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Biomedical subjects

Eleanor M Simonsick

Publications and source records attributed to Eleanor M Simonsick.

At least 55 records · Page 3Linked to original sources
PubMed2004

Weight-loss intention in the well-functioning, community-dwelling elderly: associations with diet quality, physical activity, and weight change.

BACKGROUND: Many older adults desire to lose weight, yet the proportion with a health-related weight-loss indication, weight-loss strategies, and success is unknown. OBJECTIVE: We examined the associations of reported intention to lose weight with health-related indications for weight loss, diet quality, physical activity, and weight-loss success in well-functioning older adults. DESIGN: This prospective, community-based cohort included 2708 elderly persons aged 70-79 y at baseline. We determined indication for weight loss by using the modified National Institutes of Health guidelines, diet quality by using the Healthy Eating Index, and weight-loss intention and physical activity by using questionnaires. Measured weight change over 1 y was assessed. RESULTS: Twenty-seven percent of participants reported an intention to lose weight, and 67% of those participants had an indication for weight loss. Participants who reported a weight-loss intention were heavier than those who did not, had more depressive symptoms, and were more likely to be dissatisfied with their weight, regardless of weight-loss indication. Participants with an intention to lose weight reported better eating behaviors and a more active lifestyle than did participants without a weight-loss intention, independent of other health conditions. No significant difference in actual weight loss was found between participants intending and not intending to lose weight, regardless of indication for weight loss. CONCLUSIONS: Despite being associated with healthier behaviors, the intention to lose weight did not predict greater weight loss in this well-functioning elderly cohort. More attention needs to be focused on the necessity and efficacy of specific strategies for weight loss in older adults.

Aged↗
PubMed2004

Serum leptin concentrations and body adipose measures in older black and white adults.

BACKGROUND: Among US adults, serum leptin concentrations are higher in women than in men and are higher in blacks than in whites independent of anthropometric measures of body fatness. OBJECTIVE: Using radiographic measures of body fat, we determined the best correlates of leptin and whether adiposity can explain sex and race differences in leptin concentrations in older adults. DESIGN: This was a cross-sectional analysis of fasting serum leptin concentrations and body fat measured by dual-energy X-ray absorptiometry (DXA), abdominal computed tomography, and standard anthropometry in 3026 well-functioning 70-79-y-old participants (42% black, 51% women) of the Health, Aging, and Body Composition Study. RESULTS: Geometric mean (+/-SE) leptin concentrations (ng/mL) were higher in the women than in the men (16.5 +/- 0.3 and 5.7 +/- 0.1, respectively) and in the black women than in the white women (20.2 +/- 0.6 and 13.9 +/- 0.4, respectively), but did not differ significantly between the white and black men (5.8 +/- 0.2 and 5.5 +/- 0.2, respectively). Percentage fat estimated from DXA showed the highest correlation with leptin (R(2) = 0.56 for both sexes). Addition of abdominal visceral fat minimally increased the correlation. In the multivariate analysis, the association with sex was eliminated after adjustment for percentage fat and visceral fat in both whites (P = 0.051) and blacks (P = 0.34). Among women, higher leptin concentrations in blacks remained after adjustment for percentage fat and visceral fat (mean race difference = 4.95 ng/mL; P < 0.001). Among men, an association with black race emerged after adjustment for these factors (mean race difference = 1.42 ng/mL; P < 0.001). CONCLUSIONS: Among older adults, higher serum leptin concentrations in women are explained by a greater percentage of body fat. Higher leptin concentrations in blacks are not explained by percentage of body fat.

Abdomen↗
PubMed2004

The association between physical function and lifestyle activity and exercise in the health, aging and body composition study.

