Elizabeth Vasquez

Impact of Obesity and Physical Activity on Functional Outcomes in the Elderly Data From NHANES 2005-2010

Objective: The objective of this study was to (a) to examine whether the association between obesity and physical functioning among older adults is moderated by physical activity (PA) and (b) to test whether this moderating effect varies by gender. Method: Data from adults (aged >60 years) who participated in the National Health and Nutrition Examination Surveys (2005-2010) were analyzed. Using multivariate logistic regression, we estimated the prevalence ratio (PR) of functional limitations and impairment in activities of daily living and instrumental activities of daily living, by body mass index and PA, while adjusting for age, educational level, and a comorbidity index. Results: The sample included 5,304 subjects (mean age = 70.4 years), and 50.5% were female. Overweight and obesity were associated with higher levels of functional limitations when compared with normal weight individuals regardless of the PA status (PR = 1.47, 95% confidence interval [CI] [1.17, 1.85], and PR = 2.71, 95% CI [2.00, 3.67], respectively) even after adjustment for confounders. Discussion: Overweight and obesity are associated with impairment in functional outcomes irrespective of PA.

Muscle Strength, Physical Activity, and Functional Limitations in Older Adults with Central Obesity

Background. Obesity and muscle weakness are independently associated with increased risk of physical and functional impairment in older adults. It is unknown whether physical activity (PA) and muscle strength combined provide added protection against functional impairment. This study examines the association between muscle strength, PA, and functional outcomes in older adults with central obesity. Methods. Prevalence and odds of physical (PL), ADL, and IADL limitation were calculated for 6,388 community dwelling adults aged ≥ 60 with central obesity. Individuals were stratified by sex-specific hand grip tertiles and PA. Logistic models were adjusted for age, education, comorbidities, and body-mass index and weighted. Results. Overall prevalence of PL and ADL and IADL limitations were progressively lower by grip category. Within grip categories, prevalence was lower for individuals who were active than those who were inactive. Adjusted models showed significantly lower odds of PL OR 0.42 [0.31, 0.56]; ADL OR 0.60 [0.43, 0.84], and IADL OR 0.46 [0.35, 0.61] for those in the highest grip strength category as compared to those in the lowest grip category. Conclusion. Improving grip strength in obese elders who are not able to engage in traditional exercise is important for reducing odds of physical and functional impairment.

A lifetime history of alcohol use disorder increases risk for chronic medical conditions after stable remission.

BACKGROUNDnThe long-term impact of a past alcohol use disorder (AUD) among those who are currently in stable remission has not been well-explored. This study examined whether a past history of AUD was associated with increased risk for chronic medical conditions in a large U.S. nationally representative sample of adults ≥30 years old.nnnMETHODSnUsing 25,840 participants from Wave 1 and Wave 2 surveys of the National Epidemiologic Survey on Alcohol and Related Condition (NESARC), multiple logistic regression analysis was conducted to compare the risk for reporting metabolic, cardiovascular, liver, gastrointestinal, and inflammatory conditions between those in full-remission from AUD for longer than 5 years and those without a history of AUD diagnosis.nnnRESULTSnCompared with a model adjusting only for age, a model adjusting for other potential psychosocial confounders revealed fewer significant associations between AUD history and chronic medical conditions, particularly for the middle-aged population and for men. For the elderly, AUD history was associated with more chronic medical conditions in fully adjusted models. AUD history was associated with severe medical conditions such as liver diseases and myocardial infarction in women. In general, longer AUD exposure and shorter remission were also associated with the risk for chronic medical conditions.nnnCONCLUSIONSnOur findings suggest associations between past AUD diagnosis and chronic medical conditions, particularly for the elderly individuals. Screening for past alcohol use problems and associated health risks are important for the promotion of aging and prevention of chronic medical conditions even when an individual presents no current symptoms of AUD.

