Correlación entre marcadores inflamatorios con función física y composición corporal en adultos mayores de la comunidad: estudio transversal / Correlation between inflammatory markers with physical function and bodycomposition in community older adults: a cross-sectional study

Introducción: El envejecimiento está relacionado con diversas enfermedades crónicas que causan inflamación sistémica, caracterizada por un aumento en los niveles sanguíneos de interleucina 6 (IL-6) y factor de necrosis tumoral alfa (TNF-α). La función física y la composición corporal podrían estar relacionadas con estos marcadores inflamatorios en adultos mayores.Objetivo: Analizar la correlación entre marcadores inflamatorios sanguíneos, función física y composición corporal en adultos mayores de la comunidad.Metodología: Estudio transversal con 245 adultos mayores (hombres 68±6 años; mujeres: 69%) de la ciudad de Londrina, Brasil. Se analizaron los niveles sanguíneos de IL-6 y TNF-α con citometría de flujo. Para la evaluación física fue considerado el equilibrio estático con la prueba de estación unipodal (PEU), la fuerza de prensión manual (FPM) utilizando un dinamómetro digital y la capacidad aeróbica con la prueba de caminata de seis minutos (PC6M). Para la evaluación de la composición corporal, fueron considerados los siguientes perímetros: cadera, pantorrilla, cuádriceps, bíceps braquial, tríceps braquial y cintura. Se analizó la correlación de las variables inflamatorias con las de función física y composición corporal, utilizando Pearson o Spearman con el software SPSS versión 22.Resultados: Los niveles de IL-6 se correlacionaron con la PEU (r: -0.22; p: 0.002), el perímetro de tríceps (r: 0.16; p: 0.023) y el de cintura (r: 0.34; p: 0.000). Los niveles de TNF-α se correlacionaron con FPM (r: -0.15; p: 0.035), el perímetro de tríceps (r: 1.79; p: 0.012) y el de cintura (r: 0.27; p< 0.001). Conclusión: Los marcadores inflamatorios están relacionados con menor fuerza, equilibrio estático y un aumento en el perímetro de tríceps y cintura en adultos mayores de la comunidad.(AU)

Introduction: Aging is associated with various chronic dis-eases that cause systemic inflammation, characterized by an in-crease in blood levels of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α). Physical function and body compositionmay be related to these inflammatory markers in older adults.Objective: To analyze the correlation between blood in-flammatory markers, physical function and body compositionin community-dwelling older adults.Methodology: A cross-sectional study was carried out with242 community-dwelling older adults (mean age was 68±6years for males and 70±6 years for females; the percentageof men was 36.6% and 69.4% of women) from the city ofLondrina, Brazil. Blood levels of IL-6 and TNF-α were analyzedwith flow cytometry. For the physical evaluation, static balancewas measured with the one-legged stance test (OLS), hand-grip strength (HGS) using a digital dynamometer and aerobiccapacity with the six-minute walk test (6MWT). For the evalu-ation of body composition, the following perimeters were con-sidered: hip, calf, quadriceps, biceps brachii, triceps brachiiand waist. The correlation of inflammatory variables withthose of physical function and body composition was analyzedusing Pearson or Spearman with SPSS version 22 software.Results: IL-6 levels were correlated with OLS (r: -0.22;p:0.002), triceps circumference (r: 0.16; p:0.023) and waist cir-cumference (r: 0.34; p:0.000). TNF-α levels were correlatedwith HGS (r: -0.15; p:0.035), triceps circumference (r: 1.79;p:0.012) and waist circumference (r: 0.27; p < 0.001).Conclusion: Inflammatory biomarkers are related to lowmuscle strength, static balance, and an increase in tricepsand waist circumference.(AU)

Association of IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with COPD: A cross-sectional study.

Introduction: Chronic obstructive pulmonary disease is a systemic disease characterized not only by respiratory symptoms but also by physical deconditioning and muscle weakness. One prominent manifestation of this disease is the decline in respiratory muscle strength. Previous studies have linked the genotypes of insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) to muscle weakness in other populations without this disease. However, there is a notable knowledge gap regarding the biological mechanisms underlying respiratory muscle weakness, particularly the role of IGF-1 and IGF-2 genotypes in this pulmonary disease. Therefore, this study aimed to investigate, for the first time, the association between IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with chronic obstructive pulmonary disease. In addition, we analyzed the relationship between oxidative stress, chronic inflammation, and vitamin D with respiratory muscle strength. Methods: A cross sectional study with 61 individuals with chronic obstructive pulmonary disease. Polymerase chain reaction of gene polymorphisms IGF-1 (rs35767) and IGF-2 (rs3213221) was analyzed. Other variables, related to oxidative stress, inflammation and Vitamin D were dosed from peripheral blood. Maximal inspiratory and expiratory pressure were measured. Results: The genetic polymorphisms were associated with respiratory muscle strength ( 3.0 and 3.5; = 0.57). Specific genotypes of IGF-1 and IGF-2 presented lower maximal inspiratory and expiratory pressure (<0.05 for all). Oxidative stress, inflammatory biomarkers, and vitamin D were not associated with respiratory muscle strength. Conclusion: The polymorphisms of IGF-1 and IGF-2 displayed stronger correlations with respiratory muscle strength compared to blood biomarkers in patients with chronic obstructive pulmonary disease. Specific genotypes of IGF-1 and IGF-2 were associated with reduced respiratory muscle strength in this population.

