Multivariable-adjusted Mean Research Articles

Length of Overnight Fasting and 6-year Weight Change in the Cancer Prevention Study-3

BackgroundLonger overnight fasting (ONF) is a potential strategy for weight control. Although promising, the evidence from large population-based studies is limited. ObjectivesTo examine the association of self-reported ONF duration with 3- and 6-y weight change in the American Cancer Society’s Cancer Prevention Study-3 prospective cohort. MethodsUnited States adult Cancer Prevention Study-3 participants completed a 24-h validated meal and snack timing and frequency grid (weekday and weekend) in 2015, from which weighted ONF hours were calculated. Participants reported body weight in 2015, 2018, and 2021. Three- and 6-y weight change (kg, and % body weight) were assessed. ResultsAmong 104,420 mostly female (78.5%) participants aged 52.7 ± 9.5 (standard deviation) y followed for 6 y, a 1-h increase in ONF length was associated with a small but statistically significant reduction in weight gain over 3- and 6-y periods [multivariable-adjusted mean difference in % body weight = −0.02, 95% confidence interval (CI): −0.05, −0.00, P = 0.03 and −0.04, 95% CI: −0.07, −0.01, P < 0.01, respectively]. The mean difference of 6-y % reduction in weight gain was slightly greater among individuals with overweight (−0.05, 95% CI: −0.10, 0.00, P = 0.05) and obesity (−0.06, 95% CI: −0.12, 0.01, P = 0.08) compared with those with healthy body mass index (−0.03, 95% CI:−0.07, 0.01, P = 0.13) or underweight (0.16, 95% CI: −0.04, 0.36, P = 0.13, Pinteraction < 0.0001). Stronger associations were observed among those ≤55 y than 56+ (P < 0.001), and those with higher waist circumference (Pinteraction < 0.0001) but not by sex or earlier/later fasting period. ConclusionsLonger ONF was associated with slightly lower body weight in adult males and females over 6 y that was stronger among those with overweight or obesity, higher waist circumference, and those aged ≤55 y. The magnitude of weight change, although in the hypothesized direction, suggests that prolonged ONF may have modest impact on weight control over time.

Association Between Serum NT-proBNP and Gray Matter Atrophy Patterns in an Older Japanese Population: The Hisayama Study.

Several population-based studies have reported that higher serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels are associated with brain morphological changes. However, no population-based studies have examined the relationship between serum NT-proBNP and various regional brain volumes in detail. We here analyzed the brain MRI data of 1201 community-dwelling Japanese aged ≥65 years. Regional gray matter volumes (GMV) and intracranial volume (ICV) were estimated by applying voxel-based morphometry (VBM) methods. The associations of serum NT-proBNP with regional GMV/ICV were examined by analysis of covariance. The regional gray matter atrophy patterns associated with elevated serum NT-proBNP levels were investigated using VBM without a priori regions of interest. The multivariable-adjusted means of the frontal, temporal, hippocampal, parahippocampal, and entorhinal GMV/ICV decreased significantly with elevated serum NT-proBNP levels (all p for trend and q values of false discovery rate correction < .05). In VBM, elevated serum NT-proBNP levels were correlated with atrophy of the bilateral hippocampi, bilateral amygdalas, bilateral parahippocampal gyri, bilateral entorhinal areas, bilateral fusiform gyri, left middle temporal gyrus, left inferior temporal gyrus, right central operculum, right posterior orbital gyrus, bilateral middle frontal gyri, anterior cingulate gyrus and bilateral medial frontal cortices. In a sensitivity analysis excluding 254 participants with mild cognitive impairment or dementia, serum NT-proBNP levels were correlated with atrophy of the bilateral hippocampi, bilateral amygdalas, bilateral parahippocampal gyri, bilateral fusiform gyri, and left middle frontal gyrus. Our data suggest that elevated serum NT-proBNP levels are associated with gray matter atrophy in brain regions that play an important role in cognitive function.

Associations between Paternal Obesity and Cardiometabolic Alterations in Offspring via Assisted Reproductive Technology.

