Raquel Aparicio-Ugarriza

A review of the cut-off points for the diagnosis of vitamin B12 deficiency in the general population

Abstract Vitamin B12 deficit is one of the most common vitamin deficiencies. However, there is no consensus on the cut-off points for vitamin B12 and its co-markers, such as folate, holotranscobalamin, methylmalonic acid and homocysteine. In order to establish the state of the art about cut-off points used to determine vitamin B12 deficiency in the last decades, the database MEDLINE was used for searching studies published in adults between December 1992 and May 2014 (69 articles), using search terms like ‘vitamin B12’, ‘cobalamin’, ‘cut-off’, ‘deficiency’ alone or in combinations. Broad ranges of cut-off points for vitamin B12 and its biomarkers were identified: vitamin B12 ranged between 100 pmol/L and 350 pmol/L, holotranscobalamin 20–50 pmol/L, methylmalonic acid 0.210–0.470 μmol/L, homocysteine 10–21.6 μmol/L, serum folate 3.7–15.9 nmol/L and red blood cell 124–397 nmol/L. For the majority of studies, the potential influence of age, analytical methods, gender and fortified food consumption was not taken in account when choosing cut-off values. This could explain the discrepancies between studies on vitamin B12 and folate deficiency prevalences. We conclude that there is inconsistency in the literature regarding vitamin B12 cut-offs. It would be necessary to establish different reference cut-offs according to age, considering the analytical methods used.

Physical Activity Patterns of the Spanish Population Are Mostly Determined by Sex and Age: Findings in the ANIBES Study

Background Representative data for the Spanish population regarding physical activity (PA) behaviors are scarce and seldom comparable due to methodological inconsistencies. Aim Our objectives were to describe the PA behavior by means of the standardized self-reported International Physical Activity Questionnaire (IPAQ) and to know the proportion of the Spanish population meeting and not meeting international PA recommendations. Material and Methods PA was assessed using the IPAQ in a representative sample of 2285 individuals (males, 50.4%) aged 9–75 years and living in municipalities of at least 2,000 inhabitants. Data were analyzed according to: age groups 9–12, 13–17, 18–64, and 65–75 years; sex; geographical distribution; locality size and educational levels. Results Mean total PA was 868.8±660.9 min/wk, mean vigorous PA 146.4±254.1 min/wk, and mean moderate PA 398.1±408.0 min/wk, showing significant differences between sexes (p<0.05). Children performed higher moderate-vigorous PA than adolescents and seniors (p<0.05), and adults than adolescents and seniors (p<0.05). Compared to recommendations, 36.2% of adults performed <150 min/week of moderate PA, 65.4% <75 min/week of vigorous PA and 27.0% did not perform any PA at all, presenting significant differences between sexes (p<0.05). A total of 55.4% of children and adolescents performed less than 420 min/week of MVPA, being higher in the later (62.6%) than in the former (48.4%). Highest non-compliance was observed in adolescent females (86.5%). Conclusion Sex and age are the main influencing factors on PA in the Spanish population. Males engage in more vigorous and light PA overall, whereas females perform more moderate PA. PA behavior differs between age groups and no clear lineal increase with age could be observed. Twenty-seven percent of adults and 55.4% of children and adolescents do not meet international PA recommendations. Identified target groups should be addressed to increase PA in the Spanish population.

Physical activity assessment in the general population; validated self-report methods

Self-reported questionnaires have been commonly used to assess physical activity levels in large cohort studies. As a result, strong and convincing evidences that physical activity can protect health are widely recognized. However, validation studies using objective measures of physical activity or energy expenditure (double labelled water, accelerometers, pedometers, etc.) indicate that the accuracy and precision of survey techniques are limited. Physical activity questionnaires could fail in estimating particularly non-vigorous physical activity. They have a disproportionate focus on volitional type exercise (i.e. biking, jogging, and walking), while not capturing the activities of daily living and low to moderate intensity movements. Energy expenditure estimates from these data are not recommended. On the other hand, despite objective tools should be the measurement of choice to assess PA level, self-reported questionnaires remain valid, and have many advantages. i.e. low costs. These kind of recalls are designed and validated for different age groups and provide value and important information, mainly about physical activity pattern. Future studies will require more precision and accuracy in physical activity measurement than those provided by traditional survey methods. We can conclude that probably a mixed approach that combines both the objective and subjective techniques involving novel devices and electronic capture of physical activity questionnaires will be more effective.

