Men Project Research Articles

Total Physical Activity, Exercise Intensity, and Walking Speed as Predictors of All-Cause and Cause-Specific Mortality Over 7 Years in Older Men: The Concord Health and Aging in Men Project

ObjectiveThe study aimed to examine the contemporaneous temporal association between changes in total physical activity, sports intensity, muscle strengthening exercise, and walking speed as predictors of all-cause, cardiovascular, cancer and other cause-specific mortality in older men. Design, setting, participants, measurementsCommunity-dwelling men aged 70 years and older from Concord Health and Aging in Men Project were assessed at baseline (2005-2007, n = 1705), 2 years (n = 1367), and 5 years follow-up (n = 958). At all time points, Physical Activity Scale for the Elderly questionnaire, walking speed over a 6-m walk, and potential confounders were assessed. Mortality was ascertained through the state death registry with a median follow-up of 7 years. ResultsAs the Physical Activity Scale for the Elderly score increased by 1 standard deviation over the follow-up period, the relative risk (RR) for mortality was 0.78 [95% confidence interval (CI) 0.69-0.88] for all-cause, 0.66 (95% CI 0.55-0.79) for cardiovascular and 0.75 (95% CI 0.61-0.94) for other cause-specific mortality, but no association was observed in cancer mortality. The RR for undertaking strenuous sports during follow-up was 0.44 (95% CI 0.26-0.72) for all-cause mortality and 0.31 (95% CI 0.13-0.70) for cancer mortality when compared with no sports participation. Increases in walking speed per standard deviation over time were also associated with a decrease in all-cause mortality (RR 0.69, 95% CI 0.61-0.78), with similar associations for cardiovascular (RR 0.60, 95% CI 0.48-0.74), but not cancer mortality. ConclusionsOlder men who engage in strenuous sports and those who increase their walking speed over time may have lower risk of all-cause and some cause-specific mortality.

Evaluating Calculated Free Testosterone as a Predictor of Morbidity and Mortality Independent of Testosterone for Cross-sectional and 5-Year Longitudinal Health Outcomes in Older Men: The Concord Health and Ageing in Men Project.

To determine whether calculated free testosterone (cFT) provides prognostic information independent of serum T for predicting morbidity and mortality in older men in cross-sectional and 5-year longitudinal analyses. We studied men aged ≥70 years at baseline (n = 1,705), 2-year and 5-year measuring serum T (liquid chromatography-mass spectrometry), SHBG (immunoassay), cFT (an assumption-free empirical formula) together with 24 morbidity and 4 mortality outcomes. For cross-sectional and longitudinal analyses we employed a joint prediction model using generalized estimating equation models adjusted for age, smoking, comorbidities, and body mass index (BMI) with men having both normal T and normal cFT as referent group. Most morbidity and mortality outcomes were predicted by a combination of low T and cFT (LL). By contrast, only a single morbidity outcome in cross-sectional and none in longitudinal analysis was predicted by low T/normal cFT (LN) or normal T/low cFT (NL) without significant LL associations (isolated discordance). While for the few outcomes that predicted morbidity in men with discordances (LN or NL), these predictions only occurred when LL was also significant. Hence, for morbidity or mortality prediction in older men, discordance between cFT and T is unusual and isolated discordance is rare, so that cFT provides minimal independent prognostic information over serum T.

PT01.5: Longitudinal Associations Between Vitamin D Metabolites and Sarcopenia in Older Australian Men: The Concord Health and Ageing in Men Project

PT01.5: Longitudinal Associations Between Vitamin D Metabolites and Sarcopenia in Older Australian Men: The Concord Health and Ageing in Men Project

Diet quality and its implications on the cardio-metabolic, physical and general health of older men: the Concord Health and Ageing in Men Project (CHAMP).

