Joanna Kostka

Cardiovascular Risk Factors and Total Serum Antioxidant Capacity in Healthy Men and in Men with Coronary Heart Disease

Whether the incidence of coronary heart disease (CHD) is related to a decrease in total antioxidant capacity (TAC) has not yet been completely clarified. We assessed TAC of blood serum in a group of 163 men with CHD aged 34.8–77.0 years and in 163 age-matched peers without CHD. Two spectrophotometric methods were applied to assess TAC: ferric reducing ability of serum (TAC-FRAS) and 2.2-diphenyl-1-picryl-hydrazyl (TAC-DPPH) tests. In the CHD group, multivariate analysis revealed that uric acid (UA), triglycerides, and systolic blood pressure contributed independently to the TAC-FRAS variance. TAC-DPPH was favorably predicted by UA concentration, but negatively so by current smoking and glucose levels. In men without CHD, UA was the only independent determinant of both TAC-FRAS and TAC-DPPH. Presence of CHD was not an independent predictor of TAC—observed between-group differences (higher TAC in CHD patients) disappeared after adjustment for other confounders. We conclude that UA is the main determinant of TAC of blood serum in men. TAC is not directly influenced by age or CHD but is related to several indices of overweight/obesity and laboratory measures of metabolic syndrome, especially in patients with CHD.

Validation of the modified mini nutritional assessment short-forms in different populations of older people in Poland

ObjectiveTo assess the usefulness in different populations of elderly people in Poland of both modified versions of Mini Nutritional Assessment Short-Forms (MNA-SFs) with a three-category scoring classification: one using BMI (MNA-SF-BMI) and another using calf circumference (MNA-SF-CC).Setting and ParticipantsA group of 932 community-dwelling subjects from the urban environment, 812 subjects from the rural environment and 859 subjects from an institutional environment (nursing homes).MeasurementsAgreement between both MNA-SFs and the MNA full form. Results: MNA-SF-BMI correctly classified 84.12%, 82.51% and 81.84% of subjects from urban, rural and institutional environment, respectively. For MNA-SF-CC those values were 82.4%, 71.8% and 76.6%, respectively. The sensitivity and specificity of MNA-SF-BMI and MNA-SF-CC against full MNA in screening for “at risk/malnutrition” and “malnutrition” were generally very high, except for relatively lower sensitivity (74.1%) when screening for “malnutrition” with MNA-SF-CC in nursing homes.ConclusionBoth MNA-SFs can be recommended as screening tools in assessing the nutritional state of the community-dwelling and institutionalised elderly in Poland. The full version of the MNA confirmed the results of MNA-SFs in this group. The “classic” MNA-SF using BMI was found to perform better than the MNA-SF-CC. The MNA-SF-CC should be used only when measuring BMI is not possible. While using MNASF-CC in nursing homes, a higher MNA-SF-CC cut-point of eleven should be rather used in this population to screen for “at risk/malnutrition”.

Physical activity and total antioxidant capacity across an adult lifespan of men.

PURPOSE The aim of the study was to determine the association between the long-term physical activity (PA) and the total antioxidant capacity (TAC) of blood serum and their association with coexisting risk factors of cardiometabolic diseases in a group of relatively healthy men. METHODS The research was conducted among 422 males age 19.2-89.8 yr, either sedentary or involved in recreational sports activities. Anthropometric measurements, lipid profile, and measurement of glucose and uric acid levels were performed in every man. Current PA, historical PA, and aerobic fitness (physical working capacity) were assessed. TAC was determined with two spectrophotometric methods: the ferric reducing ability of serum (TAC-FRAS) and 2,2-diphenyl-1-picryl-hydrazyl (TAC-DPPH) tests. RESULTS TAC was not related to the age of the subjects. Higher current and historical PA were associated with a more favorable cardiometabolic risk profile but not TAC. In fact, current PA level was connected with lower values of TAC-FRAS. Values of both TAC-FRAS and TAC-DPPH decreased with an increase of aerobic capacity. Individuals with coexisting anthropometric and biochemical risk factors of cardiovascular diseases and with elevated values of arterial pressure had higher TAC. Values of both TAC-FRAS (r = 0.66) and TAC-DPPH (r = 0.39) were strongly positively correlated with uric acid level. CONCLUSIONS Overweight, obesity, higher blood pressure, unfavorable blood lipid profile, and especially higher uric acid levels are connected with greater TAC of blood serum across an adult mans life. High PA and fitness are associated with a more favorable overall risk profile of cardiovascular and metabolic diseases but are related to lower TAC.