OBJECTIVES: To determine whether older adults who exercise demonstrate higher levels of physical function than those who do not exercise but are physically active throughout the day. DESIGN: Cross-sectional examination of baseline data from the Health, Aging and Body Composition (Health ABC) study. SETTING: Health ABC field centers in Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: Three thousand seventy-five well-functioning black and white men and women aged 70 to 79. MEASUREMENTS: Physical activity and exercise were assessed using a modified leisure-time physical activity questionnaire. Participants were classified as inactive (reporting <1,000 kcal/wk of exercise activity and < or =2,719 kcal/wk of total physical activity), lifestyle active (reporting <1,000 kcal/wk of exercise activity and >2,719 kcal/wk of total physical activity), or exerciser (reporting> or =1,000 kcal/wk of exercise activity). Physical function measures included the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) battery, the Health ABC battery, a 400-m walk test, and isokinetic strength testing of the knee extensors. RESULTS: The lifestyle active and exerciser groups had similar total activity levels (men: 6,135 kcal/wk and 6,734 kcal/wk, respectively; P=.108; women: 5,695 kcal/wk and 5,854 kcal/wk, respectively; P=.335). When examining lower extremity performance in relation to physical activity, a progressive trend was evident, with the inactive individuals most likely to have impaired performance on the EPESE battery (men: 33.7%, 24.3%, and 19.1%, P<.001; women: 49.9%, 37.3%, and 28.4%, P<.001; inactive, lifestyle active, and exerciser, respectively). Progressive trends of similar magnitude were present for the Health ABC battery, time to walk 400 m, and knee extensor strength. In multivariate linear regression, those in the inactive and lifestyle active groups had poorer scores on the Health ABC performance battery than individuals in the exercise group after controlling for demographic factors and prevalent disease (men: inactive beta=-0.27, P<.001, lifestyle active beta=-0.07, P=.032; women: inactive beta=-0.23, P<.001, lifestyle active beta=-0.07, P<.059). After controlling for demographic factors and prevalent disease, the lifestyle active and exercisers had similar proportions of functionally limited older persons (scoring <10 on the EPESE battery). CONCLUSION: Older adults who participate in 20 to 30 minutes of moderate-intensity exercise on most days of the week have better physical function than older persons who are active throughout the day or who are inactive. Any type of physical activity is better than no activity for protection against functional limitations, but exercise confers greater benefit for physical capacity.

Activities of Daily Living↗
PubMed2004

Physical activity, exercise, and inflammatory markers in older adults: findings from the Health, Aging and Body Composition Study.

OBJECTIVES: To examine the association between physical activity and inflammatory markers, with consideration for body fatness and antioxidant use. DESIGN: Cross-sectional study, using baseline data from the Health, Aging and Body Composition Study. SETTING: Metropolitan areas surrounding Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: Black and white, well-functioning men and women (N=3,075), aged 70 to 79. MEASUREMENTS: Interviewer-administered questionnaires of previous-week household, walking, exercise, and occupational/volunteer physical activities. Analysis of covariance was used to examine the association between activity level and serum C-reactive protein (CRP), interleukin-6 (IL-6), and plasma tumor necrosis factor alpha (TNFalpha) with covariate adjustment. Antioxidant supplement use (multivitamin, vitamins E or C, beta carotene) was evaluated as an effect modifier of the association. RESULTS: Higher levels of exercise were associated with lower levels of CRP (P<.01), IL-6 (P<.001), and TNFalpha (P=.02) (e.g., CRP=1.95 mg/L for no exercise and 1.72 for >180 min/wk). Adjustment for body fatness attenuated the associations somewhat. Use of antioxidant supplements modified the CRP (P(interaction)=.01) and IL-6 (P(interaction)=.08) associations such that concentrations were low in those taking supplements (e.g., CRP=1.79-1.84 across exercise levels) and higher in nonsupplement users who did no exercise (2.03) than in those who did the most (1.72). Among nonexercisers, higher levels of other physical activity were related to lower levels of CRP (P<.01) and IL-6 (P=.02) but not TNFalpha (P=.36), even after accounting for body fat. CONCLUSION: Inflammatory markers are lower in older adults with higher levels of exercise and nonexercise activity and in antioxidant supplement users regardless of exercise level.

Aged↗
PubMed2004

Inflammatory markers and incident mobility limitation in the elderly.

