The average heart rate and breath-holding time of plain and enhanced scan had no significant differences compared with the control group. The proportion of the coronary segments with grade 1 ,grade 2 and grade 3 image quality also had no significant difference compared with the control group (96.5%,2.3% and 1.2% vs. 97.1%, 2.0% and 0.9%, P>0.05). Conclusions DSCT coronary artery imaging in senile patients is noninvasive, safe and simple, and excellent coronary artery image can be obtained without oral Betaloc preparation. It can be used as a routine examination in the clinical diagnosis of coronary heart disease.
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Objective To explore the scanning technique and image quality of coronary artery imaging with dual-source CT without oral Betaloc preparation in the patients with high heart rate.Methods 412 cases were undergone coronary imaging with dual-source CT (including plain and enhanced scans) ,among them,there were 30 cases with heart rate more than 100 bpm.Multi-planar reconstruction(MPR),maximum intensity projection(MIP) and volume rendering (VR) were performed using contrast-enhanced images.The image quality was classified into 3 grades, and coronary segments named according to AHA standard were evaluated.Results The average heart rate during enhanced scan in the 30 cases was (115.6?11.8)(101～139)bpm,the average breath hold time was (5.7?1.2) s.The best reconstruction phase was in the systolic phase. Altogether 424 coronary segments were evaluated, among them 93.9%(398/424)belonged to the first grade,5.0%(21/424)belonged to the second grade,and 1.2%(5/424) belonged to the third grade. Conclusion Without oral administration of Betaloc preparation, good coronary artery images can be obtained in the patients with high heart rate by dual-source CT.