Pub Date : 2025-09-01DOI: 10.1016/j.lanhl.2025.100764
Raj C Shah MD , Prof Joanne Ryan PhD , Katherine L Webb MA , Prof Rory Wolfe PhD , Prof Andrew Chan MD , Trevor T-J Chong MBBS , Prof Michael E Ernst PharmD , Prof Sara E Espinoza MD , Olivia Flynn BMed , Song Yuin Lee MBBS , John McNeil MBBS , Prof Mark R Nelson MBBS , Suzanne G Orchard PhD , Prof Christopher M Reid PhD , Kerry Sheets MD , Prof Nigel P Stocks MBBS , Prof Nilakshi S Weerasinghe MBBS , Michelle E Wilson PhD , Robyn L Woods PhD , Prof Anne M Murray MD
Background
In the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial, low-dose aspirin was not associated with survival free of dementia and persistent physical disability (a measure of a healthy lifespan); however, there was a small increased risk of death. Given the long pre-clinical phase of many ageing conditions, we aimed to examine the legacy effect (post-trial) and the longer-term effect of aspirin versus placebo through extended follow-up in the ASPREE-XT observational study.
Methods
Between March 10, 2010, and Dec 24, 2014, 19 114 community-dwelling people in Australia and the USA, aged predominantly 70 years and older, were randomly assigned to low-dose aspirin or placebo for a median of 4·7 years as part of the ASPREE trial. Post-trial observational follow-up continued for a median of 4·3 years (IQR 4·1–4·6). All components of the primary endpoint (ie, incident dementia, persistent physical disability, and death) were adjudicated by masked expert panels. Analyses used Cox proportional hazards models with intention-to-treat.
Findings
15 633 participants (8836 [56·5%] were women, 6797 [43·5%] were men; 981 [6·3%] were not White) were eligible for and agreed to observational follow-up. There was no effect of randomisation to aspirin (34·37 events per 1000 person-years) versus placebo (33·68 per 1000 person-years) on the primary endpoint (hazard ratio [HR] 1·02; 95% CI 0·94–1·11; p=0·63) in the ASPREE-XT period. Similarly, over the period of both ASPREE and ASPREE-XT, no long-term effect of aspirin versus placebo was observed on the composite outcome of death, dementia, or persistent physical disability over almost a decade of follow-up (HR 1·01; 95% CI 0·95–1·08; p=0·65), including no long-term effect on deaths (1·06; 0·99–1·14; p=0·10). No effect of aspirin on incident major haemorrhagic events as compared with placebo was found in ASPREE-XT; however, aspirin was associated with an increased hazard for incident major haemorrhagic events across both ASPREE and ASPREE-XT (1·24; 1·10–1·39).
Interpretation
Low-dose aspirin does not appear to be effective in promoting a healthy lifespan in initially healthy, community-dwelling older people.
Funding
National Institute on Aging and the National Cancer Institute (USA).
{"title":"Aspirin and healthy lifespan in older people: main outcome of the ASPREE-XT observational study","authors":"Raj C Shah MD , Prof Joanne Ryan PhD , Katherine L Webb MA , Prof Rory Wolfe PhD , Prof Andrew Chan MD , Trevor T-J Chong MBBS , Prof Michael E Ernst PharmD , Prof Sara E Espinoza MD , Olivia Flynn BMed , Song Yuin Lee MBBS , John McNeil MBBS , Prof Mark R Nelson MBBS , Suzanne G Orchard PhD , Prof Christopher M Reid PhD , Kerry Sheets MD , Prof Nigel P Stocks MBBS , Prof Nilakshi S Weerasinghe MBBS , Michelle E Wilson PhD , Robyn L Woods PhD , Prof Anne M Murray MD","doi":"10.1016/j.lanhl.2025.100764","DOIUrl":"10.1016/j.lanhl.2025.100764","url":null,"abstract":"<div><h3>Background</h3><div>In the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial, low-dose aspirin was not associated with survival free of dementia and persistent physical disability (a measure of a healthy lifespan); however, there was a small increased risk of death. Given the long pre-clinical phase of many ageing conditions, we aimed to examine the legacy effect (post-trial) and the longer-term effect of aspirin versus placebo through extended follow-up in the ASPREE-XT observational study.</div></div><div><h3>Methods</h3><div>Between March 10, 2010, and Dec 24, 2014, 19 114 community-dwelling people in Australia and the USA, aged predominantly 70 years and older, were randomly assigned to low-dose aspirin or placebo for a median of 4·7 years as part of the ASPREE trial. Post-trial observational follow-up continued for a median of 4·3 years (IQR 4·1–4·6). All components of the primary endpoint (ie, incident dementia, persistent physical disability, and death) were adjudicated by masked expert panels. Analyses used Cox proportional hazards models with intention-to-treat.</div></div><div><h3>Findings</h3><div>15 633 participants (8836 [56·5%] were women, 6797 [43·5%] were men; 981 [6·3%] were not White) were eligible for and agreed to observational follow-up. There was no effect of randomisation to aspirin (34·37 events per 1000 person-years) versus placebo (33·68 per 1000 person-years) on the primary endpoint (hazard ratio [HR] 1·02; 95% CI 0·94–1·11; p=0·63) in the ASPREE-XT period. Similarly, over the period of both ASPREE and ASPREE-XT, no long-term effect of aspirin versus placebo was observed on the composite outcome of death, dementia, or persistent physical disability over almost a decade of follow-up (HR 1·01; 95% CI 0·95–1·08; p=0·65), including no long-term effect on deaths (1·06; 0·99–1·14; p=0·10). No effect of aspirin on incident major haemorrhagic events as compared with placebo was found in ASPREE-XT; however, aspirin was associated with an increased hazard for incident major haemorrhagic events across both ASPREE and ASPREE-XT (1·24; 1·10–1·39).</div></div><div><h3>Interpretation</h3><div>Low-dose aspirin does not appear to be effective in promoting a healthy lifespan in initially healthy, community-dwelling older people.</div></div><div><h3>Funding</h3><div>National Institute on Aging and the National Cancer Institute (USA).</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100764"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.lanhl.2025.100763
Prof Mikel Izquierdo PhD , Robinsón Ramírez-Vélez PhD , Prof Maria A Fiatarone Singh MD FRACP
Integrating exercise prescriptions with medication management represents a novel approach for enhancing health and function, optimising medication effectiveness, and reducing adverse drug reactions and polypharmacy in older adults (ie, those aged ≥60 years). This Personal View highlights the need for a comprehensive assessment of lifestyle, diagnoses, geriatric syndromes, and medications with an emphasis on fully incorporating exercise treatment into geriatric care. Exercise is an alternative to less effective or unsafe medications for many conditions, including depression, anxiety, insomnia, osteoarthritis, and dementia. Exercise is an important adjunct to pharmacotherapy for many common chronic conditions such as coronary artery disease, heart failure, diabetes, osteoporosis, cancer, and chronic obstructive pulmonary disease. Adding exercise to drug management can mitigate adverse drug reactions, enhance medication compliance, and reduce the adverse effects of sedentary behaviour and ageing processes on chronic disease expression. Targeted exercise programmes have also been shown to ameliorate drug-induced side-effects, including anorexia, falls, sarcopenia, osteoporosis, and orthostatic hypotension, and to overcome constraints such as reduced aerobic fitness, balance impairment, and muscle atrophy due to some medications. Health-care professionals require additional training and support to ensure that exercise assumes a key, central role in older adults with multimorbidity and polypharmacy, as supported by the current literature. This Personal View describes practical approaches to incorporating exercise into clinical practice as a step towards an integrated geriatric care model, with the ultimate aim of increasing health span and minimising disability.
