Cognitive Reserve Characteristics and Occupational Performance Implications in People with Mild Cognitive Impairment.

The Cognitive Reserve hypothesis suggests that there are individual differences in the ability to cope with the pathologic changes in Alzheimer's Disease. The proportion of elderly individuals has increased in recent years; this increase emphasizes the importance of early detection of mild cognitive impairment and the promotion of healthy ageing. The purpose of our study is to characterize cognitive reserve and occupational performance implications in people with mild cognitive impairment. 125 patients with mild cognitive impairment were enrolled. The Montreal Cognitive Assessments (MoCA) was used to evaluate cognitive status and the Cognitive Reserve Index Questionnaire (CRIq) as an indicator of cognitive reserve. Higher level of education was associated with higher MoCA scores (r = 0.290, p = 0.001). Positive significant correlations were observed between MoCA and total CRIq (r = 0.385, p < 0.001) as well as its three sub-domains, education (r = 0.231, p = 0.010), working activity (r = 0.237, p = 0.008) and leisure time (r = 0.319, p < 0.001). This study findings provide the importance of considering socio-behavioral factors in cognitive status. This research helps to describe the importance of engaging occupationally along the whole life-course as a potential protective factor in ageing, and includes a perspective of occupational therapy regarding the hypothesis of cognitive reserve.

Long-Term Dietary and Physical Activity Interventions in the School Setting and Their Effects on BMI in Children Aged 6-12 Years: Meta-Analysis of Randomized Controlled Clinical Trials.

Preventive actions and potential obesity interventions for children are mainly researched throughout the school period, either as part of the school curricula or after regular school hours, via interventions mostly lasting less than 12 months. We aimed to perform a meta-analysis on randomized controlled clinical trials to evaluate the evidence of the efficacy of long-term school-based interventions in the management of childhood obesity in terms of BMI from a dietary and physical activity-based approach. Eleven randomized controlled clinical trials were examined using the random effects model, and the results showed that there were no significant effects associated with physical activity + nutrition intervention in school children aged 6-12 years, with a pooled standardized mean difference (SMD) (95% CI) of -0.00 (-0.05, 0.04). No effects were observed after subgroup analysis based on the intervention length. The findings from our study indicate that long-term school-based interventions on physical activity and dietary habits received by children aged 6-12 years seem to have no effect on BMI. However, the promotion of such interventions should not be discouraged, as they promote additional positive health outcomes for other domains of children's health.

Plasma Fatty Acids and Quantitative Ultrasound, DXA and pQCT Derived Parameters in Postmenopausal Spanish Women.

Different factors may contribute to the development of osteopenia or osteoporosis. Fatty acids are key nutrients for health, and a number of studies have reported an association between bone mineral density (BMD) and fatty acid intake. We aimed to investigate the relationships between serum levels of different fatty acids and bone parameters determined by quantitative bone ultrasound (QUS), peripheral quantitative computed tomography (pQCT), and dual-energy X-ray absorptiometry (DXA) in a sample of Spanish postmenopausal women. We enrolled a total of 301 postmenopausal women (median age 59 years; interquartile range (IQR) 7) in this study. All participants underwent full densitometric screening, including calcaneal quantitative ultrasound (QUS), peripheral quantitative computed tomography (pQCT), and dual-energy X-ray absorptiometry (DXA), as well as plasma fatty acid measurement. After adjustment for potential confounders, plasma n-3 polyunsaturated fatty acid (PUFA) levels correlated with BMD in the spine (r = 0.150; p = 0.014) and femoral neck (r = 0.143; p = 0.019). By multiple linear regression, an independent statistically significant positive relationship was observed between BMD in the spine and BMI (ß = 0.288; p = 0.001) as well as total plasma n-3 PUFAs (ß = 0.155; p = 0.009). The plasma n-3 PUFA level was also a significant and positive predictor of BMD at the femoral neck (ß = 0.146; p = 0.009). Independent risk factors for low BMD (T-score ≤ 1) were determined by logistic regression analysis, and a relatively high level of plasma n-3 PUFAs (OR = 0.751; 95% CI 0.587-0.960, p = 0.022) was identified as a protective factor against low bone mass. In this single-center sample of Spanish postmenopausal women, we reported a significant positive and statistically independent association between BMD and plasma levels of n-3 PUFAs.

