Function In Community-dwelling Adults Research Articles

Abstract 15976: Age and Sex Differences in the Association of Habitual Physical Activity With Cardiovascular Structure and Function in Community-Dwelling Adults

Introduction: The association of habitual physical activity (PA) with subclinical cardiovascular remodeling and their modifications by age and sex are not well understood in community-dwelling adults. Methods: We studied 5685 (mean age 49±15 y, 53% F) participants of the Framingham Heart Study 2 nd generation Exam 8 (2005-2008) and 3 rd generation Exam 1 (2002-2005) without cardiovascular disease (CVD) and with PA, echocardiography [left ventricular mass, volume (LVM, LVEDV)], and applanation tonometry (aortic stiffness, carotid-femoral pulse wave velocity [CFPWV]. PA was assessed using a validated activity questionnaire. We assessed the relationship of PA to echocardiographic and vascular stiffness measures using linear regression adjusting for CVD risk factors and evaluated age and sex interactions on these relations. Results: Higher PA was overall associated with greater LVM (p<0.0001) and LVEDV (p<0.0001), which appeared driven by those aged <48 years of age (p<0.0001) and men (p≤0.0002 for both LVM and LVEDV) [ TABLE ]. In women, PA was associated with higher LVM (p=0.02) but not LVEDV (p=0.09). There was a borderline inverse association of PA with PWV (p=0.05). In contrast to the association of PA with LV structure, the associations of PA with PWV were significant among age ≥48 years (p=0.005) and women (p=0.008). Conclusions: In a large sample of adults in the community, we observed divergent associations of habitual PA with ventricular and vascular remodeling between age and sex groups. The mechanisms of these differential associations and impact on outcomes deserve further study.

Exploratory and confirmatory factor analyses identify three structural dimensions for measuring physical function in community-dwelling older adults.

Physical function is a strong indicator of biological age and quality of life among older adults. However, the results from studies exploring the structural dimensions of physical function are inconsistent, and the measures assessed vary greatly, leading to a lack of comparability among them. This study aimed to construct a model to identify structural dimensions that are suitable and best assess physical function among community-dwelling adults 60-74 years of age in China. This study was conducted in 11 communities in Shanghai, China, from May to July 2021. A total of 381 adults 60-74 years of age were included in the study. Measured physical function data were used in factor analyses. Data collected from individuals were randomly assigned to either exploratory factor analysis (EFA) (n=190) or confirmatory factor analysis (CFA) (n=191). The statistical software used in the study was SPSS for EFA and AMOS for CFA. To test the properties of the structural dimension model of physical function, various fit indices, convergent validity, and discriminant validity were calculated. The EFA results derived seven indicators in three factors, with 58.548% of the total variance explained. The three factors were mobility function (three indicators), which explained 26.380% of the variance, handgrip strength and pulmonary function (two indicators), which explained 19.117% of the variance, and muscle strength (two indicators) which explained 13.050% of the variance. The CFA indicated that this model had an acceptable fit (χ2/df ratio, 2.102; GFI, 0.967; IFI, 0.960; CFI, 0.959; and RMSEA, 0.076), and the criteria for convergent validity and discriminability were also met by the model. The constructed structural dimension model of physical function appeared to be a suitable and reliable tool to measure physical function in community-dwelling adults aged 60-74 years in China. The structural dimension indicators identified by this model may help sports medicine experts and healthcare providers offer more targeted interventions for older adults to reverse or slow the decline of physical function and to offer actionable targets for healthy aging in this population.

Association between Malnutrition Risk Factors and Physical Function in Community-Dwelling Adults ≥80 Years

Malnutrition is associated with accelerated loss of physical function in old adults, but the assessment of malnutrition in primary prevention is challenging. This study aimed to investigate if malnutrition risk factors; poor appetite, dysphagia, and poor dental state, were associated with reduced physical function in community-dwelling adults ≥80 years. The study is based on data from two cross-sectional studies. Physical function was assessed by the Short Physical Performance Battery (score ≤ 9 indicate reduced physical function) and poor appetite, dysphagia and poor dental status was assessed by single questions. A total of 900 participants were included (age 85.1 ± 3.7 years; 60.9% females; 62.8% had reduced physical function). Participants with reduced physical function were older, had a higher BMI, more polypharmacy, more falls, and lower quality of life. Poor appetite was reported by 10.8% and associated with reduced physical function (adjusted-OR 1.93, 95%CI 1.18–3.15). No association was identified between dysphagia, poor dental state and reduced physical function (adjusted-OR 0.96, 95%CI 0.53–1.75 and adjusted-OR 0.99, 95%CI 0.41–2.35, respectively). The assessment of appetite during primary preventive strategies was feasible and may offer an opportunity for identification of very old community-dwelling adults at risk of reduced physical function.

