Open Access
Gait speed as a mediator of the effect of sarcopenia on dependency in activities of daily living
(Wiley, 2019) Pérez Sousa, Miguel A.; Venegas Sanabria, Luis Carlos; Chavarro Carvajal, Diego Andrés; Cano Gutiérrez, Carlos Alberto; Izquierdo Redín, Mikel; Correa Bautista, Jorge Enrique; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak
Background: Sarcopenia in older adults is strongly associated with an increase in dependency in activities of daily living (ADL) and with a decline in gait speed. Interestingly, gait speed has been shown to independently predict mortality. In this context, our study aimed to explore the mediator role of gait speed on the relationship between sarcopenia and dependency in ADL. Methods: A cross-sectional study was conducted in Colombia, 19 705 older adults with a mean age of 70 years, 55.6% women, 16.1% with sarcopenia, and 14.7% mild, moderate, or severe dependency in ADL, according to ‘SABE Survey 2015’. Sarcopenia was assessed by calf circumference and ADL dependence through the Barthel Index. Gait speed was measured over a distance of 3 m. The association between sarcopenia condition and gait speed and dependency level was analysed by linear regression adjusted by covariates. To examine whether gait speed mediated the association between sarcopenia and dependence components of physical function, simple mediation models were generated using ordinary least squares with the macro PROCESS version 3.2, adjusted for age, sex, and body mass index (BMI). Results: Significant differences (P < 0.05) were found in gait speed and dependency in ADL between the sarcopenia and non-sarcopenia groups after adjusting for age, sex, and BMI. BMI was significantly higher in the non-sarcopenia group whereas dependency was significantly higher in the sarcopenia group (19.6% vs. 13.8%). Results from mediation model regression analysis indicated a significant and direct detrimental effect of sarcopenia on dependency in ADL (β = −0.05; P < 0.001), and a significant indirect effect of gait speed on the direct effect (−0.009 to −0.004). Conclusions: The negative effect of sarcopenia on functional dependence was mediated by the gait speed. Therefore, gait speed may positively influence the detrimental effect of sarcopenia for dependency, after adjusting for age, gender, and BMI. Consequently, physical exercise should be promoted and focused to circumvent the gait speed decline associated with age in older people with sarcopenia.
Open Access
Sit to stand muscle power reference values and their association with adverse events in Colombian older adults
(Nature Research, 2022) Ramírez Vélez, Robinson; Izquierdo Redín, Mikel; García Hermoso, Antonio; Ordóñez-Mora, Leidy Tatiana; Cano Gutiérrez, Carlos Alberto; Campo-Lucumí, Florelba; Pérez Sousa, Miguel A.; Ciencias de la Salud; Osasun Zientziak
Recently, a valid method to assess lower-body muscle power based on a sit-to-stand feld test (STS) has been published. Our study aimed to describe lower-body muscle power in older individuals aged≥ 60 years and examine the relationship of muscle weakness with adverse events according to gender- and age-specifc muscle weakness cut-of points. A total of 3689 Colombian older adults (57.6% women, age 69.1 ± 6.9 years) from the 2015 Survey on Health, Well-Being, and Aging in Latin America and the Caribbean (SABE) participated in this study. Lower-body muscle power normalized to body mass was estimated by the fve-repetitions STS test. Anthropometric, physical performance and clinical characteristics were collected. Age-specifc percentiles using the LMS method, cut-of points and association with adverse events were calculated. Lower-body muscle power was greater in men than among women (2.2 ± 0.7 vs. 1.6 ± 0.5W·kg−1, respectively; p < 0.001) at all ages. Muscle power ranked in the 50th percentile between 2.38 and 1.30W·kg−1 in men, whereas women ranked between 1.79 and 1.21 W·kg−1. According to the cut-of points, lower-limb muscle power < 1 standard deviation in men was associated with having dynapenia, poor gait speed, cognitive impairment and mental, visual, hearing and memory problems. While, women were associated with having sarcopenia, dynapenia, poor gait speed, cognitive impairment, mental, hearing and memory problems, dementia and hospitalizations of> 24 h in the last year. Overall, participants with poor lower-limb muscle power had a signifcantly higher risk of adverse events [in men: odds ratio (OR)= 1.51, 95% confdence interval (CI) = 1.19–1.91, p < 0.001; in women: OR= 1.52, 95% CI = 1.27–1.87, p = 0.001] than their stronger counterparts. This study is the frst to describe lower-limb muscle power values and cutof points among a nationally representative sample of Colombian older adults. In men, 7 of the 14 adverse events studied were associated with lower muscle strength, whereas in women, it was 9 of the 14 adverse events.