Impact of a Postoperative Intervention Educational Program on the Quality of Life of Patients with Hip Fracture: A Randomized, Open-Label Controlled Trial.

The objective of this study was to determine the impact of a postoperative educational intervention program on the health-related quality of life (HRQoL) of patients with hip fracture using a controlled clinical trial in a randomized, multicenter study. In total, 102 patients (45.5%) from trauma units at the two University Hospitals of the province of Cáceres received the educational program, whereas 122 (54.5%) did not. Patients were consecutively included in either an intervention or a control group. Patients from the intervention group received an educational program during admission and the postoperative period. Patients from the control group did not receive any educational program. These patients were managed according to routine protocols. The patients were predominantly female (76.3%), aged 84.6 years (SD 6.1). All dimensions in both groups at 12 months showed a significant decrease with respect to baseline, except for bodily pain in both groups (p = 0.447; p = 0.827) and social functioning in the intervention group (p = 0.268). Patients receiving the educational program showed higher levels in the dimensions of the Mental Component Summary (MCS-12) (p = 0.043), vitality (p = 0.010), and social functioning (p < 0.001), as well as in the dimensions of the SF-12 health survey questionnaire of HRQoL 12 months after surgery. In conclusion, our study of the intervention group showed that there were significant improvements in MCS-12, vitality, and social function dimensions compared to the control group.

Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up.

We aimed to know the prevalence of post-stroke depression (PSD) in our context, identify the variables that could predict post-stroke depression, by using the Hamilton Depression Rating Scale, occurring within six months after stroke, and identify patients at high risk for PSD. METHODS: descriptive, cross-sectional and observational study. We included 173 patients with stroke (transient ischemic attack (TIA) included) and collected sociodemographic and clinical variables. We used the Hamilton Depression Scale (HDS) for depression assessment and Barthel Index and modified Rankin Scale (mRS) for functional assessment. The neurological severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS). RESULTS: 35.5% were women, aged 71.16 (±12.3). Depression was present in 42.2% patients (n = 73) at six months after stroke. The following variables were significantly associated with PSD: diagnosis of previous depression (p = 0.005), the modified Rankin Scale at discharge (p = 0.032) and length of hospital stay (p = 0.012). CONCLUSION: PSD is highly prevalent after stroke and is associated with the severity, left location of the stroke, and the degree of disability at discharge. Its impact justifies the evaluation and early treatment that still continues to be a challenge today.

Long-chain omega-3 polyunsaturated fatty acid dietary intake is positively associated with bone mineral density in normal and osteopenic Spanish women.

The regular consumption of long-chain omega-3 polyunsaturated fatty acids (LCO3-PUFAs) results in general health benefits. The intake of LCO3-PUFAs has been reported to contribute to bone metabolism. We aimed to investigate the relationships between dietary intakes of LCO3-PUFAs and bone mineral density (BMD) in Spanish women aged 20-79 years old. A total of 1865 female subjects (20-79 years old) were enrolled, and lumbar (L2, L3, L3 and total spine), hip (femoral neck (FN), femoral trochanter (FT) and Ward's triangle (WT)) bone mineral density (BMD) were measured by dual energy X-ray absorptiometry (DXA). Dietary intakes of total energy, calcium, vitamin D, alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and n-6 fatty acids (linoleic acid (LA) and arachidonic acid (AA)) were assessed by a self-administered food frequency questionnaire (FFQ). Spearman's rank correlations between LCO3-PUFAs and BMD were estimated. Partial correlations controlling for age, weight, height, dietary calcium, vitamin D, menopausal status and energy were calculated. A multiple regression analysis was computed to assess significant associations with BMD in this population. After adjustment for potential confounding factors, there were positive correlations between ALA, EPA and DHA intake and BMD. According to the WHO diagnosis criteria for osteoporosis, in this population of normal and osteopenic women, the dietary intake of ALA was also significantly associated with BMD at the hip. In normal women, the dietary intake of DHA was also significantly associated with BMD at the lumbar spine. No significant associations between LCO3-PUFAs and BMD were detected in the lumbar spine of osteopenic or osteoporotic women. The dietary intake of LCO3-PUFAs was positively associated with BMD in Spanish women at both the hips and the lumbar spine. We highlight that the intake of LCO3-PUFAs is not significantly associated with BMD in osteoporotic women; however, the intake of LCO3-PUFAs seems to be positively associated with BMD at both the hips and the lumbar spine in normal and osteopenic women.