Association Between Social Participation and Cognitive Function in Community-Dwelling Adults.

Social participation is associated with cognitive function; however, their causal relationships have not been reported yet. This study was designed to examine the autoregressive effects and bidirectional causal relationship between social participation and cognitive function. In this secondary longitudinal data analysis, we enrolled 4,834 Korean adults. A cross-lagged panel model with fixed effects was used to examine the causal relationships between social participation and cognitive function. Both participation (unstandardized coefficient = .370, p < .001) and cognitive function (unstandardized coefficient = .151, p < .001) had positive autoregressive effects over time. Participation had a cross-lagged effect on cognitive function (unstandardized coefficient = .061, p < .001). However, the cross-lagged effects of cognitive function on participation were not statistically significant (unstandardized coefficient = .051, p = .312). Various health-care programs that promote social participation and improve cognitive function must be established. Additional studies are required to confirm the causal effects of cognitive function on participation.

Evaluating the Impact of a Regional Student-Led Physiotherapy Clinic Model to Improve Self-Reported Function in Community-Dwelling Adults With Neurological Diagnoses.

Neurological conditions are a major cause of health morbidity that negatively impacts function and quality of life (QoL). Despite this burden, community services are disproportionally scarce. Student-led physiotherapy services (SLSs) are a model that can increase community access to health care while providing authentic clinical experiences for students. SLSs consistently demonstrate high client satisfaction; however, limited evaluation of the impact of this model on the client's clinical outcomes exists. Therefore the aim of this project was to evaluate the impact of a physiotherapy student-led community-based rehabilitation service. The SLS operated 4 days a week over a 15-week period. Forty-two community-dwelling clients (mean age 74 years) with a neurological diagnosis were included. During initial consultation, participants completed basic demographics, up to 3 Patient-Specific Functional Scales (PSFSs) and a QoL questionnaire (World Health Organization Quality of Life-Brief Questionnaire [WHOQOL-BREF]). At discharge, participants completed the WHOQOL-BREF, PSFS, and a patient experience survey. Risk event data were also collected. Over half of the PSFS items targeted mobility (55%). There was a significant improvement (P < 0.05) in median change (quartiles) for pre-/post-PSFS scores for clients whose primary condition was balance 1.0 (0.0-3.0), cerebrovascular accident 1.0 (2.0-3.0) or multiple Sclerosis 1.0 (1.0-2.0), and mean (SD) WHOQOL-BREF scores for Physical Health (12.2 ± 1.5 to 13.1 ± 1.3) and Social Relationships (12.7 ± 2.7 to 16.6 ± 3.3). Patient experience survey results indicated that clients had confidence and trust in students. No adverse events were reported. The SLS model provides a strategy to increase access to health care and clinical placement capacity. Findings demonstrated improved self-rated function, QoL, and positive patient experience for community-dwelling clients with nonacute neurological diagnoses.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A380).

009 Self-Reported Sleep Efficiency and Duration are Associated with Systemic Bioenergetic Function in Community-Dwelling Adults

Abstract Introduction Sleep is important for aging, health, and disease, but its cellular role in these outcomes is poorly understood. Basic research suggests that disturbed and insufficient sleep impair mitochondrial bioenergetics, which is involved in numerous aging-related chronic conditions. However, the relationship between sleep and bioenergetics has not been examined in humans. We examined associations of self-reported sleep with systemic bioenergetic function in peripheral blood mononuclear cells (PBMCs) of community-dwelling adults. Methods N = 43 adults (79% female) ages 48–70 (M = 61.63, SD = 5.99) completed the Pittsburgh Sleep Quality Index (PSQI) from which key components of sleep (satisfaction, alertness, timing, efficiency, and duration) were calculated. Participants provided blood samples from which PBMCs were isolated and measured for bioenergetics using extracellular flux analysis. Associations of sleep components with bioenergetic parameters, including the Bioenergetic Health Index (BHI), were examined. Results In bivariate analyses, lower sleep efficiency was associated with lower maximal respiration, spare capacity, and BHI (ps &amp;lt; 0.05). Longer sleep duration was associated with lower BHI (p &amp;lt; 0.01) and later sleep timing was associated with higher basal respiration, ATP-linked respiration, maximal respiration, spare capacity, and non-mitochondrial respiration (ps &amp;lt; 0.05). After adjustment for age, sex, and body mass index, lower sleep efficiency (β = 0.52, p &amp;lt; 0.01) and longer sleep duration (β = -0.43, p &amp;lt; 0.01) were associated with lower BHI. Conclusion Self-reported indices of sleep efficiency and duration are related to systemic bioenergetic function in humans, suggesting a possible cellular pathway linking sleep to health. Support (if any) T32HL082610