Both assisted reproductive technology (ART) and obesity are associated with adverse cardiometabolic alterations in offspring. However, the combined effects of paternal obesity and ART on offspring cardiometabolic health are still unclear. To clarify cardiometabolic changes in offspring of obese fathers conceived using ART. Retrospective cohort study conducted between June 2014 and October 2019. Center for reproductive medicine. A total of 2890 singleton visits aged 4-10 years were followed. None. Age-and sex-specific z-score of body mass index(BMI), blood pressure, insulin resistance and lipid profile were examined. We observed a strong association between paternal BMI categories and offspring BMI, blood pressure, and insulin resistance. Compared to offspring of fathers with normal weight, multivariable-adjusted mean difference for BMI z-score were 0.53 (95%CI: 0.37-0.68) for obese fathers, 0.17 (95%CI: 0.05-0.30) for overweight fathers, and -0.55 (95%CI: -0.95--0.15) for underweight fathers; corresponding values for systolic blood pressure z-score were 0.21(95%CI: 0.07-0.35), 0.10 (95%CI: -0.01-0.21), and -0.24 (95%CI: -0.59-0.11), and corresponding values for HOMA-IR z-score were 0.31(95%CI: 0.16-0.46), 0.09(95%CI: -0.02-0.21), and -0.11 (95%CI: -0.48-0.28), respectively. The mediation analyses suggested that 57.48% to 94.75% of the associations among paternal obesity and offspring cardiometabolic alterations might be mediated by offspring BMI. Paternal obesity was associated with an unfavourable cardiometabolic profile in ART-conceived offspring. Mediation analyses indicated that offspring BMI was a possible mediator of the association between paternal obesity and the offspring impaired metabolic changes.

Longitudinal Changes in Arterial Stiffness Associated with Physical Activity Intensity: The Toon Health Study.

Several studies have revealed an association between moderate-to-vigorous physical activity (MVPA) and arterial stiffness, which is a known risk factor for cardiovascular disease. However, a few studies have considered the difference in the longitudinal effect of its intensity in a large general population. Therefore, we examined the effect of MVPA intensity on longitudinal changes in arterial stiffness. We conducted a prospective cohort study involving 1,982 Japanese men and women. Arterial stiffness was measured using the cardio-ankle vascular index (CAVI) at baseline and 5-year follow-up. Physical activity was quantified using the Japan Arteriosclerosis Longitudinal Study Physical Activity Questionnaire and categorized into quartiles as MVPA levels. Linear mixed models were used to examine the differences at baseline and the rate of changes in CAVI associated with MVPA levels for over 5 years. The multivariable-adjusted mean differences in CAVI at baseline were significantly lower in the third (β=-0.019 [95% confidence interval {CI}=-0.033 to -0.005]) and fourth (β=-0.018 [95% CI=-0.035 to -0.001]) quartiles of the MVPA group compared with those in the lowest quartile of MVPA, and the significant effect persisted 5 years later. In summary, this study provides evidence to support the existence of a threshold for beneficial levels of MVPA in the prevention of arterial stiffness. Furthermore, this study suggests that exceeding this threshold may exert similar effects on arterial stiffness. These findings suggest that an optimal level of MVPA exists for preventing arterial stiffness, and exceeding this threshold may not engender additional benefits.

Trends of physical fitness related to weight status: An analysis including over 412,000 Swiss young male conscripts from 2007 to 2022

ObjectiveThe high prevalence of obesity among young adults in the civilian population pose challenges in recruiting physically fit soldiers. We assessed the trend of physical fitness related to weight status among Swiss male conscripts. MethodsCross-sectional data of medical examination data during mandatory conscription for the Swiss Armed Forces, 2007–2022 (N = 412,186). The conscription physical test (CPT) assessed five aspects of physical fitness, each aspect scoring 0–25, one component being an endurance test (ET). CPT and ET categories were defined as per military guidelines: “Insufficient”, “Sufficient”, “Good”, “Very Good” and “Excellent”. Weight status was based on body mass index (BMI). ResultsConscripts with obesity (BMI ≥ 30 kg/m2) and overweight (BMI 25–29.99) had significantly (p < 0.001) lower CPT and ET scores compared to normal weight [multivariable-adjusted mean: 54.7 ± 0.1 and 66.5 ± 0.1, vs. 73.6 ± 0.1 for CPT; 8.8 ± 0.1 and 12.5 ± 0.1, vs. 15.3 ± 0.1 for ET] and a higher likelihood to be categorized as “Insufficient” [weighted relative-risk ratio and (95 %CI): 70.4 (63.7–77.7) and 2.35 (2.16–2.55) for CPT; 77.1 (71.0–83.7) and 3.05 (2.91–3.20) for ET] or “Sufficient” [7.67 (7.38–7.97) and 2.02 (1.99–2.06) for CPT; 8.93 (8.37–9.52) and 2.02 (1.98–2.06) for ET]. Compared to normal weight conscripts, the CPT and ET scores decreased over the conscription years for conscripts with obesity (multivariable-adjusted mean yearly change: −0.11 ± 0.02 for CPT; −0.032 ± 0.007 for ET) and overweight (−0.16 ± 0.01 for CPT and −0.044 ± 0.004 for ET). ConclusionMale Swiss conscripts with overweight and obesity have lower physical fitness than normal weight conscripts, and this condition tends to worsen over the conscription years.

