Effect of Exercise Programs on Physical Performance in Community-Dwelling Older Adults with and without Frailty: Systematic Review and Meta-Analysis.

BACKGROUND: The measurement of physical performance constitutes an indicator of the physical functional capacity of older adults with and without frailty. AIM: To present a synthesis of knowledge on the effect of exercise programs on physical performance in older adults with and without frailty in the community. METHOD: A systematic review was carried out in accordance with the PRISMA-2020 criteria. The search for articles was made until 4 May 2023 in PubMed, Scopus, Web of Science, Cochrane Library, SciELO and LILACS. The outcome variable was physical performance, measured through the SPPB (Short Physical Performance Battery). The mean difference (MD) was estimated to evaluate the effect. RESULT: We found 2483 studies, of which 12 met the eligibility criteria for the systematic review and 9 for the meta-analysis. The effect of exercise on SPPB scores was significantly higher in the exercise group compared to control in non-frail older adults with MD = 0.51 [95% CI, 0.05 to 0.96, p < 0.05]. Likewise, in older adults with frailty, the effect of exercise on the global SPPB score was significantly higher in the exercise group compared to the control with MD = 0.66 [95% CI, 0.09 to 1.24, p < 0.05]. CONCLUSION: Our findings suggest that exercise programs are effective in increasing and/or maintaining physical performance in older adults with and without frailty, whose effect is more evident in older adults with frailty, probably due to the greater margin of recovery of intrinsic capacity. This systematic review shows the differentiated effect of exercise training on physical performance in older adults with and without frailty. Scientific evidence reinforces the importance of implementing physical exercise programs in all older adults, including those who are frail. However, it is necessary to specify the types and doses (duration, frequency and intensity), for individualized groups, previously grouped according to the SPPB score.

Advanced Activities of Daily Living in Community-Dwelling Older Adults: A Cross-Sectional Study of the Mexican Health and Aging Study (MHAS 2018).

BACKGROUND: The advanced activities of daily living (AADLs) in old age is a key indicator of the mobility domain for the intrinsic capacity of older adults living in the community; for this reason, it is relevant to know the prevalence and risk factors related to performing fewer AADLs in different populations. AIM: To determine the prevalence and factors associated with the ability to perform AADLs in older adults reported in the Mexican Study of Health and Aging (MSHA 2018). METHODS: A secondary cross-sectional analysis of the MSHA 2018 data was carried out, including a convenience sample of 6474 subjects ≥ 60 years of age, for both sexes, without cognitive deficits. Nine questions related to AADLs were selected from the database. Multiple logistic regression analysis was performed to determine factors associated with <3 AADLs, including sociodemographic, lifestyle, and health status factors. RESULTS: The prevalence of the ability to perform <3 AADLs was 63%. Age is the most important risk factor for <3 AADLs, which increases by the decade, followed by sedentary lifestyle (OR = 2.15, 95% CI: 1.91-2.42, p < 0.0001). CONCLUSIONS: Our findings suggest that age, schooling, urban residence, sedentary lifestyle, and comorbidity are the main risk factors for <3 AADLs in older Mexican adults.

Detection of Insomnia and Its Relationship with Cognitive Impairment, Depression, and Quality of Life in Older Community-Dwelling Mexicans.

Sleep disturbances are one of the most frequent health problems in old age, among which insomnia stands out. It is characterized by difficulty falling asleep, staying asleep, frequent awakenings, or waking up too early and not having restful sleep, which may be a risk factor for cognitive impairment and depression, affecting functionality and quality of life. Insomnia is a very complex multifactorial problem that requires a multi- and interdisciplinary approach. However, it is frequently not diagnosed in older community-dwelling people, increasing the risk of psychological, cognitive, and quality of life alterations. The aim was to detect insomnia and its relationship with cognitive impairment, depression, and quality of life in older community-dwelling Mexicans. An analytical cross-sectional study was carried out in 107 older adults from Mexico City. The following screening instruments were applied: Athens Insomnia Scale, Mini-Mental State Examination, Geriatric Depression Scale, WHO Quality of Life Questionnaire WHOQoL-Bref, Pittsburgh Sleep Quality Inventory. The frequency of insomnia detected was 57% and its relationship with cognitive impairment, depression, and low quality of life was 31% (OR = 2.5, 95% CI, 1.1-6.6. p < 0.05), 41% (OR = 7.3, 95% CI, 2.3-22.9, p < 0.001), and 59% (OR = 2.5, 95% CI, 1.1-5.4, p < 0.05), respectively. Our findings suggest that insomnia is a frequent clinical disorder that is not diagnosed and a significant risk factor for cognitive decline, depression, and poor quality of life.

Relationship between Self-Perception of Aging and Quality of Life in the Different Stages of Reproductive Aging in Mexican Women.