Dietary Intake of Cadmium, Lead and Mercury and Its Association with Bone Health in Healthy Premenopausal Women.

The bone is one of the relevant target organs of heavy metals, and heavy metal toxicity is associated with several degenerative processes, such osteoporosis and bone mineral alterations, that could lead to fractures. We aimed to study a presumed relationship between bone density, evaluated by quantitative bone ultrasound (QUS), dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT) and the dietary intake of cadmium, lead and mercury in healthy premenopausal women. A total of 158 healthy, non-smoking, premenopausal women were incorporated into the study. A validated food frequency questionnaire (FFQ) was administered to assess intake during the preceding seven days. The median predicted dietary cadmium intake among the 158 women studied was 25.29 µg/day (18.62-35.00) and 2.74 µg/kg body weight/week (b.w./w) (1.92-3.83). Dietary lead intake was 43.85 µg/day (35.09-51.45) and 4.82 µg/kg b.w./w (3.67-6.13). The observed dietary mercury intake was 9.55 µg/day (7.18-13.57) and 1.02 µg/kg b.w./w (0.71-1.48). Comparisons, in terms of heavy metal intake, showed no significant results after further adjusting for energy intake. No statistically significant correlations between heavy metal intake and the QUS, DXA and pQCT parameters were observed. Levels of dietary exposure of cadmium, lead and mercury were mostly within the recommendations. We did not find associations between the QUS, DXA and pQCT parameters and the dietary intake of the studied heavy metals in healthy premenopausal women.

Evaluation of the Dietary Intake of Cadmium, Lead and Mercury and Its Relationship with Bone Health among Postmenopausal Women in Spain.

BACKGROUND: Heavy metals, such as lead, cadmium, and mercury, are absorbed through contaminated food sources and water. Few studies have investigated the extent to which dietary heavy metals are associated with low bone mineral density. AIMS: We aimed to characterize the dietary intake of the heavy metals lead, cadmium and mercury among healthy, non-smoking postmenopausal women in Spain. Furthermore, we sought to establish a putative relationship between bone health and the intake of these heavy metals in this population. STUDY DESIGN: The daily intake of the heavy metals considered for the different food groups was calculated by accounting for food content and consumption in 281 postmenopausal women. Bone measurements were performed using a Quantitative Bone Ultrasound (QUS), a Dual-Energy X-ray Absorptiometry (DXA) and a Peripheral Quantitative Computed Tomography (pQCT). RESULTS: The average estimated dietary cadmium exposure among the 281 women studied was 29.87 µg/day (20.41-41.04) and 3.03 µg/kg body weight (b.w.; 2.17-4.40). Dietary lead exposure was 46.24 µg/day (38.11-54.77) and 4.87 µg/kg b.w. (4.00-6.14). The estimated dietary mercury exposure was 11.64 µg/day and 1.19 µg/kg b.w. (0.82-1.76). Participants were classified according to their heavy metal intake (above or below the respective medians). After further adjustment for potential confounding factors, no significant differences were found in all the measured parameters (p > 0.05). CONCLUSIONS: We did not find associations between bone health and the dietary intake of three heavy metals in postmenopausal women. Dietary intake of the measured heavy metals were within the recommended values.

Antiproliferative Properties of Oleuropein in Human Osteosarcoma Cells.

In this study, we evaluated the antiproliferative activity on two human osteosarcoma cell lines (MG-63 and Saos2) of oleuropein, an olive oil compound traditionally found in the Mediterranean diet. Oleuropein exhibited obvious cytotoxic effects on human osteosarcoma cells in a concentration- and time-dependent manner. Statistical analysis of IC50 by the Probit regression method suggested that oleuropein had similar toxic effects on both cell lines tested (IC50 range from 247.4-475.0 µM for MG63 cells and from 798.7-359.9 µM for Saos2 cells).

Greater Calcium Intake is Associated with Better Bone Health Measured by Quantitative Ultrasound of the Phalanges in Pediatric Patients Treated with Anticonvulsant Drugs.

