Hanneke A.H. Wijnhoven

Gender Differences in Health-Related Quality of Life Among Asthma Patients

Objective. To identify and explain differences between men and women with asthma regarding health-related quality of life (HRQoL). Methods. A cross-sectional study was performed among 967 asthma patients recruited from general practice. Data were collected by means of a pulmonary function assessment, a face-to-face interview, and a written questionnaire. Results. Women with asthma reported lower scores on HRQoL in the age groups 16–34 and 56–75 years but not in the age group 35–55 years. In all age groups, women reported more severe dyspnea but had higher levels of pulmonary function. The poorer HRQoL reported by women could be explained by a more severe dyspnea and a higher level of medication use in women. Conclusions. The finding that women with asthma aged 16–34 and 56–75 years report poorer HRQoL than men is not due to a more severe disease state in terms of pulmonary obstruction but does seem to be related to a more severe subjective disease state in women than in men.

Sex differences in consequences of musculoskeletal pain

Study Design. Cross-sectional population-based study. Objective. To study sex differences in consequences of musculoskeletal pain (MP): limited functioning, work leave or disability, and healthcare use. Summary of Background Data. MP is a major public health problem in developed countries due to high prevalence rates and considerable consequences. There are indications that consequences of MP differ for men and women. Methods. Data of a Dutch population-based study were used, limited to persons 25 to 64 years of age (n = 2517). Data were collected by a postal questionnaire. Results. Women with any MP report more healthcare use for MP, i.e., contact with a medical caregiver and use of medicines than men, while men report more work disability (ever in life) due to low back pain only, irrespective of work status. None of the sex differences can be explained by age, household composition, educational level, smoking status, overweight, physical activity, and pain catastrophizing. Older age was related to more limited functioning due to MP (women), work disability due to MP (men), and healthcare use due to MP (men and women). A one-person household was associated with work disability (women) and use of medicines (men). Low educational level was associated with limited functioning (men), work leave (men), contact with a medical caregiver (men), and work disability (men and women). Smoking was associated with limited functioning (men), work leave (women), and healthcare use (women). Physical inactivity was associated with limited functioning due to MP in women. Pain catastrophizing was associated with limited functioning, work leave, and healthcare use (men and women) and work disability (men). Conclusions. Consequences of MP show a slightly different pattern for men and women. Women with any MPreport more healthcare use for MP, while men report more work disability due to low back pain only. These sex differences can not be explained by general risk factors, but associations between these factors and consequences of MP show some sex differences.

Low Mid-Upper Arm Circumference, Calf Circumference, and Body Mass Index and Mortality in Older Persons

Background. Low body mass index is a general measure of thinness. However, its measurement can be cumbersome in older persons and other simple anthropometric measures may be more strongly associated with mortality. Therefore, associations of low mid-upper arm circumference, calf circumference, and body mass index with mortality were examined in older persons. Methods. Data of the Longitudinal Aging Study Amsterdam, a population-based cohort study in the Netherlands, were used. The present study included community-dwelling persons 65 years and older in 1992–1993 (n = 1,667), who were followed until 2007 for their vital status. Associations between anthropometric measures and 15-year mortality were examined by spline regression models and, below the nadir, Cox regression models, transforming all measures to sex-specific Z scores. Results. Mortality rates were 599 of 826 (73%) in men and 479 of 841 (57%) in women. Below the nadir, the hazard ratio of mortality per 1 standard deviation lower mid-upper arm circumference was 1.79 (95% confidence interval, 1.48–2.16) in men and 2.26 (1.71–3.00) in women. For calf circumference, the hazard ratio was 1.45 (1.22–1.71) in men and 1.30 (1.15–1.48) in women and for body mass index 1.38 (1.17–1.61) in men and 1.56 (1.10–2.21) in women. Excluding deaths within the first 3 years after baseline did not change these associations. Excluding those with a smoking history, obstructive lung disease, or cancer attenuated the associations of calf circumference (men) and body mass index (women). Conclusions. Based on the stronger association with mortality and given a more easy assessment in older persons, mid-upper arm circumference seems a more feasible and valid anthropometric measure of thinness than body mass index in older men and women.