Biological aging has an abrupt beginning in women, changing their body and perceptions, which are not accepted easily because the actual stereotypes are focused on youth and anti-aging. Our interest was to explore what the self-perception of aging (SPA) is in middle-aged women throughout the reproductive aging stages and their association with the quality of life. A cross-sectional study was conducted with 240 women (40−69 years) living in Mexico City, who were separated according to their reproductive aging stage. An electronic version of the Spanish version of the Self-rated Attitudes Towards Old Age (SATO) and the WHO Quality of Life-Bref (WHOQoL) was applied to these women and was sent by WhatsApp or email. Seventeen women of the total sample (7%) had a negative self-perception of aging. There is an association between SATO and WHOQoL (r = −0.273, p < 0.0001), but in the menopausal transition stage, the association is strong in the psychological subscale, and after menopause, early and late postmenopausal women show a better association in the social subscale. Negative SPA impacts the WHOQoL psychological dimension and not the total WHOQoL score. Our findings suggest an association between SPA and quality of life in different reproductive aging stages.

Effect of a Community Gerontology Program on the Control of Metabolic Syndrome in Mexican Older Adults.

Background: Metabolic syndrome (MS) is highly prevalent in older adults; it constitutes a risk factor for cognitive deterioration, frailty, and Alzheimer's disease. For this reason, the WHO has pointed out the importance of the implementation of community programs for the training of healthy aging. The aim of this study was to evaluate the effect of a community gerontology program framed in active aging on the control of metabolic syndrome in older adults. Methods: An experimental study was carried out in a convenience sample of 80 older adults diagnosed with MS according to the ATPIII criteria, comprising (1) experimental group (EG), n = 40; (2) control group (CG), n = 40. During a 6-month period, the EG participated in a supervised community gerontology program, and the CG was assessed monthly. Results: A statistically significant decrease was observed in the number of components for the diagnosis of MS. In this regard, of the total of participants with a diagnosis of MS in EG, only 28% maintained the diagnosis of MS (ATPIII ≥ 3 criteria), in contrast to 83% of the CG participants (p < 0.0001). Conclusions: Our findings suggest that health self-care training within the framework of active aging is effective for the control of MS in older adults.

Oxidative Stress Risk Is Increased with a Sedentary Lifestyle during Aging in Mexican Women.

Oxidative stress (OS) increases during the human aging process, and the sedentary lifestyle could be a prooxidant factor. In this study, we determine the effect of sedentary lifestyle on OS during the aging process in Mexican women. A longitudinal study of two-year follow-up was carried out with 177 community-dwelling women (40-69 y) from Mexico City. We measured as OS markers plasma malondialdehyde, erythrocyte glutathione peroxidase (GPx) and superoxide dismutase (SOD), total plasma antioxidant status, uric acid level, antioxidant gap, and SOD/GPx ratio. To define OS using all the markers, we defined cut-off values of each parameter based on the 90th percentile of young healthy subjects and, we calculated a stress score (SS) ranging from 0 to 7, which represented the intensity of the marker modifications. All the women answered a structured questionnaire about prooxidant factors, including physical activity specially the type of activity, frequency, and duration, and they answered Spanish versions of self-assessment tests for establishing dysthymia and insomnia as potential confounders. Principal component and Poisson regression analysis were used as statistical tools, being two-year OS the primary outcome. The OS was considerate as SS ≥ 4 and sedentary lifestyle as <30 min/day of physical activity, beside several prooxidant factors and age that were covariables. SS is higher in sedentary lifestyle women after the two-year follow-up; although, the difference was statistically significant only in older women. Four principal components were associated with the OS, and 7 out of 8 prooxidant factors were important for the analysis, which were included in the Poisson model. The predictive factors for OS were the sedentary lifestyle (adjusted PR = 2.37, CI95%: 1.30-4.30, p < 0.01), and age, in which the risk increases 1.06 (CI95%:1.02-2.11, p < 0.01) by each year of age. Our findings suggest that a sedentary lifestyle increases the OS during the aging in Mexican women.

Relación entre la obesidad central y el estrés oxidativo en mujeres premenopáusicas versus posmenopáusicas / Relationship between central obesity and oxidative stress in premenopausal versus postmenopausal women

