One-year Increase Research Articles

Impact of systolic blood pressure on epicardial adipose tissue in patients with chronic coronary artery disease

Abstract Objectives The current study aimed to investigate the impact of systolic blood pressure (SBP) on epicardial adipose tissue (EAT) volume in a large, multi-center cohort of patients with chronic coronary artery disease (CAD). Methods We included 879 patients with CAD (mean age: 58±11 years; 294 females; 72% Chinese, 20% Indian/Malay, 8% Others) in the APOLLO study. The EAT volume was measured using non-contrast computed tomography (CT) imaging. The contour of the pericardium was traced from the pulmonary artery bifurcation to the apex of the heart. CT attenuation between -190 and -30 Hounsfield units (HU) was used to select the EAT on every axial slice. The EAT volumes were automatically calculated from 3-dimensional fat voxels at each axial slice, which were then summed to obtain the total EAT volume (Figure 1). Results EAT volume was positively correlated with age (r=0.261, P<0.0001). With a one-year increase in age, the EAT volume was found to increase by 1.5 cm3, adjusting for other confounders. The mean EAT volume for males was 8.3 cm3 higher than for females (P=0.015). Patients with hypertension had significantly higher EAT volume (134±51 vs. 114±48 cm3, P<0.0001) compared to those without hypertension. Multivariable analysis adjusted for age, gender and other cardiac risk factors showed that the presence of hypertension (P=0.043) was independently associated with EAT volume. Compared to the highest SBP tertile (≥148 mmHg), those in the lowest SBP tertile (≤132 mmHg) had lower EAT volume (117±52 vs. 128±51 cm3, P=0.007). When examined as a continuous variable, higher SBP was significantly associated with higher EAT volume: for every 10mmHg increase in SBP, EAT volume increased by 2.6 cm3. Conclusion The study found a significant association between hypertension and increased EAT volume, emphasizing the importance of managing hypertension to reduce cardiovascular risk.

Rising trend of dentist-prescribed antibiotics in Brazil: 2011-2021.

To describe the trends in antibiotic prescribing by dental practitioners and to investigate the relationship between these trends and some factors of public oral health services in Minas Gerais (MG), Brazil. This was a time-series analysis of antibiotics prescribed by dental practitioners between January 2011 and December 2021. The outcome variables were number of defined daily doses (DDD) and DDD/1000 population/year in a sample of cities in MG. Covariates were public oral healthcare factors, such as coverage, estimates of dental procedures, and frequency of dental pain. Linear time-series regression models were used to examine trends and the influence of covariates on antibiotic prescribing. Overall, the number of prescriptions increased by 334.69% between 2011 and 2021, with amoxicillin being the most commonly prescribed drug (78.53%). The number of DDD for all antibiotics increased from 17,147.13 to 77,346.67 and the average DDD/1000 inhabitants/year was 126.66 (SD: 130.28). The linear time-series regression model showed that for each one-year increase, the average log DDD/1000 inhabitants increased by 0.35 (standard error = 0.07, p < 0.001). No covariates were found to be associated with the outcome. In Minas Gerais, Brazil, a significant upward trend was observed in the number of prescriptions and the number of DDD of antibiotics prescribed by dental practitioners. No influence of factors related to public oral healthcare services on the outcome was observed, thereby emphasizing the need for further research on factors influencing medication use in dental practice.

Exploring Longitudinal Associations between Farmer Health and Wellbeing, and Dairy Herd Subclinical Mastitis Prevalence and Productivity: The HUNT Study, Norway

The health and wellbeing of farmers is one aspect of the sustainability of agriculture, as is the health and productivity of livestock. Previous research suggests a possible association between the 2, but the complexity of the relationships between farmers and their livestock can hamper research efforts. This observational study utilizes high quality existing survey and register data from a cohort of Norwegian dairy enterprises to explore possible longitudinal associations between farmer health and wellbeing (general health, chronic disease or condition, chronic pain, anxiety or depression symptoms, or poor life satisfaction) and changes in dairy herd udder health (estimated by the proportion of milk tests with a high somatic cell count (SCC%)) or milk yield (kilograms per cow-year equivalent). We found evidence of a general trend toward increased SCC% with poor farmer health or wellbeing. If the farmer had poor self-reported general health, the odds ratio (OR) for a one-year increase in SCC% at the enterprise was 1.51 (95% CI: 0.76,2.99, OR 1.80 (0.71, 4.51) after adjustment for possible effect modifiers) compared with those with good health, and for poor life satisfaction the OR was 1.50 (0.71,3.15) (2.61 (0.92,7.39) after adjustment). We also find evidence that enterprises where a farmer was experiencing poor health or wellbeing tended to have lower odds of a decrease in milk yield than other enterprises. The OR for a one-year decrease in milk yield with any chronic disease or condition was 0.42 (0.24,0.76), and with symptoms of anxiety or depression the OR was 0.56 (0.23,1.34). Potential confounders and effect modifiers are discussed and explored. These results suggest that further longitudinal research to unravel the relationships between farmer health and wellbeing, and livestock health and productivity is needed.