Early determinants for the development of undernutrition in an older general population: Longitudinal Aging Study Amsterdam

Undernutrition may be an important modifiable risk factor for poor clinical outcomes in older individuals. To achieve earlier detection or prevention of undernutrition, more information is needed about risk factors for the development of undernutrition in community-dwelling older individuals. The objective was to identify early determinants of incident undernutrition in a prospective population-based study. Baseline data (1992-3) on socio-economic, psychological, medical, functional, lifestyle and social factors of 1120 participants aged 65-85 years of the Longitudinal Aging Study Amsterdam were used. Undernutrition, defined as a BMI < 20 kg/m2 or self-reported involuntary weight loss ≥ 5 % in the last 6 months, was assessed every 3 years during a 9-year follow-up period. Cox proportional-hazards regression analysis was used to investigate the association between early determinants at baseline and incident undernutrition. In 9 years, 156 participants (13·9 %) developed undernutrition. In univariate analyses, female sex, depressive symptoms, anxiety symptoms, multiple chronic diseases, high medication use (women), poor appetite, no alcohol use v. light alcohol use, loneliness, not having a partner, limitations in performing normal activities due to a health problem, low physical performance (participants aged < 75 years) and reporting difficulties walking stairs (participants aged < 75 years) were statistically significantly associated with incident undernutrition. In a multivariate model, poor appetite and reporting difficulties walking stairs (participants aged < 75 years) remained early determinants. The results of the present study can be used to identify subgroups of older individuals with increased risk of undernutrition and to identify modifiable determinants for the purpose of prevention of undernutrition.

Development and validation of criteria for determining undernutrition in community-dwelling older men and women: The Short Nutritional Assessment Questionnaire 65+

BACKGROUND & AIMS There is no valid, fast and easy-to-apply set of criteria to determine (risk of) undernutrition in community-dwelling older persons. The aim of this study was to develop and validate such criteria. METHODS Selection of potential anthropometric and undernutrition-related items was based on consensus literature. The criteria were developed using 15-year mortality in community-dwelling older persons ≥ 65 years (Longitudinal Aging Study Amsterdam, n = 1687) and validated in an independent sample (InCHIANTI, n = 1142). RESULTS Groups distinguished were: (1) undernutrition (mid-upper arm circumference <25 cm or involuntary weight loss ≥4 kg/6 months); (2) risk of undernutrition (poor appetite and difficulties climbing staircase); and (3) no undernutrition (others). Respective hazard ratios for 15-year mortality were: (1) 2.22 (95% CI 1.83-2.69); and (2) 1.57 (1.22-2.01) ((3) = reference). The area under the curve (AUC) was 0.55. Comparable results were found stratified by sex, excluding cancer/obstructive lung disease/(past) smoking, using 6-year mortality, and applying results to the InCHIANTI study (hazard ratios 2.12 and 2.46, AUC 0.59). CONCLUSIONS The developed set of criteria (SNAQ⁶⁵⁺) for determining (risk of) undernutrition in community-dwelling older persons shows good face validity and moderate predictive validity based on the consistent association with mortality in a second independent study sample.

High prevalence of undernutrition in Dutch community-dwelling older individuals

OBJECTIVE To examine the prevalence of undernutrition in community-dwelling older individuals (≥65 y) using data from various settings. METHODS A cross-sectional observational study was performed to examine the prevalence of undernutrition in three samples (all ≥65 y): 1) 1267 community-dwelling individuals participating in a large prospective population-based study, the Longitudinal Aging Study Amsterdam (LASA) in 1998/99; 2) 814 patients receiving home care in 2009/10; and 3) 1878 patients from general practices during the annual influenza vaccination in 2009/10. Undernutrition was assessed by the Short Nutritional Assessment Questionnaire 65+. RESULTS Mean age was 77.3 y (SD 6.7) in the LASA sample, 81.6 y (SD 7.4) in the home care sample, and 75.3 y (SD 6.5) in the general practice sample. The prevalence of undernutrition was highest in the home care sample (35%), followed by the general practice (12%) and LASA (11%) samples. The prevalence of undernutrition increased significantly with age in the general practice and LASA samples. Gender differences were observed in the general practice and home care samples; women were more likely to be undernourished in the general practice sample and men were more likely to be undernourished in the home care sample. CONCLUSION The prevalence of undernutrition in Dutch community-dwelling older individuals was relatively high, especially in home care patients.