Open Access
Role for physical fitness in the association between age and cognitive function in older adults: a mediation analysis of the SABE colombia study
(MDPI, 2021) Pérez Sousa, Miguel A.; Pozo Cruz, Jesús del; Olivares Sánchez-Toledo, Pedro Rufino; Cano Gutiérrez, Carlos Alberto; Izquierdo Redín, Mikel; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
Objectives. We investigated the association between physical fitness and cognitive status. Further, we examined whether physical fitness mediates the association between cognitive functioning and aging. Design. Cross-sectional study. Setting. Urban and rural Colombian older adults. Methods. 4416 participants from the SABE study were included in the current analysis. Physical fitness was assessed with the handgrip test and the usual gait speed test. Cognitive status was evaluated through the Folstein Mini-Mental State Examination. A parallel mediation path was used to test the possible mediator role of physical fitness between aging and cognitive functioning. Results. Older adults with lower handgrip strength (HGS) were more likely to have mild-cognitive status than older adults with healthy HGS (OR = 1.53, 95% CI = 1.15; 2.02). In addition, older adults with a slower gait speed were more likely to have mild cognitive impairment (OR = 2.05, 95% CI = 1.54; 2.78). Age had an inverse relationship with cognitive function (β = -0.110, 95% CI = -0.130; -0.100) and it was also inversely associated with HGS (β = -0.003, 95% CI = -0.005; -0.002) and gait speed (β = -0.010, 95% CI = -0.011; -0.009). The indirect effects, which indicate that the effect of age on cognitive function is transmitted through mediators, showed that both gait speed (β = -0.028, 95% CI = -0.036; -0.020) and HGS (β = -0.014, 95% CI = -0.024; -0.005) were independent mediators of the detrimental effect of aging on cognitive function. Conclusions. Physical fitness mediates the effects of aging on cognitive functioning. Our findings suggest that physical activity can be a key factor to prevent cognitive deterioration during aging process.
Open Access
Reference values for handgrip strength and their association with intrinsic capacity domains among older adults
(Wiley, 2019) Ramírez Vélez, Robinson; Correa Bautista, Jorge Enrique; García Hermoso, Antonio; Cano Gutiérrez, Carlos Alberto; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak
Objective The purposes of this study were three-fold: (i) to describe handgrip strength in older individuals aged >= 60 years in Colombia; (ii) to identify sex-specific and age-specific muscle weakness cut-off points in older adults; and (iii) to determine the odds of adverse events for each of the intrinsic capacity domains for individuals with handgrip strength greater than the muscle weakness cut-off points, as compared with their weaker counterparts. Methods A cross-sectional study was conducted in Colombia, among 5237 older adults aged >= 60 years old (58.5% women, 70.5 +/- 7.8 years), according to 'SABE Survey 2015'. Handgrip strength data were obtained with a Takei dynamometer. Sociodemographic variables, five domains of intrinsic capacity (i.e. locomotion, vitality, cognition, psychological, and sensory), and medical conditions were assessed and analyzed. Adjustments variables were age, ethnicity, socio-economic status, urbanicity, body mass index, smoking status, alcohol intake, drug use, physical activity, and co-morbid chronic diseases. Sex-stratified analyses were conducted with logistic regression models. Results Handgrip strength was greater among men than among women (26.7 +/- 8.5 vs. 16.7 +/- 5.7 kg, respectively, P < 0.001) at all ages. Weak handgrip strength cut-off points ranged from 17.4 to 8.6 and from 10.1 to 4.9 in men and women, respectively. Overall, participants with optimal handgrip strength had better intrinsic capacity [in men, odds ratio (OR) = 0.62, 95% confidence interval (CI) 0.53 to 0.71; P < 0.001; and in women, OR = 0.79, 95% CI 0.68 to 0.92; P = 0.002] than their weaker counterparts. Also, men with optimal handgrip strength had a lower risk of hospitalization (OR = 0.47, 95% CI 0.29 to 0.78; P = 0.004) than their weaker counterparts. Conclusions This study is the first to describe handgrip strength values and cut-off points for muscle weakness among a nationally representative sample of Colombian older adults by age and sex. After categorizing older adults as weak or not weak based on the handgrip cut-off points, non-weakness was associated with a decreased odds of intrinsic capacity impairments. These cut-off points may be good candidates for clinical assessment of risks to physical and mental health in older Colombian adults.