DNA methylation age acceleration is associated with incident cognitive impairment in the Health and Retirement Study.

DNA methylation clocks have emerged as promising biomarkers for cognitive impairment and dementia. Longitudinal studies exploring the link between DNA methylation clocks and cognitive decline have been constrained by limited sample sizes and a lack of diversity. Our study aimed to investigate the longitudinal associations between DNA methylation clocks and incident cognitive impairment using a larger sample size encompassing a US nationally representative sample from the Health and Retirement Study. We measured DNA methylation age acceleration in 2016 by comparing the residuals of DNA methylation clocks, including GrimAge, against chronological age. Cognitive decline was determined by the change in Langa-Weir cognition status from 2016 to 2018. Using multivariable logistic regression, we evaluated the link between DNA methylation age acceleration and cognitive decline, adjusting for cell-type proportions, demographic, and health factors. We also conducted an inverse probability weighting analysis to address potential selection bias from varying loss-to-follow-up rates. The analytic sample (N=2,713) at baseline had an average of 68 years old, and during the two years of follow-up, 12% experienced cognitive decline. Participants who experienced cognitive decline during follow-up had higher baseline GrimAge (mean = 1.2 years) acceleration compared to those who maintained normal cognitive function (mean = -0.8 years, p < 0.001). A one-year increase in GrimAge acceleration was associated with 1.05 times higher adjusted and survey-weighted odds of cognitive decline during follow-up (95% CI: 1.01-1.10). This association was consistent after accounting for loss-to-follow-up (OR = 1.07, 95% CI: 1.04-1.11). Our study offers insights into DNA methylation age acceleration associated with cognitive decline, suggesting avenues for improved prevention, diagnosis, and treatment.

Turning the page on energy poverty? Quasi-experimental evidence on education and energy poverty in Zimbabwe

We investigate the long-term causal effects of education on energy poverty among households headed by men and women, leveraging the 1980 Zimbabwe school reform as a quasi-experiment. This reform, which significantly expanded educational opportunities for all children, serves as an ideal setting for assessing the impact of education on energy poverty within a regression discontinuity design, with age at reform determining exposure. Exposure to the reform resulted in a 2.08-year average increase in schooling and a 28.3 percentage point (pp) increase in the probability of completing secondary schooling. The reform's impact was more pronounced for women, increasing their schooling by 2.35 years (compared to 1.68 years for men) and for rural residents, with a 2.53-year increase (compared to 1.00 year for urban residents). A one-year increase in education reduces the risk of energy poverty by an estimated 8.56%, more pronounced among male-head families (5 pp) than among female-headed households (4.6 pp). This increased education enhances labour market outcomes, household economic status, infrastructure quality, and access to information and promotes progressive societal norms. These findings underscore education's crucial role in sustainable and gender-inclusive economic development, highlighting the potential of educational policy in reducing energy poverty and advancing gender equality in low-income countries.