OBJECTIVES: To examine the relationship between indicators of inflammation and the incidence of mobility limitation in older persons. DESIGN: Prospective cohort study: the Health, Aging and Body Composition Study. SETTING: Pittsburgh, Pennsylvania, and Memphis, Tennessee. PARTICIPANTS: A total of 2,979 men and women, aged 70 to 79, without mobility limitation at baseline. MEASUREMENTS: Serum levels of interleukin (IL)-6, tumor necrosis factor alpha (TNFalpha), and C-reactive protein (CRP) and soluble cytokine receptors (IL-2sR, IL-6sR, TNFsR1, TNFsR2) were measured. Mobility limitation was assessed and defined as reporting difficulty or inability to walk one-quarter of a mile or to climb 10 steps during two consecutive semiannual assessments over 30 months. RESULTS: Of the 2,979 participants, 30.1% developed incident mobility limitation. After adjustment for confounders (demographics, prevalent conditions at baseline, body composition), the relative risk (RR) of incident mobility limitation per standard deviation (SD) increase was 1.19 (95% confidence interval (CI)=1.10-1.28) for IL-6, 1.20 (95% CI=1.12-1.29) for TNFalpha, and 1.40 (95% CI=1.18-1.68) for CRP. The association between inflammation and incident mobility limitation was especially strong for the onset of more severe mobility limitation and when the levels of multiple inflammatory markers were high. When persons with baseline or incident cardiovascular disease events or persons who were hospitalized during study follow-up were excluded, findings remained similar. In a subset (n=499), high levels of the soluble receptors IL2sR and TNFsR1 (per SD increase: RR=1.23 (95% CI=1.04-1.46) and RR=1.28 (95% CI=1.04-1.57), respectively) were also associated with incident mobility limitation. CONCLUSION: Findings suggest that inflammation is prognostic for incident mobility limitation over 30 months, independent of cardiovascular disease events and incident severe illness.

Aged↗
PubMed2004

Black and white differences in cognitive function test scores: what explains the difference?

Several studies have reported that older black and Latino adults have lower cognitive function test scores than older white adults, but few have comprehensively examined reasons for score differences. This study evaluates whether differences in health and socioeconomic indicators, including literacy level, can explain differences in cognitive function test scores between older black and white adults.

Black or African American↗
PubMed2004

Influenza vaccination by race among disabled community dwelling older women.

Disabled older adults have been shown to be at risk for underutilization of some preventive services relative to able-bodied individuals. The Women's Health and Aging Study surveyed female Medicare enrollees in Baltimore, Maryland, who were among the most disabled community-dwelling women at the start of the study. Longitudinal survey data from the study were used to test for the existence or emergence of racial variation in influenza vaccination rates, for which racial variation has been shown in the general population. The primary analysis, using data on the same women before and after Medicare flu shot coverage began, suggested that influenza vaccination rates increased after Medicare coverage began and that there was no difference by race. A secondary analysis using data on women who were interviewed only after Medicare flu shot coverage began showed some racial variation, although the difference may have been larger prior to coverage. The utilization rate did not approach the Healthy People 2010 target.

Aged↗
PubMed2003

Inflammatory markers and onset of cardiovascular events: results from the Health ABC study.

BACKGROUND: Inflammation plays an important role in cardiovascular disease. The aim of this study is to investigate the predictive value of several inflammatory markers on the incidence of cardiovascular events in well-functioning older persons. METHODS AND RESULTS: The subjects were 2225 participants 70 to 79 years old, without baseline cardiovascular disease, who were enrolled in the Health, Aging, and Body Composition study. Incident coronary heart disease (CHD), stroke, and congestive heart failure (CHF) events were detected during an average follow-up of 3.6 years. Blood levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-alpha) were assessed. After adjustment for potential confounders, IL-6 was significantly associated with all outcomes (CHD events, per IL-6 SD increase: RR, 1.27; 95% CI, 1.10 to 1.48; stroke events, per IL-6 SD increase: RR, 1.45; 95% CI, 1.12 to 1.86; CHF events, per IL-6 SD increase: RR, 1.72; 95% CI, 1.40 to 2.12). TNF-alpha showed significant associations with CHD (per TNF-alpha SD increase: RR, 1.22; 95% CI, 1.04 to 1.43) and CHF (per TNF-alpha SD increase: RR, 1.59; 95% CI, 1.30 to 1.95) events. CRP was significantly associated with CHF events (per CRP SD increase: RR, 1.48; 95% CI, 1.23 to 1.78). A composite summary indicator of inflammation showed a strong association with incident cardiovascular events, with an especially high risk if all 3 inflammatory markers were in the highest tertile. CONCLUSIONS: Findings suggest that inflammatory markers are independent predictors of cardiovascular events in older persons.