Association Between Frequency of Social Contact and Brain Atrophy in Community-Dwelling Older People Without Dementia: The JPSC-AD Study.

Epidemiologic evidence has shown that social isolation, a low frequency of social contact with others, is associated with the risk of dementia and late-life depressive symptoms. Therefore, we hypothesized that low frequency of social contact may be involved in brain atrophy, and depressive symptoms may play some role in this relationship. We aimed to evaluate the association between low frequency of social contact and the volumes of various brain regions and to assess the extent to which depressive symptoms mediate these relationships from a large population-based multisite cohort study. Dementia-free community-dwelling Japanese aged 65 years or older underwent brain MRI scans and a comprehensive health examination. Frequency of contact with noncohabiting relatives and friends was determined by asking a single question with 4 categories: everyday, several times a week, several times a month, and seldom. Total and regional brain volumes, intracranial volume (ICV), and white matter lesion volume were estimated using FreeSurfer software. The associations between frequency of social contact and brain volumes per ICV were examined using analyses of covariance. Mediation analyses were conducted to calculate the proportion of the associations explained by depressive symptoms. We included 8,896 participants. The multivariable-adjusted mean of the total brain volume in the group with the lowest frequency of social contact was significantly lower compared with that in the group with the highest frequency of social contact (67.3% vs 67.8%), with a significant increasing trend across the groups (p value for trend <0.001). The white matter lesion volume increased significantly with lower frequency of social contact (0.30% in the lowest frequency group vs 0.26% in the highest frequency group, p value for trend <0.001). Lower frequency of social contact was associated with smaller volumes in the temporal lobe, occipital lobe, cingulum, hippocampus, and amygdala (all q values of false discovery rate correction <0.05). The relationships seemed to be partly mediated by depressive symptoms, which accounted for 15%-29% of the observed associations. Lower frequency of social contact was associated with decreased total and cognitive function-related regional brain volumes. In addition, depressive symptoms partially explained the association in community-dwelling older people without dementia in Japan.

Associations of Food Insecurity with Dietary Inflammatory Potential and Risk of Low Muscle Strength.

Food insecurity refers to the uncertain availability of or limited access to nutritious food. Poor diets prevalent among food insecure populations may incite an inflammatory state and subsequently negatively affect skeletal muscle metabolism. To examine the inflammatory mechanistic potential of the association between food insecurity and the risk of low muscle strength, we analyzed cross-sectional data from 8624 adults aged ≥20 years from the Korean National Health and Nutrition Examination Survey 2014-2015. Household food security status was assessed using an 18-item food security survey module. The inflammatory potential of diets was estimated by the dietary inflammation index (DII). Low muscle strength was ascertained using hand grip strength. In the multivariable-adjusted model, greater food insecurity was significantly associated with a higher DII score and risk of low muscle strength. The multivariable-adjusted mean difference (95% confidence interval) on the DII, comparing the "moderate-to-severe" food insecurity group with the "food secure" group, was 0.43 (0.06-0.80) (P-trend: <0.001) and the odds ratio (95% confidence intervals) of low muscle strength for the same comparison groups was 2.06 (1.07-3.96) (P-trend: 0.005). Our results suggest that individuals with greater food insecurity may be susceptible to diets with greater inflammatory potential, which may contribute to a loss of muscle strength.

Sun Exposure and Intima-Media Thickness in the Mexican Teachers' Cohort Study.