Physical activity assessment in the general population: instrumental methods and new technologies

The objective measurement of human movement and the quantification of energy expenditure due to physical activity is an identified need in both research and the clinical setting. Validated and well-defined reference methods (double labelled water, direct calorimetry, indirect calorimetry) are expensive and mostly limited to the laboratory setting. Therefore, in the last years, several objective measurement devices have been developed which are appropriate for field studies and clinical settings. There is no gold standard among them, as all have limitations. Pedometers are small, non-expensive, count the steps taken and give information on total physical activity, but not about physical activity patterns and behaviour. Accelerometers are expensive, save information about frequency and intensity of physical activity, but not about type of physical activity. Both pedometers and accelerometers only save information about lower body movement, but reliability about the estimation of energy expenditure is limited. Heart rate monitoring relates intensity to energy expenditure, but gives no information about physical activity. GPS watches are portable, relatively inexpensive, non-invasive and provide distance, speed, and elevation with exact time and location, but are maybe limited for the assessment of brief higher speed movement and energy expenditure. Combined motion sensors combine accelerometry with the measurement of physiological variables and share advantages of single devices and are more precise. Manufacturer software which applies activity-specific algorithms for the calculation of energy expenditure can affect energy expenditure results. Most of the devices estimate energy expenditure more accurately at light to moderate intensities; underestimation increases at very light and higher intensity activities.

Trace element contents in toenails are related to regular physical activity in older adults.

The aim was to assess the trace element contents in toenails of older adults and its association with regular physical activity. Cross-sectional multicentre study in Spain, collecting data from a random sample of 380 participants (54% female) aged 55–80 years (men) and 60–80 years (women) with no previously documented cardiovascular disease. Physical activity performed was measured using the Minnesota Leisure-time Physical Activity Questionnaire. The 25 most inactive and 25 most active individuals for each sex were selected for this study (final sample n = 100). Anthropometric measurements were performed and toenail samples collected for calcium (Ca), chromium (Cr), iron (Fe), cobalt (Co), nickel (Ni), zinc (Zn), selenium (Se) and mercury (Hg) analysis. Significant differences between sexes were reported in Ca concentrations, women having lower concentrations than men. No differences were reported in trace element contents between active and inactive men. Active women showed higher Ca, Cr, Fe, Co, and Zn and lower Hg contents than their inactive peers (all p<0.05). Inactive women showed lower Ca and Co levels (735.0 mg/kg and 4.5 μg/kg, respectively) than inactive men (1170.0 mg/kg and 7.9 μg/kg, respectively). Active women had lower Ca and higher levels of Cr (936.0 mg/kg and 1230.0 μg/kg, respectively) than active men (1070.0 mg/kg and 522.0 μg/kg, respectively). The present data added new information on the element contents in toenails of healthy Spanish older adults. The concentration of trace elements was similar in both sexes except for Ca which were lower in women. The trace element contents in women’s toenails, but not in men, were markedly influenced by physical activity, with higher levels of Ca and Fe and lower Hg among active females.

Western and Mediterranean Dietary Patterns and Physical Activity and Fitness among Spanish Older Adults

Objectives: To assess prevailing food patterns, and its association with physical activity and fitness among Spanish older adults. Methods: Cross-sectional study in Spain, collecting data from a sample (n = 380; 54% female) aged 55–80 years (men) and 60–80 years (women) with no previously documented cardiovascular disease. Body weight, body fat and waist circumference were assessed. Physical activity performed was measured using the Minnesota Leisure-time Physical Activity Questionnaire (LTPA). Physical fitness was assessed using a validated physical fitness test battery. Food consumption was assessed by a validated semi-quantitative food-frequency questionnaire. Factor analysis identified two major dietary food patterns: “Western” (WDP) and “Mediterranean” (MDP) dietary patterns. Results: Participants in MDP’s fourth quartile were classified in the second (men) and third (men and women) tertile of LTPA. After adjusting for age, body fat, waist-to-height ratio, and METs, in both sexes, a negative significant association was found between 30-s Chair stand and 6-min walking test, a positive significant association was found between 30-m Gait speed and 8-foot Time Up-and-Go (except in men) tests with WDP. The 30-m Gait speed test was negatively associated with MDP in men. Conclusions: MDP is associated with more time spent on LTPA, and this association was independent of body composition and a fast gait speed in men. WDP is associated with slower gait speed and lower body strength, agility and aerobic endurance. MDP has protective effect on healthy physical fitness, and WDP may be a contributor to frailty.