Aged↗
PubMed2003

Inflammatory markers and depressed mood in older persons: results from the Health, Aging and Body Composition study.

Patients with major depression have elevated levels of inflammatory cytokines. We examined the link between inflammatory markers and depressed mood in a community-based sample of older people. Data are from 3024 well-functioning older persons, 70-79 years of age, participating in the Health, Aging and Body Composition study. Depressed mood was defined as a Center for Epidemiologic Studies Depression scale score of 16 or higher. Plasma concentrations of interleukin (IL)-6, tumor necrosis factor (TNF)-alpha, and C-reactive protein (CRP) were measured. Compared with the 2879 nondepressed subjects, the 145 persons with depressed mood had higher median plasma levels of IL-6 (2.04 vs. 1.83 pg/mL, p =.02), TNF-alpha (3.43 vs. 3.16 pg/mL, p =.05), and CRP (1.96 vs. 1.66 mg/L, p =.03). After adjustment for health and demographic variables, depressed mood was especially prevalent among persons who had a high (above median) plasma level for at least two of the inflammatory markers. Compared with those without high levels, for persons with a high level for two or all three markers the risk of depressed mood was 2.45 (95% confidence interval [CI] = 1.34-4.47) and 2.40 (95% CI = 1.27-4.53), respectively. The association between depressed mood and serum level of IL-6 was significantly stronger in men than in women. In old age, depressed mood is associated with high levels of inflammatory markers, suggesting that depressed mood is causing and/or caused by systemic inflammation.

Aged↗
PubMed2003

Association of high coronary heart disease risk status with circulating oxidized LDL in the well-functioning elderly: findings from the Health, Aging, and Body Composition study.

OBJECTIVE: Although circulating oxidized LDL (oxLDL) is elevated in persons with coronary heart disease (CHD), whether oxLDL is elevated in persons with high CHD risk before any events is unknown. Therefore, we studied the association between high, predicted CHD risk and oxLDL in the Health ABC cohort. METHODS AND RESULTS: This cohort included 385 persons with CHD and 1183 persons at high risk; the latter were all persons with CHD risk equivalents: noncoronary forms of clinical atherosclerotic disease, diabetes, and a 10-year risk for CHD >20% by Framingham scoring. The remaining 1535 participants were at low risk. Levels of oxLDL were 1.18+/-0.61 mg/dL for low-risk persons, 1.50+/-0.81 mg/dL for high-risk persons without diagnosed CHD, and 1.32+/-0.83 mg/dL for persons with CHD (P<0.001). The odds ratio for high CHD risk in the highest quintile of oxLDL, compared with the lowest quintile and after adjusting for age, sex, race, LDL cholesterol, smoking status, and C-reactive protein, was 2.79 (P<0.001). CONCLUSIONS: The odds ratio for elevated oxLDL among persons with high CHD risk before any CHD events was higher than that among persons with established CHD. A likely explanation is that once CHD is diagnosed, individuals are frequently treated with a statin, which is associated with lowering of LDL cholesterol and oxLDL levels.

Aged↗
PubMed2003

Is a fall just a fall: correlates of falling in healthy older persons. The Health, Aging and Body Composition Study.

OBJECTIVES: To identify factors associated with falling in well-functioning older people. DESIGN: Cross-sectional analyses of report of falls over the past 12 months using baseline data from the Health, Aging and Body Composition Study. SETTING: Clinic examinations in Pittsburgh, Pennsylvania, or Memphis, Tennessee. PARTICIPANTS: Three thousand seventy-five high-functioning black and white elderly aged 70 to 79 living in the community. MEASUREMENTS: Physical function assessed using self-report and performance measures. Health status indicators included diseases, medication use, and body composition measures. RESULTS: Almost one-quarter (24.1%) of women and 18.3% of men reported at least one fall within the year before the baseline examination. Fallers were more likely to be female; white; report more chronic diseases and medications; and have lower leg strength, poorer balance, slower 400-meter walk time, and lower muscle mass. In men, multivariate logistic regression models showed white race (adjusted odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.2-1.6), slower 6-meter walk speed (OR = 1.1, 95% CI = 1.0-1.3), poor standing balance (OR = 1.2, 95% CI = 1.0-1.4), inability to do 5 chair stands (OR = 1.7, 95% CI = 1.3-1.9), report of urinary incontinence (UI) (OR = 1.5, 95% CI = 1.1-2.0), and mid-quintile of leg muscle strength (OR = 0.6, 95% CI = 0.4-0.9) to be independently associated with report of falling. In women, benzodiazepine use (OR = 1.6, 95% CI = 1.0-2.6), UI (OR = 1.5, 95% CI = 1.2-1.9), and reported difficulty in rising from a chair (OR = 1.4, 95% CI = 1.2-1.6) were associated with past falls. CONCLUSION: Falls history needs to be screened in healthier older adults. Even for well-functioning older persons, specific correlates of falling can be identified to define those at risk.

Accidental Falls↗
PubMed2003

Prevalence and correlates of anxiety symptoms in well-functioning older adults: findings from the health aging and body composition study.

OBJECTIVES: To determine the prevalence and correlates of anxiety symptoms in the absence of depression, in older black and white people. DESIGN: Cross-sectional study. SETTING: Baseline assessment of a biracial cohort of community-resident well-functioning men and women aged 70 to 79 participating in the Health Aging and Body Composition study. PARTICIPANTS: Three thousand forty-one participants (mean age 74, 52% women, 58% white). MEASUREMENTS: Participants were asked about three major anxiety symptoms (feeling fearful, tense/keyed-up, or shaky/nervous) derived from the Hopkins Symptom Checklist. Participants were considered to have anxiety symptoms if they reported feeling at least two anxiety symptoms "a little" or one symptom "quite a bit" in the past week. Logistic regression models were used to identify demographic, psychosocial, and health-related correlates of anxiety symptoms. RESULTS: Anxiety symptoms occurred in 15% of older people without depression and 43% of those with depression. Of nondepressed older people, women were more likely to have anxiety symptoms than men (P <.01), especially white women (20% prevalence). After multivariate adjustment, the chronic conditions of urinary incontinence (odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1-1.9), hearing impairment (OR = 1.4, 95% CI = 1.0-2.1), hypertension (OR = 1.3, 95% CI = 1.0-1.7) and poor sleep (OR = 1.7, 95% CI = 1.3-2.4) were associated with a higher prevalence of anxiety symptoms. Persons with poorer psychosocial functioning, low personal mastery (OR = 2.0, 95% CI = 1.6-2.5) and the need for more emotional support (OR = 2.2, 95% CI = 1.7-2.8), also had higher rates of anxiety symptoms. CONCLUSION: Anxiety symptoms are common in depressed and nondepressed older people. Given the high prevalence and coexistence with depressive symptoms, it will be important to conduct longitudinal studies that assess depressive and anxiety symptoms to clarify the direction and influence and disentangle the health-related consequences of these two conditions.

Aged↗
PubMed2003

Lower extremity physical performance and hip bone mineral density in elderly black and white men and women: cross-sectional associations in the Health ABC Study.