INTRODUCCIÓN: los cambios endocrinológicos de la menopausia producen un incremento en la adiposidad central y el estrés oxidativo, por lo que podría inferirse que las mujeres posmenopáusicas obesas mostrarían un estrés oxidativo significativamente mayor que las mujeres premenopáusicas. OBJETIVO: evaluar la relación entre la obesidad central y el estrés oxidativo en mujeres premenopáusicas en comparación con posmenopáusicas utilizando diferentes índices. MÉTODOS: estudio transversal con 237 mujeres premenopáusicas y 255 posmenopáusicas (40-60 años). Como marcadores de estrés oxidativo se midieron los niveles de malondialdehído plasmático y ácido úrico sérico, las enzimas antioxidantes superóxido-dismutasa y glutatión-peroxidasa eritrocitarias, y la capacidad plasmática antioxidante total. También se obtuvieron el peso, la estatura y la circunferencia de cintura y cadera, con lo que se calcularon los índices de masa corporal (IMC), cintura-cadera (ICC) y cintura-talla (ICT). RESULTADOS: se observaron más de un 30 % de obesidad y un 50 % de sobrepeso en ambos grupos. Los niveles de malondialdehído y de ácido úrico son más altos en las mujeres con sobrepeso/obesidad en ambos grupos. El ICT tuvo una correlación positiva con el nivel de malondialdehído (r = 0,298, p < 0,0001) y ácido úrico (r = 0,263, p < 0,0001), y una negativa con la actividad de GPx (r = -0,148, p < 0,01). Con un valor de corte de ICT > 0,6, aumentan el malondiahldehído y el ácido úrico, sin importar el estado menopáusico. Los demás índices no mostraron ninguna relación. CONCLUSIÓN: nuestros hallazgos sugieren una asociación entre la obesidad central medida por el ICT y el aumento del estrés oxidativo, independientemente del estado menopáusico

BACKGROUND: endocrine changes in midlife women produce an increase in central obesity and oxidative stress, thus it is possible that obese postmenopausal women exhibit a higher oxidative stress than premenopausal women. OBJECTIVE: to evaluate the relationship between central obesity and oxidative stress in premenopausal compared with postmenopausal women using different indices. METHODS: this is a cross-sectional study that included 237 pre- and 255 post-menopausal women (40-60 years old). As oxidative stress markers we measured plasma malondialdehyde and serum uric acid levels, erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GPx), and total plasma antioxidant status. We also measured height, weight, and waist and hip circumferences, and we calculated body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). RESULTS: we found over 30 % of women within the obesity range, whereas 50 % were placed in the overweight category in both groups. Plasma malondialdehyde and serum uric acid levels were higher in women with overweight or obesity than in women with normal weight regardless of menopausal status. We found a positive correlation between WHtR and malondialdehyde level (r = 0.298, p < 0.0001) and serum uric acid level (r = 0.263, p < 0.0001), and a negative correlation with erythrocyte GPx activity (r = -0.148, p < 0.01). If we use a WHtR > 0.6, malondialdehyde and uric acid levels increase regardless of menopausal status. The other indices measured did not show any relationship. CONCLUSION: our findings suggest that there is an association between central obesity, as measured with WHtR, and increased oxidative stress regardless of menopausal status

[Relationship between central obesity and oxidative stress in premenopausal versus postmenopausal women]. / Relación entre la obesidad central y el estrés oxidativo en mujeres premenopáusicas versus posmenopáusicas.

INTRODUCTION: Background: endocrine changes in midlife women produce an increase in central obesity and oxidative stress, thus it is possible that obese postmenopausal women exhibit a higher oxidative stress than premenopausal women. Objective: to evaluate the relationship between central obesity and oxidative stress in premenopausal compared with postmenopausal women using different indices. Methods: this is a cross-sectional study that included 237 pre- and 255 post-menopausal women (40-60 years old). As oxidative stress markers we measured plasma malondialdehyde and serum uric acid levels, erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GPx), and total plasma antioxidant status. We also measured height, weight, and waist and hip circumferences, and we calculated body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR). Results: we found over 30% of women within the obesity range, whereas 50% were placed in the overweight category in both groups. Plasma malondialdehyde and serum uric acid levels were higher in women with overweight or obesity than in women with normal weight regardless of menopausal status. We found a positive correlation between WHtR and malondialdehyde level (r = 0.298, p < 0.0001) and serum uric acid level (r = 0.263, p < 0.0001), and a negative correlation with erythrocyte GPx activity (r = -0.148, p < 0.01). If we use a WHtR > 0.6, malondialdehyde and uric acid levels increase regardless of menopausal status. The other indices measured did not show any relationship. Conclusion: our findings suggest that there is an association between central obesity, as measured with WHtR, and increased oxidative stress regardless of menopausal status.

INTRODUCCIÓN: Introducción: los cambios endocrinológicos de la menopausia producen un incremento en la adiposidad central y el estrés oxidativo, por lo que podría inferirse que las mujeres posmenopáusicas obesas mostrarían un estrés oxidativo significativamente mayor que las mujeres premenopáusicas. Objetivo: evaluar la relación entre la obesidad central y el estrés oxidativo en mujeres premenopáusicas en comparación con posmenopáusicas utilizando diferentes índices. Métodos: estudio transversal con 237 mujeres premenopáusicas y 255 posmenopáusicas (40-60 años). Como marcadores de estrés oxidativo se midieron los niveles de malondialdehído plasmático y ácido úrico sérico, las enzimas antioxidantes superóxido-dismutasa y glutatión-peroxidasa eritrocitarias, y la capacidad plasmática antioxidante total. También se obtuvieron el peso, la estatura y la circunferencia de cintura y cadera, con lo que se calcularon los índices de masa corporal (IMC), cintura-cadera (ICC) y cintura-talla (ICT). Resultados: se observaron más de un 30% de obesidad y un 50% de sobrepeso en ambos grupos. Los niveles de malondialdehído y de ácido úrico son más altos en las mujeres con sobrepeso/obesidad en ambos grupos. El ICT tuvo una correlación positiva con el nivel de malondialdehído (r = 0,298, p < 0,0001) y ácido úrico (r = 0,263, p < 0,0001), y una negativa con la actividad de GPx (r = -0,148, p < 0,01). Con un valor de corte de ICT > 0,6, aumentan el malondiahldehído y el ácido úrico, sin importar el estado menopáusico. Los demás índices no mostraron ninguna relación. Conclusión: nuestros hallazgos sugieren una asociación entre la obesidad central medida por el ICT y el aumento del estrés oxidativo, independientemente del estado menopáusico. Palabras clave.

