Arto Y. Strandberg

The Effect of Smoking in Midlife on Health-Related Quality of Life in Old Age: A 26-Year Prospective Study

BACKGROUND Smoking shortens life expectancy by 7 to 10 years. However, it is unclear whether the enhanced longevity of nonsmokers produces increased disability and decreased quality of life during these extra final years. This study evaluates the long-term effect of smoking in midlife on health-related quality of life (HRQoL) in old age. METHODS Prospective cohort study with a 26-year follow-up of 1658 white men (born 1919-1934) of similar socioeconomic status who were participating in the Helsinki Businessmen Study. All men were healthy at baseline in 1974, when cardiovascular risk factors and smoking habits were assessed. The participants were reevaluated with the use of mailed questionnaires in 2000; HRQoL was measured with the use of the RAND 36-Item Health Survey (similar to the Medical Outcomes Study Short-Form Health Survey) and related to the baseline smoking status. Total mortality through 2000 was determined from Finnish national registers. RESULTS Participants who had never smoked (n = 614) lived a mean of 10 years longer than heavy smokers (>20 cigarettes daily; n = 188). Among survivors in 2000 (n = 1131), the never-smokers had the highest (ie, best) scores on all RAND 36-Item Health Survey scales. The differences were greatest between never-smokers and heavy smokers, ranging from 4 points on the scale of social functioning to 14 points on the physical functioning scale. The physical component summary score showed a graded deterioration of HRQoL with an increasing number of cigarettes smoked daily (P = .01). CONCLUSIONS During the 26-year follow-up of this socioeconomically homogeneous male cohort, HRQoL deteriorated with an increase in daily cigarettes smoked in a dose-dependent manner. Never-smokers lived longer than heavy smokers, and their extra years were of better quality.

Association of Telomere Length in Older Men With Mortality and Midlife Body Mass Index and Smoking

BACKGROUND Leukocyte telomere length has been taken as a measure of biological age but several inconsistencies exist. METHODS We investigated associations between leukocyte telomere length in old age, midlife risk factors, and mortality. The Helsinki Businessmen Study (a cohort of mainly business executives, born 1919-1934) had baseline assessments of cardiovascular risk factors including body mass index between 1964 and 1973 at a mean age of 40. Leukocyte telomere length and proportion of short telomeres were measured from DNA samples collected in 2002-2003 (n = 622, mean age 78 years). Body mass index and smoking in old age were assessed from questionnaires. Total mortality was verified from registers through January 2010. Main outcome measures were relationships between telomeres, body mass index, smoking, and mortality. RESULTS Leukocyte telomere length and notably proportion of short telomeres (<5kb) in old age were significantly (p =. 008 after full adjustments) and in a graded manner associated with midlife overweight and smoking. The associations were independent of age and cardiovascular risk factors including postload glucose. Associations with body mass index and smoking were nonsignificant in old age, and telomere length did not predict 7-year total mortality. CONCLUSIONS We conclude that smoking and overweight in midlife, irrespective of glucose, cholesterol and blood pressure, are related to shorter leukocyte telomeres in old men. Telomere length in old age did not predict total mortality possibly due to competing causes.

Association of midlife obesity and cardiovascular risk with old age frailty: a 26-year follow-up of initially healthy men

Objective and hypothesis:To investigate whether old age frailty is predicted by midlife overweight/obesity and cardiovascular disease (CVD) risk.Design:Longitudinal observational study (the Helsinki Businessmen Study).Subjects:In their midlife in 1974, 1815 initially healthy men (mean age 47 years) were clinically investigated, whereupon their weight status (normal weight<25 kg m−2, overweight 25⩽body mass index <30 kg m−2 and obese ⩾30 kg m−2), CVD risk factors and a composite risk score (%) of coronary artery disease (CAD) were assessed. After a 26-year follow-up in 2000, when 425 men had died, the frailty status of survivors (80.9%, n=1125, mean age 73 years) was assessed using a postal questionnaire including the RAND-36/SF-36 instrument. Phenotypic criteria were used to define frailty, and according to these criteria, 40.0% (n=450), 50.4% (n=567) and 9.6% (n=108) were classified as not frail, prefrail and frail, respectively. Risks are presented as odds ratios (OR) with 95% confidence intervals (CI).Results:Compared with normal weight, the development of frailty was significantly higher among those men who were overweight or obese in midlife, with fully adjusted ORs (95% CI) of 2.06 (1.21–3.52) and 5.41 (1.94–15.1), respectively. Even the development of prefrailty was significantly increased with midlife overweight (OR 1.39; 95% CI, 1.03–1.87) and obesity (OR 2.96; 95% CI, 1.49–5.88). Age-adjusted composite CAD score in midlife predicted similarly 26-year total mortality (OR per 1% increase:1.16; 95% CI, 1.08–1.24) and development of frailty (OR 1.16; 95% CI, 1.02–1.33).Conclusion:Overweight/obesity and higher CAD risk in midlife were associated with frailty 26 years later. Preventing old age frailty should be recognized as an important goal of obesity and CVD risk control.

