metabolic syndrome and physical performance in elderly men: the osteoporotic fractures in men study...
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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
http://minuqol.com/images/metabolic-syndrome.gif
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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