The revised Dietary Guideline Index (DGI-2013) scores individuals' diets according to their compliance with the Australian Dietary Guideline (ADG). This cross-sectional study assesses the diet quality of 794 community-dwelling men aged 74 years and older, living in Sydney, Australia participating in the Concord Health and Ageing in Men Project; it also examines sociodemographic and lifestyle factors associated with DGI-2013 scores; it studies associations between DGI-2103 scores and the following measures: homoeostasis model assessment - insulin resistance, LDL-cholesterol, HDL-cholesterol, TAG, blood pressure, waist:hip ratio, BMI, number of co-morbidities and medications and frailty status while also accounting for the effect of ethnicity in these relationships. Median DGI-2013 score was 93·7 (54·4, 121·2); most individuals failed to meet recommendations for vegetables, dairy products and alternatives, added sugar, unsaturated fat and SFA, fluid and discretionary foods. Lower education, income, physical activity levels and smoking were associated with low scores. After adjustments for confounders, high DGI-2013 scores were associated with lower HDL-cholesterol, lower waist:hip ratios and lower probability of being frail. Proxies of good health (fewer co-morbidities and medications) were not associated with better compliance to the ADG. However, in participants with a Mediterranean background, low DGI-2013 scores were not generally associated with poorer health. Older men demonstrated poor diet quality as assessed by the DGI-2013, and the association between dietary guidelines and health measures and indices may be influenced by ethnic background.

Cross-Sectional and Longitudinal Relationships Between Inflammatory Biomarkers and Frailty in Community-dwelling Older Men: The Concord Health and Ageing in Men Project.

Previous studies demonstrated associations between IL-6 and frailty, but associations between a wide range of cytokines, chemokines, and growth factors with prevalent and incident frailty has not been studied. Community-dwelling men aged more than 75 enrolled in the 5-year and 8-year follow-up of the CHAMP study were assessed. Twenty-seven inflammatory biomarkers were measured using the Bio-Plex Pro Human Cytokine 27-plex Assay kit at 5-year follow-up. Frailty was determined using the Fried frailty phenotype (FP) and Rockwood frailty index (FI) at both time-points. Age, body mass index, smoking, alcohol, and comorbidity were also assessed. In cross-sectional analysis of the 5-year follow-up, the unadjusted odds ratio (OR) for frail versus robust evaluated by the FP showed significant associations for IL-6 (OR: 1.56, 95% confidence interval [CI]: 1.23-1.98) and IL-8 (OR: 1.28, 95% CI: 1.00-1.63). IL-6 remained significantly associated in the age-adjusted (OR: 1.58, 95% CI: 1.21-2.05) and multivariable-adjusted model (OR: 1.54, 95% CI: 1.16-2.05). No associations were observed between pre-frail versus robust. In longitudinal unadjusted analysis, IL-8 (OR: 1.32, 95% CI: 1.03-1.70) and IP-10 (OR: 1.32, 95% CI: 1.03-1.70) at 5-year predicted incident frailty at 8-year follow-up. IL-8 remained longitudinally associated with incident frailty after age (OR: 1.34, 95% CI: 1.03-1.75) but not multivariable (OR: 1.20, 95% CI: 0.98-1.70) adjustment. Similar results were seen using the FI. None of the other biomarkers had significant associations with incident frailty. Our findings suggest that IL-6 and IL-8 may be cross-sectionally associated with frailty and that all measured inflammatory biomarkers were not causally related to frailty. Together with previous studies, the results suggest that frailty is specifically linked to IL-6 and IL-8 rather than simply representing a nonspecific pan-inflammatory condition.

EPIDEMIOLOGY OF FRAILTY AND GERIATRIC SYNDROMES IN OLDER AUSTRALIAN MEN

The geriatric syndromes (cognitive impairment, falls, incontinence and poor mobility) and frailty are major causes of loss of independence among older people. The aim of this paper is to describe the prevalence and incidence of these conditions among men participating in the Concord Health and Ageing in Men Project (CHAMP), an epidemiological cohort (panel) study of a representative sample of 1705 community-dwelling Australian men aged 70 years and over. At baseline, only 21% of men had one or more of the geriatric syndromes and only 10% were frail (based on Cardiovascular Health Study criteria). After five years, 59% of men were still alive and had not developed any of the geriatric syndromes. The geriatric syndromes and frailty only became common after age 85 years. These data support the concept of the “old old” (those aged 85 years and over) as a distinct group requiring specialised health and aged care services.