Relación entre el estrés oxidativo y la pérdida de masa muscular en la posmenopausia temprana: estudio exploratorio / Relationship between oxidative stress and muscle mass loss in early postmenopause: an exploratory study

Antecedentes: Los cambios endocrinológicos debidos a la menopausia se han asociado al estrés oxidativo y la pérdida de masa muscular. El objetivo fue determinar la relación entre ambas variables en la posmenopausia temprana. Material y métodos: Estudio transversal exploratorio con 107 mujeres pre- y posmenopáusicas (40-57 años). Como marcadores de estrés oxidativo se midieron los niveles de lipoperóxidos plasmáticos y ácido úrico sérico, las enzimas antioxidantes superóxido dismutasa y glutatión peroxidasa, y la capacidad plasmática antioxidante total. También se midió la masa muscular por impedancia bioeléctrica y la fuerza por dinamometría, y se calculó masa músculo-esquelética, índice de masa esquelética, masa libre de grasa e índice de masa corporal. Resultados: Más del 90% de las participantes fueron diagnosticadas de sobrepeso u obesidad. En las mujeres posmenopáusicas los marcadores de masa y fuerza muscular eran más bajos, con correlación negativa entre el nivel de lipoperóxidos y el índice de masa esquelética (r= -0,326, p< 0,05), y positiva entre el ácido úrico (r=0,295, p< 0,05) y el mismo índice. En un modelo multivariante que incluye los marcadores de estrés oxidativo, edad y circunferencia de cintura, se encontró que el nivel de lipoperóxidos es el que más contribuye a explicar la disminución de la masa esquelética en la posmenopausia; por cada aumento de 0,1μmol/l de lipoperóxidos hay un decremento del índice de masa esquelética de 3,03 unidades. Conclusión: Nuestros hallazgos sugieren una asociación entre el aumento del estrés oxidativo y la pérdida de masa muscular en la posmenopausia temprana

Background: Endocrine changes due to menopause have been associated to oxidative stress and muscle mass loss. The study objective was to determine the relationship between both variables in early postmenopause. Material and methods: An exploratory, cross-sectional study was conducted in 107 pre- and postmenopausal women (aged 40-57 years). Levels of serum lipid peroxides and uric acid and enzymes superoxide dismutase and glutathione peroxidase, as well as total plasma antioxidant capacity were measured as oxidative stress markers. Muscle mass using bioelectrical impedance and muscle strength using dynamometry were also measured. Muscle mass, skeletal muscle index, fat-free mass, and body mass index were calculated. Results: More than 90% of participants were diagnosed with overweight or obesity. Postmenopausal women had lower values of muscle mass and strength markers, with a negative correlation between lipid peroxide level and skeletal muscle index (r= -0.326, p<.05), and a positive correlation between uric acid and skeletal muscle index (r=0.295, p<.05). A multivariate model including oxidative stress markers, age, and waist circumference showed lipid peroxide level to be the main contributor to explain the decrease in skeletal muscle mass in postmenopause, since for every 0.1μmol/l increase in lipid peroxide level, skeletal muscle index decreases by 3.03 units. Conclusion: Our findings suggest an association between increased oxidative stress and muscle mass loss in early postmenopause

Relationship between oxidative stress and muscle mass loss in early postmenopause: an exploratory study. / Relación entre el estrés oxidativo y la pérdida de masa muscular en la posmenopausia temprana: estudio exploratorio.

BACKGROUND: Endocrine changes due to menopause have been associated to oxidative stress and muscle mass loss. The study objective was to determine the relationship between both variables in early postmenopause. MATERIAL AND METHODS: An exploratory, cross-sectional study was conducted in 107 pre- and postmenopausal women (aged 40-57 years). Levels of serum lipid peroxides and uric acid and enzymes superoxide dismutase and glutathione peroxidase, as well as total plasma antioxidant capacity were measured as oxidative stress markers. Muscle mass using bioelectrical impedance and muscle strength using dynamometry were also measured. Muscle mass, skeletal muscle index, fat-free mass, and body mass index were calculated. RESULTS: More than 90% of participants were diagnosed with overweight or obesity. Postmenopausal women had lower values of muscle mass and strength markers, with a negative correlation between lipid peroxide level and skeletal muscle index (r= -0.326, p<.05), and a positive correlation between uric acid and skeletal muscle index (r=0.295, p<.05). A multivariate model including oxidative stress markers, age, and waist circumference showed lipid peroxide level to be the main contributor to explain the decrease in skeletal muscle mass in postmenopause, since for every 0.1µmol/l increase in lipid peroxide level, skeletal muscle index decreases by 3.03 units. CONCLUSION: Our findings suggest an association between increased oxidative stress and muscle mass loss in early postmenopause.

