Giovanna Romanato

Metabolic syndrome and all-cause and cardiovascular mortality in an Italian elderly population: the Progetto Veneto Anziani (Pro.V.A.) Study.

OBJECTIVE—The purpose of this study was to explore the association of metabolic syndrome and each of its components with all-cause and cardiovascular mortality in a general Italian elderly population. RESEARCH DESIGN AND METHODS—Metabolic syndrome, diagnosed by National Cholesterol Education Program Adult Treatment Panel III criteria, all-cause mortality, and cardiovascular mortality, was evaluated in 2,910 subjects aged ≥65 years of the Progetto Veneto Anziani (Pro.V.A.) Study during a mean follow-up time of 4.4 years. RESULTS—After multivariable adjustment, metabolic syndrome was associated with increased all-cause mortality in all subjects (hazard ratio 1.41 [95% CI 1.16–1.72], P = 0.001), among men (1.42 [1.06–1.89], P = 0.017), and among women (1.47 [1.13–1.91], P = 0.004). High glucose in all subjects (1.27 [1.02–1.59], P = 0.037) and in women (1.61 [1.16–2.24], P = 0.005) and low HDL cholesterol in women (1.48 [1.08–2.02], P = 0.014) were predictors of all-cause mortality, even independently of the interactions of different metabolic syndrome components. After multivariable adjustment, metabolic syndrome was also associated with increased cardiovascular mortality in all subjects (1.60 [1.17–2.19], P = 0.003), among men (1.66 [1.00–2.76], P = 0.051), and among women (1.60 [1.06–2.33], P = 0.025). High glucose (2.17 [1.28–3.68], P = 0.004) and low HDL cholesterol (1.78 [1.07–2.95], P = 0.026) among women predicted higher cardiovascular mortality. CONCLUSIONS—In this general Italian elderly population, among metabolic syndrome components, all-cause mortality is better predicted by high glucose in all subjects and in women and by low HDL cholesterol in women, whereas cardiovascular mortality is better predicted by high glucose and low HDL cholesterol in women.

Diabetes as a risk factor for cognitive decline in older patients.

Aims: To assess the role of type 2 diabetes as a risk factor for cognitive decline among elderly people. Methods: Analyses were carried out on data from the Italian Longitudinal Study on Aging, a study on 5,632 subjects aged 65–84 years, with baseline in 1992 and follow-ups in 1996 and 2000. Results:At baseline, diabetic women had significantly worse scores on all cognitive tests compared to nondiabetic women, but did not show worsening over time, whereas men with diabetes did not show worse scores on cognitive tests at baseline compared to nondiabetic males; however, diabetes in men was associated with a risk of cognitive decline over time, particularly in attention. Higher levels of HbA1c were associated with poorer performance on memory tests at follow-up in both sexes. Conclusion: The impact of diabetes on cognitive status might differ in older men and women, probably because of a survival effect, with a higher mortality at a younger age among diabetic men. The metabolic and cardiovascular abnormalities associated with diabetes might be responsible for the cognitive decline, at different rates and ages, in men and women. The routine assessment of diabetes complications in the elderly should include cognitive evaluation in both sexes.

Diabetes and osteoporosis

Care of patients with diabetes should include assessment of bone health. The extension of the average life expectancy of people with diabetes, which has accompanied improvements in medical care, has also increased the significance of osteoporosis. In addition to the usual causes of osteoporosis associated with aging, bone health is also compromised by diabetes. Studies on bone involvement in patients with diabetes mellitus have generated conflicting results, largely because of the pathogenetic complexity of the condition. It is now clear that patients with type 1 diabetes have lower bone mineral density (BMD) and a higher risk of fractures. Evidence is emerging that patients with type 2 diabetes who have complications are also at increased risk of certain types of osteoporotic fractures, despite having a higher BMD when compared to patients with type 1 diabetes. Although many factors, including number and type of falls, visual impairment, neuropathy, and reduced muscle strength, influence the probability of fractures, the most significant factor seems to be the strength of the bone itself. Thus, sarcopenia, a reduction in muscle mass and muscle strength, is considered one of the main determinants of bone fragility. The aim of this review is to examine the occurrence of osteoporosis in type 1 and type 2 diabetes.