We aimed to investigate and compare the effects of chronic antiepileptic therapy on bone health in pediatric patients using quantitative ultrasound of the phalanges (QUS) and controlling for potential confounding factors, particularly nutrient intake. The amplitude-dependent speed of sound (Ad-SoS) was measured in 33 epileptic children and 32 healthy children aged 6.5 ± 3.1 and 6.3 ± 1.1 (mean ± SD) years, respectively. There were no significant differences in the demographics such as age, weight and height between epileptic children and the control group children. None of the children in the epileptic or the treatment group were found to have a vitamin D deficiency. There were no significant differences in laboratory tests between groups. Lower QUS figures were found in the epileptic children (p = 0.001). After further adjustment for potential confounders such age, height, weight, calcium intake, vitamin D intake, physical activity and sex, the differences remained significant (p < 0.001). After further classification of the participants based on the tertile of calcium intake, no significant differences were found between patients and healthy controls in the greatest tertile of calcium intake (p = 0.217). We conclude that anticonvulsant therapy using valproate may lead to low bone mass in children and that an adequate intake of calcium might counteract such deleterious effects.

Increased bone mineral density is associated with breastfeeding history in premenopausal Spanish women.

INTRODUCTION: During lactation abundant calcium is lost from the mother as a result of the amount of breast milk produced. Lactation leads to transient fragility, with some women experiencing even fragility fractures, but nearly all of these women subsequently undergo a large increase in bone mineral density (BMD), confirming that the BMD must have declined during lactation but it increases after weaning. We have retrospectively examined the relationship between the duration of breastfeeding and bone properties in Spanish premenopausal healthy women, to identify the site-specific changes in BMD. MATERIAL AND METHODS: Four hundred and thirty-three premenopausal healthy women, 295 with a mean of 7.82 ±6.68 months of exclusive breastfeeding and 138 control women, were studied. We examined total, trabecular and cortical volumetric BMD (mg/mm(3)) at the distal radius using peripheral quantitative computed tomography. Areal BMD (g/cm(2)) was measured using dual energy X-ray absorptiometry at the femoral neck, lumbar spine, trochanter and Ward's triangle. Phalangeal bone ultrasound was measured by amplitude-dependent speed of sound. RESULTS: Areal BMD analysis at L2-L4 revealed significant intergroup differences (p < 0.05). There were significant intergroup differences in the volumetric BMD in both total and cortical bone (p < 0.05). The observed BMD of breast-feeders was higher than the BMD in non-breast-feeding women. Additionally, the lactation subgroup analysis revealed significant differences in the areal BMD at trochanter and L2-L4 (p < 0.05) and in the cortical volumetric BMD (p < 0.05). CONCLUSIONS: This study adds to the growing evidence that breastfeeding has no deleterious effects and may confer an additional advantage for BMD in premenopausal women.

Quantitative ultrasound in Spanish children and young adults with cystic fibrosis.

We studied the relationship between bone density and cystic fibrosis in Spanish children and young adults. We measured the phalangeal bone amplitude-dependent speed of sound (Ad-SoS) in 35 patients with cystic fibrosis and in 30 healthy controls matched for gender, age, and body mass index (BMI). Participants were subjects with normal levels of 25(OH) Vitamin D. We found no difference in Ad-SoS between patients and controls. The only difference between the groups was that the patients had a significantly higher daily caloric intake than the controls (p < .05) as a result of the patient group's greater intake of fats (p < .05). There was a positive correlation between Ad-SoS and weight (p < .0001), but after adjusting for potential confounding factors such as age, the correlation was lost. The percentage of ideal weight did not differ between the two groups. We conclude that well-nourished CF patients had similar Ad-SoS to controls.

Bone ultrasound and physical activity in postmenopausal Spanish women.

We studied the effects of moderate physical activity on bone mass in healthy postmenopausal women as assessed by quantitative bone ultrasound. We enrolled a total of 326 postmenopausal women (60.95 ± 8.51 years old and 13.02 ± 9.52 years since menopause) and categorized them by weekly physical activity in their leisure time (sedentary, moderate, and active). We administered a questionnaire on general health and diet and measured bone density by ultrasound on phalanges II-V in the nondominant hand. We found no significant difference in the amplitude-dependent speed of sound (Ad-SoS; p > .05) between sedentary and active women. We concluded that the changes induced by moderate physical activity on bone mass are minimal in healthy postmenopausal women.