Control glucémico relacionado con la autoestima y depresión de adultos mayores con diabetes mellitus en la Ciudad de México / Glycemic control related to self-esteem and depression in older adults with diabetes mellitus in Mexico City

Resumen

Introducción: el envejecimiento por sí mismo constituye un factor de riesgo para la presencia de diabetes mellitus, ya que por sus complicaciones, alta mortalidad y cronicidad se afecta gradual y progresivamente el bienestar psicológico de quien la padece.

Objetivo: determinar la relación entre la autoestima baja y la depresión con el control glucémico de los adultos mayores de la Ciudad de México.

Metodología: estudio transversal analítico en 182 adultos mayores con diabetes mellitus. Se evaluaron parámetros antropométricos y bioquímicos, se aplicó la Escala de Autoestima de Rosemberg y la Escala de Depresión Geriátrica (GDS-Yesavage). El análisis fue con medidas de tendencia central, dispersión, chi cuadrada y t de Student; para calcular el riesgo se utilizó razón de momios con un intervalo de confianza al 95% (IC95%).

Resultados: se identificó autoestima alta en 36 y 19% (p < 0.01) y depresión en 34 y 56% (p = 0.004) de los adultos mayores con y sin control glucémico, respectivamente. Se encontró una asociación con la autoestima media y baja (razón de momios (RM) = 2.39, IC95% de 1.0-5.3 p = 0.01) y presencia de depresión (RM= 2.50, IC95% 1.34-4.67, p = 0.004).

Conclusión: los resultados sugieren una relación positiva de autoestima baja y depresión con el control glucémico de los adultos mayores diabéticos.

Abstract

Introduction: Aging by itself is a risk factor for the presence of diabetes mellitus, since the psychological well-being of the sufferer is gradually and progressively affected due to its complications, high mortality and chronicity.

Objective: To determine the relationship between low self-esteem and depression with glycemic control of older adults in Mexico City.

Methods: Analytical cross-sectional study in 182 older adults with diabetes mellitus. Anthropometric and biochemical parameters were evaluated; the Rosemberg Self-esteem Scale and the Geriatric Depression Scale (GDS-Yesavage) were applied. For the analysis we used measures of central tendency, dispersion, chi-squared and Student's t; to calculate risk, it was used odds ratio [OR] with 95% confidence interval (95%CI).

Results: High self-esteem was identified in 36 and 19% (p < 0.01) and depression in 34 and 56% (p = 0.004) of older adults with and without glycemic control, respectively. It was found an association between average self-esteem and low self-esteem (OR = 2.39, 95%G 1.0-5.3, p = 0.01) and presence of depression (OR = 2.50,95%CI 1.34-4.67, p = 0.004).

Conclusion: These results suggest a positive relationship of low self-esteem and depression with the glycemic control of diabetic older adults.

Relationship between Social Support Networks and Physical Functioning in Older Community-Dwelling Mexicans.

Some studies have demonstrated the relationship between social support networks (SSNs) and health status. In this sense, it has been considered that physical and mental functioning is a key indicator of the health in the age people. The aim of this study was to determine the association between social support networks and physical functioning. A cross-sectional study was carried out including a convenience sample of 150 older community-dwelling Mexicans. We assessed the familial, extra-familial and institutional SSNs; social contacts; the activities of daily living (ADL); the instrumental activities of daily living (IADLs); and physical functioning task (PFT) performance among study participants. Of the 150 older subjects, 53 reported living alone (35%), 113 (75%) reported having few SSNs, and 37 (25%) reported having enough SSNs. Persons with few familial SSNs were at increased odds of demonstrating dependence in at least one of the ADL (OR = 3.25, 95% CI 1.06-9.92, p < 0.05). Likewise, persons with few institutional SSNs and few social contacts were at increased odds of demonstrating dependence in at least one of the IADL (OR = 6.96, 95% CI 1.57-30.7, p < 0.01; OR = 5.02, 95% CI 1.44-17.5, p < 0.01, respectively). We also observed that having few extra-familial SSNs and few social contacts were the main risk factors for PFT dependence, with ORs of 3.70 (95% CI 1.21-11.2, p < 0.05) and 3.85 (95% CI 1.10-13.5, p < 0.05), respectively. Our findings suggest that having few SSNs could be a significant risk factor for reduced physical functioning in older adults.