Objective: To determine whether long-term sun exposure has a protective role in subclinical cardiovascular disease in adult Mexican women. Materials and Methods: We conducted a cross-sectional analysis of a sample of women from the Mexican Teachers' Cohort (MTC) study. Sun exposure was assessed in the MTC 2008 baseline questionnaire, in which women were asked about their sun-related behavior. Vascular neurologists measured carotid intima-media thickness (IMT) using standard techniques. Multivariate linear regression models were used to estimate the difference in mean IMT and 95% confidence intervals (95% CIs), according to categories of sun exposure and multivariate logistic regression models were used to estimate the odds ratio (OR) and 95% CIs for carotid atherosclerosis. Results: The mean age of participants was 49.6 ± 5.5 years, the mean IMT was 0.678 ± 0.097 mm, and the mean accumulated hours of weekly sun exposure were 2.9 ± 1.9. Prevalence of carotid atherosclerosis was 20.9%. Compared with women in the lowest quartile of sun exposure, women in the highest quartile had lower mean IMT, but this was not significant in the multivariable adjusted analysis. (Adjusted mean % difference: -0.8; 95% CI: -2.3 to 0.8). The multivariate adjusted ORs of carotid atherosclerosis were 0.54 (95% CI: 0.24-1.18) for women who were exposed 9 hours. For women who denied regular sunscreen use, those in the higher exposure category (9 hours) had lower mean IMT compared with those in the lower category (multivariable-adjusted mean % difference = -2.67; 95% CI: -6.9 to -1.5). Conclusions: We observed that cumulative sun exposure was inversely associated with IMT and subclinical carotid atherosclerosis. If these findings are further replicated and seen for other cardiovascular outcomes, sun exposure could be an easy, affordable strategy to lower overall cardiovascular risk.

Cooking methods are associated with inflammatory factors, renal function, and other hormones and nutritional biomarkers in older adults

Evidence of the role of cooking methods on inflammation and metabolic health is scarce due to the paucity of large-size studies. Our aim was to evaluate the association of cooking methods with inflammatory markers, renal function, and other hormones and nutritional biomarkers in a general population of older adults. In a cross sectional analysis with 2467 individuals aged ≥ 65, dietary and cooking information was collected using a validated face-to-face dietary history. Eight cooking methods were considered: raw, boiling, roasting, pan-frying, frying, toasting, sautéing, and stewing. Biomarkers were analyzed in a central laboratory following standard procedures. Marginal effects from generalized linear models were calculated and percentage differences (PD) of the multivariable-adjusted means of biomarkers between extreme sex-specific quintiles (Q) of cooking methods consumption were computed ([Q5 − Q1/Q1] × 100). Participants’ mean age was 71.6 years (53% women). Significant PD for the highest vs lowest quintile of raw food consumption was − 54.7% for high sensitivity-C reactive protein (hs-CRP), − 11.9% for neutrophils, − 11.9% for Growth Differentiation Factor-15, − 25.0% for Interleukin-6 (IL-6), − 12.3% for urinary albumin, and − 10.3% for uric acid. PD for boiling were − 17.8% for hs-CRP, − 12.4% for urinary albumin, and − 11.3% for thyroid-stimulating hormone. Concerning pan-frying, the PD was − 23.2% for hs-CRP, − 11.5% for IL-6, − 16.3% for urinary albumin and 10.9% for serum vitamin D. For frying, the PD was a 25.7% for hs-CRP, and − 12.6% for vitamin D. For toasting, corresponding figures were − 21.4% for hs-CRP, − 11.1% for IL-6 and 10.6% for vitamin D. For stewing, the PD was 13.3% for hs-CRP. Raw, boiling, pan-frying, and toasting were associated with healthy profiles as for inflammatory markers, renal function, thyroid hormones, and serum vitamin D. On the contrary, frying and, to a less extent, stewing showed unhealthier profiles. Cooking methods not including added fats where healthier than those with added fats heated at high temperatures or during longer periods of time.

Association of the prefrailty with global brain atrophy and white matter lesions among cognitively unimpaired older adults: the Nakajima study

Physical frailty has been associated with adverse outcomes such as dementia. However, the underlying structural brain abnormalities of physical frailty are unclear. We investigated the relationship between physical frailty and structural brain abnormalities in 670 cognitively unimpaired individuals (mean age 70.1 years). Total brain volume (TBV), hippocampal volume (HV), total white matter hypointensities volume (WMHV), and estimated total intracranial volume (eTIV) on the 3D T1-weighted images were automatically computed using FreeSurfer software. Participants were divided into two states of physical frailty (robust vs. prefrail) based on the revised Japanese version of the Cardiovascular Health Study criteria. The multivariable-adjusted mean values of the TBV-to-eTIV ratio was significantly decreased, whereas that of the WMHV-to-eTIV ratio was significantly increased in the prefrail group compared with the robust group. Slowness, one of the components of physical frailty, was significantly associated with reduced TBV-to-eTIV and HV-to-eTIV ratios, and slowness and weakness were significantly associated with an increased WMHV-to-eTIV ratio. Our results suggest that the prefrail state is significantly associated with global brain atrophy and white matter hypointensities. Furthermore, slowness was significantly associated with hippocampal atrophy.

