Fulvio Lauretani

Executive Function Correlates with Walking Speed in Older Persons: The InCHIANTI Study

Objectives: To study the association between performance on psychological tests of executive function and performance on lower extremity tasks with different attentional demands in a large sample of nondemented, older adults.

Associations Between Vitamin D Status and Pain in Older Adults: The Invecchiare in Chianti Study

OBJECTIVES: To examine cross‐sectional associations between vitamin D status and musculoskeletal pain and whether they differ by sex.

Plasma Polyunsaturated Fatty Acids and the Decline of Renal Function

BACKGROUNDnRecent studies suggest an association between polyunsaturated fatty acids (PUFAs) and the development of chronic kidney disease. The aim of this study was to examine the relationship between PUFAs and renal function in older adults.nnnMETHODSnWe performed a cross-sectional and prospective analysis of 931 adults, > or = 65 years old, enrolled in the InCHIANTI study, a population-based cohort in Tuscany, Italy. Plasma PUFAs were measured at enrollment, and creatinine clearance was estimated by the Cockcroft-Gault equation at baseline and after 3-year follow-up.nnnRESULTSnAt enrollment, participants with higher creatinine clearance had higher concentrations of HDL cholesterol, total plasma PUFAs, plasma n-3 fatty acid (FA), and plasma n-6 FA and lower triglycerides. From enrollment to the 3-year follow-up visit, creatinine clearance declined by 7.8 (12.2) mL/min (P <0.0001). Baseline total plasma PUFAs, n-3 FA, n-6 FA, and linoleic, linolenic, and arachidonic acids were strong independent predictors of less steep decline in creatinine clearance from baseline to follow-up (P <0.0001, after adjusting for baseline creatinine clearance). After adjusting for baseline creatinine, baseline total plasma PUFAs, n-3 FA, and linoleic, linolenic, and arachidonic acids were negatively associated with creatinine at 3-year follow-up. Participants with higher plasma PUFAs at enrollment had a lower risk of developing renal insufficiency, defined by a creatinine clearance <60 mL/min, during 3-year follow-up.nnnCONCLUSIONnHigh PUFA concentrations, both n-3 FA and n-6 FA, may attenuate the age-associated decline in renal function among older community-dwelling women and men.

Carotenoids as protection against disability in older persons.

The purpose was to examine the relationship of total plasma carotenoids, an indicator of fruit and vegetable intake, with walking speed and severe walking disability in older adults. Nine hundred twenty-eight men and women aged 65 to 102 years from the Invecchiare in Chianti (Aging in the Chianti Area [InCHIANTI]) study, a population-based cohort in Tuscany, Italy, were studied. Plasma carotenoids were measured at enrollment (1998-2000), and walking speed over 4 meters and 400 meters distance were assessed at enrollment and 6 years later (2004-2006). At enrollment, 85 of 928 (9.2%) participants had severe walking disability (defined as being unable to walk or having a walking speed at the 4-meter walking test < 0.4 m/sec). After adjusting for potential confounders, participants with high total plasma carotenoids were significantly less likely to have prevalent severe walking disability (odds ration [OR] 0.59, 95% confidence interval [CI] 0.38-0.90, p = 0.01) and had higher walking speed over 4 meters (beta = 0.024, standard error [SE] = 0.011, p = 0.03) and over 400 meters (beta = 0.019, SE = 0.010, p = 0.04). Of 621 participants without severe walking disability at enrollment who were seen 6 years later, 68 (11.0%) developed severe walking disability. After adjusting for potential confounders, higher total plasma carotenoids were associated with a significantly lower risk of developing severe walking disability (OR 0.51, 95% CI 0.30-0.86, p = 0.01) and were associated with a less steep decline in 4-meter walking speed over a 6-year follow-up (n = 579; beta = 0.026, SE = 0.012, p = 0.03) and with lower incidence rates of being unable to successfully complete the 400-meter walking test at the 6-year follow-up visit (beta = -0.054, SE = 0.03, p = 0.04). High plasma carotenoids concentrations may be protective against the decline in walking speed and the development of severe walking disability in older adults.

Measures of Physical Performance Capture the Excess Disability Associated With Hip Pain or Knee Pain in Older Persons

BACKGROUNDnHip pain (HP) and knee pain (KP) may specifically affect function and performance; few studies investigate the functional impact of HP or KP in the same population.nnnMETHODSnPopulation-based sample of older individuals living in the Chianti area (Tuscany, Italy) (1998-2000); 1006 persons (564 women and 442 men) were included in this analysis; 11.9% reported HP and 22.4% reported KP in the past 4 weeks. Self-reported disability and lower extremity performance, measured by 400-m walk test and by the short physical performance battery (SPPB, including standing balance, chair raising, and 4-m walk test), were compared in participants reporting HP or KP versus those free of these conditions; the relationship of HP or KP with performance and self-reported disability was studied, adjusting for age, sex, hip or knee flexibility, muscle strength, multiple joint pain, major medical conditions, and depression.nnnRESULTSnParticipants reporting HP were more likely to report disability in shopping, cutting toenails, carrying a shopping bag, and using public transportation; those with KP reported more disability in cutting toenails and carrying a shopping bag. Participants reporting HP or KP had significantly lower SPPB scores. Adjusting by SPPB, pain no longer predicted self-reported disability, except for HP-carrying a shopping bag.nnnCONCLUSIONSnIn our cohort of older persons, those with HP reported disability in a wider range of activities than those with KP. Physical performance measured by SPPB was impaired in both conditions. Reduced lower extremity performance captures the excess disability associated with either HP or KP.