Relationship between social support networks and diabetes control and its impact on the quality of life in older community-dwelling Mexicans.

OBJECTIVE: To determine the relationship between social support networks and diabetes control and its impact on quality of life in older community-dwelling Mexicans. METHODS: A cross-sectional study was carried out on a convenience sample of 182 older diabetic people who were active participants in community self-care and mutual help groups in Mexico City for more than one year. All were independents and had medical diagnostics determining that they had diabetes without complications for one year or more. We measured biochemical and anthropometric parameters, social support networks for older people (SSN-Older) and perceived quality of life. Patients with uncontrolled diabetes mellitus had HbA1c (%) ≥ 8. RESULTS: It was found that 65% (118/182) of the elderly diabetics in the study were controlled. We observed a significantly higher average score in the SSN-Older scale on the extra-familial support subscale in the controlled diabetic group compared with the uncontrolled group (57 ± 25 vs. 49 ± 30, p < 0.05). Additionally, the average satisfaction score, as observed from SSN-Older scale data, was significantly higher in the controlled diabetics group compared with the uncontrolled group (51 ± 21 vs.42 ± 22, p = 0.01). Likewise, in the quality of life analysis, we observed that 81% of the controlled diabetics perceived a high quality of life compared with 19% of the uncontrolled group (p < 0.001). CONCLUSIONS: Our findings suggest that social support networks, especially community self-help groups, represent a determining social capital for control of diabetes mellitus in older people in the community.

Relationship between social support networks and diabetes control and its impact on the quality of life in older community-dwelling Mexicans / Relación entre las redes de apoyo social con el control de la diabetes y su impacto sobre la calidad de vida en ancianos mejicanos que viven en la comunidad

Objective: To determine the relationship between social support networks and diabetes control and its impact on quality of life in older community-dwelling Mexicans. Methods: A cross-sectional study was carried out on a convenience sample of 182 older diabetic people who were active participants in community self-care and mutual help groups in Mexico City for more than one year. All were independents and had medical diagnostics determining that they had diabetes without complications for one year or more. We measured biochemical and anthropometric parameters, social support networks for older people (SSN-Older) and perceived quality of life. Patients with uncontrolled diabetes mellitus had HbA1c (%) ≥ 8. Results: It was found that 65% (118/182) of the elderly diabetics in the study were controlled. We observed a significantly higher average score in the SSN-Older scale on the extra-familial support subscale in the controlled diabetic group compared with the uncontrolled group (57 ± 25 vs. 49 ± 30, p < 0.05). Additionally, the average satisfaction score, as observed from SSN-Older scale data, was significantly higher in the controlled diabetics group compared with the uncontrolled group (51 ± 21 vs. 42 ± 22, p = 0.01). Likewise, in the quality of life analysis, we observed that 81% of the controlled diabetics perceived a high quality of life compared with 19% of the uncontrolled group (p < 0.001). Conclusions: Our findings suggest that social support networks, especially community self-help groups, represent a determining social capital for control of diabetes mellitus in older people in the community (AU)

Objetivo: determinar la relación entre las redes de apoyo social y control de la diabetes, y su impacto en la calidad de vida en adultos mayores mexicanos. Métodos: se llevó a cabo un estudio transversal en una muestra de 182 adultos mayores diabéticos que estaban participando en grupos comunitarios de autocuidado y ayuda mutua en la Ciudad de México durante más de un año. Todos eran independientes y tenían diagnóstico médico de diabetes mellitus sin complicaciones durante un año o más. Medimos parámetros bioquímicos, incluyendo hemoglobina glucosilada (HbA1c), y antropométricos, las redes de apoyo social para adultos mayores (RAS-mayores) y calidad de vida percibida. Se consideró como diabetes mellitus descontrolada cuando los pacientes tenían HbA1c (%) ≥ 8. Resultados: se encontró que el 65% (118/182) de los diabéticos participantes estaban controlados. Se observó una puntuación media significativamente mayor en la escala RAS-mayores en la subescala de apoyo social extra-familiar en el grupo de diabéticos controlados en comparación con el grupo de descontrolados (57 ± 25 vs. 49 ± 30, p < 0,05). Asimismo, la puntuación media de satisfacción de las redes de apoyo social fue significativamente mayor en el grupo de diabéticos controlados (51 ± 21 frente a 42 ± 22, p = 0,01). Del mismo modo, en el análisis de la calidad de vida, se observó que el 81% de los diabéticos controlados percibe una calidad de vida alta en comparación con el 19% del grupo de diabéticos descontrolados (p < 0,001). Conclusiones: nuestros resultados sugieren que las redes de apoyo social extra-familiar, en particular los grupos de autoayuda de la comunidad, representan un capital social relevante por el control de la diabetes mellitus de las personas mayores de la comunidad (AU)

[Postmenopausal symptoms severity enhancement oxidative stress in women with metabolic syndrome]. / La severidad de los síntomas posmenopáusicos incrementa el estrés oxidativo en mujeres con síndrome metabólico.