{"title":"Integrating exercise and medication management in geriatric care: a holistic strategy to enhance health outcomes and reduce polypharmacy","authors":"Prof Mikel Izquierdo PhD , Robinsón Ramírez-Vélez PhD , Prof Maria A Fiatarone Singh MD FRACP","doi":"10.1016/j.lanhl.2025.100763","DOIUrl":"10.1016/j.lanhl.2025.100763","url":null,"abstract":"<div><div>Integrating exercise prescriptions with medication management represents a novel approach for enhancing health and function, optimising medication effectiveness, and reducing adverse drug reactions and polypharmacy in older adults (ie, those aged ≥60 years). This Personal View highlights the need for a comprehensive assessment of lifestyle, diagnoses, geriatric syndromes, and medications with an emphasis on fully incorporating exercise treatment into geriatric care. Exercise is an alternative to less effective or unsafe medications for many conditions, including depression, anxiety, insomnia, osteoarthritis, and dementia. Exercise is an important adjunct to pharmacotherapy for many common chronic conditions such as coronary artery disease, heart failure, diabetes, osteoporosis, cancer, and chronic obstructive pulmonary disease. Adding exercise to drug management can mitigate adverse drug reactions, enhance medication compliance, and reduce the adverse effects of sedentary behaviour and ageing processes on chronic disease expression. Targeted exercise programmes have also been shown to ameliorate drug-induced side-effects, including anorexia, falls, sarcopenia, osteoporosis, and orthostatic hypotension, and to overcome constraints such as reduced aerobic fitness, balance impairment, and muscle atrophy due to some medications. Health-care professionals require additional training and support to ensure that exercise assumes a key, central role in older adults with multimorbidity and polypharmacy, as supported by the current literature. This Personal View describes practical approaches to incorporating exercise into clinical practice as a step towards an integrated geriatric care model, with the ultimate aim of increasing health span and minimising disability.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100763"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.lanhl.2025.100749
Juliana S Oliveira PhD , Prof Catherine Sherrington PhD , Prof Stephen R Lord PhD , Giane C Camara MPhil , Shannon Colley BA , Courtney A West MHC , Abby Haynes PhD , Heidi Gilchrist PhD , Wing S Kwok PhD , Louise MN Pearce PhD , Geraldine Wallbank BAppSc , Mallory Trent PhD , Prof Adrian Bauman PhD , Anne C Grunseit PhD , Prof Kaarin J Anstey PhD , Prof Anne Tiedemann PhD
Background
Exercises targeting balance and strength are proven to prevent falls. Yoga is growing in popularity and can improve balance and mobility in older adults, but its effects on falls have not been rigorously tested. In this study, we aimed to compare the effects of Iyengar yoga-based exercise and seated relaxation yoga on the rate of falls among older adults.
Methods
This pragmatic, two-arm, parallel randomised controlled trial recruited Australian community-dwelling people aged 60 years and older who were not currently practising yoga and who lived independently. Participants were randomly assigned (1:1) to the intervention (Iyengar yoga-based exercise) or control (seated relaxation yoga) group using a computer-generated sequence. Participants and yoga instructors were unmasked, but research staff verifying falls data and assessing goal attainment were masked to group allocation. Intervention participants received 80 supervised, 1-h, twice-weekly yoga classes over 12 months, and were encouraged to undertake unsupervised practice on 2 additional days per week. Control participants attended two 1-h supervised workshops focused on seated breathing and stretching. Most classes were held online due to the COVID-19 pandemic. The primary outcome was fall rate per year. Secondary outcomes were mental wellbeing, physical activity, quality of life, balance self-confidence, physical function, sleep quality, pain, and goal attainment, all assessed in the intention-to-treat population. The study protocol was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001183178).
Findings
Between Oct 3, 2019, and Oct 28, 2021, 2182 older adults expressed their interest in participating, 810 were assessed for eligibility, 110 were excluded, and 700 were randomly assigned to either the Iyengar yoga exercise programme or the control group (seated yoga relaxation programme; 350 participants per group). The mean age of participants was 67 years (SD 5·2), and 570 (81%) were female and 130 (19%) were male. Six intervention participants reported musculoskeletal-related adverse events associated with the yoga programme, and no serious adverse events occurred. Contrary to expectations, there was a higher fall rate in the intervention group than in the control group (0·87 vs 0·64 falls per person-year; incidence rate ratio 1·33 [95% CI 1·01–1·75; p=0·044]). The intervention improved the number of hours per week of planned physical activity (mean difference 0·96 h per week [95% CI 0·43–1·49]; p<0·0001), self-reported balance confidence (mean difference 2·94 [0·60–5·28]; p=0·014), and goal attainment (mean difference 0·60 [0·26–0·94]; p=0·0006). No significant between-group differences were identified for other secondary outcomes.
