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Prevalence of diabetes and depressive symptomatology and their effect on mortality risk in elderly Italians: The Italian Longitudinal Study on Aging
No full textAIM: This study assessed the prevalence of depressive symptomatology (DS) in older individuals with diabetes to determine whether diabetes and DS are independent predictors of mortality, and if their coexistence is associated with an increased mortality risk.
METHODS: Analyses were based on data from the Italian Longitudinal Study on Aging (ILSA), a prospective community-based cohort study in which 5632 individuals aged 65-84years were enrolled. The role of diabetes and DS in all-cause mortality was evaluated using the Cox model, adjusted for possible confounders, for four groups: 1) those with neither diabetes nor DS (reference group); 2) those with DS but without diabetes; 3) those with diabetes but no DS; and 4) those with both diabetes and DS.
RESULTS: Type 2 diabetes mellitus (T2DM) was present in 13.8% of the participants; they presented with higher baseline rates of DS compared with the non-diabetic controls. During the first follow-up period, participants with DS but not diabetes had a 42% higher risk of all-cause mortality compared with the reference control group (HR=1.42; 95% CI: 1.02-1.96), while participants with diabetes but not DS had an 83% higher risk of death than the reference group (HR=1.83; 95% CI: 1.19-2.80). The risk of death for those with both disorders was more than twice that for the reference group (HR=2.58; 95% CI: 1.55-4.29). Analyses of deaths from baseline to the second follow-up substantially confirmed these results.
CONCLUSION: The prevalence rate of DS is higher in elderly people with diabetes and their coexistence is associated with an increased mortality risk
The metabolic syndrome, incidence of diabetes and mortality among the elderly: the Italian Longitudinal Study of Ageing.
No full textAIM: To investigate whether or not the metabolic syndrome (MetS) can predict the incidence of diabetes and all-cause mortality among elderly subjects.
METHODS: Analyses were based on data collected by the Italian Longitudinal Study on Aging (ILSA) that, between 1992 and 1996, enrolled 5632 participants aged 65 to 84 years. The analyses included 3081 participants for whom complete data were available. Logistic-regression models were designed to study the influence of the MetS on the incidence of diabetes, adjusting for individual MetS components and possible confounders. Data on mortality collected between baseline and the 1996 follow-up were also considered, and Cox's proportional hazards models were used to determine the death risk attributable to the synergistic relationship between the MetS and diabetes.
RESULTS: The MetS was strongly associated with an increased risk of diabetes (OR: 5.53, 95% CI: 2.89-10.60). After adjusting for its individual components and possible confounders, the MetS maintained an important role in predicting the incidence of diabetes (OR: 2.65, 95% CI: 0.97-7.24) together with the fasting glucose component (OR: 5.89, 95% CI: 2.89-11.98). Over the 4-year follow-up, participants with diabetes, but without the MetS, and subjects with the MetS, but without diabetes, had no significant risk of death compared with the reference group. Elderly subjects who had both the MetS and diabetes had almost double the risk of death vs the reference group (HR: 1.80, 95% CI: 1.04-3.12).
CONCLUSION: The MetS is associated with the incidence of diabetes, and the synergy between the MetS and diabetes is an important risk factor for all-cause mortality in elderly subjects
Epidemiology of distal symmetrical neuropathies in the Italian elderly
No full textOBJECTIVES:
To estimate prevalence and incidence of distal symmetric neuropathies (DSN) in the Italian elderly, and to evaluate the accuracy of our procedure to screen for DSN.
METHODS:
In eight Italian municipalities, a population-based sample was directly evaluated both at baseline (1992) and after a 3-year follow-up. Cohort members who had died were studied. DSN diagnosis and subtyping were made according to specified diagnostic criteria.
RESULTS:
Our screening procedure proved accurate (sensitivity 94.7%, specificity 70%, positive predictive value 18.9%), and provided an adjusted prevalence of 7.0 (95% CI, 6.9 to 7.0). Women outnumber men both in the oldest age groups and as a whole. Rates increase with increasing age in both genders. Among the 2,845 individuals re-screened at the follow-up and the 221 deceased subjects with reliable information, we identified 100 incident cases of DSN. Adjusted annual incidence rate (per 1,000 person-years) in the population 65 to 84 years of age is 7.9 (95% CI, 6.3 to 9.5), and for the nondiabetic DSN is 5.76 (95% CI, 4.3 to 7.3). Age significantly predicted the onset of DSN both in diabetic individuals (for every increasing year of age RR = 1.07; 95% CI, 1.01 to 1.14) and in the entire study population (RR = 1.05; 95% CI, 1.02 to 1.09).