Longitudinal Associations Between Vitamin D Metabolites and Sarcopenia in Older Australian men: The Concord Health and Aging in Men Project.

To explore the associations between serum 25-hydroxyvitamin D (25D) and 1,25-dihydroxyvitamin D (1,25D) levels at baseline and incidence of sarcopenia over time in older Australian community-dwelling older men. Of the 1,705 men aged ≥70 years (2005-2007) participating in the Concord Health and Ageing in Men Project, those without sarcopenia at baseline (n = 1,312 for 25D and n = 1,231 for 1,25D), 2 years (n = 1,024 for 25D and n = 956 for 1,25D), and 5-year follow-up (n = 709 for 25D and n = 663 for 1,25D) were included in the study. The main outcome measurement was the incidence of sarcopenia defined as appendicular lean mass adjusted for body mass index <0.789 and grip strength <26.0 kg. Serum 25D and 1,25D levels were measured at baseline by radioimmunoassay (Diasorin, Stillwater, MN) and categorized into quartiles as predictor variables. Covariates included age, income, season of blood collection, physical activity, vitamin D supplement and medication use, measures of health, serum parathyroid hormone (PTH), estimated glomerular filtration rate (eGFR), albumin, and white blood cell count. In this study, incidence of sarcopenia was 3.9% in men at the 2-year follow-up and 8.6% at the 5-year follow-up. In adjusted analysis, men with vitamin D levels in the lowest quartiles (25D <40nmol/L; 1,25D <62 pmol/L) showed significant associations with increased odds of incident sarcopenia compared to those with vitamin D levels in the highest quartiles over 5 years. [25D: odds ratio (OR) 2.53 (95% confidence interval (CI) 1.14, 5.64) p = .02; 1,25D: OR 2.67 (95% CI 1.28, 5.60) p = .01]. After further adjustments for the respective other serum vitamin D measure, (either 25D or 1,25D), the association remained significant [25D: OR 2.40 (95% CI 1.02, 5.64) p = .04; 1,25D: OR 2.23 (95% CI 1.04, 4.80) p = .04]. Low serum 1,25D and 25D concentrations at baseline are independently associated with the incidence of sarcopenia over the subsequent 5 years. Although our data do not prove any causal relationship, it is conceivable that maintaining vitamin D sufficiency may reduce the incidence of sarcopenia in ageing men.

Re: Lower Urinary Tract Symptoms and Incident Falls in Community Dwelling Older Men: The Concord Health and Ageing in Men Project

Re: Lower Urinary Tract Symptoms and Incident Falls in Community Dwelling Older Men: The Concord Health and Ageing in Men Project

SIRT1 Polymorphisms and Serum-Induced SIRT1 Protein Expression in Aging and Frailty: The CHAMP Study.

The nutrient sensing protein, SIRT1 influences aging and nutritional interventions such as caloric restriction in animals, however, the role of SIRT1 in human aging remains unclear. Here, the role of SIRT1 single-nucleotide polymorphisms (SNPs) and serum-induced SIRT1 protein expression (a novel assay that detects circulating factors that influence SIRT1 expression in vitro) were studied in the Concord Health and Ageing in Men Project (CHAMP), a prospective cohort of community dwelling men aged 70 years and older. Serum-induced SIRT1 expression was not associated with age or mortality, however participants within the lowest quintile were less likely to be frail (odds ratio (OR) 0.34, 95% confidence interval (CI) 0.17-0.69, N = 1,309). Serum-induced SIRT1 expression was associated with some markers of body composition and nutrition (height, weight, body fat and lean % mass, albumin, and cholesterol) but not disease. SIRT1 SNPs rs2273773, rs3740051, and rs3758391 showed no association with age, frailty, or mortality but were associated with weight, height, body fat and lean, and albumin levels. There were some weak associations between SIRT1 SNPs and arthritis, heart attack, deafness, and cognitive impairment. There was no association between SIRT1 SNPs and the serum-induced SIRT1 assay. SIRT1 SNPs and serum-induced SIRT1 expression in older men may be more closely associated with nutrition and body composition than aging and age-related conditions.