Introducción: La enfermedad pulmonar obstructiva crónica es una enfermedad sistémica caracterizada no solo por síntomas respiratorios, sino también por el deterioro físico y la debilidad muscular. Una manifestación destacada de esta enfermedad es el declive en la fuerza de los músculos respiratorios. Estudios previos han vinculado los genotipos de factor de crecimiento insulínico 1 y 2 (IGF-1 e IGF-2) con la debilidad muscular en poblaciones sin esta enfermedad. Sin embargo, existe un vacío de conocimiento con respecto a los mecanismos biológicos subyacentes a la debilidad de los músculos respiratorios, en particular el papel de los genotipos IGF-1 e IGF-2 en esta enfermedad pulmonar. Por lo tanto, este estudio tuvo como objetivo investigar, por primera vez, la asociación de los genotipos IGF-1 e IGF-2 con la fuerza de los músculos respiratorios en individuos con enfermedad pulmonar obstructiva crónica. Además, analizamos la relación entre el estrés oxidativo, la inflamación crónica y la vitamina D con la fuerza de los músculos respiratorios. Métodos: Un estudio transversal con 61 individuos con enfermedad pulmonar obstructiva crónica. Se analizó la reacción en cadena de la polimerasa de los polimorfismos genéticos IGF-1 (rs35767) e IGF-2 (rs3213221). Otras variables relacionadas con el estrés oxidativo, la inflamación y la vitamina D se dosificaron a partir de muestras de sangre periférica. Se midieron las presiones inspiratorias y espiratorias máximas. Resultados: Los polimorfismos genéticos están asociados con la fuerza de los músculos respiratorios (F: 3.0 y 3.5; R2= 0.57). Genotipos específicos de IGF-1 e IGF-2 presentaron bajos valores en las presiones inspiratorias y espiratorias (p<0.05 en todos los casos). El estrés oxidativo, los biomarcadores inflamatorios y la vitamina D no se asociaron con la fuerza de los músculos respiratorios. Conclusión: Los polimorfismos de IGF-1 e IGF-2 mostraron correlaciones más sólidas con la fuerza de los músculos respiratorios en pacientes con enfermedad pulmonar obstructiva crónica en comparación con los biomarcadores sanguíneos. Genotipos específicos de IGF-1 e IGF-2 se asociaron con una disminución de la fuerza de los músculos respiratorios en esta población.

Association of IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with COPD: A cross-sectional study / Asociación de los genotipos de IGF-1 e IGF-2 con la fuerza muscular respiratoria en individuos con EPOC: estudio transversal

Introduction Chronic obstructive pulmonary disease is a systemic disease characterized not only by respiratory symptoms but also by physical deconditioning and muscle weakness. One prominent manifestation of this disease is the decline in respiratory muscle strength. Previous studies have linked the genotypes of insulin-like growth factor 1 and 2 (IGF-1 and IGF-2) to muscle weakness in other populations without this disease. However, there is a notable knowledge gap regarding the biological mechanisms underlying respiratory muscle weakness, particularly the role of IGF-1 and IGF-2 genotypes in this pulmonary disease. Therefore, this study aimed to investigate, for the first time, the association between IGF-1 and IGF-2 genotypes with respiratory muscle strength in individuals with chronic obstructive pulmonary disease. In addition, we analyzed the relationship between oxidative stress, chronic inflammation, and vitamin D with respiratory muscle strength. Methods A cross sectional study with 61 individuals with chronic obstructive pulmonary disease. Polymerase chain reaction of gene polymorphisms IGF-1 (rs35767) and IGF-2 (rs3213221) was analyzed. Other variables, related to oxidative stress, inflammation and Vitamin D were dosed from peripheral blood. Maximal inspiratory and expiratory pressure were measured. Results The genetic polymorphisms were associated with respiratory muscle strength ( 3.0 and 3.5; = 0.57). Specific genotypes of IGF-1 and IGF-2 presented lower maximal inspiratory and expiratory pressure (<0.05 for all). Oxidative stress, inflammatory biomarkers, and vitamin D were not associated with respiratory muscle strength. Conclusion The polymorphisms of IGF-1 and IGF-2 displayed stronger correlations with respiratory muscle strength compared to blood biomarkers in patients with chronic obstructive pulmonary disease. Specific genotypes of IGF-1 and IGF-2 were associated with reduced respiratory muscle strength in this population.

Introducción La enfermedad pulmonar obstructiva crónica es una enfermedad sistémica caracterizada no solo por síntomas respiratorios, sino también por el deterioro físico y la debilidad muscular. Una manifestación destacada de esta enfermedad es el declive en la fuerza de los músculos respiratorios. Estudios previos han vinculado los genotipos de factor de crecimiento insulínico 1 y 2 (IGF-1 e IGF-2) con la debilidad muscular en poblaciones sin esta enfermedad. Sin embargo, existe un vacío de conocimiento con respecto a los mecanismos biológicos subyacentes a la debilidad de los músculos respiratorios, en particular el papel de los genotipos IGF-1 e IGF-2 en esta enfermedad pulmonar. Por lo tanto, este estudio tuvo como objetivo investigar, por primera vez, la asociación de los genotipos IGF-1 e IGF-2 con la fuerza de los músculos respiratorios en individuos con enfermedad pulmonar obstructiva crónica. Además, analizamos la relación entre el estrés oxidativo, la inflamación crónica y la vitamina D con la fuerza de los músculos respiratorios. Métodos Un estudio transversal con 61 individuos con enfermedad pulmonar obstructiva crónica. Se analizó la reacción en cadena de la polimerasa de los polimorfismos genéticos IGF-1 (rs35767) e IGF-2 (rs3213221). Otras variables relacionadas con el estrés oxidativo, la inflamación y la vitamina D se dosificaron a partir de muestras de sangre periférica. Se midieron las presiones inspiratorias y espiratorias máximas. Resultados Los polimorfismos genéticos están asociados con la fuerza de los músculos respiratorios (F: 3.0 y 3.5; R2= 0.57). Genotipos específicos de IGF-1 e IGF-2 presentaron bajos valores en las presiones inspiratorias y espiratorias (p<0.05 en todos los casos). El estrés oxidativo, los biomarcadores inflamatorios y la vitamina D no se asociaron con la fuerza de los músculos respiratorios. Conclusión Los polimorfismos de IGF-1 e IGF-2 mostraron correlaciones más sólidas con la fuerza de los músculos respiratorios en pacientes con enfermedad pulmonar obstructiva crónica en comparación con los biomarcadores sanguíneos. Genotipos específicos de IGF-1 e IGF-2 se asociaron con una disminución de la fuerza de los músculos respiratorios en esta población

