Dahan da Cunha Nascimento, Nicholas Rolnick, Isabella da Silva Almeida, Gerson Cipriano Junior, João Luiz Durigan
Abstract: Null hypothesis significant testing (NHST) is the dominant statistical approach in the geriatric and rehabilitation fields. However, NHST is routinely misunderstood or misused. In this case, the findings from clinical trials would be taken as evidence of no effect, when in fact, a clinically relevant question may have a “non-significant” p-value. Conversely, findings are considered clinically relevant when significant differences are observed between groups. To assume that p-value is not an exclusive indicator of an association or the existence of an effect, researchers should be encouraged to report other statistical analysis approaches as Bayesian analysis and complementary statistical tools alongside the p-value (eg, effect size, confidence intervals, minimal clinically important difference, and magnitude-based inference) to improve interpretation of the findings of clinical trials by presenting a more efficient and comprehensive analysis. However, the focus on Bayesian analysis and secondary statistical analyses does not mean that NHST is less important. Only that, to observe a real intervention effect, researchers should use a combination of secondary statistical analyses in conjunction with NHST or Bayesian statistical analysis to reveal what p-values cannot show in the geriatric and rehabilitation studies (eg, the clinical importance of 1kg increase in handgrip strength in the intervention group of long-lived older adults compared to a control group). This paper provides potential insights for improving the interpretation of scientific data in rehabilitation and geriatric fields by utilizing Bayesian and secondary statistical analyses to better scrutinize the results of clinical trials where a p-value alone may not be appropriate to determine the efficacy of an intervention.
摘要：零假设显著性检验（NHST）是老年医学和康复领域的主要统计方法。然而，NHST 经常被误解或误用。在这种情况下，临床试验结果会被视为无影响的证据，而事实上，与临床相关的问题可能只有 "不显著 "的 p 值。相反，当观察到组间存在显著差异时，研究结果才被视为与临床相关。假设 p 值不是关联或效应存在的唯一指标，则应鼓励研究人员在报告 p 值的同时报告其他统计分析方法，如贝叶斯分析和补充统计工具（如效应大小、置信区间、最小临床重要性差异和基于幅度的推断），以通过更有效、更全面的分析来改进对临床试验结果的解释。然而，关注贝叶斯分析和二次统计分析并不意味着 NHST 就不那么重要。只是，为了观察到真正的干预效果，研究人员应将二次统计分析与 NHST 或贝叶斯统计分析结合起来使用，以揭示老年医学和康复研究中 p 值无法显示的内容（例如，与对照组相比，干预组长寿老年人手握力增加 1 千克的临床重要性）。本文通过利用贝叶斯和二次统计分析来更好地审查临床试验的结果，为改进康复和老年医学领域科学数据的解释提供了潜在的见解，在临床试验中，仅用 p 值来确定干预措施的疗效可能并不合适。
{"title":"Frequentist, Bayesian Analysis and Complementary Statistical Tools for Geriatric and Rehabilitation Fields: Are Traditional Null-Hypothesis Significance Testing Methods Sufficient?","authors":"Dahan da Cunha Nascimento, Nicholas Rolnick, Isabella da Silva Almeida, Gerson Cipriano Junior, João Luiz Durigan","doi":"10.2147/cia.s441799","DOIUrl":"https://doi.org/10.2147/cia.s441799","url":null,"abstract":"<strong>Abstract:</strong> Null hypothesis significant testing (NHST) is the dominant statistical approach in the geriatric and rehabilitation fields. However, NHST is routinely misunderstood or misused. In this case, the findings from clinical trials would be taken as evidence of no effect, when in fact, a clinically relevant question may have a “non-significant” <em>p</em>-value. Conversely, findings are considered clinically relevant when significant differences are observed between groups. To assume that <em>p</em>-value is not an exclusive indicator of an association or the existence of an effect, researchers should be encouraged to report other statistical analysis approaches as Bayesian analysis and complementary statistical tools alongside the <em>p</em>-value (eg, effect size, confidence intervals, minimal clinically important difference, and magnitude-based inference) to improve interpretation of the findings of clinical trials by presenting a more efficient and comprehensive analysis. However, the focus on Bayesian analysis and secondary statistical analyses does not mean that NHST is less important. Only that, to observe a real intervention effect, researchers should use a combination of secondary statistical analyses in conjunction with NHST or Bayesian statistical analysis to reveal what <em>p</em>-values cannot show in the geriatric and rehabilitation studies (<em>eg,</em> the clinical importance of 1kg increase in handgrip strength in the intervention group of long-lived older adults compared to a control group). This paper provides potential insights for improving the interpretation of scientific data in rehabilitation and geriatric fields by utilizing Bayesian and secondary statistical analyses to better scrutinize the results of clinical trials where a <em>p</em>-value alone may not be appropriate to determine the efficacy of an intervention.<br/><br/><strong>Keywords:</strong> statistics, statistical significance, effect size, p-value<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"54 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139761882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: This study aimed to establish equations for estimating muscle mass through anthropometric parameters or together with physical function parameters in the community-dwelling older adults, providing a simple way of muscle mass assessment. Methods: In this cross-sectional descriptive study, a total of 1537 older adults were recruited from the community and accepted the measurements of height, weight, upper arm and calf circumferences, grip strength, and walking speed. Body composition including appendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis (BIA). Participants were randomly divided into the development or validation group. Stepwise multiple linear regression was applied to develop equations in the development group. Thereafter, Pearson correlation coefficients, Bland-Altman plots, paired t-test, intraclass correlation coefficient (ICC) and paired-samples t-tests were used to assess the validity of the equations. Results: All parameters were significantly correlated with ASM (r = 0.195~0.795, P < 0.001) except for the age in the validation group (P = 0.746). The most optimal anthropometric equation was: [adjusted R2 = 0.911, standard error of the estimate (SEE) = 1.311, P < 0.001]. Comparatively speaking, this equation showed high correlation coefficient (r = 0.951, P < 0.001) and ICC (ICC = 0.950, P < 0.001). No significant differences were found between BIA-measured ASM and the estimated ASM. The Bland-Altman plot showed that the mean difference between the estimated ASM and BIA-measured ASM was 0 kg and the limits of agreement of ASM was − 2.70~2.60 kg. Furthermore, inclusion of physical function did not significantly improve the adjusted R2 and SEE. Conclusion: The anthropometric equation offers a practical alternative simple and dependable method for estimating ASM in community-dwelling older adults.