Relationship of chronotype and social jetlag with adherence to the Japanese dietary guidelines among workers

ABSTRACT While late chronotype and greater social jetlag have been associated with poor dietary behavior among the general population, these associations have not been investigated among workers, who struggle to align their sleep timings with work schedules. We aimed to explore the cross-sectional association of social jetlag and a late chronotype with adherence to a healthy diet among Japanese workers. Participants were 1,435 non-shift workers (18–78 years) who attended a nutritional survey. Social jetlag was defined as the difference in the midpoint of sleep times between weekdays and weekends, while chronotype was estimated using the mid-sleep time on weekends that was corrected with sleep debt on weekdays. We calculated the adherence score of the Japanese Food Guide Spinning Top (JFGST) – healthy diet guidelines for Japanese. Multivariable linear regression analyses were used to calculate the adjusted means and 95% confidence intervals (CI) for adherence scores of social jetlag and chronotype. We found that greater social jetlag was associated with a lower JFGST score. The multivariable-adjusted mean (95% CI) of JFGST scores were 39.7 (39.1–40.2), 38.7 (37.9–39.6), and 38.1 (36.6–39.7) for <1 hour, 1 to <2 hours, and ≥2 hours of social jetlag, respectively (P-trend = 0.02). Workers with late chronotypes had significantly lower adherence scores on JFGST [36.3 (34.7–37.8); P-trend = 0.002]. Results suggest that a late chronotype and social jetlag are inversely associated with adherence to a healthy diet among Japanese workers.

Association Between Diabetes and Gray Matter Atrophy Patterns in a General Older Japanese Population: The Hisayama Study.

To examine the association between diabetes and gray matter atrophy patterns in a general older Japanese population. In 2012, a total of 1,189 community-dwelling Japanese aged ≥65 years underwent brain MRI scans. Regional gray matter volumes (GMV) and intracranial volume (ICV) were measured by applying voxel-based morphometry (VBM) methods. The associations of diabetes and related parameters with the regional GMV/ICV were examined using an ANCOVA. The regional gray matter atrophy patterns in the subjects with diabetes or elevated fasting plasma glucose (FPG) or 2-h postload glucose (2hPG) levels were investigated using VBM. Subjects with diabetes had significantly lower mean values of GMV/ICV in the frontal lobe, temporal lobe, insula, deep gray matter structures, and cerebellum than subjects without diabetes after adjusting for potential confounders. A longer duration of diabetes was also significantly associated with lower mean values of GMV/ICV in these brain regions. The multivariable-adjusted mean values of the temporal, insular, and deep GMV/ICV decreased significantly with elevating 2hPG levels, whereas higher FPG levels were not significantly associated with GMV/ICV of any brain regions. In the VBM analysis, diabetes was associated with gray matter atrophy in the bilateral superior temporal gyri, right middle temporal gyrus, left inferior temporal gyrus, right middle frontal gyrus, bilateral thalami, right caudate, and right cerebellum. The current study suggests that a longer duration of diabetes and elevated 2hPG levels are significant risk factors for gray matter atrophy in various brain regions.

Olfaction and kidney function in community-dwelling older adults.

BackgroundIn older adults, kidney function declines with age. People with advanced kidney diseases may have poor olfaction. However, it is unclear whether poor olfaction is a marker for declining renal function or future risk of chronic kidney disease (CKD). We therefore investigated olfaction in relation to kidney function and risk of CKD.MethodsThese secondary data analyses were limited to participants of the year 3 clinical visit of the Health Aging and Body Composition Study. The analytic sample size varied between 1427 to 2531, depending on participant eligibility and data availability for each analysis. Olfaction was tested using the Brief Smell Identification Test (B-SIT), defined as anosmia (score≤6), hyposmia (7–8), moderate (9–10), and good function (10–11) at baseline. We estimated glomerular filter rate (eGFR) at baseline and seven years later using the CKD-EPI creatinine-cystatin C equation, and defined incident CKD as eGFR<60 ml/min/1.73m2 and eGFR decline ≥1 ml/min/1.73m2/year. Further, we identified CKD hospitalization events from hospitalization and death records. We used inverse probability weighting and weighted multivariable regressions to account for censoring in the prospective analyses and used absolute risk regression to account for competing risk of death.ResultsAt baseline, compared to participants with good olfaction, the multivariable-adjusted mean eGFR was 3.00 ml/min/1.73m2 lower (95% confidence interval (CI): -5.25, -0.75) for those with anosmia and 1.87 lower (95% CI: -3.94, 0.21) for those with hyposmia with a P for linear trend < 0.001. Those with anosmia at baseline was had a significantly lower eGFR seven years later (-5.31, 95% CI: -8.58, -2.04, P for trend = 0.002), but the association was attenuated after further accounting for baseline eGFR (-2.37, 95%CI: -4.91, 0.16, P for linear trend = 0.147). Olfactory function was not associated with incident CKD or CKD hospitalization.ConclusionIn older adults > age 70 years, poor olfaction is associated with lower kidney function, but not future CKD risk. These associations should be further investigated in relatively younger population.