CONCLUSIONS:
We provide the first population-based distal symmetric neuropathies incidence data, as well as prevalence rates from an unselected sample of Italian elderly. Distal symmetric neuropathies are an age-associated condition, but the frequency of diabetic distal symmetric neuropathies declines with age, coincident with an increase in nondiabetic cases
Alcohol consumption and cardiovascular risk factors in older lifelong wine drinkers: The Italian Longitudinal Study on Aging.
No full textAbstract. BACKGROUND AND AIMS: A protective effect of moderate alcohol consumption on the cardiovascular system has consistently been reported, but limited evidence has been produced on the association of alcohol with metabolic factors in the elderly. The aim of this study was to investigate the association between different levels of current alcohol consumption and cardiovascular risk factors in a representative sample of elderly Italian men, mainly wine drinkers. METHODS AND RESULTS: This is a cross-sectional multi-centre study on a population-based sample of Italian men aged 65-84 years, drawn from the Italian Longitudinal Study on Aging (ILSA) cohort. The analyses included 1896 men. Almost all the drinkers (98%) drank wine as a lifelong habit. Adjusted ORs for risk levels for cardiovascular factors (BMI, waist circumference, fibrinogen, α2 protein, white blood cells, HDL cholesterol, Apo A-I, total cholesterol, Apo B-I, triglycerides, LDL, glycated hemoglobin, insulin, fasting plasma glucose, HOMA IR, systolic and diastolic blood pressure) were estimated, comparing drinkers with teetotalers using multivariate logistic regression models. We found alcohol consumption in older age associated with healthier hematological values of fibrinogen, HDL cholesterol, Apo A-I lipoprotein and insulin, but it was also associated with a worse hematological picture of total, LDL cholesterol levels, and systolic pressure. CONCLUSION: Our results indicated in elderly moderate wine drinkers a noticeably safe metabolic, inflammatory and glycemic profile that might balance higher blood pressure, leading to a net benefit. These findings however need to be placed in relation to the known adverse social and health effects of heavy drinking
Incidence of Dementia, Alzheimer's Disease, and vascular Dementia in Italy. The ILSA Study.
No full text
An adequate threshold for body mass index to detect underweight condition in elderly persons: the Italian Longitudinal Study on Aging (ILSA)
Get PDFBACKGROUND:
The present study aims at defining a body mass index (BMI) threshold for risk of being underweight in elderly persons on the basis of the BMI distribution in a large Italian population-based sample and on its ability to predict short-term mortality.
METHODS:
At baseline (1992), BMI was obtained for 3110 (1663 males and 1447 females) persons aged 65-84 participating in the Italian Longitudinal Study on Aging (ILSA). BMI and risk factors (age, sex, education, smoking status, disability, and disease status) have been considered for their potential association with 4-year all-cause mortality. Information on vital status at 1995 was obtained for 2551 participants.
RESULTS:
The fifth centile of BMI was well approximated by a value of 20 for both sexes. Also in both sexes, at a BMI value of 24 the a posteriori probability of death started to increase, doubling at a value of 22 for men and 20 for women. Crude mortality was 14.6% for men and 9.8% for women. The hazard ratios and confidence intervals (CIs) comparing mortality for each BMI two-unit class to the 26-28 class, after adjusting for confounding variables, showed significantly higher rates only for BMI values below 20 (2.9; 95% CI, 1.2-7.0), although a consistent increase in hazard ratio (1.6; 95% CI, 0.9-3.0) already appeared for the 20-22 BMI group.
CONCLUSIONS:
Our study confirms that low BMI is an independent predictive factor of short-term mortality in elderly persons. A BMI value of 20 kg/m2 seems to be a reliable threshold for defining underweight elderly persons at high risk. Nevertheless, more careful clinical and nutritional management should also be applied to elderly persons with higher BMI values
Consumo di alcol e funzionalità renalein una coorte di maschi anziani italiani
No full textOBIETTIVO: In letteratura non è ancora stata investigata la relazione tra
consumo moderato di alcol e funzione renale nelle persone anziane. Lo
scopo del presente studio è stato quello di indagare il rapporto tra consumo
di alcol e funzione renale nella popolazione anziana italiana maschile.
MATERIALI E METODI: Il campione di questo studio è costituito da 1.785
uomini di età compresa tra i 65-84 anni inclusi nell’Italian Longitudinal Study
on Aging (ILSA) il cui obiettivo era studiare la prevalenza e l’incidenza di
patologie croniche della popolazione anziana, identificando i fattori di rischio
e di protezione. Lo studio ILSA è iniziato nel 1992 con due successive
rilevazioni di follow-up nel 1995 e 2000. Ogni indagine prevedeva due fasi,
un momento di valutazione di screening per tutti i partecipanti (consistente
in anamnesi, esame fisico, esami di laboratorio e test diagnostici) ed una
fase successiva solo per i positivi ad una o più malattie croniche attraverso
una valutazione clinica specialistica. Nel questionario anamnestico utilizzato
vi erano anche domande per valutare il consumo di alcol nei diversi periodi
della vita. Escludendo 315 ex-bevitori, nella presente analisi, i restanti 1470
soggetti sono stati ripartiti in cinque classi di consumo di alcol: astemi, ≤12g/
die, 13-24g/die, 25-47 g/die, e” 48 g/die. In questo studio, per le stime di
prevalenza si sono analizzati i dati rilevati al tempo basale (1992), mentre per
l’incidenza si sono utilizzate le informazioni raccolte al primo follow-up (1995).