Impact of the Pandemic Time on the Mental Health of People with Dementia and Their Family Caregivers in Brazil and Chile: One-Year Follow-Up.

Background: Previous studies reported the negative impact of social isolation on mental health in people with dementia (PwD) and their caregivers, butlongitudinal studies seem scarcer. Objective: To describe a one-year follow-up impact of the COVID-19 pandemic on PwD and their caregivers in both Brazil and Chile. Methods: This study analyzed the impact of the pandemic on the psychological and physical health of PwD and their family caregivers after one year of follow-up in three outpatient clinics in Brazil (n = 68) and Chile (n = 61). Results: In both countries, PwD reduced their functional capacity after one year of follow-up (p = 0.017 and p = 0.009; respectively) and caregivers reported worse physical and mental health (p = 0.028 and p = 0.039). Only in Chile, caregivers reported more sadness associated with care (p = 0.001), and reduced time sleeping (p = 0.07). Conclusions: In conclusion, the COVID-19 pandemic appears to have had a long-lasting impact on PwD and their caregivers. However, it is essential to acknowledge that the inherent progression of dementia itself may also influence changes observed over a year.

Effectiveness of Whey Protein Supplementation during Resistance Exercise Training on Skeletal Muscle Mass and Strength in Older People with Sarcopenia: A Systematic Review and Meta-Analysis.

OBJECTIVE: To determine the effectiveness of whey protein (WP) supplementation during resistance exercise training (RET) vs. RET with or without placebo supplementation on skeletal muscle mass, strength, and physical performance in older people with Sarcopenia. METHODS: Electronic searches in the PubMed, Embase, Scopus, Web of Science, LILACS, SPORTDiscus, Epistemonikos, and CINAHL databases were performed until 20 January 2023. Randomized clinical trials conducted on sarcopenic adults aged 60 or older were included. The studies had to compare the effectiveness of the addition of supplements based on concentrated, isolated, or hydrolyzed whey protein during RET and compare it with RET with or without placebo supplementation on skeletal muscle mass and strength changes. The study selection process, data extraction, and risk of bias assessment were carried out by two independent reviewers. RESULTS: Seven randomized clinical trials (591 participants) were included, and five of them provided data for quantitative synthesis. The overall pooled standardized mean difference (SMD) estimate showed a small effect size in favor of RET plus WP for skeletal muscle mass according to appendicular muscle index, with statistically significant differences compared with RET with or without the placebo group (SMD = 0.24; 95% CI, 0.05 to 0.42; p = 0.01; I2 = 0%, p = 0.42). The overall pooled mean difference (MD) estimate showed a significant difference of +2.31 kg (MD = 2.31 kg; 95% CI, 0.01 to 4.6; p = 0.05; I2 = 81%, p < 0.001) in handgrip strength in the RET plus WP group compared with the RET group with or without placebo. The narrative synthesis revealed discordance between the results of the studies on physical performance. CONCLUSIONS: WP supplementation during RET is more effective in increasing handgrip strength and skeletal muscle mass in older people with Sarcopenia compared with RET with or without placebo supplementation. However, the effect sizes were small, and the MD did not exceed the minimally important clinical difference. The quality of the evidence was low to very low according, to the GRADE approach. Further research is needed in this field.

Incidence and Clinical Implications of Anatomical Variations in the Pancreas and Its Ductal System: A Systematic Review and Meta-Analysis.

OBJECTIVE: This systematic review analyzes the anatomical variants in the pancreas and its ductal system to report on their association with pancreatic pathologies. METHODS: We conducted a search of the MEDLINE, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS databases from their inception to July 2023. The methodological quality was assessed with the Anatomical Quality Assessment (AQUA) tool. Finally, the pooled prevalence was estimated using a random effects model. RESULTS: 55 studies were found that met the eligibility criteria. The overall prevalence of pancreas divisum (PD) was 18% (95% CI = 15-21%). The prevalence of PD associated with pancreatitis was 30% (95% CI = 1-61%). CONCLUSIONS: An anatomical variant of the pancreas such as PD may be the cause of bile duct obstruction, resulting in various clinical complications, such as pancreatitis. Hence, knowing this variant is extremely important for surgeons, especially for those who treat the gastroduodenal region.