Comparative analysis of the expected demands for nursing care services among older people from urban, rural, and institutional environments

Background Demand for nursing and social services may vary depending on the socio-demographic variables, health status, receipt of formal and informal care provided, and place of residence. Objectives To conduct a comparative analysis of the expectations of older people from urban, rural, and institutional environments concerning nursing care with respect to the care provided and elements of a comprehensive geriatric assessment. Material and methods The study comprised 2,627 individuals above the age of 65 years living in urban (n=935) and rural (n=812) areas as well as nursing homes (n=880). Results Family care was most often expected both in urban (56.6%) and rural (54.7%) environments, followed by care provided simultaneously by a family and nurse (urban – 18.8%; rural – 26.1%) and realized only by a nurse (urban – 24.6%; rural – 19.2%). Not surprisingly, nursing home residents most commonly expected nursing care (57.5%) but 33.1% preferred care provided by family or friends and neighbors. In the whole cohort of people living in the home environment (n=1,718), those living with family demonstrated willingness to use primarily care implemented by the family (62.0%), while respondents living alone more often expected nursing services (30.3%). In the logistic regression model, among the respondents living in the city, only the form of care already received determined the expectations for nursing care. Among the respondents living in the county, the presence of musculoskeletal disorders, better nutritional status, and current care provided by family decreased expectations for nursing care. Higher cognitive functioning, symptoms of depression, and living alone increased the willingness to obtain nursing care. Conclusion Older inhabitants of urban areas, rural areas, and those residing in institutions have different expectations for individual nursing care. Nearly 45% of seniors living in the community expect to obtain nursing care, while only 1.6% do not expect any social or nursing help. While the expectations for the provision of nursing care are significantly increased by living alone, they are decreased by having access to care provided by family. Support for families to take care of elderly relatives would appear to be essential for an effective nursing and social care system.

Inappropriate nutrients intake is associated with lower functional status and inferior quality of life in older adults with depression

Objectives The study is a case-control analysis of whether depression impairs physical and cognitive functioning and quality of life, and whether there is a relationship between nutrient deficiencies and these adverse changes. Patients and methods A total of 130 older subjects participated in the study: 65 with diagnosed depression (16 men and 49 women) and 65 age- and sex-matched controls without depression. All patients underwent comprehensive geriatric assessment. Nutritional state was assessed with the Mini Nutritional Assessment, cognitive performance was evaluated by the Mini-Mental State Examination and physical functioning by the Timed “Up & Go” test and handgrip strength. The pattern of consumption of various nutrients was analyzed in detail. Results The differences in cognitive functioning observed between the groups were related to specific nutrient intake, as was handgrip strength to some extent. The differences in nutritional status, several functional tests and muscle strength were related to both the presence of depression and inappropriate consumption of certain nutrients. Conclusion The incidence of falls and poor quality of life may be partially associated with the presence of depression. The inappropriate intake of selected nutrients may impair the functioning and quality of life of older adults with depression, such as the excess consumption of sucrose and insufficient consumption of protein, fiber, eicosapentaenoic acid, niacin and vitamin B6. Particular nutrients should be translated into dietary patterns which allow the individual patient to address these nutrient deficiencies.

Physical Activity, Aerobic Capacity, and Total Antioxidant Capacity in Healthy Men and in Men with Coronary Heart Disease

Objective. The purpose of the study was to assess total antioxidant capacity (TAC) of blood serum in relation with habitual leisure time physical activity (LTPA) and aerobic capacity in a group of 90 men with coronary heart disease (CHD) aged 34.8–77.0 years and in 90 age-matched peers without CHD. Methods. Two spectrophotometric methods were applied to assess TAC: Ferric Reducing Ability of Serum (TAC-FRAS) and 2.2-diphenyl-1-picryl-hydrazyl (TAC-DPPH) tests. Aerobic capacity was expressed as physical working capacity at 85% of the maximal heart rate (PWC85%HRmax). Results. CHD patients had higher values of TACFRAS (1.37 ± 0.28 versus 1.27 ± 0.23 mmol FeCl2·L−1; P < 0.05) but there were no group differences for TAC-DPPH and for uric acid (UA). Negative correlation was found between LTPA (also when calculated per kg of body mass) and TAC-DPPH in CHD patients. In CHD patients, TAC-FRAS and UA were lower in subjects with higher aerobic capacity expressed as PWC85%HRmax/kg. Those associations were not found in healthy men. Conclusions. We conclude that TAC of blood serum is moderately adversely related to LTPA and aerobic capacity in patients with CHD. UA, as the main determinant of serum TAC, may be partially responsible for those associations.