{"title":"Development and Validation of Estimation Equations for Appendicular Skeletal Muscle Mass in Chinese Community-Dwelling Older Adults","authors":"Yun Sun, Tongtong Yin, Mengli Li, Fangfang Wang, Jiaying Qi, Hui Zhang, Li Wang, Jiehua Zhao, Yu Zhang","doi":"10.2147/cia.s440967","DOIUrl":"https://doi.org/10.2147/cia.s440967","url":null,"abstract":"<strong>Purpose:</strong> This study aimed to establish equations for estimating muscle mass through anthropometric parameters or together with physical function parameters in the community-dwelling older adults, providing a simple way of muscle mass assessment.<br/><strong>Methods:</strong> In this cross-sectional descriptive study, a total of 1537 older adults were recruited from the community and accepted the measurements of height, weight, upper arm and calf circumferences, grip strength, and walking speed. Body composition including appendicular skeletal muscle mass (ASM) was measured using bioelectrical impedance analysis (BIA). Participants were randomly divided into the development or validation group. Stepwise multiple linear regression was applied to develop equations in the development group. Thereafter, Pearson correlation coefficients, Bland-Altman plots, paired <em>t</em>-test, intraclass correlation coefficient (ICC) and paired-samples <em>t</em>-tests were used to assess the validity of the equations.<br/><strong>Results:</strong> All parameters were significantly correlated with ASM (<em>r</em> = 0.195~0.795, <em>P</em> < 0.001) except for the age in the validation group (<em>P</em> = 0.746). The most optimal anthropometric equation was: <![CDATA[${rm{ASM}} = - 5.142 - 4.346 times {rm{sex}}left({{rm{men}} = 1,{rm{women}} = 2} right),+ 0.136 times {rm{weight}}left({{rm{kg}}} right) + 9.009 times {rm{height}}left({rm{m}} right) + 0.283 times {rm{calf}}{rm{circumference}}left({{rm{cm}}} right) - 0.034 times {rm{age}}left({{rm{years}}} right)$]]> [adjusted <em>R</em><sup>2</sup> = 0.911, standard error of the estimate (SEE) = 1.311, <em>P</em> < 0.001]. Comparatively speaking, this equation showed high correlation coefficient (<em>r</em> = 0.951, <em>P</em> < 0.001) and ICC (ICC = 0.950, <em>P</em> < 0.001). No significant differences were found between BIA-measured ASM and the estimated ASM. The Bland-Altman plot showed that the mean difference between the estimated ASM and BIA-measured ASM was 0 kg and the limits of agreement of ASM was − 2.70~2.60 kg. Furthermore, inclusion of physical function did not significantly improve the adjusted <em>R</em><sup>2</sup> and SEE.<br/><strong>Conclusion:</strong> The anthropometric equation offers a practical alternative simple and dependable method for estimating ASM in community-dwelling older adults.<br/><br/><strong>Keywords:</strong> appendicular muscle mass, anthropometry, physical function, estimation equation, older adults<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"254 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139761821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiancao Ding, Ying Sun, Kan Zhang, Wei Huang, Mei Tang, Dai Zhang, Yunli Xing
Objective: This study explored whether anticoagulation is safe for frail and non-frail elderly patients who have nonvalvular atrial fibrillation (NVAF). Methods: At hospital discharge, the anticoagulant regimen and frailty status were recorded for 361 elderly patients (aged ≥ 75 y) with NVAF. The patients were followed for 12 months. The endpoints included occurrence of thrombosis; bleeding; all-cause death; and cardiovascular events. Results: At hospital discharge, frailty affected 50.42% of the population and the anticoagulation rate was 44.04%. At discharge, age (OR 0.948, P = 0.006), paroxysmal NVAF (OR 0.384, P < 0.001), and bleeding history (OR 0.396, P = 0.001) were associated with a decrease in rate of receiving anticoagulation, while thrombotic events during hospitalization (OR 2.281, P = 0.021) were associated with an increase. Relative to non-frail patients, those with frailty showed a higher rate of ischemic stroke (5.33% cf. 3.01%), bleeding (P = 0.006) events, and all-cause mortality (P = 0.001). Relative to the group without anticoagulation, in those with anticoagulation the rate of thrombotic events was lower (6.99 cf. 10.98%) and bleeding events were higher (20.98 cf. 12.72%), but the risk of major bleeding was comparable. Conclusion: In the elderly patients with NVAF, the decision toward anticoagulation therapy at hospital discharge was influenced by age, bleeding history, paroxysmal atrial fibrillation diagnosis, and absence of thrombosis. Frail patients were at greater risk of bleeding and all-cause mortality. Anticoagulation tended to reduce the risk of thrombotic events.
