Anemia: its impact on hospitalizations and length of hospital stay in nursing home and community older adults.

OBJECTIVE: To examine the association between anemia and its severity on hospitalizations and length of stay (LOS) in hospital in older adults. PARTICIPANTS: A cross-sectional sample of 590 adults from long term care facilities (NH) and community ambulatory care (C) in the Bronx, NY. MEASUREMENTS: Patient demographics, medical history, hospitalizations during an 18-month period, LOS per hospitalization, and laboratory parameters including hemoglobin (Hb) at enrollment and during hospitalization. RESULTS: Anemia and hospitalization occurred in 62% and 64% of the sample, respectively. NH residents were older (P = .0013), had fewer hospitalizations (P = .001) but similar rates of anemia, anemia severity, gender ratios and LOS per hospitalization as C subjects (all P > .05). Females were older (P = .0455), had fewer hospitalizations (P = .001) and more severe anemia than males (P < .0005). The likelihood of hospitalization increased 1) as anemia severity increased (P < .00005), 2) in African Americans (P = .002), 3) in males (P = .006), and 4) as anemia duration increased (P < .0005). Anemic patients had significantly longer total LOS days than non-anemic individuals (P < .00005); total LOS also increased as severity of anemia increased (P = .0022). CONCLUSIONS: Our findings suggest anemia, in particular chronic and severe anemia in older Americans is associated with an increased likelihood of hospitalizations and an increased LOS when hospitalized. The recognition and treatment of anemia in older adults has the potential to reduce hospitalizations and LOS and decrease overall health care costs to individuals and third party providers.

Importance of the high-molecular-mass isoform of adiponectin in improved insulin sensitivity with rosiglitazone treatment in HIV disease.

The present study was designed to investigate the relationship of isoforms of adiponectin to insulin sensitivity in subjects with HIV-associated insulin resistance in response to treatment with the thiazolidinedione, rosiglitazone. The two isoforms of adiponectin, HMW (high-molecular-mass) and LMW (low-molecular-mass), were separated by sucrose-gradient-density centrifugation. The amount of adiponectin in gradient fractions was determined by ELISA. Peripheral insulin sensitivity (Rd) was determined with hyperinsulinaemic-euglycaemic clamp, whereas hepatic sensitivity [HOMA (Homoeostasis Model Assessment) %S] was based on basal glucose and insulin values. Treatment with rosiglitazone for 3 months resulted in a significant improvement in the index of hepatic insulin sensitivity (86.4+/-15% compared with 139+/-23; P=0.007) as well as peripheral insulin sensitivity (4.04+/-0.23 compared with 6.17+/-0.66 mg of glucose/kg of lean body mass per min; P<0.001). Improvement in HOMA was associated with increased levels of HMW adiponectin (r=0.541, P=0.045), but not LMW adiponectin. The present study suggests that the HMW isoform of adiponectin is important in the regulation of rosiglitazone-mediated improvement in insulin sensitivity in individuals with HIV-associated insulin resistance, particularly in the liver.

Influence of age on the association of retinol-binding protein 4 with metabolic syndrome.

OBJECTIVE: The relationships of retinol-binding protein 4 (RBP4) with insulin sensitivity and body fat distribution have been investigated in a few recent studies with conflicting results. This may have been due to differences in ages of the subjects in the different studies. The aim of this study was to investigate whether the association of RBP4 and insulin sensitivity and percent trunk fat are influenced by age. METHODS AND PROCEDURES: Cross-sectional analyses of 48 young subjects and 55 elderly subjects. Insulin sensitivity was determined by a hyperinsulinemic-euglycemic clamp. Body fat distribution was determined by a dual-energy X-ray absorptiometry (DXA). RESULTS: In the young subjects, RBP4 levels were associated with insulin sensitivity (r = -0.30, P = 0.04), percent trunk fat (r = 0.54, P < 0.001), triglycerides (r = 0.44, P = 0.003), low-density lipoprotein (r = 0.38, P = 0.01). In contrast, in the elderly subjects there was no correlation between RBP4 levels and insulin sensitivity (r = -0.18, P = 0.20), percent trunk fat (r = 0.00, P = 0.10), triglycerides (r = 0.25, P = 0.10), and low-density lipoprotein (r = -0.11, P = 0.47). DISCUSSION: The associations of RBP4 with insulin sensitivity, percent trunk fat, and lipid levels are influenced by age.