Association of Muscle Strength, Power, and Optimal Shortening Velocity With Functional Abilities of Women With Chronic Osteoarthritis Participating in a Multi-modal Exercise Program

We assessed the relative association of quadriceps muscle strength and power as well as optimal shortening velocity (υ(opt)) to physical functioning in 28 women aged 50-87 years with chronic osteoarthritis participating in a three-week multimodal exercise program. Quadriceps muscle strength, power, υ(opt), and functional performance using the Activities of Daily Living (ADL) scale, Timed Up & Go (TUG) test, Tinetti test, and 6-Minute Walking Test (6-MWT) were assessed pre- and postrehabilitation. With rehabilitation, patients improved the values of strength, power, and the results of all functional tests. Both at baseline and postrehabilitation, functional status was more strongly related to power and υ(opt) than to strength. Functional gains obtained with rehabilitation were not related to changes in power or υ(opt), and only very modestly related to changes in strength. Future studies should assess the benefits and feasibility of power- and velocity-oriented training in patients with osteoarthritis.

Physical Activity in Older Adults in Relation to Place of Residence and Coexistent Chronic Diseases

BACKGROUND The goal of this study was to assess the physical activity (PA) and its determinants of older people living in the 3 different environments. METHODS Three equal (n = 693 each) groups of individuals aged ≥65 years living in urban, rural and institutional environments took part in this study. PA was measured by the Seven Day Recall PA Questionnaire (energy expenditure-PA-EE) and the Stanford Usual Activity Questionnaire (health-related behaviors-PA-HRB). RESULTS PA-EE was highest in the rural environment and lowest in nursing homes. PA-HRB were most common in urban area. Older age, lower education level, several concomitant diseases and the number of systematically used medications were consistently related to lower PA-EE and PA-HRB. Smoking habit, presence of hypertension, musculoskeletal and gastrointestinal disorders had different association to PA-EE and PA-HRB in the 3 environments. CONCLUSIONS Subpopulations of older people differ from the general population with regard to their level of PA and its association with sociodemographic data and concomitant diseases. Concomitant serious diseases significantly decrease the level of PA of older subjects. The relationship between PA and nondebilitating disorders may vary depending on the living environment or PA assessment methodology.

THE CONSEQUENCES OF FALLS TO PHYSICAL ACTIVITY, SLEEP DURATION AND QUALITY OF LIFE AMONG OLDER INSTITUTIONALIZED ADULTS

Abstract Objective: Falls are among “the ‘giants’ of geriatrics”. The aim of the study was to examine the consequences of falls to physical activity (PA), sleep duration and quality of life (QoL) among institutionalized older people. Methods: 253 residents of three nursing homes at the age of 65 years or more participated in the study. Falls were registered during one year and after this time the Stanford Usual Activity Questionnaire was performed with each subject and each subject answered the questions concerning the sleep duration. The QoL was examined with the EuroQol-5D questionnaire. Results: Falls occurred in 103 subjects. The subjects with the history of fall were characterized by a lower level of PA, lower number of sleep hours and lower basic activities of daily living. In the EuroQol 5D questionnaire responses indicating mobility, self-care and anxiety problems were more pronounced in fallers. Conclusions : Low level of PA is a serious consequence of falls occurrence. History of falls is related to shorter sleep duration. PA and sleep restrictions as well as worse functional capacity may consequently deteriorate the quality of life among older institutionalized adults. Future studies should assess prospectively the bidirectional relationship of lower PA and falls as well as the influence of other factors such as sarcopenia or frailty.

Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation

OBJECTIVE The purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program. METHODS Thirty-one post-stroke patients (60.6±12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee (Fext, Fflex) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test. RESULTS The rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of non-paretic limbs. At baseline examination muscle strength difference between both Fflexkg-1 and Fextkg-1 had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for Fextkg-1 and, interestingly, even more prominent for Fflexkg-1. CONCLUSIONS MMEP can effectively increase muscle strength and functional capacity in post-stroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors.