Federica Limongi

Adherence to the Mediterranean Diet and all-cause mortality risk in an elderly Italian population: Data from the ILSA study

ObjectiveThe aim of this study was to evaluate adherence to the Mediterranean Diet (MD) and its association with all-cause mortality in an elderly Italian population.DesignData analysis of a longitudinal study of a representative, age stratified, population sample.SettingStudy data is based upon the Italian Longitudinal Study on Aging (ILSA) a prospective, community-based cohort study. The baseline evaluation was carried out in 1992 and the follow-up in 1996 and 2000.ParticipantParticipant food intake assessment was available at baseline for 4,232 subjects; information on survival was available for 2,665 at the 2000 follow-up.MeasurementsAdherence to the MD was evaluated with an a priori score based on the Mediterranean pyramid components. Cox proportional hazard models were used to assess the relationship between the MD score and all-cause mortality. Six hundred and sixty five subjects had died at the second follow-up (identified up to the first and second follow-up together; mean follow-up: 7.1±2.6 years).ResultsAt the 2000 follow-up, adjusting for other confounding factors, participants with a high adherence to MD (highest tertile of the MD score distribution) had an all-cause mortality risk that was of 34% lower with respect to the subjects with low adherence (Hazard Ratio=0.66; 95% CI: 0.49-0.90; p=0.0144).ConclusionAccording to study results, a higher adherence to the MD was associated with a low all-cause mortality risk in an elderly Italian population.

Osteoarthritis, comorbidity and pain: Their role in determining functional limitations in older populations (European project on Osteoarthritis)

To evaluate the role of comorbidity and pain in the association between hip/knee osteoarthritis (OA) with self‐reported as well as performance‐based functional limitations in a general elderly population.

The metabolic syndrome, incidence of diabetes and mortality among the elderly: the Italian Longitudinal Study of Ageing.

AIM To investigate whether or not the metabolic syndrome (MetS) can predict the incidence of diabetes and all-cause mortality among elderly subjects. METHODS Analyses were based on data collected by the Italian Longitudinal Study on Aging (ILSA) that, between 1992 and 1996, enrolled 5632 participants aged 65 to 84 years. The analyses included 3081 participants for whom complete data were available. Logistic-regression models were designed to study the influence of the MetS on the incidence of diabetes, adjusting for individual MetS components and possible confounders. Data on mortality collected between baseline and the 1996 follow-up were also considered, and Coxs proportional hazards models were used to determine the death risk attributable to the synergistic relationship between the MetS and diabetes. RESULTS The MetS was strongly associated with an increased risk of diabetes (OR: 5.53, 95% CI: 2.89-10.60). After adjusting for its individual components and possible confounders, the MetS maintained an important role in predicting the incidence of diabetes (OR: 2.65, 95% CI: 0.97-7.24) together with the fasting glucose component (OR: 5.89, 95% CI: 2.89-11.98). Over the 4-year follow-up, participants with diabetes, but without the MetS, and subjects with the MetS, but without diabetes, had no significant risk of death compared with the reference group. Elderly subjects who had both the MetS and diabetes had almost double the risk of death vs the reference group (HR: 1.80, 95% CI: 1.04-3.12). CONCLUSION The MetS is associated with the incidence of diabetes, and the synergy between the MetS and diabetes is an important risk factor for all-cause mortality in elderly subjects.

Role of Osteoarthritis, Comorbidity, and Pain in Determining Functional Limitations in Older Populations: European Project on Osteoarthritis

To evaluate the role of comorbidity and pain in the association between hip/knee osteoarthritis (OA) with self‐reported as well as performance‐based functional limitations in a general elderly population.

Incidence of dementia: evidence for an effect modification by gender. The ILSA Study

BACKGROUND Gender differences for incidence of dementia among elderly people have been usually investigated considering gender as a predictor and not as a stratification variable. METHODS Analyses were based on data collected by the Italian Longitudinal Study on Aging (ILSA), which enrolled 5,632 participants aged 65-84 years between 1992 and 2000. During a median follow-up of 7.8 years, there were 194 cases of incident dementia in the participants with complete data. Cox proportional hazard models for competing risks, stratified by sex, were defined to determine risk factors in relation to developing dementia. RESULTS The incidence rate of dementia increased from 5.57/1,000 person-years at 65-69 years of age to 30.06/1,000 person-years at 80-84 years. Cox proportional hazard models for competing risks of incidence of dementia and death revealed that, among men, significant risk factors were heart failure, Parkinsons disease, family history of dementia, mild depressive symptomatology and age, while triglycerides were associated with a lower risk of developing dementia. Significant risk factors in women were age, both mild and severe depressive symptomatology, glycemia ≥109 mg/dL, and a BMI < 24.1 kg/m². Even as little as three years of schooling was found to be a significant protective factor against the incidence of dementia only for women. CONCLUSIONS Our results suggest that there is an effect modification by gender in our study population in relation to the association between low education level, lipid profile, BMI, and glycemia and dementia.