Physical activity in midlife and telomere length measured in old age

Physical activity has been associated with alterations in telomere length, a potential indicator of biological aging, but several inconsistencies exist. Our aim was to investigate the associations between physical activity in midlife and leukocyte telomere length (LTL) measured in old age in the Helsinki Businessmen Study, Finland. At entry, in 1974, 782 men (mean age 47) completed a questionnaire about their physical activity and this was collapsed into 3 categories: low (n=148), moderate (n=398) and high physical activity (n=236, 7 of whom had a competitive activity level). After 29-year follow-up in 2003, mean LTL and the proportion of short (<5 kB) telomeres were measured from DNA samples of a random subcohort of survivors (n=204, mean age 76) using the Southern blot technique. Adjusted for age, body mass index (BMI), cholesterol and smoking in 1974, the moderate physical activity group had longer mean LTL (8.27 kB, SE 0.05) than the low (8.10 kB, SE 0.07), or high (8.10 kB, SE 0.05) physical activity groups (P=0.03 between groups). Conversely, the proportion of short telomeres was lowest in the moderate physical activity group (11.35%, SE 0.25), and higher in the high (12.39%, SE 0.29), and the low physical activity (12.21%, SE 0.39) groups (P=0.02 between groups). We conclude that the results of this observational cohort study give support to the idea that both low and high physical activity is in the long-term associated with factors shortening LTL.

Impact of midlife weight change on mortality and quality of life in old age. Prospective cohort study

OBJECTIVE: To examine the effects of weight change during midlife on long-term mortality risk and quality of life in old age.DESIGN: Prospective cohort study with a 26-y follow-up.SUBJECTS: Socioeconomically homogeneous sample of 1657 men (born 1919–1934) who had attended health checks during the 1960s, were healthy and professionally active in 1974, and could recall their weight at the age of 25 y.MAIN OUTCOME MEASURES: Total mortality 1974–2000, scales of the RAND-36 (SF-36) health survey in 91% (n=1147) of the survivors in 2000.RESULTS: Body weight increased from 25 y of age until midlife, but not thereafter. During the 26-y follow-up, 392 men (23.7% of the initial 1974 cohort) died. Weight at 25 y of age did not predict death, but the adjusted mortality risk was significantly increased in the highest quartile of midlife weight gain (≥15.0 kg) compared with lower quartiles (RR 1.39, 95% CI 1.12–1.73). In 2000, multivariate analyses (adjusted for body weight at the age of 25 y and in 2000, age, smoking, alcohol and subjective health and physical fitness in 1974) showed impairment in all eight RAND-36 scales (statistically significantly in seven) with increasing weight gain in midlife.CONCLUSION: In this homogeneous male cohort, only the largest weight gain from 25 y of age to midlife predicted long-term mortality. Weight gain sensitively affected later health-related quality of life, and zero weight gain up to midlife was associated with the best quality of life in old age.

Leisure-Time Physical Activity in Midlife Is Related to Old Age Frailty

BACKGROUND There are scarce studies of the long-term associations between leisure-time physical activity (LTPA) in midlife and phenotypic frailty in old age. METHODS We studied healthy Caucasian men of high socioeconomic status (N = 514), who had participated in health checkups during the 1960s (the Helsinki Businessmen Study, Finland). In 1974, they were examined with questionnaires and clinical examinations, and LTPA was collapsed into three categories: low (n = 87), moderate (n = 256), and high (n = 171). In 2000, at mean age of 74, survivors were assessed for physical activity and frailty phenotype using the modified Fried criteria validated in our cohort. Four criteria were used: (a) weight loss > 5% from midlife or current body mass index < 21kg/m(2), (b) physical inactivity, (c) low vitality, and (d) physical weakness. Responders with 3-4, 1-2, and zero criteria were classified as frail, prefrail, and nonfrail, respectively. RESULTS The prevalence of frailty was 16.1%, 10.2%, and 4.7% in the low, moderate, and high LTPA groups, respectively. Higher midlife LTPA was significantly related to lower prevalence of both frailty and prefrailty in old age. After adjusting for baseline age, smoking, body mass index, blood pressure, and alcohol, the risk of frailty was 80% lower in the high LTPA group compared with the low LTPA group (odds ratio = 0.20; 95% confidence interval 0.07-0.55). This finding was supported by the relationships between the change of physical activity and frailty in old age. CONCLUSIONS In this socioeconomically homogenous male cohort, higher physical activity since midlife was strongly associated with less frailty in old age.

