Health Risk, Functional Markers and Cognitive Status in Institutionalized Older Adults: A Longitudinal Study.

A Follow-up of vitamin B12 and lipids status is essential in older people, being closely related to non-communicable diseases. Their relationships with cognitive and physical status are not clear. The aim was to analyze the evolution of vitamin B12 and related parameters, lipid and hematological profiles, and their relationships with cognitive and physical status among institutionalized elderly. Sixty residents, ranged from 62 to 99, were evaluated. Biomarkers (vitamin B12 and related parameters, lipid and hematological profiles), functional capacity (handgrip, arm and leg strength), and cognitive status (Mini-Mental State Examination) were evaluated four times at 4-month intervals. At the beginning of the study, 63% and 70% of the sample showed abnormal homocysteine and folate values, respectively. At the end of the year, abnormal homocysteine increased to 68%, abnormal folate values decreased to 50%. Throughout the year, serum folate showed a significant increase (14.9 vs. 16.3 nmol/L), (p < 0.05). Serum cobalamin (299 vs. 273 pmol/L). HDL-cholesterol (49.9 vs. 47.0 mg/dL) and triglyceride levels (102.4 vs. 123.2 mg/dL) showed a significant decrease and increase respectively in mean values (all p < 0.05). Serum cobalamin and HDL-cholesterol were the most important biomarkers associated with cognitive function (both p < 0.05). The most relevant biomarkers associated with poor physical strength depending on the body part analyzed were low concentrations of HDL-cholesterol, LDL-cholesterol, apolipoprotein A1, and albumin (all p < 0.05). The evolution of lipid biomarkers, their significance with cognitive values, and association with handgrip, point to the importance of the handgrip measurement, a very simple test, as an important health marker. Both serum albumin and physical strength are important health markers in older people.

Sedentarism, active lifestyle and sport: Impact on health and obesity prevention.

The benefits of regular physical activity have been known since ancient Greek. But in the last Century the scientific knowledge around this topic has progressed enormously, starting with the early studies of JN Morris and RS Paffenberger, who demonstrated that physical activity at work reduced incidence of cardiovascular disease and mortality. In the Harvard alumni study, the lowest risk was associated with a weekly output of 1000 to 2000 kcal performing vigorous activities. Further studies in all age groups have supported these findings and have added that even moderate levels of physical activity provide considerable benefits to health, including lower prevalence of overweight and obesity at all ages. Metabolic fat oxidation rate is highest at exercise intensities between 45 and 65% of VO2max. This means that people must be active regularly and force physiological mechanisms at certain intensities. All this body of evidence has contributed to current WHO physical activity recommendations of 150 min/week of moderate to vigorous physical activity (MVPA) in adults and elderly, and 60 min/day of MVPA in children and adolescents, with additional strength training, apart from adopting an active lifestyle. In the last 50 years, occupational physical activity has been reduced for about 120 kcal/day, and sedentarism has emerged as an additional risk factor to physical inactivity. Even if less than 60 min of TV time in adults have been related to lower average BMI, there is still a need for research to determine the appropriate dose of exercise in combination with sedentary behaviours and other activities in the context of our modern lifestyle in order to prevent obesity at all ages. As public health measures have failed to stop the obesity epidemic in the last 3 decades, there is clearly a need to change the paradigm. The inclusion of sport scientists, physical education teachers and other professionals in the multidisciplinary team which should be responsible for drawing the road map to prevent the increase of the obesity epidemic effectively is a "must" from our point of view.

