Patterns and Correlates of Grip Strength in Older Americans.

BACKGROUND: Muscle strength is a sensitive indicator of morbidity and mortality in older adults. Loss of muscle strength contributes to a decline in physical functioning. Hand grip strength is a simple measurement but correlated with total body muscle strength. This study evaluated the patterns and correlates of grip strength among older adults in the United States. METHOD: The grip strength data were analyzed from the National Health and Nutrition Examination Survey. RESULT: Individuals (n=1009) aged ≥65 years old who had a grip strength measure were included in this analysis. Age distribution was 31.5%, 27.2%, 16.2%, and 25.0% for 65-69, 70-74, 75-79, and 80+ respectively. Race distribution was 81.1%, 8.3%, 7.1%, and 3.5% for Whites, Blacks, Hispanics, and Asians respectively. The mean grip strength was 71.7kg in males and 44.6kg in females, and declined as age increased (p<.0001). Blacks had the highest grip strength, followed by Whites and Hispanics, and Asians had the lowest measure (p<.0001). Although several variables were found to be correlated with grip strength univariately, after adjusting for gender, age, and race, the factors that remained significantly and independently associated with weak grip strength were lower body weight, not being in good health status, and physical limitations. CONCLUSION: Grip strength reduced as age increased. Blacks and Whites displayed higher grip strength than Asians and Hispanics. General health status, weight status and physical functioning were independently associated with grip strength. These findings suggest that grip strength could be a useful indicator for overall health assessment in older adults.

Epidemiology of Obesity in the Hispanic Adult Population in the United States.

Obesity is a major health concern in Hispanic populations. This study evaluated the epidemiology of obesity and associated factors among Hispanics using the data from the 2013-2014 National Health and Nutrition Examination Survey. Among the 1241 participants (20 years of age or older), the prevalence rates were as follows: overweight, 77.1%; obesity, 42.4%; and central obesity, 57.0%. These rates were consistent throughout most age groups. Significantly, more females than males were obese. Higher obesity rates were seen among those with diabetes, high cholesterol, hypertension, heart disease, and arthritis. Those born in the United States were more likely to be obese. Effective obesity prevention programs are vital for this population.

Patterns and correlates of grip strength change with age in Afro-Caribbean men.

BACKGROUND: muscle strength is essential for physical functions and an indicator of morbidity and mortality in older adults. Among the factors associated with muscle strength loss with age, ethnicity has been shown to play an important role. OBJECTIVE: to examine the patterns and correlates of muscle strength change with age in a population-based cohort of middle-aged and older Afro-Caribbean men. METHODS: handgrip strength and body composition were measured in 1,710 Afro-Caribbean men. Data were also collected for demographic variables, medical history and lifestyle behaviours. RESULTS: the age range of the study population was 29-89 years. Grip strength increased below age 50 years, and decreased after age 50 years over 4.5-year follow-up. The average loss in grip strength was 2.2% (0.49% per year) for ages 50 years or older and 3.8% (0.64% per year) for ages 65 years or older. The significant independent predictors of grip strength loss included older age, a greater body mass index, lower initial arm lean mass and greater loss of arm lean mass. CONCLUSION: Afro-Caribbean men experience a significant decline in muscle strength with advanced age. The major independent factors associated with strength loss were similar to other ethnic groups, including age, body weight and lean mass.

Prevalence and correlates of vitamin D deficiency in US adults.

Mounting evidence suggests that vitamin D deficiency could be linked to several chronic diseases, including cardiovascular disease and cancer. The purpose of this study was to examine the prevalence of vitamin D deficiency and its correlates to test the hypothesis that vitamin D deficiency was common in the US population, especially in certain minority groups. The National Health and Nutrition Examination Survey 2005 to 2006 data were analyzed for vitamin D levels in adult participants (N = 4495). Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D concentrations ≤20 ng/mL (50 nmol/L). The overall prevalence rate of vitamin D deficiency was 41.6%, with the highest rate seen in blacks (82.1%), followed by Hispanics (69.2%). Vitamin D deficiency was significantly more common among those who had no college education, were obese, with a poor health status, hypertension, low high-density lipoprotein cholesterol level, or not consuming milk daily (all P < .001). Multivariate analyses showed that being from a non-white race, not college educated, obese, having low high-density lipoprotein cholesterol, poor health, and no daily milk consumption were all significantly, independently associated with vitamin D deficiency (all P < .05). In summary, vitamin D deficiency was common in the US population, especially among blacks and Hispanics. Given that vitamin D deficiency is linked to some of the important risk factors of leading causes of death in the United States, it is important that health professionals are aware of this connection and offer dietary and other intervention strategies to correct vitamin D deficiency, especially in minority groups.