Knowledge and attitude of traumatic dental injuries in Mongolian schoolteachers

BackgroundTraumatic dental injury (TDI) is a growing public health concern worldwide, and children and adolescents are commonly affected. Because TDI often occurs at school, the response of teachers to these injuries is crucial. However, teachers in various countries have been shown to lack knowledge of effective TDI first-aid response and need an intervention to improve their knowledge. The aim of the study presented here was to ascertain and analyze teachers’ knowledge of and attitude about TDI in Mongolia.Materials and methodsA cross-sectional study of full-time teachers in Mongolia was performed using an online questionnaire (compiled from relevant studies) from September 2022 to December 2022. The questionnaire consists of 47 items and among them 14 were used to assess the teacher’s knowledge, and 5 were for attitude towards TDI. The maximum possible score was 14 points and grouped as follows good, moderate, and poor. T-test, ANOVA test (post-hoc) and linear regression analysis were performed.ResultsThe online survey provided quantitative data from 2821 participants: 28% were elementary school teachers, 29% middle school teachers, and 42% high school teachers. Their mean age was 36.7 ± 9 years, and 2433 (86%) were female. The mean score of the TDI knowledge of the teachers was 5.3 ± 2.1 out of 14. The ANOVA test showed that older (p < 0.01) and more experienced teachers (p < 0.01) had higher scores. Teachers in the eastern (5.46 ± 2.2) and southern (5.49 ± 2.2) provinces had higher mean scores than in the other provinces (p < 0.02). Teachers majored in natural sciences (5.4 ± 2.2) had a higher score than those in the social sciences (5.2 ± 2.1) and difference were significant (p < 0.02). The multiple regression model statistically significantly predicted a one-year increase in experience, the TDI score increased 0.034 (95% CI 0.026, 0.043) unit.ConclusionsThe knowledge regarding TDI and effective first-aid response to such injury is low in teachers in Mongolia. However, the teachers’ attitude about TDI was positive and they wanted to learn and improve their knowledge. Therefore, further education and training programs are advised.

Characteristics associated with SARS-CoV-2 testing, infection and vaccine uptake among essential non-healthcare workers in Montréal, 2021.

Essential non-healthcare workers experienced higher rates of SARS-CoV-2 infection compared to non-essential workers. Identify characteristics associated with SARS-CoV-2 testing, infection and vaccine uptake among essential non-healthcare workers in Montréal, Québec. Secondary, cross-sectional analysis of data collected from participants prospectively recruited in two observational studies (first study, Onsite Testing Study, January-March 2021; second study, Self-Testing Study, July-October 2021) of essential non-healthcare workers in 2021. Logistic regression with generalized linear mixed models was used to explore characteristics associated with our outcomes (previous SARS-CoV-2 testing, exposure and vaccination). Overall, 2,755 participants were included (first study, Onsite Testing Study, n=2,128; and second study, Self-Testing Study, n=627). A higher proportion of participants identified as male (n=1,601; 58%), non-White (n=1,527; 55%) and worked in the manufacturing/supplier sector (n=1,706; 62%). Relative to the first study, Onsite Testing Study, participants in the second study, Self-Testing Study, had higher odds (78% vs. 46%; aOR 4.1, 95% CI: 3.2-5.2) of previous SARS-CoV-2 testing and of testing positive prior to study enrolment (6.2% vs. 4.3%; aOR 1.7, 95% CI: 1.1-2.6). Individuals reporting recent SARS-CoV-2 exposure had higher odds of previous SARS-CoV-2 testing (aOR 4.0, 95% CI: 3.0-5.4), while older age (aOR 0.98, 95% CI: 0.98-0.99 per one-year increase) and being male (aOR 0.6, 95% CI: 0.5-0.7) were associated with lower odds of previous testing. Results were similar in stratified analyses. Participants from businesses with more than 50 employees had higher odds of having received a SARS-CoV-2 vaccine (91% vs. 80%; aOR 2.6, 95% CI: 1.4-4.8). Consideration of individual and business characteristics associated with testing and vaccination programs for SARS-CoV-2 could improve equity, uptake and impact.

Depression and its associated factors among people living with HIV in the Volta region of Ghana

Depression among people living with HIV/AIDS in higher-income countries is associated with suboptimal adherence to antiretroviral therapy and though counterintuitive. Yet, less is known regarding how depression, social support, and other sociodemographic factors influence outcomes among people living with HIV, particularly in resource-limited settings like Ghana. In view of this gap, this study investigated factors associated with depressive symptoms among people living with HIV in the Volta region of Ghana. A total of 181 people living with HIV from a local antiretroviral clinic was purposively sampled for the study. The questionnaire included the Center for Epidemiologic Studies Depression Scale, the Internalized Stigma of HIV/AIDS Tool, and the Interpersonal Support Evaluation List-12. An independent student t-test, one-way analysis of variance, and chi-square test were conducted to ascertain the associations among the variables of interest. The magnitude of association was evaluated with multiple linear regression. The average depression score among the participants was 9.1±8.8 and 20.4% reported signs of depression. Majority (78%) of participants who were depressed were male compared to females (p = 0.031). In the multiple linear regression, every one-year increase in age was significantly associated with an estimated 0.012 standard deviation increase in depression scores (95% CI: 0.002–0.021) after adjusting for all other variables in the model. Every unit standard deviation increase in social support was significantly associated with an estimated 0.659 standard deviation increase in depression scores (95% CI:0.187–1.132), after adjusting for all other variables in the model. We found a high prevalence of depressive symptoms among people living with HIV especially among males. An increase in age and social support was associated with an increase in depressive symptoms among people living with HIV in this study. We recommend further study using longitudinal approach to understand this unexpected association between depression and social support among people living with HIV in Ghana.

