metabolic syndrome and physical performance in elderly men: the osteoporotic fractures in men study...

METABOLIC SYNDROME AND PHYSICAL PERFORMANCE IN ELDERLY MEN: THE

OSTEOPOROTIC FRACTURES IN MEN STUDYEVERSON-ROSE SA, PAUDEL M, TAYLOR BC, ET AL. THE AMERICAN GERIATRICS SOCIETY 2011; 59:1376-

1384

AUTHORS HAD NO FINANCIAL OR ANY OTHER KIND OF PERSONAL CONFLICTS WITH THIS PUBLICATION

Terry Son

Mercer University

PharmD Candidate

October 21, 2011

Background

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Background

Metabolic Syndrome (MetS) Age-adjusted prevalence of MetS is

nearly 24% in the United States and increases with age

Adults age 60 or older, the prevalence exceeds 40%

Increases risk for stroke, cardiovascular diseases, DM, and mortality

Is related to cognitive decline

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Background

Metabolic Syndrome (defined in study):Glucose dysregulation or insulin resistance

Impaired fasting glucose (IFG) 100 - < 126 mg/dl

Diabetes mellitus Fasting glucose ≥ 126 mg/dl

History of diabetes or use of hypoglycemic medications at baseline, or hyperinsulinemia

Background

Metabolic Syndrome (defined in study) continued:Two of the 4 characteristics

SBP ≥ 140 mmHg or drug treatment for HTN HDL-C < 35 mg/dl Triglyceride ≥ 150 mg/dl BMI ≥ 30 kg/m²

Objective

To examine the association between metabolic syndrome (MetS) and objective measures of physical performance

Design

Cross-sectional analysis of cohort study, The Osteoporotic Fractures in Men Study

March 2000 to April 2002

Setting/Patients

Six clinical sites in the United States

Ambulatory men 65 yo and older

5995 enrolled; 5,457 analyzed

Inclusion/Exclusion

Inclusion: ≥ 65 yo w/o bilateral hip replacement Able to walk w/o assistance of another

person Healthy aging and fracture risk

Exclusion: Not specified

Intervention

Association between metabolic syndrome (MetS) and physical performance was evaluated in 3 ways:

Performance scores were examined in relation to individual MetS components

Performance examined according to number of MetS components a person had

Performance for men with and w/o MetS was evaluated based on WHO criteria

Intervention

Physical Performance assessed upper and lower body strength, gait speed, and balanceGrip strength Narrow walk speed Walking speedTime to complete five repeated chair stands

Physical performance measured at baseline

Intervention

Individual scores were converted to quintilesWorst = 1Best = 5Unable to compete = 0

Scores were summed for all overall scoreMean 11.6 ± 4.3, range 1-20

Outcomes

Primary Analyses:Evaluate the individual MetS components in relation to physical performanceEvaluate overall performance scores for men with and without MetS (according to WHO criteria)

Outcomes

Secondary Analyses:Evaluate the individual physical performance measures

Grip strength Narrow walk speed Walking speed Repeated chair stands

Statistics

Descriptive statistics t-test for continuous variablesChi-square tests for categorical variables

Linear Regression modelsModel 1 (minimally adjusted model)

Included covariates for age, race, education, clinic site

Model 2: (multivariable-adjusted model) Included additional covariates for smoking status,

alcohol consumption, physical activity, history of falls or fractures, self-rated health , and # of chronic medical conditions.

Statistics

t-testUsed for 2 independent samples

Men with and w/o MetSContained continuous data

Can take on any value within a finite or infinite

interval Can be counted, ordered, and measured Examples: SBP, BMI, physical activity scale,

and age

Results

Subcomponent DM Hyperinsulinemia IFG

N 840 1,143 1,279

Component

Glucose dysregulation

or insulin resistance *

Obese

HTN or Using

Anti-HTN Medication

s

Low HDL-C

High Triglyceride

s

N 3,262 1,187 2,458 733 1,992

% tage 60 22 45 13 36.5

*

Participant Characteristics

Results

# of MetS Component

s

3 or more 2 1 0

N 1,495 1,447 1,614 901

Participant Characteristics

1,437 (26.3%) participants met WHO criteria for MetS

IFG, DM, hyperinsulinemia, and

At least 2 of 4 characteristics (HTN, low HDL-C, obese, low triglycerides)

Baseline Demographics

Results

SBP or HTN is not associated with physical performance

Low HDL-C is not significantly associated with physical performance after adjustment for multiple variables

Results

Figure 1: Mean Physical Performance score according to number of MetS components

P = < 0.001

Results adjusted using multivariable model

The greater # of MetS components, the lower the physical performance score

Results when minimally adjusted had similar trend across component categories (P< 0.001)

Results

Participants without MetS did statistically better on physical performance measures whether adjusted minimally or multivariablely

Results

Physical performance was affected in participants with MetS on:Narrow walk speedWalking speedRepeated chair stands

Whether or not the participants have MetS, grip strength performance was not significantly affected

Authors’ Conclusion

Metabolic dysregulation is related to objectively assessed poorer physical performance in relatively healthy older men

Participants with MetS had significantly worse performance of objective indicators on physical function than their peers without MetS

Commentary

Strengths Physical performances were assessed

objectively Well-characterized cohort of community-

dwelling, older men Performance-based measures served as

more valid measures than self-reported measures

Commentary

Limitations May not be generalized to men from other

demographics WHO criteria were adapted to define MetS

because data on DBP or microalbuminuria were lacking, and BMI was used instead of waist circumference

Did not address mechanism by which MetS contributes to poorer performance

Data were cross-sectional only and did not address the temporal association

Metabolic syndrome

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