Franco Romagnoni

Body Mass Index, Body Cell Mass, and 4‐Year All‐Cause Mortality Risk in Older Nursing Home Residents

Objectives: To investigate the relationship between body composition (assessed using body mass index (BMI) and body cell mass (BCM)) and all‐cause mortality in a sample of older nursing home residents.

Low Levels of High-Density Lipoprotein Cholesterol Are a Marker of Disability in the Elderly

Background: In the elderly, high-density lipoprotein cholesterol (HDL-C) seems to have further clinical meanings besides the inverse relationship with coronary heart disease (CHD); indeed, low values have been found in elderly subjects with functional disability, chronic illness, and in severe clinical conditions. Objective: To verify the hypothesis that low HDL-C might be a ‘marker’ for disability, we evaluated the relationship between lipoprotein parameters and functional status, over a period of 2 years, in a large sample of institutionalized elderly. Methods: 344 institutionalized subjects aged over 65 years were studied. They were divided into two groups according to basal disability level: ‘low–mild’: class A–E, and ‘high’: class F–G of the Katz index. 124 survivors, independent in at least two basic activities of daily living (BADL) at enrollment, were divided into two groups on the basis of 2 years’ modifications in functional status: stable/improved or worsened (lost ≥2 BADL). Results: Total cholesterol, LDL-C, HDL-C, and apo A-I levels were lower in the high disability group, while no differences in triglycerides and apo B levels emerged. Multiple logistic regression analysis showed that severe disability was associated with HDL-C (II vs. III tertile: OR 2.01; CI 95% 1.04–3.91; I vs. III tertile: OR 2.52; CI 95% 1.23–5.15), total cholesterol (I vs. III tertile: OR 2.35; CI 95% 1.14–4.81), blood glucose (OR 0.98), and body mass index (OR 0.91), independently from uric acid, number of pathologies, number of drugs, body cell mass, vitamin B12 and folic acid plasma levels, waist/hip ratio, age, and gender. Subjects who lost ≥2 BADL in the 2-year follow-up consistently showed lower basal HDL-C levels compared to subjects with stable/improved functional status, and this difference was significant after adjustment for basal Katz class, age, gender, number of pathologies, blood glucose, body mass index, and waist/hip ratio. Conclusions: The results of this study suggest that in the elderly severe disability is strongly associated with low HDL-C levels. Longitudinal data support the hypothesis that low HDL-C might be considered as a marker for ‘ongoing’ disability in BADL.

Lipids and other risk factors selected by discriminant analysis in symptomatic patients with supra-aortic and peripheral atherosclerosis

BackgroundDifferent patterns of risk factors might be related to the involvement of specific vascular districts by atherosclerosis. In this sense, many investigations have addressed coronary artery disease, whereas extracoronary atherosclerosis has received less extensive attention. Methods and ResultsVascular risk factors, with particular attention to lipid parameters (total cholesterol [TC]; triglycerides; high density lipoprotein cholesterol [HDL-C], HDI2 and HDL3 cholesterol [HDL2-C, HDL3-C]), were evaluated by means of univariate and multivariate (discriminant) analysis in a group of 169 patients (128 men and 41 women; mean ages, 58±7 and 62±7 years, respectively) with clinically and angiographically demonstrated atherosclerosis of the supra-aortic trunk and/or lower limbs. Patients with coronary artery disease were excluded from this study. The control group consisted of 140 age- and sex-matched individuals. By univariate analysis, smoking was more closely associated with peripheral atherosclerosis, whereas blood pressure was higher in patients with supra-aortic disease. Unrecognized diabetes mellitus was a frequent finding in patients with peripheral disease. The percentage of hyperlipidemias was fourfold higher in patients than in control subjects, with differences consisting of higher triglycerides and lower HDL-C, HDL2-C, and HDL3-C concentrations. By discriminant analysis, high correct classification (CC) rates were achieved in the various patient subgroups on the basis of variables selected from the statistical function. In male patients with peripheral disease, the variables HDL-C, smoking, diastolic blood pressure, uric acid, and glucose, in that order, yielded a CC in 90.4% of the cases; in female patients, smoking, TC/HDL-C, and body mass index gave a CC rate of 95.9%. In men with cerebral disease, the selected variables TC/HDL-C, diastolic blood pressure, and TC yielded a CC of 90.7%; in women, uric acid, TC/HDL-C, and fibrinogen levels produced a CC rate of 89.2%. ConclusionsRisk profiles in atherosclerosis of the supra-aortic trunks and lower limbs seem to differ in relation to gender and circulatory district involved. The importance of lipid parameters, in particular HDL-C, HDL2-C, and TC/HDL-C, as extracoronary risk factors is further confirmed.