{"title":"Effects of Anticoagulant Therapy and Frailty in the Elderly Patients with Atrial Fibrillation","authors":"Jiancao Ding, Ying Sun, Kan Zhang, Wei Huang, Mei Tang, Dai Zhang, Yunli Xing","doi":"10.2147/cia.s453527","DOIUrl":"https://doi.org/10.2147/cia.s453527","url":null,"abstract":"<strong>Objective:</strong> This study explored whether anticoagulation is safe for frail and non-frail elderly patients who have nonvalvular atrial fibrillation (NVAF).<br/><strong>Methods:</strong> At hospital discharge, the anticoagulant regimen and frailty status were recorded for 361 elderly patients (aged ≥ 75 y) with NVAF. The patients were followed for 12 months. The endpoints included occurrence of thrombosis; bleeding; all-cause death; and cardiovascular events.<br/><strong>Results:</strong> At hospital discharge, frailty affected 50.42% of the population and the anticoagulation rate was 44.04%. At discharge, age (OR 0.948, <em>P</em> = 0.006), paroxysmal NVAF (OR 0.384, <em>P</em> < 0.001), and bleeding history (OR 0.396, <em>P</em> = 0.001) were associated with a decrease in rate of receiving anticoagulation, while thrombotic events during hospitalization (OR 2.281, <em>P</em> = 0.021) were associated with an increase. Relative to non-frail patients, those with frailty showed a higher rate of ischemic stroke (5.33% cf. 3.01%), bleeding (<em>P</em> = 0.006) events, and all-cause mortality (<em>P</em> = 0.001). Relative to the group without anticoagulation, in those with anticoagulation the rate of thrombotic events was lower (6.99 cf. 10.98%) and bleeding events were higher (20.98 cf. 12.72%), but the risk of major bleeding was comparable.<br/><strong>Conclusion:</strong> In the elderly patients with NVAF, the decision toward anticoagulation therapy at hospital discharge was influenced by age, bleeding history, paroxysmal atrial fibrillation diagnosis, and absence of thrombosis. Frail patients were at greater risk of bleeding and all-cause mortality. Anticoagulation tended to reduce the risk of thrombotic events.<br/><br/><strong>Keywords:</strong> elderly, non-valvular atrial fibrillation, frailty, anticoagulation<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"1 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139761630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jonne Åkerla, Jaakko Nevalainen, Jori S Pesonen, Antti Pöyhönen, Juha Koskimäki, Jukka Häkkinen, Teuvo LJ Tammela, Anssi Auvinen
Purpose: To evaluate a random forest (RF) algorithm of lower urinary tract symptoms (LUTS) as a predictor of all-cause mortality in a population-based cohort. Materials and Methods: A population-based cohort of 3143 men born in 1924, 1934, and 1944 was evaluated using a mailed questionnaire including the Danish Prostatic Symptom Score (DAN-PSS-1) to assess LUTS as well as questions on medical conditions and behavioral and sociodemographic factors. Surveys were repeated in 1994, 1999, 2004, 2009 and 2015. The cohort was followed-up for vital status until the end of 2018. RF uses an ensemble of classification trees for prediction with a good flexibility and without overfitting. RF algorithms were developed to predict the five-year mortality using LUTS, demographic, medical, and behavioral factors alone and in combinations. Results: A total of 2663 men were included in the study, of whom 917 (34%) died during follow-up (median follow-up time 15.0 years). The LUTS-based RF algorithm showed an area under the curve (AUC) 0.60 (95% CI 0.52– 0.69) for five-year mortality. An expanded RF algorithm, including LUTS, medical history, and behavioral and sociodemographic factors, yielded an AUC 0.73 (0.65– 0.81), while an algorithm excluding LUTS yielded an AUC 0.71 (0.62– 0.78). Conclusion: An exploratory RF algorithm using LUTS can predict all-cause mortality with acceptable discrimination at the group level. In clinical practice, it is unlikely that LUTS will improve the accuracy to predict death if the patient’s background is well known.
{"title":"Do LUTS Predict Mortality? An Analysis Using Random Forest Algorithms","authors":"Jonne Åkerla, Jaakko Nevalainen, Jori S Pesonen, Antti Pöyhönen, Juha Koskimäki, Jukka Häkkinen, Teuvo LJ Tammela, Anssi Auvinen","doi":"10.2147/cia.s432368","DOIUrl":"https://doi.org/10.2147/cia.s432368","url":null,"abstract":"<strong>Purpose:</strong> To evaluate a random forest (RF) algorithm of lower urinary tract symptoms (LUTS) as a predictor of all-cause mortality in a population-based cohort.<br/><strong>Materials and Methods:</strong> A population-based cohort of 3143 men born in 1924, 1934, and 1944 was evaluated using a mailed questionnaire including the Danish Prostatic Symptom Score (DAN-PSS-1) to assess LUTS as well as questions on medical conditions and behavioral and sociodemographic factors. Surveys were repeated in 1994, 1999, 2004, 2009 and 2015. The cohort was followed-up for vital status until the end of 2018. RF uses an ensemble of classification trees for prediction with a good flexibility and without overfitting. RF algorithms were developed to predict the five-year mortality using LUTS, demographic, medical, and behavioral factors alone and in combinations.<br/><strong>Results:</strong> A total of 2663 men were included in the study, of whom 917 (34%) died during follow-up (median follow-up time 15.0 years). The LUTS-based RF algorithm showed an area under the curve (AUC) 0.60 (95% CI 0.52– 0.69) for five-year mortality. An expanded RF algorithm, including LUTS, medical history, and behavioral and sociodemographic factors, yielded an AUC 0.73 (0.65– 0.81), while an algorithm excluding LUTS yielded an AUC 0.71 (0.62– 0.78).<br/><strong>Conclusion:</strong> An exploratory RF algorithm using LUTS can predict all-cause mortality with acceptable discrimination at the group level. In clinical practice, it is unlikely that LUTS will improve the accuracy to predict death if the patient’s background is well known.<br/><br/><strong>Keywords:</strong> lower urinary tract symptoms, mortality, machine learning, cohort studies<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"82 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139761718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Huaishun Wang, Chi Zhang, Longdong Xu, Jiaping Xu, Guodong Xiao
Background and Purpose: Elevated heart rate (HR) after mechanical thrombectomy (MT) was associated with an increased risk of adverse outcomes. However, optimal HR management after MT remains unclear. This study aimed to identify patient subgroups with distinct HR trajectories after MT and explore their association with outcomes. Methods: Acute ischemic stroke patients undergoing MT therapy were prospectively recruited from July 2020 to December 2022. Their heart rate indicators were collected every hour for 72 hours after MT procedure. Latent variable mixture modeling was used to separate subjects into five groups with distinct HR trajectories. The primary outcome was poor functional outcome (mRS score > 2) at 3 months. Additional outcome was all-cause mortality (mRS score = 6) at 3 months. Results: A total of 224 patients with large vessel occlusion were enrolled, with a mean age of 65.2+14.0 years. Eighty-seven patients had a good functional outcome, and 137 patients had a poor functional outcome. Five distinct HR trajectories were observed: low (19.2%), moderate (33.0%), rapidly stabilized HR group (20.5%), persistently high HR group (21.0%), and very high HR group (6.3%). After adjusting for potential confounders, the HR trajectory group was independently associated with poor functional outcome at 3 months (P for interaction = 0.022). The risk of having poor functional outcome was increased in the rapidly stabilized HR group (odds ratio, 3.18 [95% confidence interval, 1.10– 9.19]), the persistently high HR group (odds ratio, 5.55 [95% confidence interval, 1.72– 17.87]) and very high HR group (odds ratio, 18.32 [95% confidence interval, 2.20– 95.52]) but not in the moderate group (odds ratio, 1.50 [95% confidence interval, 0.61– 3.69]), when compared with the low HR group. No significant association was found between trajectory group and 3-month all-cause mortality. Conclusion: HR during the first 72 hours after MT may be categorized into distinct trajectory groups, which differ in relation to poor functional outcome event risks. The findings may help to recognize potential candidates for future HR control trials.