Los beneficios de la práctica regular de actividad física se conocen desde la antigua Grecia. En el siglo XX, el avance del conocimiento científico fue enorme, empezando con los estudios de JN Morris y RS Paffenberger, que demostraron que la actividad física en el trabajo reducía la incidencia de morbilidad y mortalidad por enfermedad cardiovascular. En el estudio de los ex alumnos de Harvard, el menor riesgo se asoció a gastos semanales de 1000 a 2000 kcal realizando actividades vigorosas. Estudios posteriores en todos los grupos de edad han verificado estos resultados. Además, se ha observado que incluso actividades a intensidades moderadas aportan beneficios importantes para la salud, incluyendo una menor prevalencia de sobrepeso y obesidad a todas las edades. La tasa metabólica de oxidación de las grasas es máxima a intensidades entre el 45 y el 65% del VO2max, que se alcanzan únicamente con entrenamientos mantenidos en el tiempo, con en fin de forzar los mecanismos fisiológicos a determinadas intensidades. Toda esta evidencia científica llevó a la OMS a formular sus recomendaciones de 150 min/semana de actividad física de moderada a vigorosa (MVPA) en adultos y mayores, y de 60 min/día de MVPA en niños y adolescentes, además de entrenamiento de la fuerza y en el contexto de un estilo de vida activo. En los últimos 50 años, la actividad física laboral se ha reducido en unas 120 kcal/día, y el sedentarismo surge como un factor de riesgo adicional a la inactividad física. Aunque se han relacionado tiempos de menos 60 min de TV en adultos con menor tasa de IMC, aun es necesario profundizar en la dosis apropiada de ejercicio físico en combinación con comportamientos sedentarios en el contexto de nuestro estilo de vida moderno para prevenir la obesidad a todas las edades. Consideramos necesario un cambio de paradigma, ya que las medidas de Salud Pública no han conseguido frenar el progreso de la epidemia de la obesidad en las últimas 3 décadas. La inclusión de los científicos y profesionales del deporte, de los profesores de educación física en el equipo multidisciplinar que debería ser el responsable de trazar las líneas maestras para prevenir y frenar la epidemia de la obesidad de forma efectiva es algo imprescindible desde nuestro punto de vista.

Sedentarism, active lifestyle and sport: impact on health and obesity prevention / Sedentarismo, vida activa y deporte: impacto sobre la salud y prevención de la obesidad

The benefits of regular physical activity have been known since ancient Greek. But in the last Century the scientific knowledge around this topic has progressed enormously, starting with the early studies of JN Morris and RS Paffenberger, who demonstrated that physical activity at work reduced incidence of cardiovascular disease and mortality. In the Harvard alumni study, the lowest risk was associated with a weekly output of 1000 to 2000 kcal performing vigorous activities. Further studies in all age groups have supported these findings and have added that even moderate levels of physical activity provide considerable benefits to health, including lower prevalence of overweight and obesity at all ages. Metabolic fat oxidation rate is highest at exercise intensities between 45 and 65% of VO2max. This means that people must be active regularly and force physiological mechanisms at certain intensities. All this body of evidence has contributed to current WHO physical activity recommendations of 150 min/week of moderate to vigorous physical activity (MVPA) in adults and elderly, and 60 min/day of MVPA in children and adolescents, with additional strength training, apart from adopting an active lifestyle. 
In the last 50 years, occupational physical activity has been reduced for about 120 kcal/day, and sedentarism has emerged as an additional risk factor to physical inactivity. Even if less than 60 min of TV time in adults have been related to lower average BMI, there is still a need for research to determine the appropriate dose of exercise in combination with sedentary behaviours and other activities in the context of our modern lifestyle in order to prevent obesity at all ages. As public health measures have failed to stop the obesity epidemic in the last 3 decades, there is clearly a need to change the paradigm. The inclusion of sport scientists, physical education teachers and other professionals in the multidisciplinary team which should be responsible for drawing the road map to prevent the increase of the obesity epidemic effectively is a "must" from our point of view (AU)

Los beneficios de la práctica regular de actividad física se conocen desde la antigua Grecia. En el siglo XX, el avance del conocimiento científico fue enorme, empezando con los estudios de JN Morris y RS Paffenberger, que demostraron que la actividad física en el trabajo reducía la incidencia de morbilidad y mortalidad por enfermedad cardiovascular. En el estudio de los ex alumnos de Harvard, el menor riesgo se asoció a gastos semanales de 1000 a 2000 kcal realizando actividades vigorosas. Estudios posteriores en todos los grupos de edad han verificado estos resultados. Además, se ha observado que incluso actividades a intensidades moderadas aportan beneficios importantes para la salud, incluyendo una menor prevalencia de sobrepeso y obesidad a todas las edades. La tasa metabólica de oxidación de las grasas es máxima a intensidades entre el 45 y el 65% del VO2max, que se alcanzan únicamente con entrenamientos mantenidos en el tiempo, con en fin de forzar los mecanismos fisiológicos a determinadas intensidades. Toda esta evidencia científica llevó a la OMS a formular sus recomendaciones de 150 min/semana de actividad física de moderada a vigorosa (MVPA) en adultos y mayores, y de 60 min/día de MVPA en niños y adolescentes, además de entrenamiento de la fuerza y en el contexto de un estilo de vida activo. 
En los últimos 50 años, la actividad física laboral se ha reducido en unas 120 kcal/día, y el sedentarismo surge como un factor de riesgo adicional a la inactividad física. Aunque se han relacionado tiempos de menos 60 min de TV en adultos con menor tasa de IMC, aun es necesario profundizar en la dosis apropiada de ejercicio físico en combinación con comportamientos sedentarios en el contexto de nuestro estilo de vida moderno para prevenir la obesidad a todas las edades. Consideramos necesario un cambio de paradigma, ya que las medidas de Salud Pública no han conseguido frenar el progreso de la epidemia de la obesidad en las últimas 3 décadas. La inclusión de los científicos y profesionales del deporte, de los profesores de educación física en el equipo multidisciplinar que debería ser el responsable de trazar las líneas maestras para prevenir y frenar la epidemia de la obesidad de forma efectiva es algo imprescindible desde nuestro punto de vista (AU)