Interpretation
This Iyengar yoga-based programme should not be recommended for fall prevention in its
背景：以平衡和力量为目标的锻炼已被证明可以防止跌倒。瑜伽越来越受欢迎，可以改善老年人的平衡和活动能力，但它对摔倒的影响还没有经过严格的测试。在这项研究中，我们旨在比较艾扬格瑜伽和坐姿放松瑜伽对老年人跌倒率的影响。方法：这项实用的，双臂，平行随机对照试验招募了60岁及以上的澳大利亚社区居民，他们目前没有练习瑜伽，并且独立生活。参与者按照电脑生成的顺序被随机分配到干预组（基于艾扬格瑜伽的锻炼）和对照组（坐式放松瑜伽）。参与者和瑜伽教练没有戴面具，但验证跌倒数据和评估目标实现情况的研究人员对小组分配不戴面具。干预参与者在12个月的时间里接受了80次有监督的、每周两次的1小时瑜伽课程，并被鼓励每周额外进行2天的无监督练习。对照组参与者参加了两个1小时的有监督的讲习班，重点是坐姿呼吸和伸展。受新型冠状病毒感染症（COVID-19）疫情影响，大部分课程都在网上进行。主要观察指标为每年的下降率。次要结果是心理健康、身体活动、生活质量、平衡自信、身体功能、睡眠质量、疼痛和目标实现，所有这些都是在意向治疗人群中评估的。该研究方案已在澳大利亚新西兰临床试验登记处注册（ACTRN12619001183178）。研究结果：在2019年10月3日至2021年10月28日期间，2182名老年人表达了参与的兴趣，810人被评估为合格，110人被排除，700人被随机分配到艾杨格瑜伽锻炼项目或对照组（坐式瑜伽放松项目，每组350人）。参与者的平均年龄为67岁（SD 5.2），女性570人（81%），男性130人（19%）。6名干预参与者报告了与瑜伽计划相关的肌肉骨骼相关不良事件，没有发生严重的不良事件。与预期相反，干预组的跌倒率高于对照组（0.87 vs 0.64 /人/年；发病率比1.33 [95% CI 1.01 - 1.75; p= 0.044]）。干预提高了每周计划体育活动的小时数（平均差异为0.96小时/周[95% CI 0.43 -1·49]）；解释：这种基于艾扬格瑜伽的计划不应以目前的形式推荐用于预防跌倒。改进的动态平衡规划和预防跌倒战略值得调查。资助：国家卫生和医学研究委员会。
{"title":"The effect of an Iyengar yoga-based exercise programme versus a seated yoga relaxation programme on falls in people aged 60 years and older (SAGE): a pragmatic, two-arm, parallel randomised controlled trial","authors":"Juliana S Oliveira PhD , Prof Catherine Sherrington PhD , Prof Stephen R Lord PhD , Giane C Camara MPhil , Shannon Colley BA , Courtney A West MHC , Abby Haynes PhD , Heidi Gilchrist PhD , Wing S Kwok PhD , Louise MN Pearce PhD , Geraldine Wallbank BAppSc , Mallory Trent PhD , Prof Adrian Bauman PhD , Anne C Grunseit PhD , Prof Kaarin J Anstey PhD , Prof Anne Tiedemann PhD","doi":"10.1016/j.lanhl.2025.100749","DOIUrl":"10.1016/j.lanhl.2025.100749","url":null,"abstract":"<div><h3>Background</h3><div>Exercises targeting balance and strength are proven to prevent falls. Yoga is growing in popularity and can improve balance and mobility in older adults, but its effects on falls have not been rigorously tested. In this study, we aimed to compare the effects of Iyengar yoga-based exercise and seated relaxation yoga on the rate of falls among older adults.</div></div><div><h3>Methods</h3><div>This pragmatic, two-arm, parallel randomised controlled trial recruited Australian community-dwelling people aged 60 years and older who were not currently practising yoga and who lived independently. Participants were randomly assigned (1:1) to the intervention (Iyengar yoga-based exercise) or control (seated relaxation yoga) group using a computer-generated sequence. Participants and yoga instructors were unmasked, but research staff verifying falls data and assessing goal attainment were masked to group allocation. Intervention participants received 80 supervised, 1-h, twice-weekly yoga classes over 12 months, and were encouraged to undertake unsupervised practice on 2 additional days per week. Control participants attended two 1-h supervised workshops focused on seated breathing and stretching. Most classes were held online due to the COVID-19 pandemic. The primary outcome was fall rate per year. Secondary outcomes were mental wellbeing, physical activity, quality of life, balance self-confidence, physical function, sleep quality, pain, and goal attainment, all assessed in the intention-to-treat population. The study protocol was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12619001183178).</div></div><div><h3>Findings</h3><div>Between Oct 3, 2019, and Oct 28, 2021, 2182 older adults expressed their interest in participating, 810 were assessed for eligibility, 110 were excluded, and 700 were randomly assigned to either the Iyengar yoga exercise programme or the control group (seated yoga relaxation programme; 350 participants per group). The mean age of participants was 67 years (SD 5·2), and 570 (81%) were female and 130 (19%) were male. Six intervention participants reported musculoskeletal-related adverse events associated with the yoga programme, and no serious adverse events occurred. Contrary to expectations, there was a higher fall rate in the intervention group than in the control group (0·87 <em>vs</em> 0·64 falls per person-year; incidence rate ratio 1·33 [95% CI 1·01–1·75; p=0·044]). The intervention improved the number of hours per week of planned physical activity (mean difference 0·96 h per week [95% CI 0·43–1·49]; p<0·0001), self-reported balance confidence (mean difference 2·94 [0·60–5·28]; p=0·014), and goal attainment (mean difference 0·60 [0·26–0·94]; p=0·0006). No significant between-group differences were identified for other secondary outcomes.</div></div><div><h3>Interpretation</h3><div>This Iyengar yoga-based programme should not be recommended for fall prevention in its ","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100749"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.lanhl.2025.100769
Katrina Davis , Sevil Yasar
{"title":"The lack of legacy benefits of low-dose aspirin: the ASPREE study","authors":"Katrina Davis , Sevil Yasar","doi":"10.1016/j.lanhl.2025.100769","DOIUrl":"10.1016/j.lanhl.2025.100769","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100769"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.lanhl.2025.100761
Giulia Gregori MS , Sanjay Mediwala MD , Michael Liebschner PhD , Daeseung Kim PhD , Mon S Bryant PhD PT , Nina Klonis BS , Prof Reina Armamento-Villareal MD , Prof Clifford Qualls PhD , Prof Dennis T Villareal MD
Background
Lifestyle interventions for weight loss might exacerbate age-related bone loss and osteoporosis. However, there is limited knowledge about their effects on bone quality. We examined whether lifestyle intervention can preserve or enhance bone quality, despite reductions in bone mineral density.
Methods
The Lifestyle Intervention to Improve Bone Quality (LIMB-Q) study was a randomised controlled trial conducted at Baylor College of Medicine and the Michael E DeBakey VA Medical Center (Houston, TX, USA) including older adults (aged 65–85 years) with obesity (BMI ≥30 kg/m2). Participants were randomly assigned to receive either an intensive lifestyle intervention (intensive lifestyle group, consisting of weight management plus exercise training) or healthy lifestyle (healthy lifestyle group, consisting of educational sessions on healthy diets). The co-primary outcomes were 12-month changes in (1) distal tibia cortical thickness, measured using high-resolution peripheral quantitative CT, and (2) hip bone strength (failure load), assessed via finite element analysis of CT scans. The primary endpoint was analysed by intention to treat (all randomly assigned patients). This trial is registered with ClinicalTrials.gov, NCT03329963 (completed).