High-Density Lipoprotein Cholesterol and Objective Measures of Lower Extremity Performance in Older Nondisabled Persons: The InChianti Study

OBJECTIVES: To evaluate the independent association between high‐density lipoprotein cholesterol (HDL‐C) levels and objective measures of lower extremity performance.

Low plasma selenium concentrations and mortality among older community-dwelling adults: the InCHIANTI Study

Aims: We examined the relationship between plasma selenium levels at enrollment and all-cause mortality over a 6-year period among participants in the InCHIANTI study. Methods: 1042 men and women ≥65 years from the InCHIANTI study, a population-based study of older adults living in the Chianti region of Tuscany, a population-based cohort in Tuscany, Italy. Plasma selenium was measured at enrollment (1998–2000), and vital status was ascertained until May 2006. Results: During follow-up, 237 participants (22.7%) died. At enrollment, mean (SD) plasma selenium concentrations among participants who survived or died were 0.96 (0.14) and 0.87 (0.18) μmol/L (p<0.0001), respectively. The proportion of participants who died, from lowest to highest quartile of selenium, was 41.3, 27.0, 18.1 and 13.5% (p<0.0001 by Mantel-Haenszel chi-square). After adjusting for age, sex, education, and chronic diseases, adults in the lowest quartile of plasma selenium at enrollment had higher mortality compared with those in the highest quartile (Hazard Ratio (HR) 1.60, 95% Confidence Interval (Cl) 1.04–2.47, p=0.034). Conclusion: Low plasma selenium may be an independent predictor of mortality among older adults living in the community.

Omega-6 and omega-3 fatty acids predict accelerated decline of peripheral nerve function in older persons

Pre‐clinical studies suggest that both omega‐6 and omega‐3 fatty acids have beneficial effects on peripheral nerve function. Rats feed a diet rich in polyunsaturated fatty acids (PUFAs) showed modification of phospholipid fatty acid composition in nerve membranes and improvement of sciatic nerve conduction velocity (NCV). We tested the hypothesis that baseline plasma omega‐6 and omega‐3 fatty acids levels predict accelerated decline of peripheral nerve function. Changes between baseline and the 3‐year follow‐up in peripheral nerve function was assessed by standard surface ENG of the right peroneal nerve in 384 male and 443 female participants of the InCHIANTI study (age range: 24–97u2003years). Plasma concentrations of selected fatty acids assessed at baseline by gas chromatography. Independent of confounders, plasma omega‐6 fatty acids and linoleic acid were significantly correlated with peroneal NCV at enrollment. Lower plasma PUFA, omega‐6 fatty acids, linoleic acid, ratio omega‐6/omega‐3, arachidonic acid and docosahexanoic acid levels were significantly predicted a steeper decline in nerve function parameters over the 3‐year follow‐up. Low plasma omega‐6 and omega‐3 fatty acids levels were associated with accelerated decline of peripheral nerve function with aging.

Erythropoietin and polyneuropathy in older persons

INTRODUCTIONnRecent studies demonstrated that erythropoietin (EPO) have a number of non-erythropoietic effects including neuroprotection and vascular protection.nnnMATERIALSnUsing data from a representative sample of older persons, we tested the hypothesis that EPO levels are correlated with peripheral nerve parameters (NVC and CMAP) assessed by surface ENG and with clinically diagnosed polyneuropathy. We selected 972 participants (aged 60-98 years) with complete data for the analyses.nnnRESULTSnWe found a significant association between EPO and age-adjusted NCV and CMAP (for NCV: 0.57+/-0.26; p = 0.03 and for CMAP: 0.54+/-0.23; p = 0.02). In logistic regression models adjusting for age, sex and multiple potential confounders, higher EPO levels were associated with a significantly lower probability of having a clinical diagnosis of polyneuropathy (OR = 0.43; 95% CI: 0.22-0.84).nnnDISCUSSIONnThese findings suggest that EPO is implicated in the pathogenesis of polyneuropathy in older persons. Whether low EPO is a risk factor for polyneuropathy should be tested in future longitudinal analyses.

Erratum: Omega-6 and Omega-3 fatty acids predict accelerated decline of peripheral nerve function in older persons (European Journal of Neurology (2007) 14, (801-808)

F. Lauretani, S. Bandinelli, B. Benedetta, A. Cherubini, A. D. Iorio, A. Blè, V. Giacomini, A. M. Corsi, J. M. Guralnik and L. Ferrucci Tuscany Regional Health Agency, Florence, Italy; Geriatric Rehabilitation, Azienda Sanitaria Firenze, Florence, Italy; Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA; Institute of Gerontology and Geriatrics, Perugia University Medical School, Perugia, Italy; Laboratory of Clinical Epidemiology, Department of Medicine and Sciences of Aging, University G. D’Annunzio, Chieti, Italy; Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA; and Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda, MD, USA