Participación social en adultos mayores con Enfermedad Pulmonar Obstructiva Crónica: características funcionales y emocionales / Social participation in older adults with Chronic Obstructive Pulmonary Disease: functional and emotional characteristics

Fundamentos: El impacto de la enfermedad pulmonar obstructiva crónica (EPOC) sobre la participación social en actividadesde la comunidad ha sido poco estudiada en adultos mayores. Por esta razón, este estudio analizó los tipos de organizaciones comunitarias donde participan los adultos mayores con EPOC y sus características funcionales y emocionales.Métodos: Fue realizado un estudio transversal con treinta y nueve adultos mayores con EPOC, de la ciudad de Londrina (Brasil),desde el año 2016 hasta 2019. Fue aplicado el cuestionario de participación social para conocer la participación en reuniones oactividades con: 1) organizaciones de adultos mayores; 2) junta de vecinos o partido político; 3) grupos religiosos, de crecimientopersonal o espiritual; 4) actividades familiares o con amigos; y 5) actividades recreativas en la comunidad. Los individuos realizaronel test de marcha de seis minutos (TM6m), Inventario de Depresión de Beck (IDB), evaluación de fuerza de prensión palmar (FPP) y elCOPD Assessment Test (CAT). La comparación entre los adultos mayores que participaron de organizaciones formales e informalesfue realizada utilizando el Test T de Student.Resultados: El 77% de los pacientes con EPOC participaron en grupos religiosos o espirituales y el 74% en actividades con familiares y amigos. Las mujeres participaron más en actividades sociales informales (P=0,002) y formales (P=0,004) que los hombres.Individuos que participaron en actividades sociales son aquellos que tuvieron menor rendimiento en TM6m y mayores puntuacionesen IDB y CAT (P<0,05 para todos).Conclusiones: La participación social de los adultos mayores con EPOC es mayor en grupos religiosos, actividades familiaresy con amigos. Adicionalmente, los adultos mayores que participan en organizaciones comunitarias son aquellos que presentan máslimitaciones funcionales y emocionales...(AU)

Backgroud: The impact of chronic obstructive pulmonary disease (COPD) on social participation in community activities hasbeen scarce studied in older adults. For this reason, this study analyzed the types of community organizations in which older adultswith COPD participate and their functional and emotional characteristics. Methods: A cross-sectional study was conducted with 39 older adults with COPD from the city of Londrina (Brazil), from 2016 to2019. The social participation questionnaire was applied to identify the participation in meetings or activities with: 1) organizations forolder adults; 2) neighbourhood councils or political parties; 3) religious, personal or spiritual growth; 4) family or friends activities; 5)recreational activities in the community. The individuals performed the 6-minute walk test (6MWT), Beck Depression Inventory (BDI), han-dgrip strength (HGS), and the COPD Assessment Test (CAT). The comparison between older adults who participate in formal and informalorganizations was made using the Student’s T-Test. Results: 77% of COPD patients participated in religious or spiritual groups and 74% in activities with family and friends. Womenparticipated more in informal (P=0.002) and formal (P=0.004) social activities than men. Individuals who have participated in socialactivities were those who had lower performance in 6MWT and higher scores in BDI and CAT (P<0.05 for all). Conclusions: The social participation of older adults with COPD is greater in religious groups, family activities and with friends.Additionally, older adults who participate in community organizations are those who have more functional and emotional limitations.This reinforces the role of community groups to support older adults with COPD who have some health limitation.(AU)

Associação entre ansiedade e depressão em brasileiros durante o isolamento social da pandemia de covid-19 / Association between anxiety and depression in brazilians during the social isolation of the COVID-19 pandemic / Asociación entre ansiedad y depresión en brasileños durante el aislamiento social por la pandemia del COVID-19

O objetivo deste estudo é analisar a associação entre ansiedade e depressão durante o isolamento social da pandemia de covid-19 no Brasil. Dados de 1.053 adultos brasileiros entre 18 e 59 anos foram coletados por meio de questionário online, entre abril e maio de 2020, para este estudo transversal. Foi utilizada a Escala Hospitalar de Ansiedade e Depressão, e foram analisados fatores sociodemográficos e econômicos. Houve 37% e 20% de risco moderado e alto de ansiedade, respectivamente. Foi observada uma relação direta entre ansiedade e ser do sexo feminino (OR: 1,55; IC95%: 1,02-2,34), ser mais jovem (OR: 4,78; IC95%: 2,71-8,42, para pessoas entre 18-28 anos) e ter rendimentos mais baixos (OR: 1,51; IC95%: 1,69-1,96). Os resultados foram na mesma direção para a depressão, e, adicionalmente, foi demonstrada associação entre isolamento social (parcial ou total) e depressão (OR: 1,42; IC95%: 1,01-2,01). Este estudo encontrou uma associação entre mulheres, populações mais jovens e indivíduos de menor renda e o risco de sofrer ansiedade e depressão durante o confinamento decretado devido à pandemia de covid-19. Além disso, o isolamento social foi associado ao risco de depressão.

The aim of this study is to analyze the association between anxiety and depression during the social isolation for COVID-19 in Brazil. Data of 1,053 Brazilian adults between 18 and 59 years old were gathered by an online questionnaire, between April and May 2020, for this cross-sectional study. The Hospital Anxiety and Depression Scale was used and sociodemographic and economic factors were analyzed. There was a 37% and 20% of moderate and high risk of anxiety, respectively. A direct relationship was observed between anxiety and being female (OR: 1.55; 95%CI: 1.02-2.34), younger (OR: 4.78; 95% CI: 2.71-8.42, for people between 18-28 years old), and having lower incomes (OR: 1.51, 95%CI: 1.69-1.96). Results were in the same vein for depression and, additionally, an association between social isolation (partial or total) and depression was shown (OR: 1.42; 95%CI: 1.01-2.01). This study reported an association between women, younger populations, and subjects with lower incomes and the risk of suffering anxiety and depression during the confinement due to the COVID-19 pandemic. In addition, social isolation was associated with risk of depression.