Plasma lipids and inflammation in active inflammatory bowel diseases

Background  Ulcerative colitis (UC) and Crohn’s disease (CD) can cause metabolic and inflammatory alterations.

Cytokine network in rectal mucosa in perianal Crohn's disease: Relations with inflammatory parameters and need for surgery†

Background: Nowadays anti‐TNF‐&agr; antibodies are used for the treatment of perianal Crohns disease (CD). Nevertheless, this treatment is effective in only a part of these patients and recent studies suggested a role for other cytokines in chronic bowel inflammation. The aim of this study was to assess the cytokine profile in the rectal mucosa of patients affected by perianal CD and to understand its relations with the systemic cytokine profile and inflammatory parameters and the need for surgery. Methods: Seventeen patients affected by perianal CD, 7 affected by CD without perianal involvement, and 17 healthy controls were enrolled and underwent blood sampling and endoscopy. During endoscopy rectal mucosal samples were taken and the expression of TNF‐&agr;, IL‐6, IL‐1&bgr;, IL‐12, and TGF‐&bgr;1 was quantified with enzyme‐linked immunosorbent assay (ELISA). Local cytokine levels were compared and correlated with diagnosis, therapy, phenotype (fistulizing and stenosing), and disease activity parameters. Results: In the group with perianal CD, rectal mucosal IL‐1&bgr;, IL‐6, and serum IL‐6 and TNF‐&agr; were higher than in patients with small bowel CD and healthy controls. IL‐12 and TGF‐&bgr;1 mucosal levels did not show any differences among the 3 groups. Mucosal IL‐6 significantly correlated with the Perianal Crohns Disease Activity Index and mucosal TNF‐&agr; and IL‐1&bgr;. Mucosal TNF‐&agr; and IL‐1&bgr; showed a direct correlation with the histological grade of disease activity. Conclusions: The cytokines network analysis in perianal CD shows the important involvement of IL‐1&bgr;, IL‐6, and TNF‐&agr;. Furthermore, mucosal levels of IL‐6 and IL‐12 are predictors of recurrence and of need for surgery in perianal CD patients.

The effects of weight changes after middle age on the rate of disability in an elderly population sample.

OBJECTIVES: To analyze the association between weight loss and weight gain after middle age and the prevalence of late disability.

Cognitive functions are not affected by dietary fatty acids in elderly subjects in the Pro.V.A. study population

Background and aims: Environmental, lifestyle, and dietary factors, including the type of dietary fatty acids consumed, may influence the onset of dementia. The aim of the present study was therefore to examine whether type of dietary fats consumed is associated with cognitive performance. Methods: Using gaschromatography, plasma phospholipid fatty acid composition was determined in a sample of subjects (age ≥ 65 years) randomly selected from the general Pro.V.A. study population. Plasma phospholipid fatty acid composition is a reliable marker of the type of fats present in the diet. The subjects’ cognitive capacity was tested using the Mini-Mental State Examination (MMSE). Results: At multiple regression analysis, the MMSE score variance was correlated with age and education level in 30% of cases, whereas the other variables considered (including type of fatty acids consumed) had an almost negligible effect. Conclusions: In free-living elderly subjects, moderate to severe cognitive impairment is not associated with dietary fatty acids.