Findings
Of 138 participants assessed for eligibility in person between Nov 9, 2017, and Nov 8, 2021, 120 were included in this study (mean age 71·4 years [SD 4·6]; 63 [53%] male and 57 [47%] female). At 12 months, weight loss was greater in the intensive lifestyle group than in the healthy lifestyle group (–11·6 kg [SE 0·5] vs –1·2 kg [0·5]). No group differences were noted in the change in distal tibia cortical thickness between the intensive lifestyle group (–0·013 mm [SE 0·026]) and the healthy lifestyle group (–0·002 mm [0·025]; between-group difference 0·027 [95% CI –0·066 to 0·120], p=0·40). The change in hip failure load at 12 months did not differ between the intensive lifestyle group (13 N [SE 25]) and the healthy lifestyle group (3 N [26]; between-group difference –6.9 N [95% CI –108 to 95], p=0·89). Exercise-related adverse events in the intensive lifestyle group included a small number of musculoskeletal events (falls [one participant], neck pain [two], and foot, shoulder, back, and leg pain [one each]).
Interpretation
Lifestyle intervention preserved bone quality in older adults with obesity during weight loss. Further research is needed to determine whether lifestyle interventions can reduce fracture risk in older adults with obesity.
Funding
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and US Department of Veterans Affairs.
背景：生活方式干预减肥可能加剧年龄相关性骨质流失和骨质疏松症。然而，关于它们对骨质量的影响的知识有限。我们研究了生活方式干预是否可以在骨密度降低的情况下保持或提高骨质量。方法：生活方式干预改善骨质量（LIMB-Q）研究是在贝勒医学院和Michael E DeBakey VA医学中心（Houston， TX， USA）进行的一项随机对照试验，研究对象为年龄在65-85岁之间的肥胖老年人（BMI≥30 kg/m2）。参与者被随机分配接受强化生活方式干预组（强化生活方式组，包括体重管理和运动训练）或健康生活方式组（健康生活方式组，包括健康饮食教育课程）。共同主要结果是12个月的变化(1)胫骨远端皮质厚度，使用高分辨率外围定量CT测量；(2)髋骨强度（失效载荷），通过CT扫描的有限元分析评估。主要终点通过治疗意向进行分析（所有随机分配的患者）。该试验已在ClinicalTrials.gov注册，编号NCT03329963（已完成）。研究结果：在2017年11月9日至2021年11月8日期间亲自评估资格的138名参与者中，120名参与者被纳入本研究（平均年龄71.4岁[SD 4.6]； 63名[53%]男性，57名[47%]女性）。12个月时，强化生活方式组的体重减轻幅度大于健康生活方式组（- 11.6 kg [SE 0.5] vs -1·2 kg [SE 0.5]）。强化生活方式组（- 0.013 mm [SE 0.026]）与健康生活方式组（- 0.002 mm[0.025]）胫骨远端皮质厚度变化无组间差异，组间差异0.027 [95% CI - 0.066 ~ 0.120], p= 0.40]。12个月时，强化生活方式组（13 N [SE 25]）和健康生活方式组（3 N[26]）髋关节衰竭负荷变化无差异，组间差异为-6.9 N [95% CI -108 ~ 95], p= 0.89)。强化生活方式组的运动相关不良事件包括少量肌肉骨骼事件（跌倒[1名参与者]，颈部疼痛[2名]，足部、肩部、背部和腿部疼痛[各1名]）。解释：生活方式干预在减肥期间保持了老年肥胖患者的骨质量。需要进一步的研究来确定生活方式干预是否可以降低老年肥胖患者的骨折风险。资助：国家糖尿病、消化和肾脏疾病研究所（NIDDK）和美国退伍军人事务部。
{"title":"Bone quality response to lifestyle intervention in older adults with obesity (LIMB-Q trial): a randomised controlled trial","authors":"Giulia Gregori MS , Sanjay Mediwala MD , Michael Liebschner PhD , Daeseung Kim PhD , Mon S Bryant PhD PT , Nina Klonis BS , Prof Reina Armamento-Villareal MD , Prof Clifford Qualls PhD , Prof Dennis T Villareal MD","doi":"10.1016/j.lanhl.2025.100761","DOIUrl":"10.1016/j.lanhl.2025.100761","url":null,"abstract":"<div><h3>Background</h3><div>Lifestyle interventions for weight loss might exacerbate age-related bone loss and osteoporosis. However, there is limited knowledge about their effects on bone quality. We examined whether lifestyle intervention can preserve or enhance bone quality, despite reductions in bone mineral density.</div></div><div><h3>Methods</h3><div>The Lifestyle Intervention to Improve Bone Quality (LIMB-Q) study was a randomised controlled trial conducted at Baylor College of Medicine and the Michael E DeBakey VA Medical Center (Houston, TX, USA) including older adults (aged 65–85 years) with obesity (BMI ≥30 kg/m<sup>2</sup>). Participants were randomly assigned to receive either an intensive lifestyle intervention (intensive lifestyle group, consisting of weight management plus exercise training) or healthy lifestyle (healthy lifestyle group, consisting of educational sessions on healthy diets). The co-primary outcomes were 12-month changes in (1) distal tibia cortical thickness, measured using high-resolution peripheral quantitative CT, and (2) hip bone strength (failure load), assessed via finite element analysis of CT scans. The primary endpoint was analysed by intention to treat (all randomly assigned patients). This trial is registered with <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, <span><span>NCT03329963</span><svg><path></path></svg></span> (completed).</div></div><div><h3>Findings</h3><div>Of 138 participants assessed for eligibility in person between Nov 9, 2017, and Nov 8, 2021, 120 were included in this study (mean age 71·4 years [SD 4·6]; 63 [53%] male and 57 [47%] female). At 12 months, weight loss was greater in the intensive lifestyle group than in the healthy lifestyle group (–11·6 kg [SE 0·5] <em>vs</em> –1·2 kg [0·5]). No group differences were noted in the change in distal tibia cortical thickness between the intensive lifestyle group (–0·013 mm [SE 0·026]) and the healthy lifestyle group (–0·002 mm [0·025]; between-group difference 0·027 [95% CI –0·066 to 0·120], p=0·40). The change in hip failure load at 12 months did not differ between the intensive lifestyle group (13 N [SE 25]) and the healthy lifestyle group (3 N [26]; between-group difference –6.9 N [95% CI –108 to 95], p=0·89). Exercise-related adverse events in the intensive lifestyle group included a small number of musculoskeletal events (falls [one participant], neck pain [two], and foot, shoulder, back, and leg pain [one each]).</div></div><div><h3>Interpretation</h3><div>Lifestyle intervention preserved bone quality in older adults with obesity during weight loss. Further research is needed to determine whether lifestyle interventions can reduce fracture risk in older adults with obesity.</div></div><div><h3>Funding</h3><div>National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and US Department of Veterans Affairs.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100761"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.lanhl.2025.100762
Augusto J Mendes PhD , Federica Ribaldi PhD , Ozge Sayin MSc , Giorgi Khachvani MD , Roberta Mulargia MD , Gabriele Volpara MA , Giulia Remoli MD , Umberto Nencha MD , Stefano Gianonni-Luza MD , Stefano Cappa MD , Giovanni B Frisoni MD
Background
Preventing cognitive impairment in older adults is a public health priority. Although multidomain interventions have shown promise as preventive strategies, the optimal combination of interventions remains unclear. This network meta-analysis aimed to compare and rank the relative efficacy of single-domain and multidomain lifestyle interventions for the prevention of cognitive impairment in older adults who are cognitively unimpaired.