Determinants of protein–energy malnutrition in community-dwelling older adults: A systematic review of observational studies

Protein-energy malnutrition is associated with numerous poor health outcomes, including high health care costs, mortality rates and poor physical functioning in older adults. This systematic literature review aims to identify and provide an evidence based overview of potential determinants of protein-energy malnutrition in community-dwelling older adults. A systematic search was conducted in PUBMED, EMBASE, CINAHL and COCHRANE from the earliest possible date through January 2013. Observational studies that examined determinants of protein-energy malnutrition were selected and a best evidence synthesis was performed to summarize the results. In total 28 studies were included in this review from which 122 unique potential determinants were derived. Thirty-seven determinants were examined in sufficient number of studies and were included in a best evidence synthesis. The best evidence score comprised design (cross-sectional, longitudinal) and quality of the study (high, moderate) to grade the evidence level. Strong evidence for an association with protein-energy malnutrition was found for poor appetite, and moderate evidence for edentulousness, having no diabetes, hospitalization and poor self-reported health. Strong evidence for no association was found for anxiety, chewing difficulty, few friends, living alone, feeling lonely, death of spouse, high number of diseases, heart failure and coronary failure, stroke (CVA) and the use of anti-inflammatory medications. This review shows that protein-energy malnutrition is a multifactorial problem and that different domains likely play a role in the pathway of developing protein-energy malnutrition. These results provide important knowledge for the development of targeted, multifactorial interventions that aim to prevent the development of protein-energy malnutrition in community-dwelling older adults.

Attribution of Causes of Weight Loss and Weight Gain to 3-Year Mortality in Older Adults: Results From the Longitudinal Aging Study Amsterdam

BACKGROUND Weight loss is associated with a higher mortality risk in old age, but the underlying cause may impact this association. We examined associations between causes of intentional and unintentional weight loss and weight gain and mortality. METHODS We used data of five triannual examination rounds of the Longitudinal Aging Study Amsterdam (age ≥ 55 years, n = 2,645) and two examination rounds of a new cohort (n = 909). Self-reported weight loss or gain and causes were measured during a personal interview. Time-dependent Cox regression was used to model the association between weight loss and gain causes and subsequent 3-year mortality. RESULTS At baseline, 16% reported weight loss (mean = 4.7 kg, SD = 3.7) in 6 months. After adjustment for potential confounders, an increased mortality risk was observed for unintentional weight loss due to medical reasons (<72 years: hazard ratio = 2.43 [95% confidence interval: 1.52-3.88]; ≥72 years: 1.62 [1.23-2.14]), unknown reasons (1.98 [1.49-2.62]), and change in eating pattern (1.89 [1.12-3.18]). No association was found for unintentional weight loss due to social reasons, intentional weight loss (dieting or physical activity), or weight gain. Weight loss due to medical or social reasons was often regained in subsequent 3 years while weight loss due to other causes was not. CONCLUSIONS Weight loss due to social reasons was not associated with mortality suggesting that not all unintentional weight loss is harmful. The increased mortality risk of other causes of unintentional weight loss may be related to underlying disease. Intentional weight loss was not associated with mortality.

Ethnic aspects of emotional distress in patients with diabetes-the Amsterdam Health Monitor Study

Depression and anxiety are relatively common in patients with diabetes, but it is unclear whether migrant patients with diabetes are at increased risk for emotional distress. We determined levels of emotional distress in patients with diabetes with a Turkish, Moroccan or Dutch ethnic background and compare distress levels with healthy control subjects. Among patients with diabetes, we examined demographic and clinical correlates of higher levels of emotional distress.

Factors associated with (risk of) undernutrition in community-dwelling older adults receiving home care: a cross-sectional study in the Netherlands.

OBJECTIVE It is generally thought that causes of undernutrition are multifactorial, but there are limited quantitative studies performed. We therefore examined a wide range of potential factors associated with undernutrition in community-dwelling older adults. DESIGN Cross-sectional study. SETTING Community-dwelling older adults (≥65 years) receiving home care in the Netherlands. SUBJECTS Data on potential factors associated with (risk of) undernutrition were collected among 300 older adults. Nutritional status was assessed by the SNAQ65+ instrument. Undernutrition was defined as mid-upper arm circumference <25 cm or unintentional weight loss of ≥4 kg in 6 months. Being at risk of undernutrition was defined as having poor appetite and inability to walk up and down stairs of fifteen steps, without resting. RESULTS Of all participants, ninety-two (31·7 %) were undernourished and twenty-four (8·0 %) were at risk of undernutrition. Based on multivariate logistic regression analyses, the statistically significant factors associated with (risk of) undernutrition (P<0·05) were: unable to go outside (OR=5·39), intestinal problems (OR=2·88), smoking (OR=2·56), osteoporosis (OR=2·46), eating fewer than three snacks daily (OR=2·61), dependency in activities of daily living (OR=1·21), physical inactivity (OR=2·01), nausea (OR=2·50) and cancer (OR=2·84); a borderline significant factor was depression symptoms (OR=1·83, P=0·053). CONCLUSIONS The study suggests that (risk of) undernutrition is a multifactorial problem and that associated factors can be found in several domains. These findings may support the development of intervention trials for the prevention and treatment of undernutrition in community-dwelling older adults.