Physical Activity Predicts Higher Physical Function in Older Adults: The Osteoarthritis Initiative

OBJECTIVESnPhysical activity reduces mobility impairments in elders. We examined the association of physical activity on risk of subjective and objective physical function in adults with and at risk for osteoarthritis (OA).nnnMETHODSnAdults aged ≥ 60 years from the longitudinal Osteoarthritis Initiative, a prospective observational study of knee OA, were classified by sex-specific quartiles of Physical Activity Score for the Elderly scores. Using linear mixed models, we assessed 6-year data on self-reported health, gait speed, Late-Life Function and Disability Index (LLFDI) and chair stand.nnnRESULTSnOf 2252 subjects, mean age ranged from 66 to 70 years. Within each quartile, physical component (PCS) of the Short Form-12 and gait speed decreased from baseline to follow-up in both sexes (all P < .001), yet the overall changes across PASE quartiles between these 2 time points were no different (P = .40 and .69, males and females, respectively). Decline in PCS occurred in the younger age group, but rates of change between quartiles over time were no different in any outcomes in either sex. LLFDI scores declined in the 70+ age group. Adjusting for knee extensor strength reduced the strength of association.nnnCONCLUSIONSnHigher physical activity is associated with maintained physical function and is mediated by muscle strength, highlighting the importance of encouraging physical activity in older adults with and at risk for OA.

Physical Activity, Central Adiposity, and Functional Limitations in Community-dwelling Older Adults

Background and Purpose:Obesity and physical inactivity are independently associated with physical and functional limitations in older adults. The current study examines the impact of physical activity on odds of physical and functional limitations in older adults with central and general obesity. Methods:Data from 6279 community-dwelling adults aged 60 years or more from the Health and Retirement Study 2006 and 2008 waves were used to calculate prevalence and odds of physical and functional limitation among obese older adults with high waist circumference (waist circumference ≥88 cm in females and ≥102 cm in males) who were physically active versus inactive (engaging in moderate/vigorous activity less than once per week). Logistic regression models were adjusted for age, sex, race/ethnicity, education, smoking status, body mass index, and number of comorbidities. Results:Physical activity was associated with lower odds of physical and functional limitations among older adults with high waist circumference (odds ratio [OR], 0.59; confidence interval [CI], 0.52-0.68, for physical limitations; OR, 0.52; CI, 0.44-0.62, for activities of daily living; and OR, 0.44; CI, 0.39-0.50, for instrumental activities of daily living). Conclusions:Physical activity is associated with significantly lower odds of physical and functional limitations in obese older adults regardless of how obesity is classified. Additional research is needed to determine whether physical activity moderates long-term physical and functional limitations.

Beyond Race and Gender: Measuring Behavioral and Social Indicators of Pain Treatment Satisfaction in Older Black and White Cancer Patients

There are a number of factors that influence compliance with prescribed plans of care. However, there remains a need to identify the collective source health, behavioral, and social constructs have on treatment satisfaction. This study aimed to identify indicators of pain treatment satisfaction among older adults receiving outpatient treatment from a comprehensive cancer center in the southeast region of the United States. Data included a sample of 149 Black and White patients diagnosed with cancer, with the majority being White (85%) and female (57%). Patients were surveyed on questions assessing pain treatment satisfaction, pain severity, and additional social characteristics. A series of multivariate models were specified, whereby patients reporting multiple chronic conditions, poor communication, and perceived discrimination were less satisfied with treatment. Positive communication, higher self-efficacy, and fewer perceived discriminatory acts were significant among the female patients only. These findings suggest the need to develop clinical models that assess how these factors influence the degree of treatment satisfaction, while providing a comprehensive mechanism by which to service the long-term needs of older adults.

Prevalence of weakness and its relationship with limitations based on the Foundations for the National Institutes for Health project: data from the Health and Retirement Study.