Physical strength is associated with Mini-Mental State Examination scores in Spanish institutionalized elderly.

AIM: The present cross-sectional study aimed at assessing muscle strength of hands, the dominant arm and legs in Spanish institutionalized elderly people according to sex, age and cognitive status. METHODS: A total of 153 elderly subjects (102 females, 51 males, mean age 83.6 ± 6.8 years) living in the region of Madrid were measured for handgrip strength (kg) with a Takei TKK 5101 digital dynamometer (range 5-100 kg, precision 0.1 kg), and arm and leg endurance strength (repetitions) according to the Rikli and Jones tests. Cognitive status was determined with the Mini-Mental State Examination (MMSE). RESULTS: The values for men and women were, respectively: 23.5 ± 7.3 kg and 11.6 ± 4.6 kg (right handgrip), 22.0 ± 7.8 kg and 10.7 ± 4.8 kg (left handgrip), 13 ± 5 and 10 ± 5 repetitions (arm strength), 8 ± 5 and 5 ± 4 repetitions (legs strength), and 21 ± 6 and 17 ± 7 (MMSE score). All parameters were significantly higher for men (P ≤ 0.01), but strength decline with age was less pronounced in women. In all MMSE groups, lower strength was associated with lower cognitive status. CONCLUSIONS: Strength values were lower in older subjects in both sexes; this difference was higher in men than in women. Higher strength values were associated with better cognitive status, which was the most influencing variable, even more than sex and age.

Efficacy of a 28-day oral cyanocobalamin supplementation on vitamin B status in Spanish institutionalized elderly.

BACKGROUND: Cobalamin deficiency is a common problem in the elderly. There is no consensus about adequate doses for supplementation. SUBJECTS/METHODS: We performed an intervention study in order to establish the efficacy of a supplement providing 500 µg cyanocobalamin for four weeks in sixty-four institutionalized elderly residents, over 60 years of age, in Madrid (Spain). Before and after treatment, concentrations of serum cobalamin, serum holotranscobalamin, serum total homocysteine, and serum and red blood cell folate were analyzed. Clusters were built according to the initial cobalamin status and differences in the effect of supplementation were checked using a general linear model for repeated measures. RESULTS: Cobalamin and holotranscobalamin increased highly significantly from 308 to 558 pmol/L and from 54 to 96 pmol/L (p < 0.001) in the whole study group as well as in each subgroup (clustered by initial cobalamin levels, all p < 0.01), with the highest relative change in the subgroup with the lowest initial cobalamin values. Total homocysteine decreased from 15 to 13 µmol/l, p < 0.001). Only the change of cobalamin (F = 4.61, p < 0.01), but not of holotranscobalamin nor total homocysteine, depended on the initial serum cobalamin status. CONCLUSIONS: A supplementation with an oral supplement solution of 500 µg cyanocobalamin daily for only four weeks, a shorter period than that found in former studies, may be considered suitable in institutionalized elderly.

Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial.