Desaturase activities and metabolic control in type 2 diabetes

The aim of this study was to elucidate the effects of a poor glycemic control on fatty acid composition and desaturase activities in type 2 diabetic patients. Plasma phospholipid fatty acid composition and desaturase activities (estimated from fatty acid product to precursor ratios) were measured in 30 type 2 diabetic patients during poor metabolic control and after achieving a good metabolic control. Significant changes were recorded in the percentages of palmitic, stearic, dihomo-gamma-linolenic, docosatetraenoic and docosapentaenoic acid. The delta-5 desaturase activity was significantly higher with poor than with good metabolic control. The changes identified in plasma phospholipid fatty acid composition and the desaturase activity in type 2 diabetic patients go in the opposite direction to those described in similar conditions in type 1 diabetic patients and may be relevant to a better understanding of the role of metabolic control in the progression of chronic complications in type 2 diabetic patients.

Association of single measurement of estimated glomerular filtration rate and non-quantitative dipstick proteinuria with all-cause and cardiovascular mortality in the elderly. Results from the Progetto Veneto Anziani (Pro.V.A.) Study

OBJECTIVE To explore the independent and combined clinical validity of estimated glomerular filtration rate (eGFR) and proteinuria on predicting all-cause and cardiovascular mortality in an Italian elderly population. METHODS Baseline eGFR and proteinuria, all-cause and cardiovascular mortality during a mean follow-up time of 4.4 years were evaluated in 3063 subjects aged 65 years and older of the Progetto Veneto Anziani (Pro.V.A.) Study. RESULTS Subjects with eGFR<60ml/min/1.73m(2) (n=956) presented a higher prevalence of proteinuria in comparison with those with eGFR≥60ml/min/1.73m(2) (33.8% vs 25.1%, p<0.01). After multivariable adjustment including proteinuria and major diseases, eGFR<60ml/min/1.73m(2) was not associated with increased all-cause mortality. After multivariable adjustment including eGFR and major diseases, proteinuria was associated with all-cause mortality in overall subjects (HR=1.43, 95% CI 1.15-1.78, p<0.01), and in both sexes. After multivariable adjustment both eGFR<60ml/min/1.73m(2) (HR=1.68, 95% CI 1.02-2.78, p=0.04), and proteinuria (HR=2.07, 95% CI 1.31-3.27, p<0.01) were associated with increased cardiovascular mortality. Subjects with both impaired eGFR and presence of proteinuria showed a higher risk for both all-cause and cardiovascular mortality compared to those with normal eGFR and absence of proteinuria. CONCLUSION In this general Italian elderly population proteinuria is an independent predictor of all-cause and cardiovascular mortality, while eGFR is not an independent predictor of all-cause mortality, and it is nominally significantly associated with cardiovascular mortality. However, mortality risk is higher in individuals with combined reduced eGFR and proteinuria.

Metabolic syndrome and cardiovascular disease in the elderly: the Progetto Veneto Anziani (Pro.V.A.) Study

Background and aims: The prevalence of the metabolic syndrome increases with age, although only few data are available about its prevalence in the general elderly population. This study describes the prevalence of the metabolic syndrome in an elderly population, and its association with cardiovascular diseases. Methods: The Progetto Veneto Anziani (Pro.V.A.) is an observational study of 3099 subjects aged 65 and older, randomly selected from the general population of Northern Italy. Cardiovascular diseases and metabolic syndrome according to Adult Treatment Panel III were evaluated in 2910 subjects. Results: The metabolic syndrome was present in 25.6% of men and 48.1% of women. Its prevalence was mainly due to high blood pressure (93%) in both sexes, and to abdominal obesity in 73% of women. The prevalence of cardiovascular diseases was significantly higher among subjects with metabolic syndrome. Together with age and former smoking habits, the metabolic syndrome was significantly associated with cardiovascular diseases. High blood pressure and low HDL were independently associated with cardiovascular diseases in men, and with high fasting plasma glucose and waist circumference in women. Conclusions: The metabolic syndrome is frequent, and significantly but not independently associated with prevalent cardiovascular diseases in the elderly. In old people, rather than the metabolic syndrome per se, some of its components are independently associated with cardiovascular diseases.