BACKGROUND: Aging is characterized by declines in physical capacity and bone mineral density (BMD), both of which contribute to increased risk for fracture. However, it is unclear if these factors coexist or are independent in elderly people, and if a relationship does exist, whether it varies by sex and/or race. METHODS: Data are from 847 white women, 723 black women, 927 white men, and 544 black men aged 70-79 years participating in the Health Aging and Body Composition (ABC) Study, a cohort of well-functioning community-dwelling elders. BMD (g/cm(2)) of the hip (femoral neck and trochanter) was determined by dual X-ray absorptiometry. Physical capacity measures included knee extensor strength, repeated chair-stands, gait speed (6 m), walking endurance (400 m), and standing balance. RESULTS: In analyses of BMD as a continuous measure, BMD and physical performance were most consistently related at the trochanter in black women, even after adjusting for body size and several covariates including physical activity. For each performance measure, black women in the bottom quartile(s) had lower BMD than those in the top quartile(s). For the femoral neck, there was a significant association with performance tasks, except for the 400-m walk. In comparison, only chair-rise performance was related to BMD at the femoral neck, and knee extensor strength, chair-rise performance, and balance with the trochanter in white women. For white and black men, trends existed only for lower BMD in those with poorer knee extensor strength. CONCLUSIONS: In this cohort of well-functioning young-old seniors, physical capacity is only modestly related to BMD at the hip. The association was strongest in black women, who as a group exhibited the poorest functional capacity in the cohort. Our data show that, although both poorer physical performance and low BMD are risk factors for fracture, they remain largely independent in the well-functioning young-old, except in black women. This independence suggests that interventions to reduce fracture incidence should be targeted at improving both physical performance and bone density.

Absorptiometry, Photon↗
PubMed2003

Walking performance and cardiovascular response: associations with age and morbidity--the Health, Aging and Body Composition Study.

BACKGROUND: The long-distance corridor walk is a timed 400-meter walk test used to assess walking endurance in well-functioning men and women aged 70-79 in the Health, Aging and Body Composition Study. METHODS: We examined walking time along with heart rate and blood pressure response in relationship to prevalent chronic conditions, weight, physical activity, and markers of subclinical disease. Of 3075 participants, 2324 (76%) completed the test with heart rate and blood pressure responses in the range expected for a moderate level of exertion. RESULTS: Slower walking time was influenced by both clinical and subclinical disease, and also was strongly related to both low and high body weight and low self-reported physical activity. Heart rate and blood pressure responses were higher with several clinical and subclinical diseases, but heart rate response and recovery were more strongly related to walking time than to disease. Higher body mass index and lower physical activity were associated with greater heart rate response and recovery. CONCLUSIONS: The independent contribution of both clinical and subclinical disease to walking time supports the use of walking tests as a summary measure of disease in older adults. The independent association of walking time with physical activity suggests that it is sensitive to levels of fitness as well. Together these findings show that walking performance is a valid indicator of physiologic reserve in older adults.

Aged↗
PubMed2003

How does low back pain impact physical function in independent, well-functioning older adults? Evidence from the Health ABC Cohort and implications for the future.

OBJECTIVE: To determine the relationships between low back pain (LBP) frequency and intensity and self-reported and performance-based physical function in a large cohort of well-functioning older adults. DESIGN: Cross-sectional survey and examination. SETTING: Community-based cohort of the Health, Aging, and Body Composition (Health ABC) study. PARTICIPANTS: Participants were 2,766 community-dwelling adults, aged 70-79; 42% were African American, 52% were men. OUTCOME MEASURES: 1) Back pain-location, frequency, intensity; 2) Hip and/or knee pain; 3) Body mass index (BMI); 4) Self-reported difficulty doing functional tasks; 5) Lower extremity function, using the battery from the Established Populations for Epidemiologic Studies in the Elderly (EPESE); 6) Self-rated health; 7) Comorbidity; 8) Depressive symptoms, using the Center for Epidemiological Studies-Depression (CES-D) scale. RESULTS: LBP was common (36%), and its frequency/intensity was significantly associated with other pain and comorbidities. In gender-specific models, LBP frequency/intensity was not significantly associated with EPESE performance score after adjusting for age, race, BMI, CES-D score, knee pain, hip pain, and other comorbidities. LBP frequency/intensity, however, was significantly associated with self-reported difficulty with most functional tasks after adjusting for important confounders. CONCLUSIONS: Among well-functioning community-dwelling older adults, LBP frequency/intensity was associated with perceived difficulty in performing important functional tasks, but not with observed physical performance. The demonstrated dose-response relationship between pain frequency/intensity and self-reported task performance difficulty underscores the importance of clinical efforts to treat pain without necessarily eradicating it. Additional work is needed to determine whether back pain is associated with a risk for progressive functional decline and loss of independence in older adults and whether therapeutic interventions can ameliorate decline and, therefore, preserve independence.