Methods
We did a systematic review and network meta-analysis of randomised controlled trials (RCTs) published in PubMed and Embase from inception until the date of our search on May 7, 2024 following a preregistered protocol in PROSPERO (CRD42024601975). We included RCTs in older adults who are cognitively unimpaired evaluating lifestyle interventions targeting diet, physical exercise, cognitive training, social activity, and health education, either alone or in combination. The primary outcome was global cognition, analysed using random-effects network meta-analysis, reporting standardised mean differences (SMDs) and 95% CIs, and compared against health education, active control, or no intervention. Subgroup analyses explored potential age-related differences and the effect of intervention duration. Risk of bias was assessed using Cochrane Risk of Bias 2, and publication bias was evaluated by assessing funnel plot asymmetry.
Findings
Of the 10 200 citations identified and 1183 full texts screened for eligibility, we identified 109 eligible RCTs, including 23 010 participants (median age 70·1 years [IQR 68·7–73·8], 14 957 [65%] female and 8053 [35%] male). Compared with health education, significant improvements in global cognition were found for physical exercise and cognitive training combined (SMD 0·26 [95% CI 0·10–0·42; p=0·0011); cognitive training alone (SMD 0·21 [0·08–0·33]; p=0·00092); diet, physical exercise, cognitive training, and health education combined (SMD 0·14 [0·02–0·27]; p=0·028); and physical exercise alone (SMD 0·14 [0·05–0·22]; p=0·0014). Random-effects models using active control and no intervention as comparators yielded similarly significant effects for the aforementioned interventions, with effect sizes in the same order. Risk of bias was high in 44 (40%) studies, and publication bias was suggested in studies comparing interventions with health education.
Interpretation
Several single-domain and multidomain lifestyle interventions are efficacious at modulating global cognition in older adults who are cognitively unimpaired, with the combination of physical exercise and cognitive training demonstrating the strongest effect. Combining lifestyle interventions might enhance efficacy, but increased number of domains does not automatically translate into greater cognitive benefits. These findings support lifestyle interventions as key components of prevention strategies; however, the
{"title":"Single-domain and multidomain lifestyle interventions for the prevention of cognitive decline in older adults who are cognitively unimpaired: a systematic review and network meta-analysis","authors":"Augusto J Mendes PhD , Federica Ribaldi PhD , Ozge Sayin MSc , Giorgi Khachvani MD , Roberta Mulargia MD , Gabriele Volpara MA , Giulia Remoli MD , Umberto Nencha MD , Stefano Gianonni-Luza MD , Stefano Cappa MD , Giovanni B Frisoni MD","doi":"10.1016/j.lanhl.2025.100762","DOIUrl":"10.1016/j.lanhl.2025.100762","url":null,"abstract":"<div><h3>Background</h3><div>Preventing cognitive impairment in older adults is a public health priority. Although multidomain interventions have shown promise as preventive strategies, the optimal combination of interventions remains unclear. This network meta-analysis aimed to compare and rank the relative efficacy of single-domain and multidomain lifestyle interventions for the prevention of cognitive impairment in older adults who are cognitively unimpaired.</div></div><div><h3>Methods</h3><div>We did a systematic review and network meta-analysis of randomised controlled trials (RCTs) published in PubMed and Embase from inception until the date of our search on May 7, 2024 following a preregistered protocol in PROSPERO (CRD42024601975). We included RCTs in older adults who are cognitively unimpaired evaluating lifestyle interventions targeting diet, physical exercise, cognitive training, social activity, and health education, either alone or in combination. The primary outcome was global cognition, analysed using random-effects network meta-analysis, reporting standardised mean differences (SMDs) and 95% CIs, and compared against health education, active control, or no intervention. Subgroup analyses explored potential age-related differences and the effect of intervention duration. Risk of bias was assessed using Cochrane Risk of Bias 2, and publication bias was evaluated by assessing funnel plot asymmetry.</div></div><div><h3>Findings</h3><div>Of the 10 200 citations identified and 1183 full texts screened for eligibility, we identified 109 eligible RCTs, including 23 010 participants (median age 70·1 years [IQR 68·7–73·8], 14 957 [65%] female and 8053 [35%] male). Compared with health education, significant improvements in global cognition were found for physical exercise and cognitive training combined (SMD 0·26 [95% CI 0·10–0·42; p=0·0011); cognitive training alone (SMD 0·21 [0·08–0·33]; p=0·00092); diet, physical exercise, cognitive training, and health education combined (SMD 0·14 [0·02–0·27]; p=0·028); and physical exercise alone (SMD 0·14 [0·05–0·22]; p=0·0014). Random-effects models using active control and no intervention as comparators yielded similarly significant effects for the aforementioned interventions, with effect sizes in the same order. Risk of bias was high in 44 (40%) studies, and publication bias was suggested in studies comparing interventions with health education.</div></div><div><h3>Interpretation</h3><div>Several single-domain and multidomain lifestyle interventions are efficacious at modulating global cognition in older adults who are cognitively unimpaired, with the combination of physical exercise and cognitive training demonstrating the strongest effect. Combining lifestyle interventions might enhance efficacy, but increased number of domains does not automatically translate into greater cognitive benefits. These findings support lifestyle interventions as key components of prevention strategies; however, the","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100762"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.lanhl.2025.100766
Mohamad I Nasser PhD , Anya Burton PhD , Hannah Wilson PhD , Tadios Manyanga MSc , Tafadzwa Madanhire PhD , Prudance Mushayavanhu FCS Orthopaedics , Munyaradzi Ndekwere FCS Orthopaedics , Joseph Chipanga , Samuel Hawley PhD , Simon Matthew Graham PhD , James Masters PhD , Kate A Ward PhD , Matthew L Costa PhD , Rashida A Ferrand PhD , Celia L Gregson FRCP
Background
The population in Africa is ageing, and fragility fractures increasing. We assessed 1-year health outcomes following hip fracture in older adults in Zimbabwe.