Circadian rhythm analysis using wearable-based accelerometry as a digital biomarker of aging and healthspan

Recognizing the pivotal role of circadian rhythm in the human aging process and its scalability through wearables, we introduce CosinorAge, a digital biomarker of aging developed from wearable-derived circadian rhythmicity from 80,000 midlife and older adults in the UK and US. A one-year increase in CosinorAge corresponded to 8–12% higher all-cause and cause-specific mortality risks and 3–14% increased prospective incidences of age-related diseases. CosinorAge also captured a non-linear decline in resilience and physical functioning, evidenced by an 8–33% reduction in self-rated health and a 3–23% decline in health-related quality of life score, adjusting for covariates and multiple testing. The associations were robust in sensitivity analyses and external validation using an independent cohort from a disparate geographical region using a different wearable device. Moreover, we illustrated a heterogeneous impact of circadian parameters associated with biological aging, with young (<45 years) and fast agers experiencing a substantially delayed acrophase with a 25-minute difference in peak timing compared to slow agers, diminishing to a 7-minute difference in older adults (>65 years). We demonstrated a significant enhancement in the predictive performance when integrating circadian rhythmicity in the estimation of biological aging over physical activity. Our findings underscore CosinorAge’s potential as a scalable, economic, and digital solution for promoting healthy longevity, elucidating the critical and multifaceted circadian rhythmicity in aging processes. Consequently, our research contributes to advancing preventive measures in digital medicine.

Adult children’s educational attainment and its relationship with older parents’ life satisfaction in India

ABSTRACT Life satisfaction is an important component of successful aging and is known to be associated with health, well-being, and longevity. This study examines the association between children’s educational attainment and life satisfaction among older parents in India while also exploring the moderating effect of the children’s and parents’ sex on the examined relationship. Additionally, the study aims to identify potential mediators and pathways that could explain the examined relationship. The study draws on data from the Longitudinal Ageing Study in India (LASI, 2017–18) wave-1. Multivariable Ordinary Least Squares (OLS) regression models, incorporating interaction analyses, were employed to examine the relationship between offspring education and parental life satisfaction. Structural Equation Modelling (SEM) was employed to investigate potential mediators and pathways of the examined relationship. The findings reveal that a one-year increase in average offspring education was associated with a 0.18 unit increase in life satisfaction among older parents. Moreover, the interaction estimates indicate that for every unit increase in offspring education, mothers experienced a 0.05 unit higher increment in life satisfaction score compared to fathers. The SEM analysis identified health behavior, physical and mental health, food insecurity, and perceived socioeconomic status as potential mediators of the relationship between children’s education and parents’ life satisfaction. The study suggests that investing in higher education for the upcoming generation could yield benefits not only for the younger generation but also for the older generation as well.

#2980 The natural history of urinary tract infections in kidney transplant recipients

