Frailty, health-related quality of life and mental well-being in older adults with cardiometabolic risk factors.

OBJECTIVE: Frailty is an emergent health-related problem in older adults. The aim of this study was to examine the health-related quality of life (HRQOL) and the effect of frailty in elderly patients with cardiometabolic risk factors. METHODS: One-hundred and one patients 65 years or older responded to an HRQOL assessment using the World Health Organization Quality of Life (WHOQOL)-26 questionnaire. Frailty was assessed using two indices: the Hebrew Rehabilitation Center for Aged (HRCA) vulnerability index and the Vulnerable Elders Survey (VES) index. In addition, these patients completed self-rating questionnaires assessing mental well-being [the 28-item version of the General Health Questionnaire (GHQ-28)] and depression (Geriatric Depression Scale). RESULTS: Based on the combination of HRCA and VES indices, 24 subjects (23.7%) met the criteria of frail. Persons > or = 75 years old and those with depressive mood or lower creatinine clearance had significantly lower WHOQOL-26 scores than their counterparts. Diabetes and macrovascular complications did not associate with the WHOQOL-26 scores. Compared with non-frail patients, the frail scored lower on the WHOQOL-26 questionnaire after adjusting for age, kidney dysfunction and depressive mood. Frail patients also reported significantly higher the GHQ-28 scores compared with non-frail patients. CONCLUSIONS: Frail older adults had a significant lower HRQOL, as well as lower mental well-being, independent of age, diabetes, macrovascular complication, kidney dysfunction and depressed mood.

New "pre-diabetes" category and the metabolic syndrome in Japanese.

BACKGROUND: Recently, impaired fasting glucose (IFG) was redefined as fasting plasma glucose of 100-125 mg/dl, and individuals with IFG and/or impaired glucose tolerance (IGT) were referred to as having "pre-diabetes". However, there is a lack of data using the new definition of IFG and "pre-diabetes". OBJECTIVE: The aim of this study was to examine associations of the metabolic syndrome components with the new "pre-diabetes" category in relatively lean Japanese. METHODS: Six hundred and sixty-one Japanese study participants underwent a 75 g oral glucose tolerance test. They were classified into three groups-normal (n=225), pre-diabetes (n=308), and diabetes (n=128). The metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III, as modified for waist circumference criteria by the Regional Office for the Western Pacific Region of WHO. RESULTS: Prevalence of the metabolic syndrome in each group was 10.7%, 27.9%, and 53.9%, respectively. Of the metabolic syndrome components, the OR for prevalent pre-diabetes was 2.00 (95% CI, 1.73-2.31, p<0.001) for fasting glucose, 1.93 (95% CI, 1.54-2.42, p<0.001) for waist circumference, and 1.36 (95% CI, 1.10-1.68, p=0.005) for triglycerides. Similar associations were found in prevalent diabetes. Insulin resistance assessed using Stumvoll's index was significantly associated with both pre-diabetes and diabetes. CONCLUSION: Pre-diabetes and the metabolic syndrome frequently coexist in relatively lean Japanese. This association seems to link with abdominal adiposity and insulin resistance.

Beta-cell function and insulin sensitivity contribute to the shape of plasma glucose curve during an oral glucose tolerance test in non-diabetic individuals.

To clarify whether beta-cell function and/or insulin resistance contributes to the shape of plasma glucose curve during an oral glucose tolerance test (OGTT), we investigated 583 Japanese subjects with normal glucose tolerance (NGT, n = 306) or impaired glucose tolerance (IGT, n = 277). Each subject was subdivided into three shapes of plasma glucose curve as follows: monophasic pattern (M type), biphasic pattern (B type) and two peaks (T type). Homeostasis model assessment of insulin resistance, quantitative insulin sensitivity check index and insulinogenic index were assessed by plasma glucose and insulin concentrations obtained at fasting or during an OGTT. There was a greater proportion of M type in the IGT group (M = 80.9%, B = 15.5% and T = 3.6%), whereas the prevalence of B and T types was much higher in the NGT group (M = 66.6%, B = 26.5% and T = 6.9%). There were significant differences in the proportions of shape types between the NGT and IGT groups (p = 0.0006). Among the NGT category, insulin sensitivity was significantly higher in the B type than in the M type, and beta-cell function adjusted for insulin resistance was significantly higher in the B and T types than in the M type. Among the IGT category, no significant differences were seen among the three shape types with respect to insulin sensitivity, but the beta-cell function adjusted for insulin resistance was significantly lower in the M type than in the B and T types. In conclusion, both impaired insulin secretion and insulin resistance may contribute to the underlying mechanisms of the shape of plasma glucose curve in Japanese subjects.

[Clinical study on tissue polypeptide antigen (TPA) in gastric cancer].

We evaluated whether assay of tissue polypeptide antigen (TPA) in the serum ia valuable for the determination of cancer stages compared to other tumor markers such as CEA, AFP, and ferritin. The study population consisted of 79 gastric cancer patients and 212 patients with benign gastroenteric disease. The percentage of positive cases for TPA (higher than 200u/l) was 41% in gastric cancer and 20% in active peptic ulcer. Serum TPA levels in well differentiated carcinoma and signet ring cell carcinoma were higher than that in other histological types. Serum TPA levels correlated well with the stage of the gastric cancer.

[Clinical study on tissue polypeptide antigen (TPA) as a tumor marker].

We evaluated whether assay of tissue polypeptide antigen (TPA) in sera is valuable for the determination of cancer stages compared to other tumor markers such as CEA, AFP, beta2-microglobulin, ferritin, and elastase-1. The study population consisted of cancer patients (33 gastric cancers, 7 colo-rectal cancers and 15 hepatomas), 169 patients with benign gastro-enteric diseases and 72 healthy volunteers. The percentage of positive cases for TPA (higher than 200 u/l) was 61% in gastric cancer, 71% in colo-rectal cancer and 87% in hepatoma. In certain non-cancerous conditions, such as gastric ulcer (active stage), acute hepatitis and chronic hepatitis, the TPA levels were increased over the level of healthy volunteers. There was no significant correlation between TPA and the other tumor markers. Our study suggests that TPA may be useful in the identification and evaluation of cancer patients.