Methods
In this prospective cohort study, a cohort of adults aged 40 years or older with hip fracture, presenting to hospitals in Harare (two public and five private hospitals) between Oct 15, 2021, and Oct 14, 2022, were followed up for 12 months. The primary outcome was survival, analysed with Kaplan–Meier curves at different timepoints (30 days, 120 days, 6–8 months, and 12 months after case identification), overall and stratified by age (<70 years vs ≥70 years), delay to presentation (no delay [≤2 weeks] vs delay [>2 weeks]), and facility type and operative management. We also quantified health-related quality of life (HRQoL), measured with 5-level EQ-5D (EQ-5D-5L), hip pain, self-reported from 0 (none) to 5 (all the time) and measured as interference with walking and sleep (1 [no interference] to 10 [complete interference]), as per the Brief Pain Inventory, and disability, measured with the WHO Disability Assessment Schedule version 2.0 (WHODAS).
Findings
Of 196 patients with hip fracture (96 [49%] female, 100 [51%] male; median age 74 years [IQR 62·5–83]), 162 (83%) had had a fragility fracture (low-energy trauma). In total, 173 (88%) were managed in a public hospital, of whom 96 (55%) received operative hip fixation. In contrast, all of the 23 (12%) managed in private facilities had an operation. After 12 months, 55 (29%) had died (49 [42%] of 117 patients aged ≥70 years, and six [9%] of 70 patients aged <70 years). In public hospitals, 31 (42%) of 73 non-operated patients died, compared with 18 (19%) of 93 patients who were operated on. Overall, survival declined to 88% (95% CI 82–92) by 30 days and to 71% (64–77) by 12 months. The probability of survival was lower in patients aged 70 years or older than in those younger than 70 years (mortality hazard ratio for ≥70 years 6·10, 95% CI 2·61−14·22). The mean HRQoL utility score decreased from 0·81 (95% CI 0·80–0·83) pre-fracture to 0·29 (0·25–0·34) at 30 days post fracture. Minimal recovery was seen after 120 days (0·34, 0·29–0·39). By 12 months, 97 (97%) of 100 patients alive and able to provide data still reported pain from their hip injury. Post-fracture disability was almost universal, with only two (2%) of 100 patients being disability-free (WHODAS=0) by 12 months.
Interpretation
Following hip fracture, survival and quality of life decreased substantially in the study population. These findings reveal the need for the implementation of guidelines to standardise care and improve operative capacity to manage the predicted rise in fractures in this region.
{"title":"Impact of hip fracture on survival, disability, pain, and health-related quality of life in Zimbabwe: a prospective cohort study","authors":"Mohamad I Nasser PhD , Anya Burton PhD , Hannah Wilson PhD , Tadios Manyanga MSc , Tafadzwa Madanhire PhD , Prudance Mushayavanhu FCS Orthopaedics , Munyaradzi Ndekwere FCS Orthopaedics , Joseph Chipanga , Samuel Hawley PhD , Simon Matthew Graham PhD , James Masters PhD , Kate A Ward PhD , Matthew L Costa PhD , Rashida A Ferrand PhD , Celia L Gregson FRCP","doi":"10.1016/j.lanhl.2025.100766","DOIUrl":"10.1016/j.lanhl.2025.100766","url":null,"abstract":"<div><h3>Background</h3><div>The population in Africa is ageing, and fragility fractures increasing. We assessed 1-year health outcomes following hip fracture in older adults in Zimbabwe.</div></div><div><h3>Methods</h3><div>In this prospective cohort study, a cohort of adults aged 40 years or older with hip fracture, presenting to hospitals in Harare (two public and five private hospitals) between Oct 15, 2021, and Oct 14, 2022, were followed up for 12 months. The primary outcome was survival, analysed with Kaplan–Meier curves at different timepoints (30 days, 120 days, 6–8 months, and 12 months after case identification), overall and stratified by age (<70 years <em>vs</em> ≥70 years), delay to presentation (no delay [≤2 weeks] <em>vs</em> delay [>2 weeks]), and facility type and operative management. We also quantified health-related quality of life (HRQoL), measured with 5-level EQ-5D (EQ-5D-5L), hip pain, self-reported from 0 (none) to 5 (all the time) and measured as interference with walking and sleep (1 [no interference] to 10 [complete interference]), as per the Brief Pain Inventory, and disability, measured with the WHO Disability Assessment Schedule version 2.0 (WHODAS).</div></div><div><h3>Findings</h3><div>Of 196 patients with hip fracture (96 [49%] female, 100 [51%] male; median age 74 years [IQR 62·5–83]), 162 (83%) had had a fragility fracture (low-energy trauma). In total, 173 (88%) were managed in a public hospital, of whom 96 (55%) received operative hip fixation. In contrast, all of the 23 (12%) managed in private facilities had an operation. After 12 months, 55 (29%) had died (49 [42%] of 117 patients aged ≥70 years, and six [9%] of 70 patients aged <70 years). In public hospitals, 31 (42%) of 73 non-operated patients died, compared with 18 (19%) of 93 patients who were operated on. Overall, survival declined to 88% (95% CI 82–92) by 30 days and to 71% (64–77) by 12 months. The probability of survival was lower in patients aged 70 years or older than in those younger than 70 years (mortality hazard ratio for ≥70 years 6·10, 95% CI 2·61−14·22). The mean HRQoL utility score decreased from 0·81 (95% CI 0·80–0·83) pre-fracture to 0·29 (0·25–0·34) at 30 days post fracture. Minimal recovery was seen after 120 days (0·34, 0·29–0·39). By 12 months, 97 (97%) of 100 patients alive and able to provide data still reported pain from their hip injury. Post-fracture disability was almost universal, with only two (2%) of 100 patients being disability-free (WHODAS=0) by 12 months.</div></div><div><h3>Interpretation</h3><div>Following hip fracture, survival and quality of life decreased substantially in the study population. These findings reveal the need for the implementation of guidelines to standardise care and improve operative capacity to manage the predicted rise in fractures in this region.</div></div><div><h3>Funding</h3><div>Wellcome Trust.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100766"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145287362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.lanhl.2025.100753
Mikaela Bloomberg PhD , Prof Jamie Brown PhD , Giorgio Di Gessa PhD , Feifei Bu PhD , Prof Andrew Steptoe DSc
Background
Whether short-term improvements in cognitive performance observed following smoking cessation are transient or if longer-term cognitive trajectories are also improved is unclear, particularly when adults are middle-aged or older at smoking cessation. We examined whether long-term cognitive trajectories improved following mid-to-late-life smoking cessation.
Methods
In this longitudinal study, we used data from three nationally representative cohort studies from 12 countries including 18 years of cognitive data (2002–20). Participants who quit smoking during follow-up were matched with an equal number of continuing smokers according to key demographic, socioeconomic, and cognitive criteria. We used piecewise linear mixed models to examine memory and fluency decline before and after smoking cessation and during a comparable time period in continuing smokers.