Effects of curcumin on the proliferation and mineralization of human osteoblast-like cells: implications of nitric oxide.

Curcumin (diferuloylmethane) is found in the rhizomes of the turmeric plant (Curcuma longa L.) and has been used for centuries as a dietary spice and as a traditional Indian medicine used to treat different conditions. At the cellular level, curcumin modulates important molecular targets: transcription factors, enzymes, cell cycle proteins, cytokines, receptors and cell surface adhesion molecules. Because many of the curcumin targets mentioned above participate in the regulation of bone remodeling, curcumin may affect the skeletal system. Nitric oxide (NO) is a gaseous molecule generated from L-arginine during the catalization of nitric oxide synthase (NOS), and it plays crucial roles in catalization and in the nervous, cardiovascular and immune systems. Human osteoblasts have been shown to express NOS isoforms, and the exact mechanism(s) by which NO regulates bone formation remain unclear. Curcumin has been widely described to inhibit inducible nitric oxide synthase expression and nitric oxide production, at least in part via direct interference in NF-κB activation. In the present study, after exposure of human osteoblast-like cells (MG-63), we have observed that curcumin abrogated inducible NOS expression and decreased NO levels, inhibiting also cell prolifieration. This effect was prevented by the NO donor sodium nitroprusside. Under osteogenic conditions, curcumin also decreased the level of mineralization. Our results indicate that NO plays a role in the osteoblastic profile of MG-63 cells.

Bone mass of Spanish school children: impact of anthropometric, dietary and body composition factors.

The purpose of this study was to: (a) determine the relationship between quantitative ultrasound (QUS) results and anthropometric, dietary and body composition factors and establish reference ranges for amplitude-dependent speed of sound (Ad-SoS) in the phalanges and broadband ultrasound attenuation (BUA) in the calcaneus of children from Extremadura, Spain, and (b) to present reference curves for this population. Healthy children (n = 245), aged 4-16 years, were included (124 girls and 121 boys). Phalangeal and calcaneal QUS measurements were performed using DBM Sonic Bone Profiler and McCue CUBA Clinical ultrasound devices, respectively. Weight, height and body mass index (BMI) were evaluated by anthropometric methods. Fat percentage, fat mass, lean mass (FFM) and total body water (TBWater) were evaluated by bioelectrical impedance measurements using a Holtain body composition analyzer. Food intake was evaluated by a 7-day food record. A gender analysis revealed that Ad-SoS and BUA parameters increased significantly with age and that both positively correlated with age, weight, height, BMI, FFM and TBWater. For both genders, Ad-SoS showed significant and positive correlations with age, weight, height, BMI, FFM, BUA and TBWater.

Ultrasound bone mass in patients undergoing chronic therapy with oral anticoagulants.

The purpose of this study was to assess the effects of chronic oral anticoagulant (OAC) treatment on bone mass using quantitative ultrasound (QUS) techniques. A total of 120 patients (47 women and 73 men) undergoing treatment with OAC and 57 healthy subjects (27 women and 30 men) participated in this study. Bone status was assessed using QUS devices that measure the amplitude-dependent speed of sound (Ad-SoS) in phalanges and the broadband ultrasound attenuation (BUA) in the calcaneus. Men undergoing OAC treatment had lower Ad-SoS, Z-score, T-score, and BUA values (all p < 0.005) and higher levels of undercarboxylated osteocalcin (u-OC) and tartrate-resistant acid phosphatase (TRAP) (both p < 0.0001) than controls. Women receiving OAC treatment had lower BUA values (p < 0.005) and total osteocalcin (OC) levels (p < 0.0001) and higher levels of u-OC and TRAP (both p < 0.0001) than controls. There was a statistically significant negative correlation between u-OC levels and Ad-SoS values in both men (r = -0.432, p = 0.0328) and women (r = -0.332, p = 0.0269) undergoing OAC treatment. In conclusion, patients undergoing OAC treatment had a loss of trabecular and cortical bone mass, possibly due to a decrease in the γ-carboxylation of osteocalcin resulting from the vitamin K antagonism of these drugs.