{"title":"Trajectory Groups of 72-Hour Heart Rate After Mechanical Thrombectomy and Outcomes","authors":"Huaishun Wang, Chi Zhang, Longdong Xu, Jiaping Xu, Guodong Xiao","doi":"10.2147/cia.s449897","DOIUrl":"https://doi.org/10.2147/cia.s449897","url":null,"abstract":"<strong>Background and Purpose:</strong> Elevated heart rate (HR) after mechanical thrombectomy (MT) was associated with an increased risk of adverse outcomes. However, optimal HR management after MT remains unclear. This study aimed to identify patient subgroups with distinct HR trajectories after MT and explore their association with outcomes.<br/><strong>Methods:</strong> Acute ischemic stroke patients undergoing MT therapy were prospectively recruited from July 2020 to December 2022. Their heart rate indicators were collected every hour for 72 hours after MT procedure. Latent variable mixture modeling was used to separate subjects into five groups with distinct HR trajectories. The primary outcome was poor functional outcome (mRS score > 2) at 3 months. Additional outcome was all-cause mortality (mRS score = 6) at 3 months.<br/><strong>Results:</strong> A total of 224 patients with large vessel occlusion were enrolled, with a mean age of 65.2+14.0 years. Eighty-seven patients had a good functional outcome, and 137 patients had a poor functional outcome. Five distinct HR trajectories were observed: low (19.2%), moderate (33.0%), rapidly stabilized HR group (20.5%), persistently high HR group (21.0%), and very high HR group (6.3%). After adjusting for potential confounders, the HR trajectory group was independently associated with poor functional outcome at 3 months (<em>P</em> for interaction = 0.022). The risk of having poor functional outcome was increased in the rapidly stabilized HR group (odds ratio, 3.18 [95% confidence interval, 1.10– 9.19]), the persistently high HR group (odds ratio, 5.55 [95% confidence interval, 1.72– 17.87]) and very high HR group (odds ratio, 18.32 [95% confidence interval, 2.20– 95.52]) but not in the moderate group (odds ratio, 1.50 [95% confidence interval, 0.61– 3.69]), when compared with the low HR group. No significant association was found between trajectory group and 3-month all-cause mortality.<br/><strong>Conclusion:</strong> HR during the first 72 hours after MT may be categorized into distinct trajectory groups, which differ in relation to poor functional outcome event risks. The findings may help to recognize potential candidates for future HR control trials.<br/><br/><strong>Key words:</strong> ischemic stroke, heart rate trajectory, mechanical thrombectomy, outcome<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"7 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139761885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: There is growing evidence that an antioxidant diet is a protective factor against frailty. However, few studies have examined the effect of comprehensive dietary antioxidants on frailty symptoms. The aim of this study was to examine the relationships between the composite dietary antioxidant index (CDAI) and frailty and the underlying mechanisms involved. Methods: Based on the National Health and Nutrition Survey (NHANES) 2003– 2018, this study included 11,277 older persons aged ≥ 60 years. In this study, frailty was defined as having a total score > 0.21 on the 49-item frailty index. Six dietary antioxidants were selected for use in calculating the CDAI. A weighted multiple logistic regression model with subgroup analysis and restricted cubic splines (RCSs) were used to examine the association between the CDAI and frailty. To examine the role of oxidative stress, mediation analyses were also conducted. Results: The association between the CDAI score and frailty risk was significant according to the multivariate model. Compared with participants in tertile 1, participants in both tertile 2 and tertile 3 had lower odds of developing frailty symptoms (OR=0.86; 95% CI=0.75– 0.97; P=0.02; and OR=0.81; 95% CI=0.70– 0.93; P=0.003). According to the subgroup analyses, the differences in interactions were not statistically significant. There was also a potential nonlinear relationship between the CDAI score and frailty risk. The serum albumin concentration and uric acid concentration had significant mediating effects on the association between the CDAI score and frailty index, with 19.25% (P=0.002) and 21.26% (P < 0.001) of the total, respectively. Conclusion: Frailty is negatively associated with the CDAI score, which may be partially mediated by oxidative stress.
{"title":"The Association Between the Composite Dietary Antioxidant Index and Frailty Symptoms: Mediating Effects of Oxidative Stress","authors":"Yue Wu, Siqi Cheng, Shaoyuan Lei, Dongxiao Li, Zhongzhong Li, Yansu Guo","doi":"10.2147/cia.s448354","DOIUrl":"https://doi.org/10.2147/cia.s448354","url":null,"abstract":"<strong>Background:</strong> There is growing evidence that an antioxidant diet is a protective factor against frailty. However, few studies have examined the effect of comprehensive dietary antioxidants on frailty symptoms. The aim of this study was to examine the relationships between the composite dietary antioxidant index (CDAI) and frailty and the underlying mechanisms involved.<br/><strong>Methods:</strong> Based on the National Health and Nutrition Survey (NHANES) 2003– 2018, this study included 11,277 older persons aged ≥ 60 years. In this study, frailty was defined as having a total score > 0.21 on the 49-item frailty index. Six dietary antioxidants were selected for use in calculating the CDAI. A weighted multiple logistic regression model with subgroup analysis and restricted cubic splines (RCSs) were used to examine the association between the CDAI and frailty. To examine the role of oxidative stress, mediation analyses were also conducted.<br/><strong>Results:</strong> The association between the CDAI score and frailty risk was significant according to the multivariate model. Compared with participants in tertile 1, participants in both tertile 2 and tertile 3 had lower odds of developing frailty symptoms (OR=0.86; 95% CI=0.75– 0.97; P=0.02; and OR=0.81; 95% CI=0.70– 0.93; P=0.003). According to the subgroup analyses, the differences in interactions were not statistically significant. There was also a potential nonlinear relationship between the CDAI score and frailty risk. The serum albumin concentration and uric acid concentration had significant mediating effects on the association between the CDAI score and frailty index, with 19.25% (<em>P</em>=0.002) and 21.26% (<em>P</em> < 0.001) of the total, respectively.<br/><strong>Conclusion:</strong> Frailty is negatively associated with the CDAI score, which may be partially mediated by oxidative stress.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"28 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139662449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiankang Xu, Longyao Zhang, Ping Wang, Chao Zhang, Shuqing Ji