Findings
We included data from 9436 participants who smoked (4718 [50·0%] smokers who quit matched with 4718 [50·0%] continuing smokers, aged 40–89 years, with 4886 [51·8%] women and 4550 [48·2%] men). In the six years before smoking cessation, matched smokers who quit and continuing smokers had similar rates of memory and fluency decline (difference in memory decline [smokers who quit–continuing smokers] –0·03 SDs [95% CI –0·06 to 0·01], p=0·16; difference in fluency decline –0·01 [–0·04 to 0·03], p=0·76). In the six years following smoking cessation, smokers who quit had memory and fluency scores that declined more slowly than continuing smokers (difference in memory decline 0·05 SDs [0·00–0·10], p=0·036; difference in fluency decline 0·05 SDs [0·01–0·10], p=0·030). Coefficients for interaction with age at smoking cessation suggested results did not differ by age at smoking cessation (p>0·05 for all).
Interpretation
In middle-aged and older smokers with initially similar cognitive trajectories, smokers who quit subsequently had more favourable trajectories than continuing smokers regardless of age at cessation. As older adults are less likely than younger people to attempt smoking cessation, improvements in long-term cognitive trajectories might provide an additional motivation to quit.
Funding
National Institute on Aging, National Institute for Health and Care Research.
{"title":"Cognitive decline before and after mid-to-late-life smoking cessation: a longitudinal analysis of prospective cohort studies from 12 countries","authors":"Mikaela Bloomberg PhD , Prof Jamie Brown PhD , Giorgio Di Gessa PhD , Feifei Bu PhD , Prof Andrew Steptoe DSc","doi":"10.1016/j.lanhl.2025.100753","DOIUrl":"10.1016/j.lanhl.2025.100753","url":null,"abstract":"<div><h3>Background</h3><div>Whether short-term improvements in cognitive performance observed following smoking cessation are transient or if longer-term cognitive trajectories are also improved is unclear, particularly when adults are middle-aged or older at smoking cessation. We examined whether long-term cognitive trajectories improved following mid-to-late-life smoking cessation.</div></div><div><h3>Methods</h3><div>In this longitudinal study, we used data from three nationally representative cohort studies from 12 countries including 18 years of cognitive data (2002–20). Participants who quit smoking during follow-up were matched with an equal number of continuing smokers according to key demographic, socioeconomic, and cognitive criteria. We used piecewise linear mixed models to examine memory and fluency decline before and after smoking cessation and during a comparable time period in continuing smokers.</div></div><div><h3>Findings</h3><div>We included data from 9436 participants who smoked (4718 [50·0%] smokers who quit matched with 4718 [50·0%] continuing smokers, aged 40–89 years, with 4886 [51·8%] women and 4550 [48·2%] men). In the six years before smoking cessation, matched smokers who quit and continuing smokers had similar rates of memory and fluency decline (difference in memory decline [smokers who quit–continuing smokers] –0·03 SDs [95% CI –0·06 to 0·01], p=0·16; difference in fluency decline –0·01 [–0·04 to 0·03], p=0·76). In the six years following smoking cessation, smokers who quit had memory and fluency scores that declined more slowly than continuing smokers (difference in memory decline 0·05 SDs [0·00–0·10], p=0·036; difference in fluency decline 0·05 SDs [0·01–0·10], p=0·030). Coefficients for interaction with age at smoking cessation suggested results did not differ by age at smoking cessation (p>0·05 for all).</div></div><div><h3>Interpretation</h3><div>In middle-aged and older smokers with initially similar cognitive trajectories, smokers who quit subsequently had more favourable trajectories than continuing smokers regardless of age at cessation. As older adults are less likely than younger people to attempt smoking cessation, improvements in long-term cognitive trajectories might provide an additional motivation to quit.</div></div><div><h3>Funding</h3><div>National Institute on Aging, National Institute for Health and Care Research.</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 9","pages":"Article 100753"},"PeriodicalIF":14.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145309379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-01DOI: 10.1016/j.lanhl.2025.100742
Reynalda Córdova PhD , Prof Jihye Kim PhD , Alysha S Thompson PhD , Hwayoung Noh PhD , Sanam Shah PhD , Christina C Dahm PhD , Christopher F Jensen MSc , Lene Mellemkjær PhD , Prof Anne Tjønneland PhD , Verena Katzke PhD , Charlotte Le Cornet PhD , Christine El-Khoury MSc , Prof Matthias B Schulze DrPH , Giovanna Masala MD , Claudia Agnoli MSc , Vittorio Simeon PhD , Rosario Tumino PhD , Fulvio Ricceri PhD , Prof W M Monique Verschuren PhD , Prof Yvonne T van der Schouw PhD , Heinz Freisling PhD
Background
It is currently unknown whether plant-based dietary patterns influence disease progression to multimorbidity after an initial non-communicable disease, and whether the associated risk of multimorbidity varies with age. This study aimed to investigate associations of plant-based diets with the risk of multimorbidity, defined as the co-occurrence of at least two chronic diseases in an individual (either cancer at any site, cardiovascular disease, or type 2 diabetes).
Methods
This prospective cohort study used data from EPIC and UK Biobank across six European countries, with participants aged 35–70 years at recruitment. We excluded participants from these cohorts who had cancer, cardiovascular disease, or type 2 diabetes at baseline or those with missing data on diet or health outcomes. Data on dietary habits were assessed either at baseline through a validated dietary questionnaire about habits in the previous 12 months or through several 24-h recall questionnaires during approximately a year of follow-up. Multistate modelling with Cox regression was used to estimate the risk of multimorbidity according to a healthful plant-based diet index (hPDI) and, separately, an unhealthful plant-based diet index (uPDI). Risk differences in adults younger than 60 years and those age 60 years and older were estimated.
Findings
407 618 participants (226 324 from EPIC and 181 294 from UK Biobank) were included in this study. During a median follow-up time of 10·9 years in EPIC and 11·4 years in UK Biobank, 6604 cancer–cardiometabolic multimorbidity events occurred in both cohorts combined. A ten-point increment of the hPDI score was associated with a lower risk of multimorbidity, with a hazard ratio (HR) of 0·89 (95% CI 0·83–0·96) in EPIC and 0·81 (0·76–0·86) in UK Biobank. This inverse association was marginally weaker in older adults than in middle-aged adults in both cohorts. In UK Biobank, a ten-point increment of the hPDI score was associated with multivariable-adjusted HRs of 0·71 (95% CI 0·65–0·79) in adults younger than 60 years and 0·86 (0·80–0·92) in those aged 60 years and older (pinteraction=0·0016). The respective HRs in EPIC were 0·86 (95% CI 0·78–0·95) and 0·92 (0·84–1·02; pinteraction=0·32). A higher adherence to an unhealthy plant-based diet was positively associated with multimorbidity risk in UK Biobank (HR per ten-point increment of uPDI 1·22, 95% CI 1·16–1·29), but this was not replicated in EPIC (1·00, 0·94–1·08).