Relationship of Decrease in Frequency of Socialization to Daily Life, Social Life, and Physical Function in Community-Dwelling Adults Aged 60 and Over after the COVID-19 Pandemic.

The study is cross-sectional in nature and aims to investigate the relationship of the frequency of socialization (FOS) to the daily life, social life, and physical function of community-dwelling adults aged 60 and over after the COVID-19 outbreak. A self-reported questionnaire survey was conducted on 3000 members of CO-OP Kagoshima, out of which 342 responses were received. Bivariate statistics was conducted followed by multiple logistic regression analysis. Questions with significant differences were set as independent variables, whereas the FOS was set as the dependent variable. Results indicate significant group differences between the decreased and increased/unchanged groups. After adjusting for potential covariates, multiple logistic regression analysis revealed decreases in the frequencies of cooking (OR: 0.07; 95% CI: 0.01–0.69; p = 0.02), shopping (OR: 18.76; 95% CI: 7.12–49.41; p < 0.01), and eating out (OR: 3.47; 95% CI: 1.21–9.97; p = 0.02), which were significantly associated with decreased FOS. The finding may inform policy making in identifying priorities for support in daily life for community-dwelling adults over the age of 60 undergoing social distancing.

Urinary Phosphate Excretion and Microvascular Function in a Population-Based Cohort

Urinary Phosphate Excretion and Microvascular Function in a Population-Based Cohort

Sarc-F and muscle function in community dwelling adults with aged care service needs: baseline and post-training relationship.

BackgroundThis study sought to better understand the psychometric properties of the SARC-F, by examining the baseline and training-related relationships between the five SARC-F items and objective measures of muscle function. Each of the five items of the SARC-F are scored from 0 to 2, with total score of four or more indicative of likely sarcopenia.MethodsThis manuscript describes a sub-study of a larger step-wedge, randomised controlled 24-week progressive resistance and balance training (PRBT) program trial for Australian community dwelling older adults accessing government supported aged care. Muscle function was assessed using handgrip strength, isometric knee extension, 5-time repeated chair stand and walking speed over 4 m. Associations within and between SARC-F categories and muscle function were assessed using multiple correspondence analysis (MCA) and multinomial regression, respectively.ResultsSignificant associations were identified at baseline between SARC-F total score and measures of lower-body muscle function (r = − 0.62 to 0.57; p ≤ 0.002) in 245 older adults. MCA analysis indicated the first three dimensions of the SARC-F data explained 48.5% of the cumulative variance. The initial dimension represented overall sarcopenia diagnosis, Dimension 2 the ability to displace the body vertically, and Dimension 3 walking ability and falls status. The majority of the 168 older adults who completed the PRBT program reported no change in their SARC-F diagnosis or individual item scores (56.5–79.2%). However, significant associations were obtained between training-related changes in SARC-F total and item scores and changes in walking speed and chair stand test performance (r = − 0.30 to 0.33; p < 0.001 and relative risk ratio = 0.40–2.24; p < 0.05, respectively). MCA analysis of the change score data indicated that the first two dimensions explained 32.2% of the cumulative variance, with these dimensions representing whether a change occurred and the direction of change, respectively.DiscussionThe results advance our comprehension of the psychometric properties on the SARC-F, particularly its potential use in assessing changes in muscle function. Older adults’ perception of their baseline and training-related changes in their function, as self-reported by the SARC-F, closely matched objectively measured muscle function tests. This is important as there may be a lack of concordance between self-reported and clinician-measured assessments of older adults’ muscle function. However, the SARC-F has a relative lack of sensitivity to detecting training-related changes, even over a period of 24 weeks.ConclusionsResults of this study may provide clinicians and researchers a greater understanding of how they may use the SARC-F and its potential limitations. Future studies may wish to further examine the SARC-F’s sensitivity of change, perhaps by adding a few additional items or an additional category of performance to each item.