Abstract Background and Aims Urinary tract infections (UTIs) can occur following kidney transplantation, but research on infection rates and outcomes is inconclusive. We therefore aimed to provide a comprehensive understanding of the natural history of UTIs and the impact on long-term outcomes. Method We performed a single-centre cohort study of kidney-only transplant recipients at the Glasgow Transplant Unit, UK. A standardised protocol for UTI screening and treatment was in use and only treated UTIs were included. We studied the first two years post-transplant as this is the time when UTIs are most likely to occur. Patients were categorised into 3 groups based on number of UTIs: no UTIs, 1-2 UTIs and ≥3 UTIs. Furthermore, patients with highly recurrent UTIs defined as ≥10 UTIs in the first 2 years were compiled and analysed. Proportional odds logistic regression was performed to identify risk factors for having ≥3 UTIs, with adjustment for age, sex, primary renal diagnosis, donor type (live donor, deceased heart beating, deceased non-heart beating) and induction immunosuppression. Results Amongst 1412 transplant recipients studied over a nine-year period, the mean age was 48 years and 563 (39.9%) were female. 1169 (82.8%) of recipients experienced no UTIs, 180 (12.7%) had 1-2 UTIs, and 63 (4.5%) had ≥3 UTIs (Fig. 1). The key risk factors for developing ≥3 UTIs were female sex: adjusted odds ratio (aOR) 1.50 (95% confidence interval 1.13-1.99), induction with anti-thymocyte globulin (ATG): aOR 6.60 (3.05-14.05), and age: aOR for each one-year increase 1.01 (1.00-1.02). There were no primary renal diagnoses (PRD) that demonstrated a significant association with ≥3 UTIs. However, individuals with tubulointerstitial disease, a group which includes structural abnormalities of the urinary tract and reflux nephropathy as a considerable proportion, showed a trend towards heightened risk: aOR 1.47 (0.97-2.22, reference group glomerulonephritis). Recipients with ≥3 UTIs had lower estimated glomerular filtration rates (eGFRs) at two years compared to the no UTI group (49.7 vs. 59.2mL/min/1.73 m2, respectively). However, there was no significant increase in mortality or graft loss between the three groups. In the group of patients with highly recurrent UTIs, consisting of 14 patients (0.01%), we observed that 3 (21%) had a PRD of reflux nephropathy, while 5 (35%) had underlying structural abnormalities of the native renal tract as a PRD. Further to this 5 (35%) of the patients received ATG induction and 5 (35%) patients had a previous transplant. Conclusion We describe a low rate of UTIs requiring treatment in the first two years after kidney transplantation. Females, older recipients and those given ATG induction were at increased risk of recurrent UTIs. There was no impact of UTIs on graft loss or patient mortality. However, eGFR at two years post-transplant was lower amongst those with recurrent UTIs. We also observed that for the patients with highly recurrent UTIs, ATG induction, previous transplants, reflux nephropathy and structural abnormalities of native renal tract may be a risk factor. Recipients at highest risk of UTIs should therefore be screened for UTIs and interventions to reduce this risk should be considered

Statin use as a moderator on the association between metformin and breast cancer risk in women with type 2 diabetes mellitus

IntroductionMetformin and statins are considered as potential agents for prevention of breast cancer, however, existing evidence does not uniformly substantiate this claim, and the data is scarce concerning their interaction in relation to breast cancer risk. This study aims to investigate whether the effect of metformin on breast cancer incidence varied by statin use among women with type 2 diabetes mellitus (T2DM).MethodsThis study included women with T2DM, without a history of cancers, and followed up for more than one year from the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) for the period 1998–2014. The dataset was structured using a person-time approach, where the cumulative medication usage was annually updated for each person. The extended Cox proportional hazards models were employed, reporting adjusted hazard ratios (HR) with 95% confidence intervals (CI).ResultsDuring a median follow-up of 5 years, 515 of 29,498 women received a breast cancer diagnosis. Each additional year of metformin or statins use corresponded to a decrease in breast cancer incidence, while the magnitude attenuated over time. Noteworthily, statin use modified the effect of metformin on breast cancer incidence. For instance, after 5 years of follow-up, one-year increase of metformin use among women who used statins for 3 years was linked to a substantially reduced breast cancer risk (HR, 95% CI: 0.88, 0.84–0.93), however, there was no significant decrease in risk for those non-statins users (HR, 95% CI: 0.96, 0.89–1.04).ConclusionsExtending metformin or statin usage by one year conferred breast cancer protection in women with T2DM. Enhanced protective effect of metformin was observed among those who also use statins. These results suggest the potential of combined metformin and statin therapy as promising breast cancer prevention strategies.

Associations of parental age at pregnancy with adolescent cognitive development and emotional and behavioural problems: a birth cohort in rural Western China