Objective: Osteoarthritis (OA) is one of the major disabling human diseases. The related studies indicate a potential correlation between walking and OA. However, there is still a lack of evidence in genetics to support the correlation between walking and OA. Therefore, this study aimed to explore the relationship between walking and OA at the genetic level. Methods: The publicly available Genome Wide Association Study (GWAS) data were used, with inverse variance weighting (IVW, the random-effects model) as the main analysis method, whereas MR-Egger, Weighted median, Simple mode, and Weighted mode as the secondary analysis methods. In addition, Cochran’s Q test, pleiotropy test, and MR-Egger intercept test were conducted to examine the heterogeneity and pleiotropy of the outcome. Results: In the MR analysis, IVW results showed a negative correlation between types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and OA (KOA or HOA) (odds ratio (OR) = 0.3224, 95% confidence interval (CI): 0.1261 to 0.8243), and the difference was of statistical significance (P = 0.0181). Moreover, IVW results also revealed a negative correlation between types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and KOA (OR = 0.1396, 95% CI: 0.0484 to 0.4026), and the difference was statistically significant (P = 0.0003). However, IVW results did not demonstrate any statistical significance types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and HOA (OR = 1.2075, 95% CI: 0.1978 to 7.3727, P = 0.8381). Conclusion: From genetic studies, types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) is negatively correlated with knee osteoarthritis (KOA), but there is no clear evidence supporting its correlation with hip osteoarthritis (HOA).
{"title":"Does Walking Have an Association with Osteoarthritis? A Two-Sample Mendelian Randomization Analysis","authors":"Jiankang Xu, Longyao Zhang, Ping Wang, Chao Zhang, Shuqing Ji","doi":"10.2147/cia.s442259","DOIUrl":"https://doi.org/10.2147/cia.s442259","url":null,"abstract":"<strong>Objective:</strong> Osteoarthritis (OA) is one of the major disabling human diseases. The related studies indicate a potential correlation between walking and OA. However, there is still a lack of evidence in genetics to support the correlation between walking and OA. Therefore, this study aimed to explore the relationship between walking and OA at the genetic level.<br/><strong>Methods:</strong> The publicly available Genome Wide Association Study (GWAS) data were used, with inverse variance weighting (IVW, the random-effects model) as the main analysis method, whereas MR-Egger, Weighted median, Simple mode, and Weighted mode as the secondary analysis methods. In addition, Cochran’s Q test, pleiotropy test, and MR-Egger intercept test were conducted to examine the heterogeneity and pleiotropy of the outcome.<br/><strong>Results:</strong> In the MR analysis, IVW results showed a negative correlation between types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and OA (KOA or HOA) (odds ratio (OR) = 0.3224, 95% confidence interval (CI): 0.1261 to 0.8243), and the difference was of statistical significance (P = 0.0181). Moreover, IVW results also revealed a negative correlation between types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and KOA (OR = 0.1396, 95% CI: 0.0484 to 0.4026), and the difference was statistically significant (P = 0.0003). However, IVW results did not demonstrate any statistical significance types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) and HOA (OR = 1.2075, 95% CI: 0.1978 to 7.3727, P = 0.8381).<br/><strong>Conclusion:</strong> From genetic studies, types of physical activity in last 4 weeks: Walking for pleasure (not as a means of transport) is negatively correlated with knee osteoarthritis (KOA), but there is no clear evidence supporting its correlation with hip osteoarthritis (HOA).<br/><br/><strong>Keywords:</strong> osteoarthritis, walking, Mendelian randomization<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"18 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139648742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Sarcopenia is an age-related condition characterized by the loss of skeletal muscle mass, muscular strength, and muscle function. In older adults, type 2 diabetes mellitus (T2DM) constitutes a significant health burden. Skeletal muscle damage and deterioration have emerged as novel chronic complications in patients with diabetes, often linked to their increased longevity. Diabetic sarcopenia has been associated with increased rates of hospitalization, cardiovascular events, and mortality. Nevertheless, effectively managing metabolic disorders in patients with T2DM through appropriate therapeutic interventions could potentially mitigate the risk of sarcopenia. Utilizing imaging technologies holds substantial clinical significance in the early detection of skeletal muscle mass alterations associated with sarcopenia. Such detection is pivotal for arresting disease progression and preserving patients’ quality of life. These imaging modalities offer reproducible and consistent patterns over time, as they all provide varying degrees of quantitative data. This review primarily delves into the application of dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasound for both qualitative and quantitative assessments of muscle mass in patients with T2DM. It also juxtaposes the merits and limitations of these four techniques. By understanding the nuances of each method, clinicians can discern how best to apply them in diverse clinical scenarios.