BACKGROUND: Oxidative stress is a serious imbalance between the reactive oxygen species (ROS) produced and the antioxidant systems, and has been identified to cause metabolic syndrome. Postmenopausal women (POS) with severe symptoms have higher oxidative stress; therefore it is possible to observe higher oxidative stress in postmenopausal women with metabolic syndrome and severe menopause related symptoms. OBJECTIVE: To determinate if the severe postmenopausal symptoms increased oxidative stress in women with metabolic syndrome. METHODS: We carry out a cross-sectional study with POS, 48 with metabolic syndrome and 52 healthy. Control group was defined as women heealthy and without severe symptoms (H-SS). Metabolic syndrome was defined according to criteria established by NCEP-ATPIII. We measured lipoperoxides by the TBARS assay as oxidative stress marker. All women answered the Menopause Rating Scale (MRS) that evaluates the severity of global symptoms in three dimensions: psychological, somatic and urogenital; and the Athens Insomnia Scale (AIS). In each questionnaire was used a cutoff value to determine the severity of symptoms and alternative cut-off value for lipoperoxides > or =0.320 mol/L. RESULTS: The prevalence of high plasma lipoperoxides levels was higher in women with metabolic syndrome (WMS), 39 [81%] vs. 33 [64%], p < 0.05. The WMS, independent of severe symptoms (SS), had high lipoperoxides levels, similar to H+SS, except in urogenital MRS dimen- sion and AIS. The risk of higher lipoperoxides increased with MS and severe symptoms RM=6.32, 95% CI: 1.32-30.20, p < 0.05, adjusted by others pro-oxidants factors. CONCLUSION: Our findings suggest that the severity of menopausal related symptoms increased oxidative stress in women with metabolic syndrome.

Menopause as risk factor for oxidative stress.

OBJECTIVE: The aim of this study was to determine the influence of menopause (hypoestrogenism) as a risk factor for oxidative stress. METHODS: We carried out a cross-sectional study with 187 perimenopausal women from Mexico City, including 94 premenopausal (mean ± SD age, 44.9 ± 4.0 y; estrogen, 95.8 ± 65.7 pg/mL; follicle-stimulating hormone, 13.6 ± 16.9 mIU/mL) and 93 postmenopausal (mean ± SD age, 52.5 ± 3.3 y; estrogen, 12.8 ± 6.8 pg/mL; follicle-stimulating hormone, 51.4 ± 26.9 mIU/mL) women. We measured lipoperoxides using a thiobarbituric acid-reacting substance assay, erythrocyte superoxide dismutase and glutathione peroxidase activities, and the total antioxidant status with the Randox kit. An alternative cutoff value for lipoperoxide level of 0.320 µmol/L or higher was defined on the basis of the 90th percentile of young healthy participants. All women answered the Menopause Rating Scale, the Athens Insomnia Scale, and a structured questionnaire about pro-oxidant factors, that is, smoking, consumption of caffeinated and alcoholic beverages, and physical activity. Finally, we measured weight and height and calculated body mass index. RESULTS: The lipoperoxide levels were significantly higher in the postmenopausal group than in the premenopausal group (0.357 ± 0.05 vs 0.331 ± 0.05 µmol/L, P = 0.001). Using logistic regression to control pro-oxidant variables, we found that menopause was the main risk factor for oxidative stress (odds ratio, 2.62; 95% CI, 1.35-5.11; P < 0.01). We also found a positive correlation between menopause rating score, insomnia score, and lipoperoxides, and this relationship was most evident in the postmenopausal group (menopause scale, r = 0.327 [P = 0.001]; insomnia scale, r = 0.209 [P < 0.05]). CONCLUSIONS: Our findings suggest that the depletion of estrogen in postmenopause could cause oxidative stress in addition to the known symptoms.

Relationship between metabolic syndrome components and oxidative stress in elderly community-dwelling Mexicans.

AIM: To determine the relationship between metabolic syndrome (MetS) components and oxidative stress (OxS) in elderly community-dwelling Mexicans. METHODS: We carried out a comparative cross-sectional study on 113 elderly subjects (> or =60 years old); 50 of them did not have MetS and 63 did have MetS (based on Adult Treatment Panel III criteria). We measured total antioxidant status (TAS), plasma lipid peroxidation (LPO), antioxidant activity of superoxide dismutase (SOD) and glutathione peroxidase (GPx), and calculated the SOD/GPx ratio. High blood pressure (HBP) was defined as systolic blood pressure (SBP) > or =140 mm Hg and/or diastolic blood pressure (DBP) > or =90 mm Hg. RESULTS: We found a statistically significant increase in the percentage of cases of severe OxS in elderly subjects with MetS in comparison to healthy elderly (17 vs. 8%, OR: 7.33, 95% CI: 1.38-42.39; p < 0.01). It was observed that subjects with 5 MetS components had a 10-fold higher risk of developing OxS than subjects with 1 component (OR: 11.00, 95% CI: 1.72-115.17; p < 0.01). A positive correlation between SBP and LPO (r = 0.202, p < 0.05), and a negative correlation of SBP and DBP with TAS activity (r = -0.232, p < 0.05; r = -0.211, p < 0.05) were also observed. CONCLUSION: Our findings suggest that MetS is linked to severe OxS, that the number of metabolic syndrome components is a significant risk factor in the development of OxS, and that HBP is the most important metabolic syndrome component linked to OxS in the elderly.