Interpretation
A healthy plant-based diet might reduce the burden of multimorbidity of cancer and cardiometabolic diseases among middle-aged and older adults.
Funding
The Korean Government (Ministry of Science and ICT).
背景：目前尚不清楚以植物为基础的饮食模式是否会影响非传染性疾病的进展，以及多病的相关风险是否随年龄而变化。本研究旨在调查植物性饮食与多病风险的关系，多病的定义是一个人同时患有至少两种慢性疾病（任何部位的癌症、心血管疾病或2型糖尿病）。方法：这项前瞻性队列研究使用了来自6个欧洲国家的EPIC和UK Biobank的数据，招募时参与者年龄为35-70岁。我们从这些队列中排除了基线时患有癌症、心血管疾病或2型糖尿病或缺乏饮食或健康结果数据的参与者。饮食习惯的数据在基线时通过一份关于前12个月饮食习惯的有效问卷或在大约一年的随访期间通过几份24小时回忆问卷进行评估。采用Cox回归的多状态模型，根据健康植物性饮食指数（hPDI）和不健康植物性饮食指数（uPDI）分别估计多种疾病的风险。对60岁以下和60岁及以上成年人的风险差异进行了评估。研究结果：407618名参与者（来自EPIC的226 324名和来自UK Biobank的181 294名）被纳入本研究。EPIC的中位随访时间为10.9年，UK Biobank的中位随访时间为11.4年，两个队列共发生了6604例癌症-心脏代谢多病事件。hPDI评分增加10分与多病风险降低相关，EPIC的风险比（HR）为0.89 (95% CI 0.83 - 0.96)， UK Biobank的风险比（HR）为0.81 （95% CI 0.76 - 0.86）。在两个队列中，老年人的这种负相关比中年人略弱。在UK Biobank中，60岁以下成年人的hPDI评分每增加10分，多变量调整后的hr为0.71 (95% CI为0.65 - 0.79)，60岁及以上成年人的hr为0.86 (95% CI为0.80 - 0.92)（p交互作用= 0.0016）。EPIC组的hr分别为0.86 （95% CI 0.78 ~ 0.95）和0.92 (95% CI 0.84 ~ 0.02)， p交互作用= 0.32。在UK Biobank中，较高的不健康植物性饮食依从性与多病风险呈正相关（uPDI每增加10个点的HR为1.22,95% CI为1.16 -1·29），但在EPIC中没有得到复制（1.00,0.94 -1·08）。解释：健康的植物性饮食可能会减少中老年人癌症和心脏代谢疾病的多重发病率。资助：韩国政府（科学和信息通信技术部）。
{"title":"Plant-based dietary patterns and age-specific risk of multimorbidity of cancer and cardiometabolic diseases: a prospective analysis","authors":"Reynalda Córdova PhD , Prof Jihye Kim PhD , Alysha S Thompson PhD , Hwayoung Noh PhD , Sanam Shah PhD , Christina C Dahm PhD , Christopher F Jensen MSc , Lene Mellemkjær PhD , Prof Anne Tjønneland PhD , Verena Katzke PhD , Charlotte Le Cornet PhD , Christine El-Khoury MSc , Prof Matthias B Schulze DrPH , Giovanna Masala MD , Claudia Agnoli MSc , Vittorio Simeon PhD , Rosario Tumino PhD , Fulvio Ricceri PhD , Prof W M Monique Verschuren PhD , Prof Yvonne T van der Schouw PhD , Heinz Freisling PhD","doi":"10.1016/j.lanhl.2025.100742","DOIUrl":"10.1016/j.lanhl.2025.100742","url":null,"abstract":"<div><h3>Background</h3><div>It is currently unknown whether plant-based dietary patterns influence disease progression to multimorbidity after an initial non-communicable disease, and whether the associated risk of multimorbidity varies with age. This study aimed to investigate associations of plant-based diets with the risk of multimorbidity, defined as the co-occurrence of at least two chronic diseases in an individual (either cancer at any site, cardiovascular disease, or type 2 diabetes).</div></div><div><h3>Methods</h3><div>This prospective cohort study used data from EPIC and UK Biobank across six European countries, with participants aged 35–70 years at recruitment. We excluded participants from these cohorts who had cancer, cardiovascular disease, or type 2 diabetes at baseline or those with missing data on diet or health outcomes. Data on dietary habits were assessed either at baseline through a validated dietary questionnaire about habits in the previous 12 months or through several 24-h recall questionnaires during approximately a year of follow-up. Multistate modelling with Cox regression was used to estimate the risk of multimorbidity according to a healthful plant-based diet index (hPDI) and, separately, an unhealthful plant-based diet index (uPDI). Risk differences in adults younger than 60 years and those age 60 years and older were estimated.</div></div><div><h3>Findings</h3><div>407 618 participants (226 324 from EPIC and 181 294 from UK Biobank) were included in this study. During a median follow-up time of 10·9 years in EPIC and 11·4 years in UK Biobank, 6604 cancer–cardiometabolic multimorbidity events occurred in both cohorts combined. A ten-point increment of the hPDI score was associated with a lower risk of multimorbidity, with a hazard ratio (HR) of 0·89 (95% CI 0·83–0·96) in EPIC and 0·81 (0·76–0·86) in UK Biobank. This inverse association was marginally weaker in older adults than in middle-aged adults in both cohorts. In UK Biobank, a ten-point increment of the hPDI score was associated with multivariable-adjusted HRs of 0·71 (95% CI 0·65–0·79) in adults younger than 60 years and 0·86 (0·80–0·92) in those aged 60 years and older (p<sub>interaction</sub>=0·0016). The respective HRs in EPIC were 0·86 (95% CI 0·78–0·95) and 0·92 (0·84–1·02; p<sub>interaction</sub>=0·32). A higher adherence to an unhealthy plant-based diet was positively associated with multimorbidity risk in UK Biobank (HR per ten-point increment of uPDI 1·22, 95% CI 1·16–1·29), but this was not replicated in EPIC (1·00, 0·94–1·08).</div></div><div><h3>Interpretation</h3><div>A healthy plant-based diet might reduce the burden of multimorbidity of cancer and cardiometabolic diseases among middle-aged and older adults.</div></div><div><h3>Funding</h3><div>The Korean Government (Ministry of Science and ICT).</div></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"6 8","pages":"Article 100742"},"PeriodicalIF":14.6,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","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