Epidemiology of vestibulo-ocular reflex function: data from the Baltimore Longitudinal Study of Aging.

To determine age-related changes in vestibulo-ocular reflex (VOR) function in community-dwelling adults, and evaluate these for associations with demographic characteristics and cardiovascular risk factors. Cross-sectional analysis within the Baltimore Longitudinal Study of Aging (BLSA), a longitudinal prospective cohort study. Vestibular testing laboratory within an acute care teaching hospital. Community-dwelling adults enrolled in the BLSA. Horizontal VOR gain measurement using video head-impulse testing and visual acuity testing. VOR gain was calculated as the ratio of eye velocity to head velocity. Demographic and cardiovascular risk factor data were collected through study questionnaires. One hundred nine subjects were analyzed with mean age (SD) 69.9 years (14.2), with a range from 26 to 92 years. VOR gain remained stable from age 26 to 79 after which it significantly declined at a rate of 0.012/year (p = 0.033) in adjusted analyses. Individuals aged 80 years or older had a nearly 8-fold increased odds of VOR gain less than 0.80 relative to those aged less than 80 years in multivariate models (prevalence of 13.2% vs. 2.8%; OR 7.79, 95% CI: 1.04-58.38). Otherwise, VOR gain did not differ significantly across demographic or cardiovascular risk groups. We report age-related decline in VOR function in individuals aged 80 years and older. Further analyses are in progress to establish the significance of these VOR abnormalities to functional and mobility outcomes in older individuals.

The relationship between sleep and physical function in community-dwelling adults: a pilot study.

More than 50% of community-dwelling adults have sleep complaints. Because aging is associated with decline in physical function, coexistent sleep difficulties may exacerbate functional decline. This pilot study explored the relationships between sleep, age, chronic disease burden, and physical function among 50 community-dwelling older adults. Findings revealed significant relationships between total sleep time and preclinical disability (r = -0.33, P ≤ .05) and mobility difficulty (r = -0.36, P ≤ .05). A regression analysis showed that total sleep time was significantly associated with mobility difficulty and preclinical disability, even after controlling for chronic disease burden. These findings suggest that total sleep time may be a catalyst for functional decline.

Tooth Loss May Predict Poor Cognitive Function in Community-Dwelling Adults without Dementia or Stroke: The PRESENT Project

Periodontal disease is a potential predictor of stroke and cognitive impairment. However, this association is unclear in adults aged 50 yr and above without a history of stroke or dementia. We evaluated the association between the number of teeth lost, indicating periodontal disease, and cognitive impairment in community-dwelling adults without any history of dementia or stroke. Dental examinations were performed on 438 adults older than 50 yr (315 females, mean age 63±7.8 yr; 123 males, mean age 61.5±8.5 yr) between January 2009 and December 2010. In the unadjusted analysis, odds ratios (OR) of cognitive impairment based on MMSE score were 2.46 (95% CI, 1.38-4.39) and 2.7 (95% CI, 1.57-4.64) for subjects who had lost 6-10 teeth and those who had lost more than 10 teeth, respectively, when compared with subjects who had lost 0-5 teeth. After adjusting for age, education level, hypertension, diabetes, hyperlipidemia, and smoking, the relationship remained significant (OR, 2.0; 95% CI, 1.08-3.69, P=0.027 for those with 6-10 teeth lost; OR, 2.26; 95% CI, 1.27-4.02, P=0.006 for those with more than 10 teeth lost). The number of teeth lost is correlated with cognitive impairment among community-dwelling adults aged 50 and above without any medical history of stroke or dementia.