Association of Serum Calcium and Phosphate Concentrations with Glucose Metabolism Markers: The Furukawa Nutrition and Health Study.

Calcium and phosphate may play an important role in cardio-metabolic abnormalities, including type 2 diabetes; however, epidemiological evidence of the association of calcium and phosphate status with glucose metabolism among Asians is limited. In the current study, we performed a cross-sectional analysis of the association of serum calcium, phosphate, and calcium–phosphate product concentrations with glucose metabolism markers among Japanese individuals. Overall, 1701 workers (aged 18–78 years) who participated in a health survey were enrolled in this study. Multivariable linear regression models were used to estimate means of homeostatic model assessment of insulin resistance (HOMA-IR), homeostatic model assessment of β-cell function (HOMA-β), and glycated hemoglobin (HbA1c). Serum calcium concentration was positively associated with HOMA-IR and HbA1c (p for trend < 0.01). Multivariable-adjusted means (95% confidence interval (CI)) of HOMA-IR for the lowest and highest quartiles of serum calcium were 0.78 (0.75–0.82) and 1.01 (0.96–1.07), respectively. The corresponding values for HbA1c were 5.24 (5.22–5.27) and 5.29 (5.26–5.32), respectively. Serum phosphate and calcium–phosphate product concentrations were inversely associated with HOMA-IR (p for trend < 0.01). Multivariable-adjusted means (95% CI) of HOMA-IR for the lowest and highest quartiles of serum phosphate were 1.04 (0.99–1.09) and 0.72 (0.69–0.76), respectively. The corresponding values for calcium–phosphate product were 1.04 (0.99–1.09) and 0.73 (0.69–0.77), respectively. The current findings suggest that higher serum calcium and lower serum phosphate concentrations are associated with IR among apparently healthy adults.

Does propolis affect the quality of life and complications in subjects with irritable bowel syndrome (diagnosed with Rome IV criteria)? A study protocol of the randomized, double-blinded, placebo-controlled clinical trial

BackgroundIrritable bowel syndrome (IBS) is one of the most frequent and recurrent gastrointestinal diseases. However, up to now, no pharmacological agent has been approved to treat IBS. Emerging evidence showed that inflammation has a vital role in enhancing nervous system sensitivity and perception of abdominal pain in subjects with IBS. Propolis is an herbal substance with a broad spectrum of antioxidants, anti-inflammatory, and prebiotic properties, which might exert beneficial effects to reduce the severity of IBS. The current clinical trial aims to evaluate the efficacy of propolis supplementation on IBS.MethodsThis single-center, randomized, double-blind, placebo-controlled clinical trial will be performed to evaluate the effect of propolis supplementation in adult patients with IBS diagnosed with Rome IV criteria. Fifty-two eligible patients will randomly be allocated to receive a propolis tablet (450 mg, containing 100 mg polyphenol compounds) or identical placebo, twice daily for 6 weeks. The primary outcome of the trial is an improvement in IBS severity from baseline to the sixth week of intervention. The secondary outcomes include the change in weight, waist circumference, and IBS quality of life. We will use the paired sample t test or Mann-Whitney U test for the within-group comparison and independent sample t test or Wilcoxon rank-sum and chi-square test or Fisher’s exact test for the between-group comparison. Besides, a multivariable-adjusted mean effect will be computed using the ANCOVA test.DiscussionWe hypothesize that propolis supplementation would be useful for treating IBS through its antioxidants, anti-inflammatory, and prebiotic properties. This trial will show the results of propolis supplementation, whether positive or negative, on IBS. If the current trial confirms our hypothesis, propolis supplementation can be a new choice in adjunctive therapy of IBS.Trial registrationIranian Registry of Clinical Trials IRCT20190708044154N1. Registered on 26 December 2019. Updated on 13 February 2020. https://en.irct.ir/trial/40983SponsorTabriz University of Medical Sciences, Tabriz, Iran

Proteinuria and Reduced Estimated Glomerular Filtration Rate are Independently Associated With Lower Cognitive Abilities in Apparently Healthy Community-Dwelling Elderly Men in Japan: A Cross-sectional Study.