Epidemiology of lifetime work-related eye injuries in the U.S. population associated with one or more lost days of work.

PURPOSE: Eye injuries are one of the most common types of work-related injuries. This study examined the lifetime prevalence rate of eye injuries at work and associated factors in the general population of the United States. METHODS: The data from the 2002 National Health Interview Survey (NHIS) were analyzed for individuals aged 18 years or older (n = 28,913). Lifetime prevalence rates of work-related eye injuries were determined by different factors, calculated as the percentage of the weighted number of people who reported to have an eye injury at work divided by the weighted total number of people in the corresponding category. RESULTS: The overall lifetime prevalence rate of work-related eye injuries was 4.4%. The lifetime age-specific prevalence rates of work-related eye injuries ranged from 2%, 3.8%, 4.9%, 6.0%, 5.4%, 4.0%, and 3.1% for ages 18-24, 25-34, 35-44, 45-54, 55-64, 65-74, and 75+ years, respectively, with the highest rate in the age of 45-54 years. Men had a more than four-times higher rate of eye injury at work than women. Workers with less than a high-school education, non-Hispanic whites, self-employed, and in the midwest region were more likely to experience eye injuries (all p-values < 0.001). Occupations of precision production, transportation, or farming, and industries of mining or construction also increased the risk of eye injuries at work. CONCLUSION: Findings of the current study underscore the need of education and prevention program on eye protection at workplaces, targeting male workers, especially those who have a low education level and are self-employed.

Use of protective eyewear in U.S. adults: results from the 2002 national health interview survey.

PURPOSE: Many eye injuries occur because of not using protective eyewear. This study analyzed the 2002 National Health Interview Survey data to examine the rate of using protective eyewear during activities that could cause eye injuries outside the workplace and the correlates of not using protective eyewear among U.S. adults. METHODS: The rate of participation in activities that could cause eye injuries and the rate of protective eyewear use during these activities were estimated using sample weights to yield national estimates. RESULTS: A total of 30,894 individuals in the survey provided valid data for the current analysis, which revealed that 29.3% of the U.S. adults reported engaging in activities that could cause an eye injury and 32.1% of those used eye protection while doing such activities. Males were more likely to use eye protection than females (34.7% vs. 25.2%). The age group of 18-24 years was least likely to use eye protection (15.3%). Other factors associated with not using protective eyewear included being black or other races, non-retired individuals, and those from low-income families (all p-values < 0.05). CONCLUSIONS: Use of protective eyewear during activities that could cause eye injuries was relatively low in the US adult population. Certain groups were at a higher risk for not using eye protection, including females, young adults aged 18-24 years, black or other races, and individuals with a low socioeconomic status. To promote eye safety, health education programs should target these high-risk groups.

Prevalence and associated factors of overweight among Mexican-American adolescents.

The purpose of this study is to evaluate the prevalence of overweight and obesity and associated factors among Mexican-American adolescents, because obesity is more common among this ethnic group. The National Health and Nutrition Examination Survey 1999-2002 data were analyzed for Mexican-American adolescents aged 12 to 19 years (n=4,109). Weight status was determined by sex-specific body mass index for age, and evaluated in relationship to demographic characteristics, participation in physical activities, dietary intake, and general health status. Overall, 40.9% of the adolescents were overweight and 22.9% were obese. Males had a higher prevalence of overweight and obesity than females. Factors associated with overweight included being from a low-income family, perceiving oneself as less physically active compared to others of the same age, having a history of asthma, and having considerably higher blood pressure. However, overweight adolescents reported a substantially lower intake for calories and all evaluated nutrients compared to nonoverweight adolescents. It is important to be aware of the high prevalence of overweight among Mexican-American adolescents, as chronic diseases such as hypertension start early among overweight adolescents. Culturally appropriate programs should be created for this ethnic group aimed at obesity prevention and weight management, including nutrition education and individual dietary counseling, with the ultimate goal of lifelong healthful eating habits.

Gambling as an emerging health problem on campus.