CONTEXT: Pediatric studies have shown that aerobic exercise reduces metabolic risk, but dose-response information is not available. OBJECTIVES: To test the effect of different doses of aerobic training on insulin resistance, fatness, visceral fat, and fitness in overweight, sedentary children and to test moderation by sex and race. DESIGN, SETTING, AND PARTICIPANTS: Randomized controlled efficacy trial conducted from 2003 through 2007 in which 222 overweight or obese sedentary children (mean age, 9.4 years; 42% male; 58% black) were recruited from 15 public schools in the Augusta, Georgia, area. INTERVENTION: Children were randomly assigned to low-dose (20 min/d; n = 71) or high-dose (40 min/d; n = 73) aerobic training (5 d/wk; mean duration, 13 [SD, 1.6] weeks) or a control condition (usual physical activity; n = 78). MAIN OUTCOME MEASURES: The prespecified primary outcomes were postintervention type 2 diabetes risk assessed by insulin area under the curve (AUC) from an oral glucose tolerance test, aerobic fitness (peak oxygen consumption [VO2]), percent body fat via dual-energy x-ray absorptiometry, and visceral fat via magnetic resonance, analyzed by intention to treat. RESULTS: The study had 94% retention (n = 209). Most children (85%) were obese. At baseline, mean body mass index was 26 (SD, 4.4). Reductions in insulin AUC were larger in the high-dose group (adjusted mean difference, -3.56 [95% CI, -6.26 to -0.85] × 10(3) µU/mL; P = .01) and the low-dose group (adjusted mean difference, -2.96 [95% CI, -5.69 to -0.22] × 10(3) µU/mL; P = .03) than the control group. Dose-response trends were also observed for body fat (adjusted mean difference, -1.4% [95% CI, -2.2% to -0.7%]; P < .001 and -0.8% [95% CI, -1.6% to -0.07%]; P = .03) and visceral fat (adjusted mean difference, -3.9 cm3 [95% CI, -6.0 to -1.7 cm3]; P < .001 and -2.8 cm3 [95% CI, -4.9 to -0.6 cm3]; P = .01) in the high- and low-dose vs control groups, respectively. Effects in the high- and low-dose groups vs control were similar for fitness (adjusted mean difference in peak VO2, 2.4 [95% CI, 0.4-4.5] mL/kg/min; P = .02 and 2.4 [95% CI, 0.3-4.5] mL/kg/min; P = .03, respectively). High- vs low-dose group effects were similar for these outcomes. There was no moderation by sex or race. CONCLUSION: In this trial, after 13 weeks, 20 or 40 min/d of aerobic training improved fitness and demonstrated dose-response benefits for insulin resistance and general and visceral adiposity in sedentary overweight or obese children, regardless of sex or race. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00108901.

Influencia de la nutrición en la capacidad funcional de un grupo de ancianos españoles / Influence of the nutritional status on the functional capability of Spanish elderly

Se ha valorado la influencia del estado nutricional (cuantificado mediante datos dietéticos, antropométricos y bioquímicos) en la capacidad funcional (medida por la adiposidad, fuerza de manos y piernas en flexión y extensión y flexibilidad) de un grupo de 11 ancianos institucionados de Madrid (España). Los principales problemas nutricionales que condicionan mermas funcionales son la obesidad, hipercolesterolemia déficit en proteínas y micronutrientes. La influencia adversa de la obesidad e hipercolesterolemia en la capacidad funcional del anciano se pone de relieve por la existencia de relaciones inversas entre la flexibilidad y la fuerza de manos y piernas con el grado de adiposidad, con el espesor de los pliegues cutáneos con la colesterolemia. Respecto a la influecia de la dieta, existen relaciones positivas entre el consumo de alimentos de la dieta, existen relaciones positivas entre el consumo de alimentos y de la mayor parte de los nutrientes con la fuerza de manos y piernas, y la significación estadística se alcanza con frecuencia en el caso de las proteínas, hierro, zinc, magnesio y vitamina B, seguidas de la vitamina C, niacina, tiamina, ácido fólico y vitamina E, En relación con los parámetros sanguíneos las correlaciones de mayor valor son las existentes entre parámetros funcionales y niveles de hierro, ferritina y vitamina C. Nuestros resultados contribuyen a confirmar la influencia de la nutrición en la capacidad funcional del anciano y ponen de relieve la necesidad de mejorar la dieta de las personas de edad, evitando las deficiencias en micronutrientes, así como la conveniencia de incrementar la actividad física del colectivo, ambas medidas supondrán una importante ayuda en la mejora sanitaria y funcional de las personas de edad avanzada