BackgroundThe association of proteinuria and reduced estimated glomerular filtration rate (eGFR) with cognition needs more clarification. We cross-sectionally examined whether proteinuria and reduced eGFR, even in moderate stages, were independently associated with lower cognition in a community-based sample of elderly men.MethodsOur cohort initially comprised 1,094 men aged 40–79 years from a random sample from Shiga, Japan in 2006–2008. Of 853 men who returned for the follow-up examination (2009–2014), we analyzed 561 who were ≥65 years, free of stroke, and completed the Cognitive Abilities Screening Instrument (CASI) at follow-up (higher CASI scores [range 0 to 100] indicate better cognition). Proteinuria was assessed via dipstick. eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration Equation. Participants were divided into three groups either by eGFR (≥60, 59–40, and <40 mL/min/1.73 m2) or by proteinuria (no, trace, and positive), considered normal, moderate, and advanced, respectively. Using linear regression, we computed mean CASI score, with simultaneous adjustment for proteinuria and eGFR in addition to other potential confounders.ResultsSignificant trends of lower cognition were observed across the groups of worse proteinuria and lower eGFR independently: multivariable-adjusted mean CASI scores were 90.1, 89.3, and 88.4 for proteinuria (Ptrend = 0.029), and 90.0, 88.5, and 88.5 for eGFR (Ptrend = 0.015) in mutual-adjustment model.ConclusionsProteinuria and reduced eGFR, even in their moderate stages, were independently associated with lower cognition in a community-based sample of elderly men. The results suggest the importance of proteinuria and low eGFR for early detection and prevention of cognitive decline.

Nutrient and food group intakes and skeletal muscle index in the Japanese elderly: a cross-sectional analysis of the NHNS 2017.

To examine nutrient and food intakes according to the levels of skeletal muscle mass index (SMI) in the elderly. Cross-sectional study. Data were derived from the 2017 National Health and Nutrition Survey in Japan. SMI was calculated by dividing appendicular skeletal muscle (or lean) mass (kg) by height squared (m2). We calculated the multivariable-adjusted means of individuals' dietary intake. Dietary intake of energy, nutrients and food categories was assessed by examining dietary records using a semi-weighed method and compared according to the sex-specific quartiles of SMI. Men and women aged ≥60 years. Among 797 men and 969 women, individuals with a higher SMI consumed more energy and more nutrients than did those with a lower SMI after adjusting for age, lifestyle and physical activity factors. After further adjusting for energy intake, total dietary fibre, vitamin A, vitamin B6, K, Fe and Cu were positively associated with higher SMI in men (Pfor trend < 0·05). For food categories, men with a higher SMI consumed more vegetables and meats, but the associations were attenuated after adjustment for energy and remained significant for vegetable only (Pfor trend = 0·018). Japanese elderly people with a higher SMI consumed more energy and nutrients and more vegetables than did those with a lower SMI. This finding shows that diet is important in preventing muscle loss among the elderly in an ageing society.

Association Between Physical Activity Levels in the Hospital Setting and Hospital-Acquired Functional Decline in Elderly Patients