Health status, health behaviours and anxiety symptoms of older male caregivers: Findings from the Concord Health and Ageing in Men Project.

To explore differences between older male caregivers and non-caregivers on health status, health behaviours and well-being, including symptoms of anxiety. Data were collected through self-completed questionnaires and face-to-face interviews with 1705 community living men aged ≥70 in the Concord Health and Ageing in Men Project. Eleven per cent of older men were caregivers, of whom 81.7% were looking after their wives or partners. Older male caregivers did not have worse physical health or more depressive symptoms than non-caregivers, but being a caregiver was associated with increased likelihood of reporting anxiety symptoms (OR: 2.32, 95% CI: 1.39-3.87). Caregivers had similar levels and frequencies of leisure activities but did more housework activities than non-caregivers. Higher anxiety levels were the main adverse health condition in older male caregivers. Strategies to assist minimising anxiety for caregivers should be a target of interventions.

Longitudinal associations between body composition, sarcopenic obesity and outcomes of frailty, disability, institutionalisation and mortality in community-dwelling older men: The Concord Health and Ageing in Men Project.

to explore the longitudinal associations between body composition measures, sarcopenic obesity and outcomes of frailty, activities of daily living (ADL) and instrumental ADL (IADL) disability, institutionalisation and mortality. men aged ≥ 70 years (2005-07) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 (n = 1,366) and 5 years (n = 954). The main outcome measures were frailty (adapted Fried criteria), ADL, including personal care and mobility and IADL disability (ability to perform tasks for independent living), institutionalisation and mortality. The Foundation for the National Institutes of Health cut-points were used for low muscle mass: appendicular lean mass (ALM):Body Mass Index (BMI) ratio (ALMBMI) <0.789 and obesity was defined as >30% fat. Generalised estimating equations were used to examine the longitudinal associations between the independent variables (obesity alone, low muscle mass and sarcopenic obesity) and frailty, ADL and IADL disability. in unadjusted, age adjusted and fully adjusted analysis, men with low muscle mass showed increased risk of frailty and IADL disability. In fully adjusted analysis, men with sarcopenic obesity had an increased risk of frailty (odds ratio (OR): 2.00 (95% confidence of interval (CI): 1.42, 2.82)) ADL disability (OR: 1.58 (95% CI: 1.12, 2.24)) and IADL disability (OR: 1.36 (95% CI: 1.05, 1.76)). Obesity alone was protective for institutionalisation (OR: 0.51 (95% CI: 0.31, 0.84)) but was not associated with any other outcomes. low muscle mass and sarcopenic obesity were associated with poor functional outcomes, independent of confounders. This would suggest that future trials on frailty and disability prevention should be designed to intervene on both muscle mass and fat mass.

Sarcopenic Obesity and Its Temporal Associations With Changes in Bone Mineral Density, Incident Falls, and Fractures in Older Men: The Concord Health and Ageing in Men Project.