BackgroundThe relationship between parental age at pregnancy and offspring development in low- and middle-income countries remains unclear. We aimed to examine the associations of parental age at pregnancy with adolescent development in rural China.MethodsWe conducted a prospective birth cohort study of offspring born to pregnant women who participated in an antenatal micronutrient supplementation trial in rural Western China. Adolescent cognitive development and emotional and behavioural problems were assessed by using the Wechsler Intelligence Scale for Children-IV and the Youth Self-Report-2001, respectively. After accounting for the possible nonlinear relationships, we examined the linear associations between parental age (in years) at pregnancy and scores of adolescent cognitive development and emotional and behavioural problems by performing generalized estimating equations.ResultsAmong 1897 adolescents followed from birth to early adolescence, 59.5% were male with a mean age of 11.8 (standard deviation (SD): 0.8) years. The mean ages of mothers and fathers at pregnancy were 24.6 (SD: 4.4) and 27.9 (SD: 4.1) years old, respectively. All the P values of the nonlinear terms between parental age and adolescent development in all domains were greater than 0.05. Each one-year increase in maternal age at pregnancy was associated with a 0.29-point (95% confidence interval (CI) 0.06, 0.52) increase in the full-scale intelligence quotient in early adolescence. After parental age was categorized into quartiles, the total behavioural problem scores of adolescents with fathers with an age in the fourth quartile (Q4) were 6.71 (95% CI 0.86, 12.57) points higher than those of adolescents with fathers with an age in the first quartile (Q1), with a linear trend P value of 0.01. Similarly, higher scores (worse behavioural problems) were observed for internalizing behavioural problems and other emotional and behavioural symptoms related to anxiety, withdrawal, social problems, thought problems and aggressive behaviour.ConclusionsAt conception, older maternal age was independently linked to better adolescent cognitive development, whereas advanced paternal age was independently associated with a greater risk of adolescent emotional and behavioral problems. These findings suggest that public health policies targeting an optimal parental age at pregnancy should be developed in the context of offspring developmental consequences.

Factors associated with pediatric trauma patients leaving against medical advice

BackgroundDischarge against medical advice (AMA) leads to worse patient outcomes, increased readmission rates, and higher cost. However, AMA discharge has received limited study, particularly in pediatric trauma patients. Our objective was to explore the risk factors associated with leaving AMA in pediatric trauma patients. MethodsWe performed a retrospective analysis on pediatric trauma patients from 2017 to 2019 using the National Trauma Data Bank. We examined patient characteristics including age (<18 years), race, sex, Glasgow Coma Scale, trauma type, primary payment methods, and Abbreviated Injury Scale. Multiple Logistic Regression models were utilized to determine characteristics associated with leaving AMA. ResultsOf the 224,196 pediatric patients included in the study, 238 left AMA (0.1%). Our study showed black pediatric trauma patients were more likely to leave AMA compared to nonblack patients (OR 1.987, 95% CI 1.501 to 2.631). Patients with self-pay coverage were more likely to leave AMA than those with other insurance coverages (OR 1.759, 95% CI 1.183 to 2.614). Blunt trauma patients were more likely to leave AMA than those with penetrating trauma (OR 1.683, 95% CI 1.216 to 2.330). Every one-year increase in age led to 15% increase in odds of AMA discharge (OR 1.150, 95% CI 1.115 to 1.186). Pediatric patients with severe abdominal injuries were less likely to leave AMA compared to those with mild abdominal injuries (OR 0.271, 95% CI 0.111 to 0.657). Patients with severe lower extremity injury were less likely to leave AMA compared to those with mild lower extremity injuries (OR 0.258, 95% CI 0.127 to 0.522). ConclusionRace, insurance, injury type, and age play a role in AMA discharge of pediatric trauma patients. Black pediatric trauma patients have ∼ double the AMA discharge rate of nonblack patients. AMA discharge remains relevant, and addressing racial and socioeconomic factors provide opportunities for future interventions in pediatric trauma care.Level of Evidence: III, retrospective study.

Genetic Correlates of Biological Aging and the Influence on Prediction of Mortality.

Longevity and disease-free survival are influenced by a combination of genetics and lifestyle. Biological age (BioAge), a measure of aging based on composite biomarkers, may outperform chronological age in predicting health and longevity. This study investigated the relationship between genetic risks, lifestyle factors, and delta age (Δage), estimated as the difference between biological and chronological age. BioAge and Δage were calculated for 52418 participants from the population-based Lifelines cohort. We computed 2 independent polygenic risk scores (PRS) for health span and DNA methylation-based aging clock to characterize genetic risks. The capacity of BioAge to predict all-cause mortality when adjusted for chronological age and genetic risks for aging, was assessed. Obesity, lifestyle, socioeconomic status, sex, and genetic variations in a population contributed to the differences in the rates of accelerated aging. The overall risk of death for a 1-year increase in BioAge for a given chronological age and sex among the genotyped participants was 11% (HR = 1.11; 95% CI: 1.09, 1.13). After adjusting for genetic factors, BioAge maintained its sensitivity for predicting mortality. Findings from this study ascertain that BioAge can be a useful tool for risk stratification in research and aging interventions.