Chocolate, well-being and health among elderly men.

Objective:We hypothesized that chocolate preference would be related to health and psychological well-being in old men.Design, setting and participants:We have followed up a socio-economically homogenous group of men, born in 1919–1934, since the 1960s. In 2002–2003, a mailed questionnaire was used to assess the health and well-being (including questions related to positive life orientation, visual analogue scales and the Zung depression score) of survivors. In addition, candy preference was inquired. Those men who reported no candy consumption (n=108) were excluded from the analyses.Outcome measures:Psychological well-being in old age.Results:The response rate was 69% (1367 of 1991). Of the respondents, 860 and 399 preferred chocolate and other type of candy, respectively. The average age in both candy groups was 76 years. Of the respondents, 99% were home-dwelling, 96% were retired and 87% were presently married, without differences between the candy groups. Men preferring chocolate had lower body mass index and waist circumference, and they also reported more exercise and better subjective health (P=0.008) than other candy consumers. Variables related to psychological well-being were consistently better in those preferring chocolate. The differences were statistically significant in feeling of loneliness (P=0.01), feeling of happiness (P=0.01), having plans for the future (P=0.0002) and the Zung depression score (P=0.02).Conclusions:In this socioeconomically homogenous male cohort, chocolate preference in old age was associated with better health, optimism and better psychological well-being.Sponsorship:The Academy of Finland, the Päivikki and Sakari Sohlberg Foundation, the Helsinki University Central Hospital and the Finnish Foundation for Cardiovascular Research.

Physical Activity at Midlife and Health-Related Quality of Life in Older Men

Brinker, and Iyasu. Acquisition of data: Brinker. Analysis and interpretation of data: Desai, Brinker, and Swann. Drafting of the manuscript: Desai and Brinker. Critical revision of the manuscript for important intellectual content: Desai, Brinker, Swann, and Iyasu. Statistical analysis: Desai. Administrative, technical, and material support: Brinker and Swann. Study supervision: Brinker and Iyasu. Financial Disclosure: At the time this project was initiated, Dr Desai was on a practicum rotation with the FDA as a resident physician within the Johns Hopkins General Preventive Residency Program. Drs Brinker, Swann, and Iyasu are employed at the FDA. These authors list no grants, directed financial support, or financial interests in these data.

Telomere Length in Old Age and Cholesterol Across the Life Course

This research was conducted as part of the Mexican Study of Nutritional and Psychosocial Markers of Frailty in Community-Dwelling Elderly. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. This project was funded by the National Council for Science and Technology of Mexico (SALUD-2006-C0145075). Author Contributions: Dr. Pozos-López developed the concept and design of the study, conducted the analyses and interpreted the data. She wrote the manuscript under the supervision of Drs. Navarrete-Reyes and Ávila-Funes. The coauthors certify that they have participated substantially in the concept and design of this work, the analysis of the data, and preparation of the manuscript. They have reviewed the final version of the manuscript and have approved it for publication. Sponsor’s Role: None.

One-Hour Glucose, Mortality, and Risk of Diabetes: A 44-Year Prospective Study in Men

T wo-hour postload glucose measurement is currently recommended for early detection of diabetes. The less time-consuming 1-hour postload glucose measurement (1-hour glucose) has been reported to predict cardiovascular mortality and Medicare expenditure and to be associated with carotid intimamedia thickness. Recently, 1-hour glucose has also aroused interest in the prediction of diabetes both in United States and Finnish cohorts and in the assessment of risk for chronic kidney disease. However, the status of 1-hour glucose as a risk-predicting tool is still far from established. Because blood 1-hour glucose was used to assess cardiovascular risk in early midlife in the Helsinki Businessmen Study during the 1960s, we had a unique opportunity to evaluate how this relatively simple test in conjunction with body mass index (BMI) would predict mortality and development of diabetes over 44 years of follow-up.