Background/Objectives:The objectives of this study were to determine the prevalence of muscle weakness using the two 2014 Foundation for the National Institutes of Health (FNIH) Sarcopenia Project criteria and its relationship with physical limitations, basic activities of daily living (ADL) and instrumental ADL.Subjects/Methods:We performed a cross-sectional analysis of community-dwelling adults from the Health and Retirement Study 2006–2008 and identified a subsample of 5092 adults aged ⩾60 years with grip strength (GS) data. Self-reported physical limitations, basic ADL and instrumental ADL were assessed. Criteria for GS (men<26u2009kg; women <16u2009kg) and GS adjusted for body mass index (GS/BMI; men <1.0; women <0.56) were applied to the sample. We determined the prevalence of muscle weakness in each sex. Multivariable logistic regression was used to calculate the association of physical limitations, basic ADL and instrument ADL with weakness definitions in each sex.Results:Mean age was 72.1 years (54.9% female). Mean GS was 38.3 and 22.9u2009kg and mean BMI was 29u2009kg/m2, respectively, in men and women. Weakness prevalence using GS and GS:BMI definitions were 7.8 and 15.2 (P<0.001), respectively, in men and 11.4 and 13.3% (P=0.04) in women. Overall prevalence of physical limitations, basic ADL limitations and instrumental ADL limitations was 52.9, 28.1 and 35.9%, respectively. In those with weakness, prevalence of physical limitations, basic ADL and instrumental ADL was 78.5, 42.3 and 65.3%, respectively, using the GS definition, and 79.7, 40.7 and 58.8%, respectively, using the GS/BMI definition. GS and the GS/BMI definitions of weakness were strongly associated with physical limitations (odds ratio (OR) 2.19 (95% confidence interval (CI): (1.67–2.87)) and 2.52 (2.01–3.17)), basic ADL (OR 1.59 (1.22–2.07) and 1.66 (1.32–2.07)) and instrumental ADLs (OR 1.98 (1.28–2.54) and 1.78 (1.44–2.20)).Conclusions:The new FNIH guidelines for weakness are associated with higher prevalence of physical limitations, basic ADL impairments and instrumental ADL impairments as compared with individuals without weakness.

Particle coatings but not silver ions mediate genotoxicity of ingested silver nanoparticles in a mouse model

Incorporation of silver nanoparticles (AgNPs) in toothpaste, food containers, dietary supplements and other consumer products can result in oral exposure to AgNPs and/or silver ions (Ag+) released from the surface of AgNPs. To examine whether ingestion of AgNPs or Ag+ results in genotoxic damage and whether AgNP coatings modulate the effect, we exposed mice orally to 20 nm citrate-coated AgNPs, polyvinylpyrrolidone (PVP)-coated AgNPs, silver acetate or respective vehicles at a 4 mg/kg dose (equivalent to 800x the EPA reference dose for Ag) for 7 days. Genotoxicity was examined in the systemic circulation and bone marrow at 1, 7, and 14 days post-exposure. We found that citrate-coated AgNPs induced chromosomal damage in bone marrow and oxidative DNA damage and double strand breaks in peripheral blood. These damages persisted for at least 14 days after exposure termination. Because oxidative DNA damage and strand breaks are repaired rapidly, their presence after exposure cessation indicates that citrate-coated AgNPs persist in the body. In contrast, PVP-coated AgNPs and silver acetate did not induce DNA or chromosomal damage at any time point measured. To determine whether coating-dependent genotoxicity is related to different AgNP changes in the gastrointestinal tract, we examined AgNP behavior and fate in an in vitro gastrointestinal digestion model using UV-visible spectroscopy and DLS. Citrate-coated AgNPs were more susceptible to agglomeration than PVP-coated AgNPs in digestive juices with or without proteins. In summary, AgNPs but not Ag+ are genotoxic following oral ingestion. Nanoparticle coatings modulate gastrointestinal transformation and genotoxicity of AgNPs, where higher agglomeration of AgNPs in gastrointestinal juices is associated with higher genotoxicity in tissues. Since genotoxicity is a strong indicator of cancer risk, further long-term studies focusing on cancer are warranted.