Dietary Intake and Food Sources of Niacin, Riboflavin, Thiamin and Vitamin B6 in a Representative Sample of the Spanish Population. The ANIBES Study

Thiamin, riboflavin, niacin, and vitamin B6 are essential micronutrients that are mainly involved in energy metabolism; they may prevent the occurrence of developmental abnormalities and chronic degenerative and neoplastic diseases. The aim was to analyze dietary intake and food sources of those four nutrients in subjects (n = 2009) aged 9–75 years old from the Spanish ANIBES (Anthropometric data, macronutrients and micronutrients intake, practice of physical activity, socioeconomic data and lifestyles in Spain) study. Dietary data were collected by means of a validated, photo-based three-day dietary food record. Underreporting was analysed according to the European Food and Safety Authority (EFSA, Parma, Italy) protocol. Mean (max–min) reported intake for the whole population of thiamin was 1.17 ± 0.02 mg/day, (0.30–3.44 mg/day), riboflavin 1.44 ± 0.02 mg/day, (0.37–3.54 mg/day), niacin 29.1 ± 0.2 mg/day (6.7–109 mg/day), and vitamin B6 1.54 ± 0.01 mg/day (0.28–9.30 mg/day). The main sources of intake for thiamin, niacin, and vitamin B6 were meat and meat products, and for riboflavin were milk and dairy products. An elevated percentage of the Spanish ANIBES population meets the EFSA recommended intakes for thiamin (71.2%), riboflavin (72.0%), niacin (99.0%), and vitamin B6 (77.2%).

Impact of physical activity and sedentary lifestyle on hydration status and liquid intake in Spanish older adults

Introduction: Data on hydration status in older adults are scarce and there are very few studies focused on the impact of physical activity on drinking behaviour. Objective: To determine the impact of physical activity and sedentary lifestyle on fluid intake in Spanish older adults. Method: 430 non-institutionalized Spanish older adults (58% females), aged 55-80 years were divided into four groups: ILS (inactive and low sedentary), HIS (inactive and high sedentary), ALS (active and low sedentary) and AHS (active and high sedentary). Experimental data were collected by questionnaires, physical fitness tests, and osmolality was measured in serum. Data was analyzed using one-way ANOVA. Results: Serum osmolality values were within references values in all subjects, independently of the physical activity and sedentary level. Liquid intake increased in parallel with physical activity. There were significant differences between ILS/ALS (p=0.002) and IHS/ALS (p=0.001), and no differences were found between AHS/IHS (p=0.066). Conclusions: Spanish elderly seem to be well hydrated independently of the physical activity and sedentary level. Physical activity has a higher impact on fluid intake than sendentary lifestyle. Supported by Instituto Salud Carlos III (PI11/01791 & CB12/03/30038). ImFINE and NUCOX are members of the EXERNET research network.

Association between blood marker analyses regarding physical fitness levels in Spanish older adults: A cross-sectional study from the PHYSMED project

Biomarkers have been postulated as essential variables to measure the effects of exercise on the human body. To investigate the relationship between physical fitness (PF) and blood biomarkers that are associated with disease risk in Spanish older adults, four hundred and twenty-nine adults (57% females) aged older than 55 years from a cross-sectional study were included. A battery of PF test was performed, and participants were divided into 3 groups: low, medium and high fitness. Blood samples were collected, and subjects were also grouped based on a particular biomarker being within its reference range. Furthermore, drug intake and dietary intake were considered for each participant. Higher concentrations out of the reference range were observed for vitamin 25(OH)D (67.9%) and total cholesterol (TC) (58.6%). Participants from the low PF group presented lower significant concentrations out of the reference range for vitamin B12 and triglycerides; however, participants in the low PF group showed higher significant concentrations out of the reference range for total homocysteine, creatinine, TC, HDL-cholesterol and LDL-cholesterol (LDL-c) than those in the high PF group (all p<0.05). Considering drugs related to blood lipid modifications, subjects who regularly consumed lipid reducers presented higher significant concentrations out of the reference range for TC and LDL-c than participants who did not take these drugs (p<0.01). Participants from the high PF group presented better blood marker profiles, namely, lower blood markers related to disease risk out of the reference range. These blood markers could be used as a routine method for considering PF groups in older adults.

A Novel Physical Activity and Sedentary Behavior Classification and Its Relationship With Physical Fitness in Spanish Older Adults: The PHYSMED Study

BACKGROUND As there is no gold-standard methodology to classify older people in relation to physical activity (PA) and sedentary behavior (SB), this paper aimed to propose a classification combining PA and SB. METHODS Within a broader study, 433 subjects, aged 55 years and older (57% females) from Madrid and Majorca, were evaluated for PA and SB by means of validated questionnaires. Physical fitness was analyzed objectively using the EXERNET test battery. Cluster analyses were used to establish behavioral patterns, combining PA and SB. RESULTS Males spent more time doing regular PA but less time walking and working at home than females (P < .001). Comparing the groups (inactive and high sedentary, inactive and low sedentary, active and high sedentary, and active and low sedentary), the worst aerobic endurance (P < .001) and lower body strength (P < .05) were obtained in males from both inactive groups. Agility was highest in the active and low sedentary group (P < .05). No significant differences were observed in females. CONCLUSIONS The proposed classification is valid, as it classifies subjects according to their PA and SB, and outcomes are related to objectively measured fitness. It could facilitate the work of public health authorities, researchers, and physicians.