Open Access
Validation of surrogate anthropometric indices in older adults: what is the best indicator of high cardiometabolic risk factor clustering?
(MDPI, 2019) Ramírez Vélez, Robinson; Pérez Sousa, Miguel A.; Izquierdo Redín, Mikel; Cano Gutiérrez, Carlos Alberto; González Jiménez, Emilio; Schmidt Río-Valle, Jacqueline; González Ruiz, Katherine; Correa Rodríguez, María; Ciencias de la Salud; Osasun Zientziak
The present study evaluated the ability of five obesity-related parameters, including a body shape index (ABSI), conicity index (CI), body roundness index (BRI), body mass index (BMI), and waist-to-height ratio (WtHR) for predicting increased cardiometabolic risk in a population of elderly Colombians. A cross-sectional study was conducted on 1502 participants (60.3% women, mean age 70 ± 7.6 years) and subjects’ weight, height, waist circumference, serum lipid indices, blood pressure, and fasting plasma glucose were measured. A cardiometabolic risk index (CMRI) was calculated using the participants’ systolic and diastolic blood pressure, triglycerides, high-density lipoprotein and fasting glucose levels, and waist circumference. Following the International Diabetes Federation definition, metabolic syndrome was defined as having three or more metabolic abnormalities. All surrogate anthropometric indices correlated significantly with CMRI (p < 0.01). Receiver operating characteristic curve analysis of how well the anthropometric indices identified high cardiometabolic risk showed that WtHR and BRI were the most accurate indices. The best WtHR and BRI cut-off points in men were 0.56 (area under curve, AUC 0.77) and 4.71 (AUC 0.77), respectively. For women, the WtHR and BRI cut-off points were 0.63 (AUC 0.77) and 6.20 (AUC 0.77), respectively. In conclusion, BRI and WtHR have a moderate discriminating power for detecting high cardiometabolic risk in older Colombian adults, supporting the idea that both anthropometric indices are useful screening tools for use in the elderly.
Open Access
Relative handgrip strength diminishes the negative effects of excess adiposity on dependence in older adults: a moderation analysis
(MDPI, 2020) Ramírez Vélez, Robinson; Pérez Sousa, Miguel A.; García Hermoso, Antonio; Zambom Ferraresi, Fabrício; Martínez Velilla, Nicolás; López Sáez de Asteasu, Mikel; Cano Gutiérrez, Carlos Alberto; Rincón Pabón, David; Izquierdo Redín, Mikel; Ciencias de la Salud; Osasun Zientziak; Universidad Pública de Navarra / Nafarroako Unibertsitate Publikoa
The adverse effects of fat mass on functional dependence might be attenuated or worsened, depending on the level of muscular strength. The aim of this study was to determine (i) the detrimental effect of excess adiposity on dependence in activities of daily living (ADL), and (ii) whether relative handgrip strength (HGS) moderates the adverse effect of excess adiposity on dependence, and to provide the threshold of relative HGS from which the adverse effect could be improved or worsened. A total of 4169 participants (69.3 +/- 7.0 years old) from 244 municipalities were selected following a multistage area probability sampling design. Measurements included anthropometric/adiposity markers (weight, height, body mass index, waist circumference, and waist-to-height ratio (WHtR)), HGS, sarcopenia 'proxy' (calf circumference), and ADL (Barthel Index scale). Moderation analyses were performed to identify associations between the independent variable (WHtR) and outcomes (dependence), as well as to determine whether relative HGS moderates the relationship between excess adiposity and dependence. The present study demonstrated that (i) the adverse effect of having a higher WHtR level on dependence in ADL was moderated by relative HGS, and (ii) two moderation thresholds of relative HGS were estimated: 0.35, below which the adverse effect of WHtR levels on dependency is aggravated, and 0.62, above which the adverse effect of fat on dependency could be improved. Because muscular strength represents a critically important and modifiable predictor of ADL, and the increase in adiposity is inherent in aging, our results underscore the importance of an optimal level of relative HGS in the older adult population.