Abstract P174: Kidney Function and Progression of Coronary Artery Calcification in Community-Dwelling Older Adults: The Rancho Bernardo Study

Background: Despite growing evidence for the separate and joint contributions of declining estimated glomerular filtration rate (eGFR) and presence of albuminuria to cardiovascular death, longitudinal studies of the association of these risk factors with coronary artery calcification, a marker of subclinical cardiovascular disease (CVD), are contradictory. Methods: We evaluated 421 community-dwelling men and women (mean age 67 years) without known heart disease who had eGFR estimated by the Modification of Diet in Renal Disease equation and albuminuria assessed by urine albumin/creatinine ratio (ACR) between 1997-99. Coronary artery calcium (CAC) was measured by electron beam computed tomography between 2001-02; 338 participants returned for a repeat scan between 2005-06, a mean of 4.5 (0.5) years later. CAC progression was defined as a difference between the follow-up square-root transformed CAC volume score and the baseline square-root transformed score &gt; 2.5 mm 3 . Results: At baseline, mean eGFR was 78 mL/min/1.73m 2 , median ACR was 10 mg/g. Median total Agatston CAC score was 77 at the baseline scan and 112 at follow-up; 45% (191 of 421) of participants had CAC&gt;100 at baseline and 46% (157 of 338) showed CAC progression. Logistic regression analyses showed no separate or joint association between eGFR or ACR with baseline CAC or with CAC progression. Table 1 shows the odds ratio (95% CI) for CAC progression for each 1 SD decrease in eGFR or increase in ACR. Conclusions: In a cohort of community-dwelling older adults, we found no longitudinal association between eGFR or ACR with CAC progression. This information may enhance our understanding of CAC progression across the spectrum of kidney function in community-dwelling adults without prevalent CVD or kidney disease. 4 Year CAC Progression per 1 SD Decrease in eGFR or Increase in ACR 1997-99 Estimated Glomerular Filtration Rate Urine Albumin/Creatinine Ratio (n=338) (n=292) Covariates Odds Ratio (95% CI) p value Odds Ratio (95% CI) p value Model 1 1.07 (0.86, 1.33) 0.54 0.99 (0.78, 1.26) 0.93 Model 2 1.04 (0.84, 1.30) 0.69 0.97 (0.77, 1.24) 0.82 Model 3 1.06 (0.85, 1.33) 0.57 1.06 (0.82, 1.37) 0.67 Model 4 1.07 (0.85, 1.33) 0.57 1.05 (0.81, 1.36) 0.69 Model 5 1.05 (0.82, 1.36) 0.68 1.06 (0.82, 1.38) 0.66 Model 6 1.10 (0.83, 1.43) 0.53 0.99 (0.75, 1.30) 0.94 Model 1: Unadj; Model 2: Age, time lapse adj; Model 3: Age, time lapse, sex adj; Model 4: Age, timelapse, sex, BMI adj; Model 5: Age, time lapse, sex, BMI and (eGFR or ACR) adj; Model 6: Age, time lapse, sex, BMI, SBP, FPG, HDL and (eGFR or ACR) adj

Elevated Natriuretic Peptide Levels and Cognitive Function in Community-dwelling Older Adults

Background Natriuretic peptides have prognostic value across a wide spectrum of cardiovascular diseases and may predict cognitive dysfunction in patients with cardiovascular disease, even in the absence of previous stroke. Little is known about the association of natriuretic peptides with cognitive function in community-dwelling adults. We assessed the association between N-terminal pro B-type natriuretic peptide (NT-proBNP) levels and cognitive function in community-dwelling ambulatory older adults in the Rancho Bernardo Study. Methods We studied 950 men and women, aged 60 years and older, who attended a research clinic visit where a medical history and examination were performed, and blood for cardiovascular disease risk factors and NT-proBNP levels were obtained. Three cognitive function tests were administered: the Mini Mental State Examination (MMSE), Trail-Making Test B (Trails B), and Category Fluency. Results Participants with high NT-proBNP levels (≥450 pg/mL; n = 198) were older and had a higher prevalence of coronary heart disease (12% vs 30%), and stroke (5% vs 11%; P ≤ .001 for both). In unadjusted analyses, all 3 cognitive function test scores were significantly associated with NT-proBNP levels ( P < .001). After adjusting for age, sex, education, hypertension, body mass index, exercise, alcohol use, smoking, low density lipoprotein cholesterol, creatinine clearance, and previous cardiovascular disease, elevated NT-proBNP levels remained independently associated with poor cognitive performance on MMSE (odds ratio [OR] 2.0; 95% confidence interval [CI], 1.1-3.6; P = .02) and Trails B (OR 1.7; 95% CI, 1.2-2.7; P = .01), but not Category Fluency (OR 1.4; 95% CI, 0.9-2.2; P = .19). Results were unchanged after excluding the 6% of participants with a history of stroke. Conclusions NT-proBNP levels were strongly and independently associated with poor cognitive function in community-dwelling older adults.