El objetivo de este estudio es analizar la asociación entre ansiedad y depresión durante el aislamiento social por la pandemia del COVID-19 en Brasil. Se recolectaron datos de 1.053 adultos brasileños, de entre 18 y 59 años de edad, mediante un cuestionario en línea, entre abril y mayo de 2020, para este estudio transversal. Se utilizó la Escala de Ansiedad y Depresión Hospitalaria, y se analizaron factores sociodemográficos y económicos. Hubo el 37% de riesgo moderado de ansiedad y el 20% de riesgo alto. Se observó una relación directa entre la ansiedad y ser mujer (OR: 1,55; IC 95%: 1,02-2,34), ser más joven (OR: 4,78; IC 95%: 2,71-8,42 para personas de entre 18 y 28 años) y tener menores ingresos (OR: 1,51; IC 95%: 1,69-1,96). Los resultados fueron los mismos para la depresión y, además, se demostró una asociación entre el aislamiento social (parcial o total) y la depresión (OR: 1,42; IC 95%: 1,01-2,01). Este estudio encontró una asociación entre ser mujer, poblaciones más jóvenes y personas de bajos ingresos con el riesgo de experimentar ansiedad y depresión durante el confinamiento por la pandemia del COVID-19. Además, el aislamiento social se asoció con el riesgo de depresión.

Effectiveness of anthocyanins rich foods on cardiometabolic factors in individuals with metabolic syndrome: a systematic review and meta-analysis.

PURPOSE: The aim of this systematic review with meta-analysis was to determine whether anthocyanin-rich foods are effective to improve cardiometabolic markers in individuals with metabolic syndrome (MetS), compared with placebo or control interventions. METHODS: We searched MEDLINE, CENTRAL, Embase, LILACS, CINAHL, and Web of Science from their inception up to March 2022. We include clinical trials (randomized clinical trials, controlled clinical trials, and cross-over trials) with anthocyanin-rich foods versus placebo or control intervention that assessment cardiometabolic factors. RESULTS: We found 14 clinical trials that met the eligibility criteria, and we included 10 studies for the quantitative synthesis. For anthocyanin-rich foods versus control interventions, the mean difference (MD) for low-density lipoprotein (LDL) was - 7.98 mg/dL (CI = - 15.20 to - 0.77, GRADE: Very low). For homeostatic model assessment for insulin resistance (HOMA-IR), the MD was 0.04 (CI = 0.08 to 0.16, GRADE: Moderate). The MD for interleukin 6 was 0.00 pg/mL (CI = - 0.01 to 0.00, GRADE: Low). For tumor necrosis factor alpha (TNF-α), the standardized mean difference (SMD) was - 0.52 pg/mL (CI = 0.85 to 0.19 GRADE: Very low) when compared with the control interventions. The certainty of the evidence for the other outcomes it is very low. CONCLUSION: Our findings suggest that anthocyanin-rich foods could improve certain cardiometabolic markers (e.g., TC, TG, LDL, and TNF-α) among individuals with MetS (with very low quality evidence according to GRADE), compared with placebo or other control interventions. PROSPERO REGISTRATION NUMBER: CRD42020187287.

Differential utility of various frailty diagnostic tools in non-geriatric hospital departments of several countries: A longitudinal study.

BACKGROUND: There is limited knowledge on the performance of different frailty scales in clinical settings. We sought to evaluate in non-geriatric hospital departments the feasibility, agreement and predictive ability for adverse events after 1 year follow-up of several frailty assessment tools. METHODS: Longitudinal study with 667 older adults recruited from five hospitals in three different countries (Spain, Italy and United Kingdom). Participants were older than 75 years attending the emergency room, cardiology and surgery departments. Frailty scales used were Frailty Phenotype (FP), FRAIL scale, Tilburg and Groningen Frailty Indicators, and Clinical Frailty Scale (CFS). Analyses included the prevalence of frailty, degree of agreement between tools, feasibility and prognostic value for hospital readmission, worsening of disability and mortality, by tool and setting. RESULTS: Emergency Room and cardiology were the settings with the highest frailty prevalence, varying by tool between 40.4% and 67.2%; elective surgery was the one with the lowest prevalence (between 13.2% and 38.2%). The tools showed a fair to moderate agreement. FP showed the lowest feasibility, especially in urgent surgery (35.6%). FRAIL, CFS and FP predicted mortality and readmissions in several settings, but disability worsening only in cardiology. CONCLUSIONS: Frailty is a highly frequent condition in older people attending non-geriatric hospital departments. We recommend that based upon their current feasibility and predictive ability, the FRAIL scale, CFS and FP should be preferentially used in these settings. The low concordance among the tools and differences in prevalence reported and predictive ability suggest the existence of different subtypes of frailty.

Recommendations and Effects of Rehabilitation Programs in Older Adults After Hospitalization for COVID-19: A Scoping Review.