Osteoprotegerin and receptor activator of the nuclear factor kappa B ligand (RANKL) in healthy pubertal girls - relationships with physical growth and classical bone turnover markers.

Osteoprotegerin (OPG) is a trap receptor for the receptor activator of the nuclear factor kappa B ligand (RANKL). We aimed to determine the OPG and free soluble RANKL (sRANKL) concentrations in girls during puberty and their relationships with pubertal stage, growth rate and serum concentrations of estradiol, as well as classical bone formation (N-terminal propeptide of type I collagen (PINP), bone-specific alkaline phosphatase (BALP), osteocalcin (OC)) and bone resorption (C-terminal telopeptide of type I collagen (CTX)) markers. The semi-longitudinal study involved 88 healthy girls, aged 11.8-13.2 years. Their weight and height were measured twice at one-year intervals. Pubertal stages were assessed using the Tanner (T) scale. Blood samples were taken at the first examination. Serum concentrations of OPG, sRANKL, CTX and BALP were determined by enzyme-linked immunosorbent assay, estradiol and PINP by radioimmunoassay and osteocalcin by immunoradiometric assay. The one-year increase in height and weight of girls in the T2 and T3 pubertal stages was greater than that of girls in the T4 stage (p=0.000, p<0.03). OPG concentrations (T2: 4.04±0.62; T3: 4.31±0.79; T4: 4.46±0.84 pmol/L) sRANKL concentrations (T2: 0.22 (IQR 0.09-0.54); T3: 0.42 (IQR 0.22-0.79); T4: 0.35 (IQR 0.16-1.04) pmol/L) and sRANKL/OPG ratios (T2: 0.05 (IQR 0.03-0.13); T3: 0.11 (IQR 0.05-0.19); T4: 0.09 (IQR 0.05-0.19) did not differ significantly between pubertal stages. Concentrations of PINP, CTX, BALP and OC were higher in girls at T3 stage than at the T4 stage (p=0.000, p=0.001, p=0.046, p=0.038; respectively). Concentrations of sRANKL and OPG did not correlate with body weight, height, growth rate, or concentrations of estradiol, PINP, CTX, BALP and OC. There were correlations between the increase in height over one year and the concentrations of PINP (r=0.499, p=0.000), CTX (r=0.311, p=0.003) and BALP (r=0.224, p=0.036), as well as of estradiol (r=-0.473, p=0.000). Unlike PINP, OC, BALP, CTX or estradiol concentrations, sRANKL and OPG concentrations do not change in girls during puberty. Neither OPG nor sRANKL concentrations correlate with somatic characteristics and classical bone turnover markers concentrations.

Testosterone Deficiency in Hypertensive Men: Prevalence and Associated Factors.

Testosterone deficiency (TD) is a prevalent condition in our midst and still very neglected. Arterial hypertension (AH) is one of the possible associated factors. To determine the prevalence of TD in a hypertensive male population and the factors associated with its occurrence, such as age, time since hypertension diagnosis, number of antihypertensive classes, body mass index (BMI), diabetes, dyslipidemia, chronic kidney disease (CKD), positive symptoms of TD (positive ADAM questionnaire) and use of spironolactone. Cross-sectional study with administration of the ADAM questionnaire, assessment of biochemical, clinical, and anthropometric data. Patients were stratified into DT and normal testosterone groups. Categorical variables were compared using the chi-squared test and continuous variables using the Mann-Witney test; variables with significance (p<0,05) were analyzed by multivariable linear regression. The prevalence of TD was 26.36%. There was an association between TD and body mass index (BMI) (p=0.0007) but there was no association with age (p=0.0520), time of hypertension diagnosis (p=0.1418), number of classes of antihypertensive drugs (p=0.732), diabetes (p=0.1112); dyslipidemia (p=0.3888); CKD (p=0.3321); use of spironolactone (p=0.3546) or positive ADAM questionnaire (p=0.2483). TD was highly prevalent and positively associated with BMI. Total testosterone (TT) declined by 8.44ng/dL with a one unit increase in BMI and dropped by 3.79ng/dL with a one-year increase in age.

