Role of blood pressure on stroke-related mortality: a 45-year follow-up study in China.

BACKGROUND: Hypertension is associated with stroke-related mortality. However, the long-term association of blood pressure (BP) and the risk of stroke-related mortality and the influence path of BP on stroke-related death remain unknown. The current study aimed to estimate the long-term causal associations between BP and stroke-related mortality and the potential mediating and moderated mediating model of the associations. METHODS: This is a 45-year follow-up cohort study and a total of 1696 subjects were enrolled in 1976 and 1081 participants died by the latest follow-up in 2020. COX proportional hazard model was used to explore the associations of stroke-related death with baseline systolic blood pressure (SBP)/diastolic blood pressure (DBP) categories and BP changes from 1976 to 1994. The mediating and moderated mediating effects were performed to detect the possible influencing path from BP to stroke-related deaths. E value was calculated in the sensitivity analysis. RESULTS: Among 1696 participants, the average age was 44.38 ±â€Š6.10 years, and 1124 were men (66.3%). After a 45-year follow-up, a total of 201 (11.9%) stroke-related deaths occurred. After the adjustment, the COX proportional hazard model showed that among the participants with SBP ≥ 160 mmHg or DBP ≥ 100 mmHg in 1976, the risk of stroke-related death increased by 217.5% (hazard ratio [HR] = 3.175, 95% confidence interval [CI]: 2.297-4.388), and the adjusted HRs were higher in male participants. Among the participants with hypertension in 1976 and 1994, the risk of stroke-related death increased by 110.4% (HR = 2.104, 95% CI: 1.632-2.713), and the adjusted HRs of the BP changes were higher in male participants. Body mass index (BMI) significantly mediated the association of SBP and stroke-related deaths and this mediating effect was moderated by gender. CONCLUSIONS: In a 45-year follow-up, high BP and persistent hypertension are associated with stroke-related death, and these associations were even more pronounced in male participants. The paths of association are mediated by BMI and moderated by gender.

Central and Peripheral Adiposity Had Different Effect on Disability in Centenarians.

Purpose: To explore the correlations between waist circumference, body mass index, calf circumference (CC), and waist-calf circumference ratio (WCR) and activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in Hainan centenarians. Patients and Methods: A total of 1,002 Hainan centenarians were selected by full sample household survey. ADLs and IADLs were used to investigate the ability of activity and instrumental activity in daily living. The possible non-linear associations were further analyzed using restricted cubic spline. Results: After adjusting for demographic characteristics (gender, age, ethnicity, marital status, educational level, and type of residence) and lifestyle (smoking, drinking, and exercise), the odds ratio (OR) of CC (continuous variable) on ADL disability in centenarians was 0.90 (95% CI: 0.85-0.96), while high WCR (continuous variable) was related with high risk of ADL disability (OR=1.73; 95% confidence interval[CI], 1.07-2.80). The ORs of CC and WCR for IADL severe disability were 0.86 (95% CI, 0.82-0.91) and 2.23 (95% CI, 1.52-3.28), respectively. Conclusion: Central (WCR) and peripheral (CC) adiposity had different effects on disability (ADL and IADL) in centenarians. Even in centenarians, maintaining muscle mass (with higher calf circumference) and avoiding central obesity are of positive significance for the prevention of ADL/IADL disability.

Dietary behaviors and patterns of centenarians in Hainan: A cross-sectional study.

OBJECTIVES: The aim of this study was to understand the diet-related behaviors of Hainan centenarians and to analyze dietary factors that affect their nutritional status. METHODS: Data were collected from the China Hainan Centenarian Cohort Study, a full sample survey including questionnaires, physical examinations, and physiologic indices of the centenarian population. The study included 1002 centenarians. The diet-related behaviors were assessed using the food frequency questionnaire; nutritional status was determined according to the Mini Nutritional Assessment - short form scale scores. We used logistic regression models to analyze the main dietary risk factors of malnutrition. RESULTS: Of all the centenarians, 94.6% maintained regular meals, 80.4% had three meals a day, 53.4% ate each meal until 80% full, 88.7% ate vegetables daily, and 70% drank one to two cups of water daily. Centenarians ate rice-based staple foods; eggs, dairy, legumes, nuts, and poultry were not popular. The main sources of meat were red meat and seafood. None liked fried food, and 19.3% preferred sweet flavors. People with normal nutritional status accounted for 12.3% of the population, whereas those with malnutrition comprised 20.8%. Dietary factors that affected nutritional status included three meals a day (odds ratio [OR], 0.366; 95% confidence interval [CI], 0.173-0.778), tea drinking (OR, 0.236; 95% CI, 0.087-0.641), and the frequency of poultry (OR, 0.261; 95% CI, 0.088-0.771), seafood (OR, 0.247; 95% CI, 0.110-0.554), nuts (OR, 0.381; 95% CI, 0.150-0.965), and pastry (OR, 0.219; 95% CI, 0.080-0.600) consumption. CONCLUSION: This was the first study on the dietary behaviors and nutritional status of centenarians using survey data. We highlighted the factors affecting nutritional status and provided scientific support for dietary strategies that may improve the nutritional status of the elderly population.