ABSTRACT: The aims of this review were to identify studies on physical rehabilitation programs and describe the potential effects on functional outcomes in patients older than 60 yrs at discharge from acute care post-COVID-19. The literature search was conducted in the MEDLINE, Cochrane CENTRAL, EMBASE, PEDro, LILACS, CINAHL, SPORTDiscus, Web of Science, and The Living OVerview of Evidence (L-OVE) COVID-19 databases. Studies with patients older than 60 yrs, hospitalized with COVID-19, and admitted to a rehabilitation program after discharge from acute care were included. Ten studies were included with a total of 572 patients. The prevalence of patients who received post-intensive care rehabilitation was 53% (95% confidence interval, 0.27-0.79; P = 0.001). The rehabilitation program included physiotherapy in nine studies, occupational therapy in three studies, and psychotherapy in two studies. The rehabilitation programs increased aerobic capacity, functional independence in basic activities of daily living, muscle strength, muscle mass, dynamic balance, physical performance, pulmonary function, quality of life, cognitive capacity and mental health. Multidisciplinary rehabilitation programs are necessary for older adults after hospitalization for COVID-19, especially those coming from intensive care units, as rehabilitation has a positive effect on important clinical outcomes.

Pulmonary function is associated with frailty, hospitalization and mortality in older people: 5-year follow-up.

BACKGROUND: The relationship between pulmonary impairment and frailty has rarely been studied in community-dwelling older adults. OBJECTIVE: This study aimed to analyze the association between pulmonary function and frailty (prevalent and incident), identifying the best cut-off points to detect frailty and its association with hospitalization and mortality. METHODS: A longitudinal observational cohort study with 1188 community-dwelling older adults was taken from the Toledo Study for Healthy Aging. The forced expiratory volume in the first second (FEV1) and the forced vital capacity (FVC) were measured with spirometry. Frailty was evaluated using the Frailty Phenotype and Frailty Trait Scale 5. Associations between pulmonary function and frailty, hospitalization and mortality in a 5-year follow-up and the best cut-off points for FEV1 and FVC were analyzed. RESULTS: FEV1 and FVC were associated with frailty prevalence (OR from 0.25 to 0.60), incidence (OR from 0.26 to 0.53), and hospitalization and mortality (HR from 0.35 to 0.85). The cut-off points of pulmonary function identified in this study: FEV1 (≤1.805 L for male and ≤1.165 L for female) and FVC (≤2.385 L for male and ≤1.585 L for female) were associated with incident frailty (OR: 1.71-4.06), hospitalization (HR: 1.03-1.57) and mortality (HR: 2.64-5.17) in individuals with and without respiratory diseases (P < 0.05 for all). CONCLUSION: Pulmonary function was inversely associated with the risk of frailty, hospitalization and mortality in community-dwelling older adults. The cut-off points for FEV1 and FVC to detect frailty were highly associated with hospitalization and mortality in the 5-year follow-up, regardless of the existence of pulmonary diseases.

Healthcare cost expenditures associated to frailty and sarcopenia.

OBJECTIVES: Frailty and sarcopenia have been related with adverse events, including hospitalization. However, its combined effect with hospitalization-related outcomes, including costs, has not been previously investigated. Our purpose was to explore how frailty, sarcopenia and its interaction could impact on healthcare expenditures. METHODS: 1358 community-dwelling older adults from the Toledo Study of Healthy Ageing (TSHA) were included. Sarcopenia was measured using the Foundation for the National Institutes of Health criteria fitted to our cohort. Frailty was defined according to Frailty Trait Scale 5 (FTS5) and the Frailty Index fitted to the cut-off points of TSHA population. Hospitalization costs were taken from hospital records and costs were attributed according to Diagnostic-Related Groups, using as the cost base year 2015. Two-part regression models were used to analyze the relationship between frailty and sarcopenia and hospital admission, number of hospitalizations, length of stay and hospitalization costs. RESULTS: Sarcopenia was associated only with the probability of being admitted to hospital. Frailty was also associated with higher hospital use, regardless of the frailty tool used, but in addition increased hospital admission costs at follow-up by 23.72% per year and by 19.73% in the full model compared with non-frail individuals. The presence of sarcopenia did not increase the costs of frailty but, by opposite, frailty significantly increased the costs in people with sarcopenia, reaching by 46-56%/patient/year at follow-up. Older adults with frailty and sarcopenia had a higher risk of hospitalization, disregarding the tool used to assess frailty, and higher hospitalization costs (FTS5) in the full model, at the cross-sectional and at the follow-up level. CONCLUSIONS: Frailty is associated with increased hospitalization costs and accounts for the potential effects of sarcopenia.

Effectiveness of kinesiotaping in patients with subacromial impingement syndrome: A systematic review with meta-analysis.

OBJECTIVE: To determine the effectiveness of kinesiotaping (KT) with or without co-interventions for clinical outcomes in patients with subacromial impingement syndrome (SIS). DESIGN: Systematic review with meta-analysis of randomized clinical trials. DATA SOURCES: Eight databases (MEDLINE, CENTRAL, EMBASE, PEDro, LILACS, CINAHL, SPORTDiscus, and Web of Science) were searched from inception until March 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Clinical trials that determine the effectiveness of KT with or without co-interventions for clinical outcomes in patients with SIS who are older than 18 years of age. RESULTS: Ten trials for the quantitative analysis were included. For pain intensity at 1-3 weeks, the overall pooled MD was -0.73 cm, 95% CI = -1.50 to 0.04 (p = 0.06), and at 3-6 weeks, it was -0.13 cm, 95% CI = -1.37 to 0.36 (p = 0.25). For shoulder function, the MD was -0.02, 95%CI = -0.30 to 0.26 (p = 0.89). For shoulder Range of Motion (ROM) flexion, the MD was -16.70, 95% CI = -0.52 to 33.92 (p = 0.06). Additionally, there was a low to moderate quality of evidence according to the GRADE rating. CONCLUSION: Kinesiotaping with or without co-interventions was not superior to other interventions for improving shoulder pain intensity, function and ROM flexion in patients with SIS.