Deficiência de Testosterona em Homens Hipertensos: Prevalência e Fatores Associados

Abstract Background: Testosterone deficiency (TD) is a prevalent condition in our midst and still very neglected. Arterial hypertension (AH) is one of the possible associated factors. Objectives: To determine the prevalence of TD in a hypertensive male population and the factors associated with its occurrence, such as age, time since hypertension diagnosis, number of antihypertensive classes, body mass index (BMI), diabetes, dyslipidemia, chronic kidney disease (CKD), positive symptoms of TD (positive ADAM questionnaire) and use of spironolactone. Methods: Cross-sectional study with administration of the ADAM questionnaire, assessment of biochemical, clinical, and anthropometric data. Patients were stratified into DT and normal testosterone groups. Categorical variables were compared using the chi-squared test and continuous variables using the Mann-Witney test; variables with significance (p&lt;0,05) were analyzed by multivariable linear regression. Results: The prevalence of TD was 26.36%. There was an association between TD and body mass index (BMI) (p=0.0007) but there was no association with age (p=0.0520), time of hypertension diagnosis (p=0.1418), number of classes of antihypertensive drugs (p=0.732), diabetes (p=0.1112); dyslipidemia (p=0.3888); CKD (p=0.3321); use of spironolactone (p=0.3546) or positive ADAM questionnaire (p=0.2483). Conclusions: TD was highly prevalent and positively associated with BMI. Total testosterone (TT) declined by 8.44ng/dL with a one unit increase in BMI and dropped by 3.79ng/dL with a one-year increase in age.

Slower speed of blood pressure recovery after standing is associated with accelerated brain ageing: Evidence from The Irish Longitudinal Study on Ageing (TILDA)

BackgroundImpaired recovery of blood pressure (BP) in response to standing up is a prevalent condition in older individuals. We evaluated the relationship between the early recovery of hemodynamic responses to standing and brain health in adults over 50. MethodsParticipants from The Irish Longitudinal Study on Ageing (TILDA) (n=411; age 67.6 ± 7.3 years; 53.4 % women) performed an active stand challenge while blood pressure and heart rate were continuously monitored. The recovery of these parameters was determined as the slope of the BP and HR response, following the initial drop/rise after standing. We have previously reported a novel and validated measure of brain ageing using MRI data, which measures the difference between biological brain age and chronological age, providing a brain-predicted age difference (brainPAD) score. ResultsSlower recovery of systolic and diastolic BP was found to be significantly associated with higher brainPAD scores (i.e., biologically older brains), where a one-year increase in brainPAD was associated with a decrease of 0.02 mmHg/s and 0.01 mmHg/s in systolic and diastolic BP recovery, respectively, after standing. Heart rate (HR) recovery was not significantly associated with brainPAD score. ConclusionThese results demonstrate that slower systolic and diastolic BP recovery in the early phase after standing is associated with accelerated brain ageing in older individuals. This suggests that the BP response to standing, measured using beat-to-beat monitoring, has the potential to be used as a marker of accelerated brain ageing, relying on a simple procedure and devices that are easily accessible.

Bone Metabolism in Men who Live with HIV Aged 50 years and Over: Impact of Infection Duration.

Early diagnosis and effective antiretroviral therapy (ART) lead to similar life expectancy in people living with HIV (PLWH) compared to the general population. This population faces problems such as decreased bone mineral density (BMD) and increased fracture risk. The aim of this study was to determine the prevalence of osteoporosis in men aged 50 years and over who were PLWH and to determine risk factors and changes in bone metabolism with bone turnover markers. 79 male PLWH aged 50 years and over were followed up in our outpatient clinic between May 2021 and October 2021. The patients' demographic, clinical, laboratory, and DEXA data were analyzed. Serum levels of bone turnover markers were measured. The prevalence of osteopenia, osteoporosis, and normal BMD was found to be 55.7%, 13.9%, and 30.4%, respectively. A correlation was found between low BMD and low body mass index, elapsed time since diagnosis of HIV infection, high rate of use of ART, and long usage time of tenofovir disoproxil fumarate + protease inhibitor. A one-year increase in HIV infection duration was associated with an increased risk of low BMD by 1.246. Compared to studies conducted on the general population, the prevalence of osteoporosis in male PLWH aged 50 years and older was two times higher. The limited effect of the duration of ART use on low BMD may be due to the patients' histories of replacement therapy. Therefore, to eliminate the negative effects of ART on BMD, it may be beneficial to start replacement therapy when necessary.