Body composition and muscle function have important implications for falls and fractures in older adults. We aimed to investigate longitudinal associations between sarcopenic obesity and its components with bone mineral density (BMD) and incident falls and fractures in Australian community-dwelling older men. A total of 1486 men aged ≥70 years from the Concord Health and Ageing in Men Project (CHAMP) study were assessed at baseline (2005-2007), 2-year follow-up (2007-2009; n = 1238), and 5-year follow-up (2010-2013; n = 861). At all three time points, measurements included appendicular lean mass (ALM), body fat percentage and total hip BMD, hand-grip strength, and gait speed. Participants were contacted every 4 months for 6.1 ± 2.1 years to ascertain incident falls and fractures, the latter being confirmed by radiographic reports. Sarcopenic obesity was defined using sarcopenia algorithms of the European Working Group on Sarcopenia (EWGSOP) and the Foundation for the National Institutes of Health (FNIH) and total body fat ≥30% of total mass. Sarcopenic obese men did not have significantly different total hip BMD over 5 years compared with non-sarcopenic non-obese men (p > 0.05). EWGSOP-defined sarcopenic obesity at baseline was associated with significantly higher 2-year fall rates (incidence rate ratio [IRR] 1.66; 95% confidence interval [CI] 1.16-2.37), as were non-sarcopenic obesity (1.30; 1.04-1.62) and sarcopenic non-obesity (1.58; 1.14-2.17), compared with non-sarcopenic non-obese. No association with falls was found for sarcopenic obesity using the FNIH definition (1.01; 0.63-1.60), but after multivariable adjustment, the FNIH-defined non-sarcopenic obese group had a reduced hazard for any 6-year fracture compared with sarcopenic obese men (hazard ratio 0.44; 95% CI 0.23-0.86). In older men, EWGSOP-defined sarcopenic obesity is associated with increased fall rates over 2 years, and FNIH-defined sarcopenic obese men have increased fracture risk over 6 years compared with non-sarcopenic obese men. © 2016 American Society for Bone and Mineral Research.

Progressive Temporal Change in Serum SHBG, But Not in Serum Testosterone or Estradiol, Is Associated With Bone Loss and Incident Fractures in Older Men: The Concord Health and Ageing in Men Project.

This study aimed to examine progressive temporal relationships between changes in major reproductive hormones across three waves of a cohort study of older men and (1) changes in bone mineral density (BMD) and (2) incident fractures (any, hip or non-vertebral) over an average of 6 years of follow-up. The CHAMP cohort of men aged 70 years and older were assessed at baseline (2005 to 2007, n = 1705), 2-year follow-up (n = 1367), and 5-year follow-up (n = 958). Serum testosterone (T), dihydrotestosterone (DHT), estradiol (E2), and estrone (E1) (by liquid chromatography-tandem mass spectrometry [LC-MS/MS]), and sex hormone-binding globulin (SHBG), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) (by immunoassay) were measured at all time-points, whereas free testosterone (cFT) was calculated using a well-validated formula. Hip BMD was measured by dual-energy X-ray absorptiometry (DXA) at all three time-points, and fracture data were verified radiographically. Statistical modeling was done using general estimating equations (GEEs). For total hip BMD, univariable analyses revealed inverse associations with temporal changes in serum SHBG, FSH, and LH and positive associations for serum E1 and cFT across the three time-points. In models adjusted for multiple covariables, serum SHBG (β = -0.029), FSH (β = -0.065), LH (β = -0.049), E1 (β = 0.019), and cFT (β = 0.033) remained significantly associated with hip BMD. However for femoral neck BMD, only FSH (β = -0.048) and LH (β = -0.036) remained associated in multivariable-adjusted models. Temporal change in serum SHBG, but not T, E2, or other hormonal variables, was significantly associated with any, nonvertebral or hip fracture incidence in univariable analyses. In multivariable-adjusted models, temporal increase in serum SHBG over time remained associated with any fracture (β = 0.060) and hip fracture (β = 0.041) incidence, but not nonvertebral fracture incidence. These data indicate that a progressive increase in circulating SHBG over time predicts bone loss and fracture risk in older men. Further studies are warranted to further characterize changes in circulating SHBG as a mechanism and/or biomarker of bone health during male ageing. © 2016 American Society for Bone and Mineral Research.