{"title":"Imaging of Sarcopenia in Type 2 Diabetes Mellitus","authors":"Dingyue Wang, Gaosen Zhang, Yana Yu, Zhen Zhang","doi":"10.2147/cia.s443572","DOIUrl":"https://doi.org/10.2147/cia.s443572","url":null,"abstract":"<strong>Abstract:</strong> Sarcopenia is an age-related condition characterized by the loss of skeletal muscle mass, muscular strength, and muscle function. In older adults, type 2 diabetes mellitus (T2DM) constitutes a significant health burden. Skeletal muscle damage and deterioration have emerged as novel chronic complications in patients with diabetes, often linked to their increased longevity. Diabetic sarcopenia has been associated with increased rates of hospitalization, cardiovascular events, and mortality. Nevertheless, effectively managing metabolic disorders in patients with T2DM through appropriate therapeutic interventions could potentially mitigate the risk of sarcopenia. Utilizing imaging technologies holds substantial clinical significance in the early detection of skeletal muscle mass alterations associated with sarcopenia. Such detection is pivotal for arresting disease progression and preserving patients’ quality of life. These imaging modalities offer reproducible and consistent patterns over time, as they all provide varying degrees of quantitative data. This review primarily delves into the application of dual-energy X-ray absorptiometry, computed tomography, magnetic resonance imaging, and ultrasound for both qualitative and quantitative assessments of muscle mass in patients with T2DM. It also juxtaposes the merits and limitations of these four techniques. By understanding the nuances of each method, clinicians can discern how best to apply them in diverse clinical scenarios.<br/><br/><strong>Keywords:</strong> diagnostic imaging, older adults, sarcopenia, skeletal muscle mass, type 2 diabetes mellitus<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"49 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139580913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yesid Hurtado, Odismar Andrea Hernández, Diana Patricia Atencio De Leon, Gustavo Duque
Abstract: Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.
{"title":"Challenges in Delivering Effective Care for Older Persons with Fragility Fractures","authors":"Yesid Hurtado, Odismar Andrea Hernández, Diana Patricia Atencio De Leon, Gustavo Duque","doi":"10.2147/cia.s433999","DOIUrl":"https://doi.org/10.2147/cia.s433999","url":null,"abstract":"<strong>Abstract:</strong> Fragility fractures occur because of low-impact trauma or even spontaneously in individuals with osteoporosis. Caring for older persons with fragility fractures can present several challenges due to the unique needs and vulnerabilities of this population. Older individuals commonly have multiple medical conditions, such as osteoporosis, arthritis, cardiovascular diseases, and diabetes. These comorbidities can complicate fracture management and increase the risk of complications. Fracture repair through surgery may be more complex in older patients due to poor bone quality, decreased tissue elasticity, and higher chances of anesthesia complications. In addition, mobility and functional limitations post-fracture are highly prevalent in this population, affecting their independence and increasing their risk of institutionalization. Addressing these challenges requires a multidisciplinary approach involving orthopedic surgeons, geriatricians, physical and rehabilitation physicians, physiotherapists, occupational therapists, dieticians, social workers, and caregivers. Preventive measures, such as fall prevention strategies and osteoporosis management, can also play a vital role in reducing the incidence of fragility fractures in older persons.<br/><br/><strong>Keywords:</strong> osteoporosis, fragility fractures, older persons, osteosarcopenia, rehabilitation<br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"15 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139556648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The correlation between glial fibrillary acidic protein (GFAP) and symptomatic intracranial hemorrhage (sICH) in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) treatment remains uncertain. We aimed to assess the association between levels of GFAP in the bloodstream and the occurrence of sICH. Methods: Between June 2019 and May 2023, 142 consecutive AIS patients undergoing EVT at Stroke Center and 35 controls from the Physical Examination Center were retrospectively included. The levels of GFAP in the bloodstream were quantified using enzyme-linked immunosorbent assay prior to endovascular treatment (T1) and 24 h after the procedure (T2). The identification of sICH was based on the Heidelberg Bleeding Classification. Results: Serum GFAP levels at T1 in AIS patients were significantly higher than those in the controls (0.249 [0.150– 0.576] versus 0.065 [0.041– 0.110] ng/mL, p = 0.001), and there was a notably elevation in GFAP levels at T2 compared to T1 (3.813 [1.474, 5.876] versus 0.249 [0.150– 0.576] ng/mL, p = 0.001). Of the 142 AIS patients, 18 (14.5%) had sICH after EVT. Serum GFAP levels at T2 showed significant associations with sICH in both the unadjusted model (OR 1.513, 95% CI 1.269– 1.805, p = 0.001) and multivariable adjusted model (OR 1.518, 95% CI 1.153– 2.000, p = 0.003). Furthermore, the addition of GFAP at T2 to conventional model resulted in a significant enhancement of risk reclassification for sICH (integrated discrimination improvement [IDI] 0.183, 95% CI 0.070– 0.295, p = 0.001). Conclusion: Serum GFAP levels were notably increased in AIS patients 24 h after EVT. Elevated GFAP levels were correlated to an elevated risk of sICH. GFAP could potentially serve as a dependable indicator for sICH in AIS individuals who treated with EVT.