Activities of Daily Living↗
PubMed2003

Diabetes is associated with subclinical functional limitation in nondisabled older individuals: the Health, Aging, and Body Composition study.

OBJECTIVE: The aim of this study was to examine the role of comorbid conditions and body composition in the association between diabetes and subclinical functional limitation, an indication of early functional decline, in well-functioning older individuals. RESEARCH DESIGN AND METHODS: This was a cross-sectional analysis of 3,075 well-functioning black and white men and women aged 70-79 years, enrolled in the Health, Aging, and Body Composition study. Diabetes was defined by self-report and/or hypoglycemic medication use or fasting glucose >/=126 mg/dl. Subclinical functional limitation was defined using self-report of capacity and objective performance measures. Comorbid conditions were identified by self-reported diagnoses, medication use, and clinical measures. Body composition measures included anthropometry and total fat (dual X-ray absorptiometry). RESULTS: Of 2,926 participants, 1,252 (42.8%) had subclinical functional limitation at baseline. Among 2,370 individuals without diabetes, 40% had subclinical functional limitation, whereas the prevalence was 53% among the 556 diabetic participants with an age/sex/race-adjusted odds ratio (OR) 1.70 (95% CI 1.40-2.06). This association remained significant when adjusted for body composition measures (OR 1.54 [1.26-1.88]), diabetes-related comorbidities, and other potential confounders (OR 1.40 [1.14-1.73]). In the fully adjusted model, consideration of HbA(1c) (< or >/=7%) and diabetes duration showed that poor glycemic control in diabetic individuals explained the association with subclinical functional limitation. CONCLUSIONS: In a well-functioning older population, diabetes is associated with early indicators of functional decline, even after accounting for body composition and diabetes-related comorbidities. Poor glycemic control contributes to this relationship. Whether improvement in glycemic control in older people with diabetes would change this association should be tested.

Aged↗
PubMed2003

Racial differences in glycemic control in a well-functioning older diabetic population: findings from the Health, Aging and Body Composition Study.

OBJECTIVE: To evaluate racial differences and factors associated with worse glycemic control in well-functioning older individuals with type 2 diabetes. Our hypothesis was that glycemic control would be worse among black than white diabetic individuals but that this association would be explained by differences in severity of diabetes, health status, health care indicators, and social, psychological, or behavioral factors. We further hypothesized that the association of race with poorer glycemic control would be limited to those with lower education or lower income. RESEARCH DESIGN AND METHODS: Cross-sectional analysis of 468 diabetic participants among a cohort of 3,075 nondisabled blacks and whites aged 70-79 years living in the community enrolled in the Health, Aging and Body Composition Study. Glycemic control was measured by the level of HbA(1c). RESULTS: A total of 58.5% of the diabetic individuals were black. Although control was poor in all diabetic participants (HbA(1c) > or =7% in 73.7%), blacks had worse glycemic control than whites (age- and sex-adjusted mean HbA(1c), 8.4% in blacks and 7.4% in whites; P < 0.01). Race differences in glycemic control remained significant, even after adjusting for current insulin therapy, cardiovascular disease, higher total cholesterol, and not receiving a flu shot in the previous year, all of which were associated with higher HbA(1c) concentrations. Controlling for these factors reduced the association by 27%. Race remained an important factor in glycemic control, even when results were stratified by education or income. CONCLUSIONS: HbA(1c) concentrations were higher in older black diabetic individuals. Differences in glycemic control by race were associated with disease severity, health status, and poorer quality of care, but these factors did not fully explain the higher HbA(1c) levels in older black diabetic individuals.

Age of Onset↗