Implementation of an active aging model in Mexico for prevention and control of chronic diseases in the elderly.

BACKGROUND: World Health Organization cites among the main challenges of populational aging the dual disease burden: the greater risk of disability, and the need for care. In this sense, the most frequent chronic diseases during old age worldwide are high blood pressure, type 2 diabetes mellitus, cancer, arthritis, osteoporosis, depression, and dementia. Chronic disease-associated dependency represents an onerous sanitary and financial burden for the older adult, the family, and the health care system. Thus, it is necessary to propose community-level models for chronic disease prevention and control in old age. The aim of the present work is to show our experience in the development and implementation of a model for chronic disease prevention and control in old age at the community level under the active aging paradigm. METHODS/DESIGN: A longitudinal study will be carried out in a sample of 400 elderly urban and rural-dwelling individuals residing in Hidalgo State, Mexico during five years. All participants will be enrolled in the model active aging. This establishes the formation of 40 gerontological promoters (GPs) from among the older adults themselves. The GPs function as mutual-help group coordinators (gerontological nuclei) and establish self-care and self-promotion actions for elderly well-being and social development. It will be conformed a big-net of social network of 40 mutual-help groups of ten elderly adults each one, in which self-care is a daily practice for chronic disease prevention and control, as well as for achieving maximal well-being and life quality in old age. Indicators of the model's impact will be (i) therapeutic adherence; (ii) the incidence of the main chronic diseases in old age; (iii) life expectancy without chronic diseases at 60 years of age; (iv) disability adjusted life years lost; (v) years of life lost due to premature mortality, and (vi) years lived with disability. DISCUSSION: We propose that the implementation of the model active aging framework will permits the empowerment of older adults, which constitutes basic social capital for chronic disease prevention and control in old age.

Undernutrition and oxidative stress as risk factors for high blood pressure in older Mexican adults.

OBJECTIVE: To determine the relationship between undernutrition and oxidative stress as risk factors for high blood pressure (HBP) in older Mexican adults. We carried out a case-control study in a convenience sample of 62 older adults, 60-80 years of age; 32 without HBP (mean age 75.8 +/- 5.1 years) and 30 with HBP (mean age 65.2 +/- 6.8 years). METHODS: We measured serum lipoperoxide (LPO) levels, antioxidant enzymes, total antioxidant activity and lipid profile; in addition, we evaluated the nutritional status with anthropometric measurements, the Mini Nutritional Assessment and food intake frequency. Data were analyzed with Student t and odds ratio (OR) statistical tests. RESULTS: We observed significantly higher LPO levels in subjects with HBP than in normotensive subjects (0.303 +/- 0.10 vs. 0.256 +/- 0.06 micromol/l; p < 0.05). With respect to risk factors for HBP, we found an OR of 12.2 (95% CI 1.9-76.4, p < 0.01) in subjects with high LPO levels (> or = 0.320 micromol/l) and an OR of 5.0 (95% CI 1.1-23.0, p < 0.05) in those with undernutrition. CONCLUSION: Our findings suggest that high LPO levels and undernutrition are significant risk factors for HBP.

Oxidative stress as a risk factor for osteoporosis in elderly Mexicans as characterized by antioxidant enzymes.

BACKGROUND: Oxidative stress (OxS) has recently been linked with osteoporosis; however, we do not know the influence of OxS as an independent risk factor for this disease. METHODS: We conducted a case-control study in 94 subjects > or =60 years of age, 50 healthy and 44 with osteoporosis. We measured total antioxidant status, plasma lipid peroxides, antioxidant activity of superoxide dismutase and glutathione peroxidase (GPx), and calculated the SOD/GPx ratio. Bone mineral density was obtained at the peripheral DXA in calcaneus using a portable Norland Apollo Densitometer. Osteoporosis was considered when subjects had a BMD of 2.5 standard deviations or more below the mean value for young adults. RESULTS: GPx antioxidant activity was significantly lower in the group of subjects with osteoporosis in comparison with the group of healthy subjects (p < 0.01); in addition, the SOD/GPx ratio was significantly higher in the group of individuals with osteoporosis (p < 0.05). In logistic regression analysis, we found OxS to be an independent risk factor for osteoporosis (odds ratio [OR] = 2.79; 95% confidence interval [95% CI] = 1.08-7.23; p = 0.034). CONCLUSION: Our findings suggest that OxS is an independent risk factor for osteoporosis linked to increase of SOD/GPx ratio.