RISULTATI: Sono state stimate la prevalenza e l’incidenza cumulativa di
insufficienza renale (IR) (GFR ≤ 60 ml / min), nei gruppi di anziani maschi
con differente consumo alcolico. L’analisi di regressione logistica aggiustata
per fattori confondenti (età, istruzione, fumo, BMI e assunzione di farmaci
ant-iipertensivi ed anti-ipercolesterolemici) e fattori intermedi (colesterolo,
fibrinogeno, ipertensione sistolica, e diabete) ha dimostrato una relazione
inversa tra consumo di alcol e deficit nella funzionalità renale, evidenziando
come il consumo moderato di alcool riduca il rischio di sviluppare insufficienza renale lieve rispetto al non consumo, con un rischio minimo [OR 0.26 (IC
95% 0.07-0.99) ] tra i consumatori da 24-48 g/die di alcol .
CONCLUSIONI: I nostri risultati suggeriscono che, in conformità con le
raccomandazioni sul consumo di alcol negli anziani, quantità moderate di
alcol non siano dannose per la funzionalità renale in uomini anziani
Vascular factors predict polyneuropathy in a non-diabetic elderly population
No full textWe prospectively examined whether vascular factors are related to an increased incidence of Chronic Idiopathic Distal Symmetric Neuropathy (CI-DSN) in a non-diabetic elderly population. In 8 Italian municipalities, 2,512 men and women without both diabetes and CI-DSN at baseline are examined. Potential effect of vascular factors was estimated by regressing new onset CI-DSN on the occurrence of several vascular diseases and risk factors. Multivariate relative risks of CI-DSN were estimated by Cox proportional hazards models. After 3.8 (±2.4) years of follow-up, we documented 51 incident CI-DSN cases. At univariate analysis, age, comorbidity, waist circumference, leg length, peripheral artery disease, and coronary heart disease proved to increase the risk of developing CI-DSN. By multivariate analyses, only age (RR = 1.08; 95 % CI, 1.02-1.14), leg length (RR = 1.05; 95 % CI, 1.01-1.1) and peripheral artery disease (RR = 2.75; 95 % CI, 1.15-6.56) proved significant predictors of CI-DSN. Separate analyses by gender show that age is an independent predictor of CI-DSN both in men and in women, while PAD predicts the disease only in men, together with body height. Incidence of CI-DSN is higher in individuals carrying vascular conditions. In men, the presence at baseline of peripheral artery disease is associated with a threefold increase in the risk of developing CI-DSN. The incidence of neuropathy in non-diabetic individuals is associated with potentially modifiable vascular factor
Changes in severity of depressive symptoms and mortality: the Italian Longitudinal Study on Aging.
No full textBACKGROUND: Depression is recognized as being associated with increased mortality. However, there has been little previous research on the impact of longitudinal changes in late-life depressive symptoms on mortality, and of their remission in particular.
METHOD: As part of a prospective, population-based study on a random sample of 5632 subjects aged 65-84 years, with a 10-year follow-up of vital status, depressive symptoms were assessed by the 30-item Italian version of the Geriatric Depression Scale (GDS). The number of participants in the GDS measurements was 3214 at baseline and 2070 at the second survey, 3 years later. Longitudinal changes in depressive symptoms (stable, remitted, worsened) were examined in participants in both evaluations (n=1941). Mortality hazard ratios (MHRs) according to severity of symptoms and their changes over time were obtained by means of Cox proportional hazards regression models, adjusting for age and other potentially confounding factors.
RESULTS: Severity is significantly associated with excess mortality in both genders. Compared to the stability of depressive symptoms, a worsened condition shows a higher 7-year mortality risk [MHR 1.46, 95% confidence interval (CI) 1.15-1.84], whereas remission reduces by about 40% the risk of mortality in both genders (women MHR 0.55, 95% CI 0.32-0.95; men MHR 0.59, 95% CI 0.37-0.93). Neither sociodemographic nor medical confounders significantly modified these associations.
CONCLUSIONS: Consistent with previous reports, the severity and persistence of depression are associated with higher mortality risks. Our findings extend the magnitude of the association demonstrating that remission of symptoms is related to a significant reduction in mortality, highlighting the need to enhance case-finding and successful treatment of late-life depression
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