Sexual Function and Mortality in Older Men: The Concord Health and Ageing in Men Project.

The longitudinal association between progressive temporal change in sexual (dys)function and mortality in older men. Community-dwelling men aged 70 years and older from the Concord Health and Ageing in Men Project were assessed at baseline (2005-2007, n = 1,705), 2-years follow-up (n = 1,367), and 5-years follow-up (n = 958). Self-reported sexual function (erectile function and sexual activity) using standardized questions were analyzed by generalized estimating equations to examine the longitudinal prediction of mortality according to change in sexual function across three time-points. Men reported to have erectile dysfunction increased from 64% to 80%, and to be sexually inactive increased from 56% to 59% over the course follow-up. In univariate analyses, erectile dysfunction (hazard ratio: 2.02, 95% confidence interval [CI]: 1.45-2.81) or having no sexual activity (hazard ratio: 2.31, 95% CI: 1.82-2.93) at baseline predicted increased mortality over the subsequent 7 years. Models adjusted for multivariate and major reproductive hormones had negligible impact on mortality prediction, but neither statistically significantly predicted mortality after adjusting for depression. Similarly, change in erectile dysfunction over time was associated with mortality over 7 years in univariate (odds ratio: 1.69, 95% CI: 1.34-2.14) and multivariate analysis, including hormones, but not after adjusting for depression (odds ratio: 1.24, 95% CI: 0.95-1.62). Change in sexual activity was associated with mortality over 7 years in univariate analysis (odds ratio: 2.37, 95% CI: 1.33-4.20) but not after adjusting for age (odds ratio: 1.45, 95% CI: 0.79-2.64). Our analyses suggest sexual dysfunction was not an independent risk factor of, but rather may be a biomarker for, all-cause mortality in older men.

MP35-17 UNDERACTIVE BLADDER (UAB) SYMPTOMS AND VOIDING PARAMETERS IN ELDERLY COMMUNITY-DWELLING MALES WITH 5 YEAR FOLLOWUP

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common in older men and there is increasing awareness of the impact of the underactive bladder (UAB) in the elderly. We assessed symptoms suggestive of UAB and voiding parameters in a group of community-dwelling elderly men over a period of 5 years. METHODS: Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects are re-assessed after two years and five years with repeat survey and clinical assessment. UAB symptoms were assessed based on the IPSS-voiding subscore (IPSSV) and correlated with voiding parameters at baseline and five year follow-up. RESULTS: 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had deceased). 275 men with prostate cancer and 302 men with previous surgical treatment for BPH were omitted from analyses. Men with significant overactive bladder symptoms (IPSSstorage subscore >5) were excluded leaving 870 men for analysis. 93% had low IPSS-V scores (0-6),6% intermediate IPSS-V (7-13) and 1% high IPSS-V(14-20). Mean peak flow rates at baseline for men with low, intermediate and high IPSS-V scores were 13.3 mls/sec, 10.9mls/ sec and 10.1mls/sec respectively (P<0.001) but there was no significant change at 5 years (12.5mls/s, 10.6mls/s, 10.8mls/s). Mean post void residual volume for men with low, intermediate and high IPSS-V scores at baseline were 66.9mls, 78.4mls and 92.6mls respectively (P1⁄40.001) and there was no significant change at 5 years. Increased total IPSS-V correlated with reduced peak flow and increased post void residual (P<0.001), but not with age. Only 18 (2%) men had surgery for LUTS between baseline and 5 years. The risk of undergoing surgery correlated with intermediate/high IPSS-V scores (P1⁄40.014). CONCLUSIONS: Both UAB symptoms and voiding parameters of uroflowmetry and post void residual volume remain relatively stable over a five year period in elderly, community-dwelling men. UAB symptoms correlated with elevated postvoid residual urine and reduced urinary flow rates although the number of men requiring surgical intervention was low.