The Role of BMI and Blood Pressure in the Relationship Between Total Cholesterol and Disability in Chinese Centenarians: A Cross-Sectional Study.

Background: Lower serum lipid metabolism might be associated with the decline of activity of daily living in the extreme longevity group. However, studies on models and possible paths of this correlation between total cholesterol (TC) and disability in centenarians are scarce. The aim of this study was to verify this correlation and explore the mediating effect of BMI and blood pressure on this relationship in Hainan centenarians. Methods: We conducted a cross-sectional analysis of 1002 centenarians from the China Hainan Centenarians Cohort Study (CHCCS). Data on demographics, anthropometry data, lifestyle, and TC levels were collected through interviews, physical examinations, and laboratory tests. The Barthel index and Lawton index, measuring the disability status, were used to estimate the activity of daily living (ADL) and instrumental activity of daily living (IADL). A multivariable logistic regression model was used to explore the correlation between disability and TC levels. Mediation analyses were used to explore the both direct and indirect effects of TC level on disability. Results: After adjusting for covariates, with 1 mmol/L increment in TC, the adjusted odds ratios (ORs) of ADL severe disability and ADL moderate & severe disability were 0.789(95%CI: 0.650-0.959) and 0.822(95%CI: 0. 0.699-0.966), respectively. There was a significant declining trend in the prevalence of different types of disability with increment in TC. The correlation was more pronounced among Hainan female centenarians. In the analysis of mediating effect among the female population, BMI significantly mediated the effect of TC levels on different types of disability. BMI and SBP, as chain mediators, multiply and chain mediated the effect of TC levels on IADL. Conclusion: Low TC levels might be correlated with a higher frequency of disability in female centenarians, and this correlation might be mediated by BMI and blood pressure.

Association of anthropometric and nutrition status indicators with cognitive functions in centenarians.

BACKGROUND & AIMS: How anthropometric and nutrition status indicators relate to cognitive function in the oldest old adults is an issue that needs to be explored. This study aimed to analyze the association of parameters and nutrition status indicators (waist circumference, BMI, calf circumference, and waist-calf circumference ratio [WCR]) with cognitive functions in centenarians. METHODS: A cross-sectional observational study was conducted with the full sample of 1002 centenarians from Hainan. The mini-mental state examination (MMSE) was used to identify cognitive impairment. Multiple logistic regression analysis was used to examine the strength of association between each anthropometric index and the risk of cognitive impairment or severe cognitive impairment identified by MMSE. Locally Weighted Scatterplot Smoothing (LOWESS) curve was used to visualize the linear or non-linear relationship of each pair. RESULTS: The risk of cognitive impairment identified by MMSE for centenarians was reduced by 12% for every 1 cm thickening of the calf circumference (OR = 0.88, 95% CI: 0.81-0.95) and the increase in each unit of WCR increased cognitive impairment the risk by 1.60 times (OR = 2.60, 95% CI: 1.31-5.13) after adjusting for demographic characteristics (i.e., gender, age, ethnicity, marital status, education level, and type of residence) and lifestyle (i.e., smoking, drinking, and exercise) related variables. CONCLUSIONS: Results suggest that calf circumference is negatively associated with the risk of cognitive impairment identified by MMSE in centenarians. Older adults with lower calf circumference should pay attention to their cognitive function.

Canonical Correlation Analysis on the Association Between Sleep Quality and Nutritional Status Among Centenarians in Hainan.

Objective: To analyze the correlation between nutritional status and sleep quality among centenarians. Methods: A total of 1,002 centenarians in Hainan were included in the full sample survey. The Mini Nutritional Assessment-Short Form (MNA-SF) was used for nutritional risk assessment and the Pittsburgh Sleep Quality Index Scale (PSQI) was used for evaluating sleep quality. Canonical correlation analysis was conducted to analyze their correlation. Results: Two statistically significant (p < 0.05) canonical coefficients were found, with the first canonical correlation coefficient having a value of 0.247, eigenvalue of 0.065, and contribution rate of 89.0%. The linear combination of nutrition variable V1, mainly determined by MNA1 (appetite loss), MNA5 (dementia/depression), and MNA2 (weight loss), indicates an association with sleep quality; the linear combination of sleep quality W1, mainly determined by PSQI1 (subjective sleep quality), PSQI7 (daytime dysfunction), and PSQI2 (sleep latency), indicates an association with nutritional status. Appetite loss, dementia/depression, and weight loss have negative correlations with subjective sleep quality and daytime dysfunction. Conclusion: Among centenarians, the relationship between nutritional status and sleep quality is bidirectional. Furthermore, appetite loss, dementia/depression, weight loss, subjective sleep quality, and daytime dysfunction are the main relevant factors.