The effects of in-hospital physical activity (PA) on outcomes among elderly patients has seldom been assessed. To assess PA levels among elderly patients hospitalized for acute medical illness and to examine the association between PA levels and functional decline and other clinical outcomes at discharge. This monocentric cohort study was performed among patients 65 years or older who were admitted for acute medical illness to the internal medicine ward of Lausanne University Hospital, Lausanne, Switzerland, from February 1 through November 30, 2018. Data were analyzed from January 1 through December 2, 2019. Daytime and 24-hour PA levels assessed via wrist accelerometers and measured in millig units (mG; 1 mG = 9.80665 × 10-3 m/s2). Functional decline (defined as a ≥5-point decrease in the modified Barthel Index), risk of bedsores, length of stay (LOS), and inability to return home. A total of 177 patients (106 [59.9%] men; median age, 83 [interquartile range, 74-87] years) were included. Lower mean (SD) PA levels were found in patients using walking aids before admission (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [3] vs 11 [5] mG), those admitted for a reason associated with functional decline (daytime, 12 [6] vs 14 [7] mG; 24-hour, 10 [4] vs 11 [4] mG), or those prescribed physiotherapy (daytime, 12 [5] vs 15 [7] mG; 24-hour, 10 [4] vs 12 [5] mG). At discharge, functional decline was found in 63 patients (35.6%; 95% CI, 25.6%-43.1%), bedsore risk in 78 (44.1%; 95% CI, 36.6%-51.7%), and inability to return home in 82 (46.3%; 95% CI, 38.8%-54.0%). After multivariate analysis, no association was found between PA levels and functional decline (multivariable-adjusted mean [SE], 13 [1] vs 13 [1] mG for daytime levels [P = .69] and 10 [1] vs 11 [1] mG for 24-hour PA levels [P = .45]) or LOS (Spearman rank correlation, ρ = -0.06 for daytime PA levels [P = .93] and -0.01 for 24-hour PA levels [P = .52]). Patients at risk of bedsores had significantly lower PA levels than those not at risk (multivariable-adjusted mean [SE], 12 [1] vs 15 [1] mG for daytime PA levels [P = .008]; 10 [1] vs 12 [1] mG for 24-hour PA levels [P = .01]). Patients able to return home had significantly higher PA levels than those institutionalized (multivariable-adjusted mean [SE], 14 [1] vs 12 [1] mG for daytime PA levels [P = .04]; 11 [1] vs 10 [1] mG for 24-hour PA levels [P = .009]). In this study, lower in-hospital daytime and 24-hour PA levels were associated with risk of bedsores and inability to return home on discharge. These findings are important given that one-third of elderly patients present with hospital-acquired functional decline.

Differences in the association of diet quality with body fat distribution between men and women.

Background/Objective:As dietary intake and endocrine metabolism are vastly different by sex, we evaluated differences in the association of diet quality with body composition between men and women.Subjects/Methods:Close to 2,000 participants from the Multiethnic Cohort completed calibrated quantitative food frequency questionnaires at cohort entry (1993–96) and clinic visit (2013–16), from which the Healthy Eating Index (HEI-2010) was computed. Adiposity measures were obtained through DXA and MRI at clinic visit. Multivariable-adjusted mean adiposity measures were estimated by tertiles of HEI-2010 scores using general linear regression. The associations of diet quality with high visceral fat (VAT) and non-alcoholic fatty liver disease (NAFLD) were examined by logistic regression. To assess sex differences, cross-product terms with HEI-2010 were added to the models.Results:Mean HEI-2010 scores were higher for women than men at cohort entry (67.4 vs. 64.0) and clinic visit (73.6 vs. 71.0). Past and current diet quality was inversely associated with adiposity measures in men and women. Although interaction terms were not significant, the magnitude of the slopes and differences in adjusted means across tertiles suggested a stronger association for women than men. When comparing individuals who maintained a high vs. poor quality diet over 20 years, women but not men showed significantly lower risks for high VAT, whereas high HEI-2010 scores predicted a lower risk of NAFLD in both sexes.Conclusions:The inverse association of diet quality with adiposity was similar in both sexes, but diet quality appeared to have a stronger influence on VAT in women than men.

Time trends of vitamin D concentrations in northern Sweden between 1986 and 2014: a population-based cross-sectional study

PurposeVitamin D, produced through cutaneous photosynthesis or ingested via foods or supplements, has generated considerable research interest due to its potential health effects. However, epidemiological data on the time trends of vitamin D status are sparse, especially from northern Europe. We examined the time trend of vitamin D concentrations in northern Sweden between 1986 and 2014.MethodsWe used data on 11,129 men and women (aged 25–74 years) from seven population-based surveys (the Northern Sweden MONICA study), recruited between 1986 and 2014. Serum vitamin D (25-hydroxyvitamin D) status was measured using a one-step immunoassay (Abbott Architect). Multivariable linear regression models, adjusted for age, sex, and a number of other variables, were used to estimate the time trend of vitamin D concentrations.ResultsThe mean value of vitamin D in the entire study population was 19.9 ng/mL [standard deviation (SD) 7.9], with lower values in men (19.4 ng/mL; SD 7.5) than in women (20.5 ng/mL; SD 8.2). Using the survey in 1986 as reference category, the multivariable-adjusted mean difference [95% confidence interval (CI)] in ng/mL was 2.7 (2.2, 3.3) in 1990, 3.2 (2.7, 3.7) in 1994, 1.6 (1.0, 2.1) in 1999, − 2.0 (− 2.5, − 1.4) in 2004, 1.0 (0.4, 1.5) in 2009, and 3.1 (2.5, 3.6) in 2014.ConclusionIn this large cross-sectional study, we observed no clear upward or downward trend of vitamin D concentrations in northern Sweden between 1986 and 2014.