MP35-18 NOT A VOLUME BUT A STRUCTURAL VARIATION OF THE PROSTATIC URETHRA WITHIN THE PROSTATE PREDICT THE DEGREE OF OBSTRUCTIVE SYMPTOM: A PROSPECTIVE MULTICENTER OBSERVATIONAL STUDY

INTRODUCTION AND OBJECTIVES: Lower urinary tract symptoms (LUTS) are common in older men and there is increasing awareness of the impact of the underactive bladder (UAB) in the elderly. We assessed symptoms suggestive of UAB and voiding parameters in a group of community-dwelling elderly men over a period of 5 years. METHODS: Community dwelling men aged 70 years and over were enrolled to participate in the Concord Health and Ageing in Men Project (CHAMP), a population based study of men living in a defined geographical area in metropolitan Sydney, Australia. Men were required to complete a survey including International Prostate Symptom Score (IPSS) and medical, medication and urological history, then attend a clinical assessment where uroflowmetry and post void residual volume were measured. Subjects are re-assessed after two years and five years with repeat survey and clinical assessment. UAB symptoms were assessed based on the IPSS-voiding subscore (IPSSV) and correlated with voiding parameters at baseline and five year follow-up. RESULTS: 1705 men aged 70-97 years participated; 1367 presented for follow-up assessment 2 years later and 940 at 5 years (382 (23%) had deceased). 275 men with prostate cancer and 302 men with previous surgical treatment for BPH were omitted from analyses. Men with significant overactive bladder symptoms (IPSSstorage subscore >5) were excluded leaving 870 men for analysis. 93% had low IPSS-V scores (0-6),6% intermediate IPSS-V (7-13) and 1% high IPSS-V(14-20). Mean peak flow rates at baseline for men with low, intermediate and high IPSS-V scores were 13.3 mls/sec, 10.9mls/ sec and 10.1mls/sec respectively (P<0.001) but there was no significant change at 5 years (12.5mls/s, 10.6mls/s, 10.8mls/s). Mean post void residual volume for men with low, intermediate and high IPSS-V scores at baseline were 66.9mls, 78.4mls and 92.6mls respectively (P1⁄40.001) and there was no significant change at 5 years. Increased total IPSS-V correlated with reduced peak flow and increased post void residual (P<0.001), but not with age. Only 18 (2%) men had surgery for LUTS between baseline and 5 years. The risk of undergoing surgery correlated with intermediate/high IPSS-V scores (P1⁄40.014). CONCLUSIONS: Both UAB symptoms and voiding parameters of uroflowmetry and post void residual volume remain relatively stable over a five year period in elderly, community-dwelling men. UAB symptoms correlated with elevated postvoid residual urine and reduced urinary flow rates although the number of men requiring surgical intervention was low.

Low Hemoglobin Concentrations Are Associated With Sarcopenia, Physical Performance, and Disability in Older Australian Men in Cross-sectional and Longitudinal Analysis: The Concord Health and Ageing in Men Project.

The objective of this study is to examine associations between Hb levels and sarcopenia, low muscle strength, functional measures, and activities of daily living (ADL) and instrumental ADL (IADL) disabilities in older Australian men. Men aged 70 years and older (2005-2007) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 years (n = 1,367), and 5 years (n = 958). The main outcome measurements were walking speed, muscle strength, ADL and IADL disabilities, and sarcopenia using the Foundation for the National Institutes of Health criteria (low appendicular lean mass adjusted for body mass index < 0.789 and poor grip strength < 26kg). Analysis was performed using Hb levels as a continuous measure, unadjusted and adjusted by age, income, body mass index, measures of health, estimated glomerular function, inflammatory markers, and medication use. Receiver operating characteristic curve analysis was performed to determine a threshold of Hb for each outcome. In cross-sectional and longitudinal analysis, for every 1g/dL increase in Hb, there was a significant reduction in risk of sarcopenia, slow walking speed, poor grip strength, inability to perform chair stands, and ADL and IADL disabilities in unadjusted, age-adjusted, and multivariate-adjusted analysis. The highest value of the Youden Index for Hb was 14.2g/dL for sarcopenia and grip strength, 14.5g/dL for walking speed, and 14.4g/dL for all other outcomes. Declines in Hb levels over time are associated with poor functional outcomes. The risks and benefits of interventions to increase Hb among older men warrant further investigation to differentiate whether this is an active contributor to age-related debility or a passive biomarker of it.