Obstructive sleep apnea, verbal memory, and executive function in a community-based high-risk population identified by the Berlin Questionnaire Akershus Sleep Apnea Project.

PurposeCognitive functions in community-dwelling adults at high risk of obstructive sleep apnea have not been described and nor are associations between cognitive functions and obstructive sleep apnea severity fully understood. The study aimed to describe verbal memory and executive function in community-dwelling adults identified by the Berlin Questionnaire and to investigate associations between these cognitive domains and different obstructive sleep apnea severity indicators.MethodsAmong 29,258 age- and gender-stratified persons 30–65 years who received the Berlin Questionnaire by mail, 16,302 (55.7%) responded. From 654 randomly drawn respondents with BQ high risk who were approached for study participation, 290 participants (55.9% males, mean age 48.2 years) were included. Verbal memory was assessed by Rey Auditory Verbal Learning Test and executive function by Stroop test. Obstructive sleep apnea severity indicators were assessed by polysomnography.ResultsMean (standard deviation) verbal learning score was 42.0 (8.9), mean interference time was 31.1 (12.7), median (25th percentile, 75th percentile) apnea–hypopnea index was 7.7 (2.4–22.2), and mean average oxygen saturation was 94.3 (2.0). Verbal learning score was independently associated with average oxygen saturation (β = 0.721, p = 0.025) in multivariate linear regression models adjusted for putative confounders. Interference time was only related to OSA severity indicators in bivariate analyses.ConclusionsVerbal memory and executive function impairments were mild in community-dwelling adults at high risk of obstructive sleep apnea. Average oxygen saturation was the indicator of obstructive sleep apnea severity most strongly associated with cognitive function.Electronic supplementary materialThe online version of this article (doi:10.1007/s11325-011-0493-1) contains supplementary material, which is available to authorized users.

Effects Of Exercise On Pain And Physical Function In Adults With Arthritis: A Meta-Analysis

Little information is available on the benefits of community based exercise programs and the optimal dose of exercise needed to obtain benefits for persons with a wide variety of arthritis and other rheumatic diseases (AORD). PURPOSE: Use the meta-analytic approach to determine the efficacy and effectiveness of exercise on pain and physical function in community-dwelling adults with AORD. METHODS: Studies were retrieved by searching 6 electronic databases, cross-referencing from retrieved studies, including review articles, and expert review. Inclusion criteria were: (1) randomized controlled trials, (2) >1 exercise intervention group, (3) community-accessible exercise interventions > 4 weeks, (4) comparative control group, (5) adults > 18 years of age with rheumatoid arthritis, osteoarthritis, fibromyalgia, lupus, gout, or ankylosing spondylitis, (6) published and unpublished studies, (7) studies published in any language between 01/01/80 and 01/01/08, and (8) data available for pain and/or physical function outcomes. Standardized effect sizes (Hedge's g) were used to calculate results for each outcome from each study. Random-effects models were used to pool pain and physical function outcomes. Data were analyzed when limited to participants who completed the intervention (per-protocol analysis) as well as all participants initially enrolled in the intervention (intention-to-treat analysis). RESULTS: Thirty-three studies representing 3180 men and women (1857 exercise, 1323 control) with rheumatoid arthritis, osteoarthritis, and fibromyalgia were included. Small, statistically significant improvements were observed for pain (per protocol, g and 95% CI, -0.37, -0.53 to -0.21; intention-to-treat -0.20, -0.33 to -0.07) and physical function (per protocol, g and 95% CI, 0.37, 0.21 to 0.52; intention-to-treat 0.34, 0.25 to 0.43). CONCLUSIONS: Exercise is efficacious and effective for improving pain and physical function in adults with the types of AORD included in the current analysis. However, there was a lack of detailed data available to determine the optimal dose as well as overall effects of exercise in those with lupus, gout, and ankylosing spondylitis. Supported under a cooperative agreement from the CDC through the AAMC, grant #U36/CCU319276, AAMC ID #MM-0944-06/06.