OBJECTIVE: The authors documented the prevalence of gambling and correlates to health among undergraduates. METHODS: The authors analyzed data from a health-habit questionnaire (gambling questions included) given to students enrolled in a university-required course. RESULTS: Gambling and problems with gambling were more frequent among men than women regardless of venue. Athletes more frequently bet on sports and played games of chance, had gambling debt, and sought help for gambling than did nonathletes. More than 50% of fraternity members gambled and had a higher prevalence of gambling debt than did other men. Several gambling practices were correlated with failure to use seatbelts, driving or riding with someone under the influence, and using drugs (including cigarettes). Twice as many students who had gambling problems reported considering or attempting suicide than did those who did not report gambling problems, and gambling was correlated with depression. CONCLUSION: These results indicate that gambling is correlated with high-risk health behaviors and indicates the need for intervention for college students with gambling problems.

Patterns and correlates of muscle strength loss in older women.

BACKGROUND: The aging process is associated with progressive declines in muscle strength, resulting in functional disability and reduced quality of life. OBJECTIVE: The purpose of this epidemiological study was to examine the age-related loss of grip strength both cross-sectionally and longitudinally and the risk factors associated with the decline in muscle strength in a large population of community-living older women (aged 65-91 years). METHODS: Clinical visits, including physical examinations and lifestyle assessment, were conducted at baseline and biennially afterwards for a total of 10 years of follow-up. The upper-body muscle strength was measured by grip strength using a hand-held dynamometer. RESULTS: The muscle strength decreased cross-sectionally (n = 9,372) as well as longitudinally (n = 5,214), as age increased, and the decline in muscle strength measured during follow-up was greater than that measured cross-sectionally at baseline. The average loss of grip strength during 10 years of follow-up was 5.1 kg, equivalent to a rate of 2.4% decline per year, with the greatest loss seen in the oldest age group (80 years or older). Cross-sectional analysis revealed that the correlates of lower muscle strength included older age, greater weight, greater height loss since age 25 years, lower protein intake, difficulties in functional tasks, and lower physical activity. In longitudinal analysis, older age, baseline strength, weight and height loss during follow-up, difficulties in functional tasks, and lower physical activity were found to be significantly and independently associated with greater loss in grip strength during follow-up. CONCLUSIONS: Cross-sectional and longitudinal analyses of age-related loss of muscle strength yielded different rates of decline. In addition to older age and difficulties in functional tasks, a number of modifiable factors, including weight and physical activity, are associated with increased decline in muscle strength among older women.

Correlates of decline in lower extremity performance in older women: A 10-year follow-up study.

BACKGROUND: Decline in lower extremity performance increases the risk of functional disability. This study examined the correlates of decline in lower extremity performance in older women. METHODS: A total of 5178 women aged 65-91 years were recruited from population-based listings from four centers in the United States. Clinical examinations were performed and lifestyle information was obtained at baseline and 10 years later. Lower extremity performance was measured by walking speed (meters/second) and time (seconds) to complete five chair-stands. Changes were calculated by subtracting baseline values from follow-up values. RESULTS: During the 10-year follow-up period, walking speed declined 17% and time to complete five chair-stands increased 22% (p < .0001). The decline in performance during the follow-up increased with baseline age: women aged 65-69 years experienced an 11% decline in walking speed and a 16% increase in the time to complete five chair-stands, while women aged 80 years or older experienced a 37% decline in walking speed and a 38% increase in chair-stand time. After adjusting for age, baseline physical performance, greater weight, greater height loss, smoking, history of arthritis and diabetes, and use of thyroid and estrogen medications were independently related to greater declines in lower extremity performance. CONCLUSIONS: Lower extremity performance decreased dramatically with advancing age in older women. Effective management of common diseases, such as arthritis and diabetes, and a healthy lifestyle, including avoidance of smoking and weight control, could help older women maintain their lower extremity physical functions.

Patterns and determinants of muscle strength change with aging in older men.

Decreased muscle strength with aging is associated with functional disability in older adults. However, few studies have longitudinally evaluated the rate of muscle strength loss and the risk factors for the loss in older men. This study examined the patterns and determinants of muscle strength change with aging in a healthy older male population. The study participants were 321 men (age range 51-84 yrs) recruited from population-based listings in the Pittsburgh region, USA. Grip strength was measured at baseline and after an average of 7-years of follow-up. The amount of longitudinal rate of grip strength loss was 2.8% per year (a total of 20% decline during 7-year follow-up). Although all age groups experienced a decline in strength during follow-up, the rate of loss accelerated with age. After adjusting for baseline measurement, grip strength loss ranged from 2.0% decline per year for men aged < 60 years to 3.4% decline per year for men aged 70 years or older (p < .0001). Multivariate analyses revealed that besides older age, other risk factors also contributed to the loss of muscle strength in older men, including back pain, use of calcium channel blockers, caffeine intake, and height and weight loss.

Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes: 10-year follow-up data from the Pittsburgh Epidemiology of Diabetes Complications Study.

OBJECTIVE: To determine the independent risk factors for coronary artery disease (CAD) in type 1 diabetes by type of CAD at first presentation. RESEARCH DESIGN AND METHODS: This is a historical prospective cohort study of 603 patients with type 1 diabetes diagnosed before 18 years of age between 1950 and 1980. The mean age and duration of diabetes at baseline were 28 (range 8-47) and 19 years (7-37), respectively, and patients were followed for 10 years. Patients with prevalent CAD were excluded from the study. Electrocardiogram (ECG) ischemia was defined by Minnesota Code (MC) 1.3, 4.1-3, 5.1-3, or 7.1; angina was determined by Pittsburgh Epidemiology of Diabetes Complications (EDC) study physician diagnosis; and hard CAD was determined by angiographic stenosis > or =50%, revascularization procedure, Q waves (MC 1.1-1.2), nonfatal myocardial infarction (MI), or CAD death. RESULTS: A total of 108 incident CAD events occurred during the 10-year follow-up: 17 cases of ECG ischemia, 49 cases of angina, and 42 cases of hard CAD (5 CAD deaths, 25 nonfatal MI or major Q waves, and 12 revascularization or > or =50% stenosis). Blood pressure, lipid levels, inflammatory markers, renal disease, and peripheral vascular disease showed a positive gradient across the groups of no CAD, angina, and hard CAD (P < 0.01, trend analysis, all variables), although estimated glucose disposal rate (eGDR) and physical activity showed inverse associations (P < 0.01, trend analysis, both variables). In addition, depressive symptomatology predicted angina (P = 0.016), whereas HbA(1) showed no association with subsequent CAD. CONCLUSIONS: These data suggest that although the standard CAD risk factors are still operative in type 1 diabetes, greater glycemia does not seem to predict future CAD events. In addition, depressive symptomatology predicts angina and insulin resistance (eGDR) predicts hard CAD end points.

Glycemia (or, in women, estimated glucose disposal rate) predict lower extremity arterial disease events in type 1 diabetes.

The purpose of this study was to determine the predictors of lower extremity arterial disease (LEAD) events in a type 1 diabetes population. Data are from the Pittsburgh Epidemiology of Diabetes Complications Study of childhood onset type 1 diabetes. At baseline, the study population had a mean age 28 (range, 8 to 47) years and duration 19 (range, 7 to 37) years. LEAD events, assessed by questionnaire or clinical examination, were defined as claudication (Rose questionnaire), foot ulceration, or lower extremity amputation. Estimated glucose disposal rate (eGDR), a measure of insulin resistance, was calculated from glycosylated hemoglobin (HbA(1)), waist-to-hip ratio (WHR), and hypertension using an equation previously validated with hyperinsulinemic euglycemic clamp studies. There were incident LEAD events in 70 of 586 subjects during 10 years follow-up, giving an incidence density of 1.3 events/100 person-years. Incidence did not differ by gender. Major predictors of LEAD events were diabetes duration, low-density lipoprotein-cholesterol (LDL-C), heart rate, eGDR, log albumin excretion rate (AER), systolic blood pressure (SBP), hypertension, proliferative retinopathy, distal symmetric polyneuropathy, and overt nephropathy (each P <.001). HbA(1), low ankle brachial index (ABI) (<0.9), and a high ankle brachial difference (ABD) (SBP > or = 75 mm Hg) also predicted LEAD events. Cox modeling suggested that duration (P <.001), HbA(1) (P <.001), hypertension (P =.006), log albumin excretion rate (P =.011), and heart rate (P =.028) predicted events independently. The overall model with HbA(1) and hypertension was significantly better than with eGDR, while the alternate models in men were similar. In women, the model with eGDR showed a significantly better fit. Glycemia, insulin resistance, hypertension and renal disease are powerful predictors of symptomatic lower extremity arterial disease in type 1 diabetes.