Differences in neighborhood social cohesion and aerobic physical activity by Latino subgroup

Previous research has examined the role of neighborhood social cohesion in physical activity outcomes; however, less is known about this relationship across Latino subgroups. The purpose of our study was to examine the association between neighborhood social cohesion and aerobic leisure-time physical activity (LTPA) among Latino adults and to determine whether these associations differ by Latino subgroup. We used cross-sectional 2013–2014 National Health Interview Survey (NHIS) data on Latinos originating from 5 countries/regions (i.e., Latinos of Puerto Rican, Mexican/Mexican-American, Cuban/Cuban-American, Dominican and Central or South American origin) aged ≥18 years (n=11,126). Multivariable logistic regression models were used to estimate associations between self-reported neighborhood social cohesion and meeting aerobic LTPA guidelines. Models were adjusted for age, sex, education, and acculturation. We also investigated whether associations varied by Latino subgroup. In adjusted models for all Latino adults, compared with those reporting low social cohesion, individuals who reported high social cohesion (Odds Ratio [OR]: 1.33; 95% Confidence Interval [CI]: 1.17–1.52) were significantly more likely to meet the aerobic physical activity guideline. When stratified by Latino subgroups, among Mexican/Mexicans-Americans (OR: 1.39; 95% CI: 1.16, 1.66) and Cuban/Cuban Americans (OR: 1.73; 95% CI: 1.00, 2.97) high social cohesion was associated with meeting the aerobic activity guideline. Among Dominicans, those who reported medium social cohesion (OR: 0.52, 95% CI: 0.29, 0.93) were less likely to meet the aerobic activity guideline. When examining aerobic physical activity outcomes in the Latino population, the role of neighborhood social cohesion and the variability among Latino subgroups should be considered.

The Association of Prediabetes and Diabetes Risk Perception With Leisure-Time Physical Activity and Weight Loss

Purpose: To examine the association of perceived risk of prediabetes and diabetes with leisure-time physical activity (LTPA) and weight loss, and determine whether the association of risk perception with LTPA and weight loss varies by race/ethnicity. Design: Cross-sectional. Setting: National Health and Nutrition Examination Survey (NHANES) 2011-2014. Subjects: Non-Latino white, non-Latino black, and Latino nondiabetic and nonprediabetic NHANES participants ≥18 years of age who were not underweight (n = 9550). Measures: Demographic characteristics, LTPA, attempted weight loss, and perceived risk of prediabetes or diabetes. Analysis: Log-binomial regression models were fit to assess the association of perceived risk with meeting LTPA recommendations and having attempted to lose weight, overall and by race/ethnicity. Results: Individuals reporting that they perceived they could be at risk for diabetes/prediabetes were less likely to meet LTPA recommendations (adjusted prevalence ratio [aPR]: 0.87; 95% confidence interval [CI]: 0.79-0.95), but significantly more likely to report attempting weight loss in the past year (aPR: 1.14; 95%CI: 1.04-1.25), compared with those reporting no risk perception. Latino and non-Latino blacks who perceived they could be at risk for diabetes/prediabetes were 25% and 35% more likely to report trying to lose weight in the past year (aPR: 1.25; 95% CI: 1.08-1.44 and aPR: 1.35; 95% CI: 1.19-1.54, respectively), compared with Latino and non-Latino blacks that did not perceive being at risk. In contrast, non-Latino whites who perceived they were at risk were 20% less likely to report meeting LTPA recommendations (aPR: 0.80; 95% CI: 0.72-0.89), compared with non-Latino whites reporting no risk perception. Conclusion: Findings highlight the role of perceived risk for prediabetes and diabetes in LTPA and weight loss, with findings varying by race/ethnicity. Awareness of prediabetes and diabetes risk could contribute to efforts aimed at improving LTPA and weight loss.