The association between cardiovascular risk factors and major cardiovascular diseases decreases with increasing frailty levels in geriatric outpatients.

BACKGROUND: Frailty marks a process of increasing dysregulation of physiological systems which increases the risk of adverse health outcomes. This study examines the hypothesis that the association between multiple cardiovascular risk factors (CVRF) and cardiovascular diseases (CVD) becomes stronger with increasing frailty severity. METHODS: Cross-sectional analysis of 339 older adults (55.2% women; aged 75.2 ±â€¯9.1 years) from an outpatient geriatric clinic from a middle-income country. The frailty index (FI) was calculated as the proportion of 30 possible health deficits. We assessed hypertension, diabetes, obesity, dyslipidemia, sedentarism and smoking as CVRF (determinants) and myocardial infarction, stroke, heart failure as CVD. Poisson regression models adjusted for age, sex, and education was applied to estimate the association between frailty as well as CVRF (independent variables) with CVD (dependent variable). RESULTS: Of the 339 patients, 18,3% were frail (FI ≥ 0.25) and 32.7% had at least one CVD. Both frailty and CVRF were significantly associated with CVD (PR = 1.03, 95% CI 1.01 to 1.05; p = 0.001, and PR = 1.46, 95% 1.24 to 1.71; p < 0.001, respectively) adjusted for covariates. The strength of the association between CVRF and CVD decreased with increasing frailty levels, as indicated by a significant interaction term of frailty and CVRF (p < 0.001). CONCLUSION: Frailty and CVRF are both associated with CVD, but the impact of CVRF decreases in the presence of frailty. When confirmed in longitudinal studies, randomized controlled trials or causal inference methods like Mendelian randomization should be applied to assess whether a shift from traditional CVRF to frailty would improve cardiovascular outcome in the oldest old.

Cadmium and lead levels consumed by patients with oral hospital diets prescriptions.

INTRODUCTION: The levels of cadmium (Cd) and lead (Pb) in foods should be monitored as a function of health risks. OBJECTIVE: To evaluate Cd and Pb levels in oral hospital diets and in an oral food complement (OFC) according to their respective consumption by patients, and to estimate the patient's exposition risk. METHODS: The levels of Cd and Pb were determined by ICP-OES in samples of regular, blend, soft and renal diets and OFC, collected on 6 weekdays. About 14.3% of the diets and OFC served were analyzed. RESULTS AND DISCUSSION: 163 patients participated, with mean weights and ages of 62.7 kg and 56.5 years, respectively, the majority being men (59.5%). The mean Cd content consumed was greater for men fed the regular and blend diets and similar amongst the sexes for the soft diet. The consumption of Cd (max. 21.02 µg/day) was below the provisional tolerable monthly intake (PTMI). The mean Pb ingested (max. 199.49 µg/day) was similar amongst the sexes. The soft diet showed the highest Pb content in September/2010, whereas the other showed no variation according to season. In September/2010 and January/2011, the soft and regular diets associated with the OFC offered 207.50 and 210.50 µg/day of Pb, respectively. CONCLUSIONS: The combination of the diet with the OFC increased the risk of an excessive ingestion of Pb, and the vulnerability of the patients to an excessive exposition to Pb could be greater due to water and medications. It was concluded that whereas the calculated ingestion of Cd conformed to the PTMI, the Pb level and ingestion represented a risk to the health of the patients.

Cadmium and lead levels consumed by patients with oral hospital diets prescriptions / Niveles de cadmio y plomo consumidos por pacientes que reciben dietas hospitalarias orales

Introduction: The levels of cadmium (Cd) and lead (Pb) in foods should be monitored as a function of health risks. Objective: To evaluate Cd and Pb levels in oral hospital diets and in an oral food complement (OFC) according to their respective consumption by patients, and to estimate the patient’s exposition risk. Methods: The levels of Cd and Pb were determined by ICP-OES in samples of regular, blend, soft and renal diets and OFC, collected on 6 weekdays. About 14.3% of the diets and OFC served were analyzed. Results and Discussion: 163 patients participated, with mean weights and ages of 62.7 kg and 56.5 years, respectively, the majority being men (59.5%). The mean Cd content consumed was greater for men fed the regular and blend diets and similar amongst the sexes for the soft diet. The consumption of Cd (max. 21.02 μg/day) was below the provisional tolerable monthly intake (PTMI). The mean Pb ingested (max. 199.49 μg/day) was similar amongst the sexes. The soft diet showed the highest Pb content in September/2010, whereas the other showed no variation according to season. In September/2010 and January/2011, the soft and regular diets associated with the OFC offered 207.50 and 210.50 μg/day of Pb, respectively. Conclusions: The combination of the diet with the OFC increased the risk of an excessive ingestion of Pb, and the vulnerability of the patients to an excessive exposition toPb could be greater due to water and medications. It was concluded that whereas the calculated ingestion of Cd conformed to the PTMI, the Pb level and ingestion represented a risk to the health of the patients (AU)

Introducción: Los niveles de cadmio (Cd) y plomo (Pb)en los alimentos deben ser controlados en función del riesgo para la salud. Objetivo: Evaluar los niveles de Cd y Pb en dietas hospitalarias orales y complemento alimentario oral (OFC) y sus ingestiones por pacientes, con estimativa del riesgo de exposición. Métodos: Los niveles de Cd y Pb se determinaron mediante ICP-OES en muestras de dietas regular, blanda, fluida, renal y OFC, recogidas 6 días non-consecutivos. Fueron analizados 14,3% de las dietas y OFC servidos. Resultados y Discusión: 163 pacientes participaron, con pesos y edades medias de 62,7 kg y 56,5 años, respectivamente, en su mayoría varones (59,5%). La media de Cd consumida fue mayor entre hombres alimentados con dietas regular y fluida y similar entre los sexos para la blanda. El consumo de Cd (máx. 21,2 μg/día) estaba por debajo de la ingesta provisional mensual tolerable(IPMT). El contenido medio de Pb ingerido fue similar entre sexos (máx. 199,49 μg/día). La dieta blanda mostró mayor contenido de Pb en septiembre/2010, mientras quelas otras no variaron según la temporada. En septiembre/2010 y enero/2011, las dietas regular y blanda asociadas al OFC aportaron 207,50 y 210,50 μg/día de Pb, respectivamente. Conclusiones: La combinación de la dieta con OFC aumentó el riesgo de ingestión excesiva de Pb. La vulnerabilidad de los pacientes a una exposición excesiva podría ser mayor en función del agua y medicamentos. La ingestión de Cd calculada cumple el IPMT, pero el nivel de Pb y su ingestión representan riesgo para los pacientes (AU)