Prevalence of diabetes and depressive symptomatology and their effect on mortality risk in elderly Italians: The Italian Longitudinal Study on Aging

AIM This study assessed the prevalence of depressive symptomatology (DS) in older individuals with diabetes to determine whether diabetes and DS are independent predictors of mortality, and if their coexistence is associated with an increased mortality risk. METHODS Analyses were based on data from the Italian Longitudinal Study on Aging (ILSA), a prospective community-based cohort study in which 5632 individuals aged 65-84years were enrolled. The role of diabetes and DS in all-cause mortality was evaluated using the Cox model, adjusted for possible confounders, for four groups: 1) those with neither diabetes nor DS (reference group); 2) those with DS but without diabetes; 3) those with diabetes but no DS; and 4) those with both diabetes and DS. RESULTS Type 2 diabetes mellitus (T2DM) was present in 13.8% of the participants; they presented with higher baseline rates of DS compared with the non-diabetic controls. During the first follow-up period, participants with DS but not diabetes had a 42% higher risk of all-cause mortality compared with the reference control group (HR=1.42; 95% CI: 1.02-1.96), while participants with diabetes but not DS had an 83% higher risk of death than the reference group (HR=1.83; 95% CI: 1.19-2.80). The risk of death for those with both disorders was more than twice that for the reference group (HR=2.58; 95% CI: 1.55-4.29). Analyses of deaths from baseline to the second follow-up substantially confirmed these results. CONCLUSION The prevalence rate of DS is higher in elderly people with diabetes and their coexistence is associated with an increased mortality risk.

How Hand Osteoarthritis, Comorbidity, and Pain Interact to Determine Functional Limitation in Older People: Observations From the European Project on OSteoArthritis Study

To examine the role of comorbidity and pain in the associations of hand osteoarthritis (OA) with self‐reported and performance‐based physical function in a general population of elderly persons.

How hand osteoarthritis, comorbidity and pain interact to determine functional limitation in older people: observations from the EPOSA study

To examine the role of comorbidity and pain in the associations of hand osteoarthritis (OA) with self‐reported and performance‐based physical function in a general population of elderly persons.

Obesity: Definition and Epidemiology

Obesity is the most prevalent form of malnutrition in the industrialized countries, and it is rapidly becoming highly prevalent also in the developing world. In 2008, 35 % of adults aged 20+ were overweight and 11 % were obese (meaning that in the world 205 million men and 300 million women were obese). Obesity is considered a multifactorial condition, caused by a complex interaction between the environment, genetic predisposition, and human behavior. The relevance of obesity as a risk factor for medical conditions is very well known; it is now considered as a major contributor to the global burden of disease and disability, because it is linked to various disabling conditions, such as heart disease, diabetes, hypertension, stroke, certain cancers, osteoarthritis, etc. Moreover, it has been reported that obesity is associated with an increased risk of death, although the relation of BMI categories with mortality has been the subject of much controversy, because epidemiologic studies have found linear, U-shaped, or J-shaped relationship between BMI and total mortality. The problem of overweight and obesity is considered one of the most pressing global issues that we will continue to face during the next several decades and demands attention from the healthcare community, researchers, and policy makers.

Cognitive impairment: classification and open issues

Several clinically-defined cognitive impairment syndromes, with differing diagnostic criteria and nomenclature, have been proposed to describe nondisabling symptomatic cognitive deficits. Incidence and prevalence rates vary as a result of different diagnostic criteria and sampling procedures across studies. The incidence rates of cognitive impairment increase with age; but no consistent data have been reported on the association with family history, age, sex, education, Apo E4 genotype, depression, and other traditional risk factors for dementia. Severalstudies have suggested that most patients with cognitive impairment clinically defined will progress to Alzheimer Disease (AD), but rates of conversion vary widely among studies. This review summarizes existing definitions and related epidemiological data.