Association Rules Analysis of Comorbidity and Multimorbidity: The Concord Health and Aging in Men Project.

Comorbidity and multimorbidity are common in older people. Here we used a novel analytic approach called Association Rules together with network analysis to evaluate multimorbidity (two or more disorders) and comorbidity in old age. A population-based cross-sectional study was undertaken where 17 morbidities were analyzed using network analysis, cluster analysis, and Association Rules methodology. A comorbidity interestingness score was developed to quantify the richness and variability of comorbidities associated with an index condition. The participants were community-dwelling men aged 70 years or older from the Concord Health and Ageing in Men Project, Sydney, Australia, with complete data (n = 1,464). The vast majority (75%) of participants had multimorbidity. Several morbidity clusters were apparent (vascular cluster, metabolic cluster, neurodegenerative cluster, mental health and other cluster, and a musculoskeletal and other cluster). Association Rules revealed unexpected comorbidities with high lift and confidence linked to index diseases. Anxiety and heart failure had the highest comorbidity interestingness scores while obesity, hearing impairment, and arthritis had the lowest (zero) scores. We also performed Association Rules analysis for the geriatric syndromes of frailty and falls to determine their association with multimorbidity. Frailty had a very complex and rich set of frequent and interesting comorbidities, while there were no frequent and interesting sets associated with falls. Old age is characterized by a complex pattern of multimorbidity and comorbidity. Single disease definitions do not account for the prevalence and complexity of multimorbidity in older people and a new lexicon may be needed to underpin research and health care interventions for older people.

OR035: Sarcopenia and Sarcopenic Obesity is Associated with Activities of Daily Living Disability in Community Dwelling Older Men: The Concord Health and Ageing in Men Project

OR035: Sarcopenia and Sarcopenic Obesity is Associated with Activities of Daily Living Disability in Community Dwelling Older Men: The Concord Health and Ageing in Men Project

MON-PP027: Sarcopenic Obesity, But not Obesity is Associated with Incident Frailty, Institutionalisation and Mortality in Community Dwelling Older Men: The Concord Health and Ageing in Men Project

Little is known about the relationship between low muscle mass (LMM) and metabolic risk factors in adolescents. We hypothesized that LMM in adolescents is associated with metabolic syndrome (MetS) and its components in Korean adolescents. This cross-sectional study included 1420 participants (749 males and 671 females), aged 12 to 19 years, who participated in the 2009-2011 Korea National Health and Nutrition Examination Surveys. Appendicular skeletal muscle mass was divided by body weight, and any value below the lower quintile of the study population, according to each age and sex category, was considered to represent LMM. A participant was considered to have MetS if he/she demonstrated at least 3 of the National Cholesterol Education Program–Adult Treatment Panel III criteria. The overall prevalence of MetS was 4.9%, with a prevalence of 7.1% in males and 2.3% in females. Low muscle mass significantly increased the risk of MetS, after adjusting for potential covariates (odds ratio [OR], 5.28; 95% confidence interval, 2.76-10.13). Similarly, the ORs for the MetS components were significantly higher in individuals with LMM than in those without LMM. In the subgroup analysis, LMM was significantly associated with MetS in both adolescent boys and girls. In addition, the adjusted OR was significantly higher in individuals with LMM than in those without, after stratifying the groups by age. In conclusion, our results suggest that adolescents with LMM may have a high risk of MetS. Public health initiatives are needed to develop interventions for preventing and treating LMM in adolescents.