背景：在接受血管内血栓切除术（EVT）治疗的急性缺血性卒中（AIS）患者中，神经胶质纤维酸性蛋白（GFAP）与症状性颅内出血（sICH）之间的相关性仍不确定。我们旨在评估血液中GFAP水平与sICH发生之间的关联：方法：回顾性纳入2019年6月至2023年5月期间在卒中中心接受EVT治疗的142例连续AIS患者和体检中心的35例对照组。在血管内治疗前（T1）和术后24小时（T2），使用酶联免疫吸附试验对血液中的GFAP水平进行量化。根据海德堡出血分类法确定 sICH：AIS患者T1时的血清GFAP水平明显高于对照组（0.249 [0.150- 0.576] 对 0.065 [0.041- 0.110] ng/mL，p = 0.001），T2时的GFAP水平明显高于T1时（3.813 [1.474, 5.876] 对 0.249 [0.150- 0.576] ng/mL，p = 0.001）。在142名AIS患者中，18人（14.5%）在EVT后发生了sICH。在未调整模型（OR 1.513，95% CI 1.269-1.805，p = 0.001）和多变量调整模型（OR 1.518，95% CI 1.153-2.000，p = 0.003）中，T2 期血清 GFAP 水平与 sICH 有显著相关性。此外，在传统模型中加入 T2 期的 GFAP 可显著提高 sICH 的风险再分类（综合分辨力提高 [IDI] 0.183，95% CI 0.070- 0.295，p = 0.001）：结论：EVT 24 小时后，AIS 患者血清 GFAP 水平明显升高。结论：EVT 24 小时后，AIS 患者血清 GFAP 水平显著升高，GFAP 水平升高与 sICH 风险升高相关。GFAP 有可能成为接受 EVT 治疗的 AIS 患者发生 sICH 的可靠指标。
{"title":"Glial Fibrillary Acidic Protein as a Potential Indicator for Symptomatic Intracranial Hemorrhage in Acute Ischemic Patients Undergoing Endovascular Thrombectomy","authors":"Minghao Li, Hua Liu, Mingyang Xu, Baiyang Yu, Minwang Guo, Xiaorong Wang, Guomei Shi, Rujuan Zhou","doi":"10.2147/cia.s448180","DOIUrl":"https://doi.org/10.2147/cia.s448180","url":null,"abstract":"<strong>Background:</strong> The correlation between glial fibrillary acidic protein (GFAP) and symptomatic intracranial hemorrhage (sICH) in acute ischemic stroke (AIS) patients undergoing endovascular thrombectomy (EVT) treatment remains uncertain. We aimed to assess the association between levels of GFAP in the bloodstream and the occurrence of sICH.<br/><strong>Methods:</strong> Between June 2019 and May 2023, 142 consecutive AIS patients undergoing EVT at Stroke Center and 35 controls from the Physical Examination Center were retrospectively included. The levels of GFAP in the bloodstream were quantified using enzyme-linked immunosorbent assay prior to endovascular treatment (T1) and 24 h after the procedure (T2). The identification of sICH was based on the Heidelberg Bleeding Classification.<br/><strong>Results:</strong> Serum GFAP levels at T1 in AIS patients were significantly higher than those in the controls (0.249 [0.150– 0.576] versus 0.065 [0.041– 0.110] ng/mL, <em>p</em> = 0.001), and there was a notably elevation in GFAP levels at T2 compared to T1 (3.813 [1.474, 5.876] versus 0.249 [0.150– 0.576] ng/mL, <em>p</em> = 0.001). Of the 142 AIS patients, 18 (14.5%) had sICH after EVT. Serum GFAP levels at T2 showed significant associations with sICH in both the unadjusted model (OR 1.513, 95% CI 1.269– 1.805, <em>p</em> = 0.001) and multivariable adjusted model (OR 1.518, 95% CI 1.153– 2.000, <em>p</em> = 0.003). Furthermore, the addition of GFAP at T2 to conventional model resulted in a significant enhancement of risk reclassification for sICH (integrated discrimination improvement [IDI] 0.183, 95% CI 0.070– 0.295, <em>p</em> = 0.001).<br/><strong>Conclusion:</strong> Serum GFAP levels were notably increased in AIS patients 24 h after EVT. Elevated GFAP levels were correlated to an elevated risk of sICH. GFAP could potentially serve as a dependable indicator for sICH in AIS individuals who treated with EVT.<br/><br/>","PeriodicalId":10417,"journal":{"name":"Clinical Interventions in Aging","volume":"70 1","pages":""},"PeriodicalIF":3.6,"publicationDate":"2024-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139517394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号