A Randomized Trial of Short-term Treatment with Folic Acid to Reduce the Oxidative Stress of Patients with Chronic Kidney Disease.

BACKGROUND: Increased generation of reactive oxygen and nitrogen species in chronic kidney disease (CKD) patients leads to increased oxidative stress. The antioxidant capacity of folic acid has been shown to scavenge radicals efficiently. OBJECTIVE: The current study was carried out to examine the effects of folic acid treatment on biochemical and oxidative stress biomarkers in patients in different stages of CKD. METHODS: This was a randomized, non-blinded, clinical trial that assessed the effects of 3 months of treatment with 5 mg of folic acid daily or no treatment in 113 outpatients within CKD stages 3a and 3b. At the end of the intervention, we analyzed the data of 66 patients treated with folic acid and 47 in the control group. Serum homocysteine levels and biochemical and oxidative/nitrosative stress biomarkers were analyzed in all patients. RESULTS: In most patients, folic acid treatment normalized homocysteine levels and increased antioxidant enzyme activity (paraoxonase 1) and decreased sulfhydryl (SH) groups. In addition, oxidative biomarkers (products of nitric oxide and lipid hydroperoxide) were significantly lower post-treatment compared to baseline in the active intervention group. In the no active intervention group, no statistically significant effects were found on the oxidative and biochemical biomarkers. CONCLUSION: Folic acid treatment in stages 3a-4 CKD patients effectively ameliorated their hyperhomocysteinemia and increased the activity of antioxidant enzymes, as well as decreased the levels of pro-oxidant biomarkers in stage G3a and G3b CKD patients. Folic acid treatment attenuated oxidative/nitrosative stress and may be considered as a possible strategy to improve redox status and diminish the damages associated with oxidative/nitrosative stress in CKD patients. Further studies are needed to confirm these findings. Clinical Trials Registration No.: This study is registered in the Brazilian Record of Clinical Trials (ReBEC), under reference RBR-2bfthr.

Relación entre la actividad física vigorosa y la composición corporal en adultos mayores / Relationship between vigorous physical activity and body composition in older adults

OBJETIVO: el objetivo del presente estudio fue analizar las relaciones entre la actividad física vigorosa y la composición corporal en personas mayores que asistían a centros de atención primaria. MATERIAL Y MÉTODOS: este estudio se caracteriza por ser un estudio epidemiológico descriptivo y transversal de 654 adultos mayores (288 hombres y 366 mujeres), la mayoría de ellos de 60 a 69 años (59 %), que asistían a centros de atención primaria en la ciudad de Maringá, Brasil. Los participantes fueron evaluados con el Cuestionario Internacional de Actividad Física (IPAQ), mediciones antropométricas y un cuestionario sociodemográfico para caracterizar la muestra. RESULTADOS: los ancianos que practican actividad física en los centros de atención primaria con intensidad vigorosa presentan mediciones más bajas de circunferencia abdominal, cintura, cadera, cuádriceps y pantorrilla en comparación con las personas mayores que practican actividad física de baja a moderada intensidad. CONCLUSIONES: la práctica de actividad física vigorosa está relacionada con bajos perímetros corporales (abdominal, cadera, cintura, pantorrilla) en las personas adultas mayores atendidas en centros de atención primaria

OBJECTIVE: the objective of the present study was to analyze the relationship between vigorous physical activity and body composition in older people who attend primary care centers. MATERIAL AND METHODS: this study is characterized by being a descriptive, cross-sectional epidemiological study in 654 older adults (288 men and 366 women), most of them between 60 and 69 years of age (59 %), attending primary care centers in the city of Maringá, Brazil. The participants were evaluated using the International Physical Activity Questionnaire (IPAQ), anthropometric measurements, and a sociodemographic questionnaire to characterize the sample. RESULTS: older adults who practice physical activities in primary care centers with vigorous intensity are associated with lower abdominal circumference, waist, hip, quadriceps, and calf measurements when compared to older people with low or moderate levels of physical activity. CONCLUSIONS: the practice of vigorous physical activity is related to low body perimeters (abdominal, hip, waist, calf) in older adults who attend primary care centers

NOVEL antioxidant and oxidant biomarkers related to sarcopenia in COPD.

BACKGROUND: The relation between oxidative stress (OS) and sarcopenia in COPD remains unknown. OBJECTIVE: To analyze OS levels and its association with sarcopenia in COPD. METHODS: Thirty-nine individuals with COPD (69±7years; 41%female) and thirty-five for the control group (69±7years; 43%female) were included. Advanced oxidation protein products (AOPP), paraoxonase-1 (PON1), superoxide dismutase activity (SOD), catalase dismutase activity (CAT), sulfhydryl group (SH), nitric oxide metabolites (NOX), total radical trapping antioxidant parameter (TRAP) were analysed. OS markers were correlated with handgrip and quadriceps strength, gait speed, skeletal muscle mass index, fat-free mass index, maximum inspiratory and expiratory pressure. European criteria were used to identify sarcopenia. RESULTS: In COPD, antioxidant capacity was correlated with muscle mass and strength (r from 0.5 to 0.64) P<0.05 for all. TRAP≤ 850 µM/trolox and AOPP≤65 µM/l were associated with sarcopenia (OR:8.3; 95% CI: 1.4-49.6 and OR:14; 95%CI: 2.2-87.1, respectively; P<0.05 for both). CONCLUSION: OS is associated with sarcopenia in COPD.