Self‐report and physical performance measures of physical function in hip osteoarthritis: Relationship to isometric quadriceps torque development

Quadriceps strength (knee extensor torque) is an important correlate of physical function in individuals with hip osteoarthritis (OA). However, it remains unclear whether the ability to rapidly generate quadriceps torque in the early phase of muscle contraction (maximal rate of torque development [MRTD]) is also associated with physical function. The purpose of this study was to quantify the independent impact of quadriceps strength and quadriceps MRTD on self-report and physical performance measures of physical function in community-dwelling adults with hip OA. Ninety-two adults with radiographically confirmed symptomatic hip OA (mean age 62 years) participated. Unilateral isometric quadriceps strength and MRTD were measured using a dynamometer. Self-report measure of physical function was assessed by the Short Form 36 (SF-36) questionnaire, and physical performance was assessed by the timed stair and step tests. In the hierarchical regression models, high maximal quadriceps strength and high quadriceps MRTD uniquely covaried with high SF-36 physical function scores after accounting for demographic, anthropometric, and pain measures. For the timed stair test, all else being equal, in 2 participants with low but identical levels of quadriceps strength, the one with a higher MRTD had better stair-climbing function. For the step test, quadriceps MRTD was not associated with step test performance over and above that of quadriceps strength. In individuals with hip OA, maximal quadriceps strength and quadriceps MRTD positively impact self-report and physical performance measures of physical function. These findings are of importance in developing intervention strategies, but they call for further study.

Carboxymethyl-lysine, an advanced glycation end product, and decline of renal function in older community-dwelling adults

Advanced glycation end products (AGEs) are bioactive molecules found in greater concentrations in foods that have been processed at high temperatures. AGEs have been associated with impaired renal function in diabetes and in uremia. The relationship between AGEs and renal function in community-dwelling adults has not been well characterized. The objective was to determine whether plasma AGEs are independently associated with chronic kidney disease (CKD) and predictive of renal function in older adults. The relationship between plasma carboxymethyl-lysine (CML), an AGE, and CKD (>or= stage 3 of National Kidney Foundation classification; estimated glomerular filtration rate [eGFR] <60 ml/min/1.73 m(2)) and eGFR at 3- and 6-years follow-up was examined in a population-based study of aging, the InCHIANTI study, in Tuscany, Italy. Of 1,008 adults, aged >or=65 years, 153 (15.2%) had CKD at enrollment. Mean (standard deviation [S.D.]) plasma CML was 365 (110) ng/ml. Plasma CML was associated with CKD (odds ratio [O.R.] expressed per 1 S.D., 1.53, 95% confidence interval [C.I.] 1.27-1.84, P < 0.0001) in a multivariate logistic regression model, adjusting for potential confounders. Plasma CML was associated with eGFR (beta = -2.77, standard error [S.E.] = 0.51, P < 0.0001) at baseline, 3-year (beta = -2.54, S.E. = 0.61, P < 0.0001) and 6-year follow-up visits (beta = -1.21, S.E. = 0.70, P = 0.08) in multivariate linear regression models, adjusting for potential confounders. The associations between plasma CML and prevalent CKD, eGFR, and eGFR at 3- and 6-year follow-up were significant and nearly unchanged after exclusion of adults with diabetes. Plasma CML is independently associated with CKD and is an independent predictor of decline in renal function in older community-dwelling adults.

Kidney Function and Sarcopenia in the United States General Population: NHANES III

Background/Aims: It is not known whether sarcopenia is associated with levels of kidney function in community-dwelling adults. Methods: Subjects were adult Third National Health and Nutrition Examination Survey participants in whom bioimpedance was performed (n = 13,770). Class I sarcopenia was defined as a skeletal mass index of 1–2 standard deviations below and class II sarcopenia as <2 standard deviations below young adult values. Results: A monotonic association existed between increasing sarcopenia prevalence and declining glomerular filtration rate: ≧90 ml/min/1.73 m², 22.8% class I, 3.8% class II sarcopenia; 60–89 ml/min/1.73 m², 33.6% class I, 5.3% class II sarcopenia, and <60 ml/min/1.73 m², 50.7% class I, 9.4% class II sarcopenia (p < 0.0001). This association dissipated when adjustment was made for older age and more comorbidity. Multivariate associations (p < 0.05) of sarcopenia and chronic kidney disease included: older age; low income-to-poverty ratio; overweight; lack of exercise; low carbohydrate, fat and protein intake; hypercalcemia; low 25-hydroxy-vitamin D₃; higher diastolic blood pressure, and insulin resistance. Conclusion: Sarcopenia is common in community-dwelling adults with chronic kidney disease. Although causality cannot be assumed, several associations may be susceptible to intervention.