Effect of beer drinking on ultrasound bone mass in women.

OBJECTIVE: To study the effect of beer consumption on bone mass in a group of healthy women, by using phalangeal bone ultrasound to evaluate the amplitude-dependent speed of sound. METHODS: This was a cross-sectional study of 1697 healthy women (mean age 48.4 y, body mass index (BMI) 19.0-32.0 kg/m(2)), recruited in a clinical convenience sample and screened for the existence of disease and/or medication that would affect calcium metabolism. Of this total, 710 were premenopausal, 176 were perimenopausal, and 811 were postmenopausal. The women recruited completed a questionnaire that contained detailed sections on current cigarette, alcohol, caffeine, and nutrient consumption. In terms of current alcohol intake, the subjects were classified as moderate drinkers, light drinkers, and nondrinkers. Drinkers were also analyzed according to the kind of alcohol consumed: wine or beer. RESULTS: Quantitative bone ultrasound values were greater in the beer drinkers compared with the no beer and/or wine drinkers. Taking the amplitude-dependent speed of sound as a dependent variable, and age, BMI, gonadal status, intake of beer and wine, and number of cigarettes per day as independent variables, we found age (beta = -1.52), BMI (beta = -3.86), gonadal status (beta = -27.47), and beer intake (beta = 1.06) to be significant. CONCLUSION: The greater bone density found in women beer drinkers might be a result of the phytoestrogen content of this alcoholic drink; this requires further investigation.

Ultrasound bone mass in schizophrenic patients on antipsychotic therapy.

OBJECTIVE: To determine bone mass using quantitative phalangeal bone ultrasound in institutionalized schizophrenic patients under chronic treatment with antipsychotic drugs. METHODS: A total of 73 patients with schizophrenia (25 women, mean age 59.84 +/- 17.01 years; 48 men, mean age 61.89 +/- 12.95 years) and 73 healthy subjects (25 women, mean age 60.37 +/- 17.16 years; 48 men, mean age 61.24 +/- 13.09 years) participated in the study. Bone status was assessed using an ultrasound device that measures the amplitude-dependent speed of sound (Ad-SoS) in metres per second. Measurements were made on the phalanges (II-V) of the non-dominant hand, and the mean value was computed. RESULTS: The schizophrenic women had higher levels of prolactin (PRL), parathyroid hormone (PTH), alkaline phosphatase (AlPh), and tartrate-resistant acid phosphatase (TRAP) (all p < 0.0001), and lower 25-hydroxyvitamin D(25(OH)D3) levels (p < 0.0001) and Ad-SoS values (p < 0.05) than controls. Ad-SoS was higher in schizophrenic men (p < 0.05). CONCLUSIONS: Schizophrenic women in treatment with antipsychotic drugs had a loss of phalangeal bone mass that was associated with the levels of vitamin D or PTH, and increased bone turnover.

Reference curve of bone ultrasound measurements in proximal phalanges in normal Spanish women.

There are clear discrepancies in how the different measurements of phalangeal bone ultrasound, such as the amplitude-dependent speed of bone ultrasound (Ad-SoS), correlate with age, given their dependence on gonadal status and other anthropometric variables. In order to contribute to clarifying these discrepancies, we evaluated the phalangeal Ad-SoS in healthy women-295 postmenopausal, 59 perimenopausal, and 270 premenopausal. Phalanges (II-V) of the nondominant hand were measured and the mean Ad-SoS was computed. There were significant differences between groups (p < 0.0001 in all cases), with the perimenopausal group presenting the intermediate values. For the overall group of women, the Ad-SoS was significantly and negatively correlated with age, weight, and body mass index (BMI), and positively correlated with height (p < 0.0001 in all cases). By gonadal status group, the premenopausal women showed the three significant negative correlations of Ad-SoS with age, weight, and BMI (each, p < 0.0001), the perimenopausal group only with BMI (p < 0.007), and the postmenopausal group with age and BMI (p < 0.0061 to p < 0.0001) and also with years since menopause (p < 0.0001). The premenopausal decline in AD-SoS requires further longitudinal studies, although in our experience it may depend on dietary habits and/or a diminished quality, though not quantity, of bone in this period of a woman's fertile life.