High-density lipoprotein cholesterol strongly discriminates between healthy free-living and disabled octo-nonagenarians: A cross sectional study

Aging is frequently associated with a deterioration in health and functional status, which often induces important modifications in several biological parameters, including plasma lipids; as a consequence, the real “meaning” of lipoprotein parameters in old individuals is complex. A cross sectional study was carried out in order to investigate the lipoprotein profile in very old individuals with or without disability, and evaluate the possible influence of other biological variables on plasma lipids. One hundred selected healthy free-living (FL) and 62 disabled (DIS) subjects aged over 80 were enrolled; 91 healthy adults matched for origin were included as controls. Lipoprotein profile [total cholesterol, triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, apoprotein A-I and B], anthropometric parameters, and ADL were measured. The FL octo-nonagenarians featured higher HDL-cholesterol levels than adult controls. DIS octo-nonagenarians showed lower total and HDL-C levels than FL. Discriminant analysis indicated that HDL-cholesterol and apo-protein A-I, but not total cholesterol, strongly discriminated between FL and DIS octo-nonagenarians. Multivariate analysis demonstrated that the waist/hip ratio, an index of visceral adiposity, was negatively associated with HDL-C levels in FL, but not in DIS elderly. We conclude that: 1) in very old individuals, the absence or presence of disability is strongly associated with high or low HDL-cholesterol values, respectively; 2) HDL-C and apo A-I are the parameters which better discriminate between FL and DIS octo-nonagenarians; and 3) the differences in HDL-C levels between FL and DIS are not due to modifications in anthropometric parameters. Prospective studies are needed to better understand the relationship between high-density lipoprotein levels, disability and aging.

Combined measurement of serum albumin and high-density lipoprotein cholesterol strongly predicts mortality in frail older nursing-home residents

Background and aims: The aim of this study was to verify the hypothesis that a combined measurement of albumin and HDL-C might predict total mortality in institutionalized frail older residents. Methods: Participants were 344 older subjects (272 F, 72 M), living in the “Istituto Riposo Anziani” (I.R.A.), a nursing-home located in Padova, North-east Italy. Functional status, comorbidity, and clinical chemistry parameters were evaluated at entry. All-cause mortality was evaluated after 2 and 4 years. The sample was divided into 4 groups by using the 50° percentile of albumin and HDL-C as cut-off value. The mortality odds ratio (OR) was estimated by multivariate logistic regression analysis. Results: Total mortality was 36.8% after 2 years and 51.8% after four years. A trend toward an increase in mortality from group 1 to 4 was observed (p for trend: 0.01). The OR for 2 and 4 years mortality was 3.83 (95% CI 1.86–7.58) and 2.66 (95% CI 1.37–5.17), respectively, in group 4 compared with group 1, after adjustment for age, gender, number of chronic diseases, functional status, BMI, diabetes, dementia, stroke, CHD, CHF, hypertension, depression, COPD, and total cholesterol levels. Conclusions: Among frail older nursing-home residents, simple measurement of serum albumin and HDL-C levels may be useful in identifying varying degrees of frailty.

Predictors of two-year mortality in older nursing home residents. The IRA study

Besides functional impairment, several factors have been associated with mortality in institutionalized older subjects, including advanced age, gender, comorbidity, and malnutrition. We investigated the possible association of a large number of factors, including functional, anthropometric, nutritional, metabolic, clinical, and demographic variables, with two-year all-cause mortality inasample of 344 institutionalized older subjects (65 years) without evidence of acute illness at the time of observation. Although a number of factors were associated with mortality risk, multivariate analysis showed that only severe disability (6 vs 0–1 lost ADL, O.R.: 3.37, C.I. 95%: 1.76–7.3) and low albumin levels (lowest vs highest tertile: O.R.: 3.0, C.I. 95%: 1.65–5.43) were independent predictors of outcome. Moreover, in the analysis stratified for degree of disability and albumin tertiles, we found a strong gradient in mortality risk with increasing disability and decreasing albumin levels. These results further support the value of these two simple parameters in identifying frail institutionalized older individuals.

Disability is associated with malnutrition in institutionalized elderly people. The I.R.A.* study

Several factors, such as disability, malnutrition, weight loss, and the interactive effect of diseases and aging have been associated with morbidity and mortality in the elderly population. Nevertheless, the relationship between disability and biological parameters has not been extensively investigated as a primary focus. In a cross sectional survey, 344 institutionalized elderly subjects were evaluated. Disability was measured according to the Katz index, and patients were divided into three groups: low (0–1 lost ADL), mild (2–4 lost ADL), and severe (5–6 lost ADL). Anthropometric, metabolic, and nutritional parameters were assessed; age, gender, number of pathologies, and number of drugs were also recorded. Data were analyzed by multiple comparison of means according to Scheffé, and by multivariate logistic regression analysis. An impairment in functional status was associated with several modifications in biological parameters. Logistic regression analysis showed that severe disability (5–6 lost ADL) was associated with low waist/hip ratio (<0.9vs >0.9, OR.1.56, CI 95%:1.08–2.25), high body resistance (>625 vs <575 Ω., OR.1.39, CI 95%:1.38-1.39), low plasma albumin levels (<3.5 vs >4.0 g/dL, OR.6.02, CI 95%:5.18–6.85), and low plasma transferrin levels (<200 vs >250 mg/dL, OR:5.47, CI 95%:4.56–4.58) independently of age, gender, comorbidity, and other confounding factors. Our results indicate that severe disability in ADL is strongly associated with anthropometric and biohumoral parameters suggesting the presence of malnutrition. A careful evaluation of the nutritional state appears to be of primary importance, and efforts to improve nutritional status are needed in approaching disabled elderly patients.