[Relationship between vigorous physical activity and body composition in older adults]. / Relación entre la actividad física vigorosa y la composición corporal en adultos mayores.

INTRODUCTION: Objective: the objective of the present study was to analyze the relationship between vigorous physical activity and body composition in older people who attend primary care centers. Material and methods: this study is characterized by being a descriptive, cross-sectional epidemiological study in 654 older adults (288 men and 366 women), most of them between 60 and 69 years of age (59 %), attending primary care centers in the city of Maringá, Brazil. The participants were evaluated using the International Physical Activity Questionnaire (IPAQ), anthropometric measurements, and a sociodemographic questionnaire to characterize the sample. Results: older adults who practice physical activities in primary care centers with vigorous intensity are associated with lower abdominal circumference, waist, hip, quadriceps, and calf measurements when compared to older people with low or moderate levels of physical activity. Conclusions: the practice of vigorous physical activity is related to low body perimeters (abdominal, hip, waist, calf) in older adults who attend primary care centers.

INTRODUCCIÓN: Objetivo: el objetivo del presente estudio fue analizar las relaciones entre la actividad física vigorosa y la composición corporal en personas mayores que asistían a centros de atención primaria. Material y métodos: este estudio se caracteriza por ser un estudio epidemiológico descriptivo y transversal de 654 adultos mayores (288 hombres y 366 mujeres), la mayoría de ellos de 60 a 69 años (59 %), que asistían a centros de atención primaria en la ciudad de Maringá, Brasil. Los participantes fueron evaluados con el Cuestionario Internacional de Actividad Física (IPAQ), mediciones antropométricas y un cuestionario sociodemográfico para caracterizar la muestra. Resultados: los ancianos que practican actividad física en los centros de atención primaria con intensidad vigorosa presentan mediciones más bajas de circunferencia abdominal, cintura, cadera, cuádriceps y pantorrilla en comparación con las personas mayores que practican actividad física de baja a moderada intensidad. Conclusiones: la práctica de actividad física vigorosa está relacionada con bajos perímetros corporales (abdominal, cadera, cintura, pantorrilla) en las personas adultas mayores atendidas en centros de atención primaria.

Sarcopenia, definición y diagnóstico: ¿Necesitamos valores de referencia para adultos mayores de Latinoamérica? / Sarcopenia, definition and diagnosis: do we need reference values in older adults from latin america?

La sarcopenia es uno de los principales síndromes geriátricos que está asociada con limitación en las actividades de la vida diaria, discapacidad y mortalidad en la población adulta mayor. Sin embargo, su definición, criterios diagnósticos y puntos de corte son diversos en la literatura, lo que dificulta el diagnóstico de la sarcopenia. El objetivo de esta revisión narrativa fue detectar en la literatura todos los consensos internacionales relacionados con sarcopenia, comparar su definición, criterios diagnósticos y puntos de corte, con el propósito de identificar una definición y criterios que puedan ser utilizados en Latinoamérica. Fueron identificados 7 consensos internacionales que han definido la sarcopenia como un síndrome/enfermedad caracterizado por la pérdida de la masa y función muscular asociada al proceso de envejecimiento. A pesar de tener una definición similar, no hay una total concordancia entre los criterios y evaluaciones. La sarcopenia puede ser detectada utilizando evaluaciones funcionales de fuerza muscular, velocidad de la marcha y equilibrio, que son frecuentemente utilizados por profesionales del área de la rehabilitación. Adicionalmente, el riesgo de sarcopenia puede ser identificado utilizando los cuestionarios SARC-F y SARC-CalF. Debido a su impacto funcional, la sarcopenia debería ser diagnosticada precozmente en adultos mayores por terapeutas ocupacionales, kinesiólogos y fisioterapeutas, para prevenir y tratar futuras complicaciones clínicas y funcionales en esta población. Es necesario la creación de valores de referencia para favorecer el diagnóstico de la sarcopenia en población latinoamericana.

Sarcopenia is one of the main geriatric syndromes that has been associated with limitation in activities of daily living, disability, and mortality in the elderly population. However, the definition, diagnostic criteria and cut-off points are diverse in the literature, which makes the diagnosis of sarcopenia difficult. The aim of this narrative review was to detect in the literature all the international consensus related to sarcopenia, to compare their definition, diagnostic criteria and cut-off points, in order to identify a definition and criteria that can be used in Latin America. Seven international consensuses were identified that have defined sarcopenia as a syndrome / disease characterized by loss of muscle mass and function associated with the aging process. Despite having a similar definition, there is not a total concordance between the criteria and evaluations. Sarcopenia can be detected using functional assessments of muscle strength, gait speed, and balance, which are frequently used by professionals in the area of rehabilitation. Additionally, the risk of sarcopenia can be assessed using SARC-F and SARC-CaF. Due to its functional impact, sarcopenia should be diagnosed early in older adults by occupational therapists, physical therapists and physiotherapists, to prevent and treat future clinical and functional complications in this population. The creation of reference values is necessary to favor the diagnosis of sarcopenia in the Latin American population.