Open Access
Glucose levels as a mediator of the detrimental effect of abdominal obesity on relative handgrip strength in older adults
(MDPI, 2020) Pérez Sousa, Miguel A.; Pozo Cruz, Jesús del; Cano Gutiérrez, Carlos Alberto; Izquierdo Redín, Mikel; Ramírez Vélez, Robinson; Ciencias de la Salud; Osasun Zientziak; Gobierno de Navarra / Nafarroako Gobernua
Excess central adiposity accelerates the decline of muscle strength in older people. Additionally, hyperglycemia, independent of associated comorbidities, is related to the loss of muscle mass and strength, and contributes to functional impairment in older adults. We studied the mediation effect of glucose levels, in the relationship between abdominal obesity and relative handgrip strength (HGS). A total of 1571 participants (60.0% women, mean age 69.1 +/- 7.0 years) from 86 municipalities were selected following a multistage area probability sampling design. Measurements included demographic and anthropometric/adiposity markers (weight, height, body mass index, and waist circumference). HGS was measured using a digital dynamometer for three sets and the mean value was recorded. The values were normalized to body weight (relative HGS). Fasting glucose was analyzed by enzymatic colorimetric methods. Mediation analyses were performed to identify associations between the independent variable (abdominal obesity) and outcomes (relative HGS), as well as to determine whether fasting glucose levels mediated the relationship between excess adiposity and relative HGS. A total of 1239 (78.8%) had abdominal obesity. Abdominal obesity had a negative effect on fasting glucose (beta = 9.04, 95%CI = 5.87 to 12.21); while fasting glucose to relative HGS was inversely related (beta = -0.003, 95%CI = -0.005 to -0.001),p< 0.001. The direct effect of abdominal obesity on relative HGS was statistically significant (beta = -0.069, 95%CI = -0.082 to -0.057),p< 0.001. Lastly, fasting glucose levels mediates the detrimental effect of abdominal obesity on relative HGS (indirect effect beta = -0.002, 95%CI = -0.004 to -0.001),p< 0.001. Our results suggest that the glucose level could worsen the association between abdominal obesity status and lower HGS. Thus, it is plausible to consider fasting glucose levels when assessing older adults with excess adiposity and/or suspected loss of muscle mass.
Open Access
Obesity-and lipid-related parameters in the identification of older adults with a high risk of prediabetes according to the American diabetes association: an analysis of the 2015 health, well-being, and aging study
(MDPI, 2019) Ramírez Vélez, Robinson; Pérez Sousa, Miguel A.; González Ruiz, Katherine; Cano Gutiérrez, Carlos Alberto; Schmidt Río-Valle, Jacqueline; Correa Rodríguez, María; Izquierdo Redín, Mikel; Romero García, Jesús Astolfo; Campos Rodríguez, Adriana Yolanda; Triana Reina, Héctor Reynaldo; González Jiménez, Emilio; Ciencias de la Salud; Osasun Zientziak
This study evaluated the predictive ability of 11 obesity-and lipid-related parameters, including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WtHR), body roundness index (BRI), 'A' body-shape index (ABSI), conicity index (CI), visceral adiposity index (VAI), triglyceride-to-glucose fasting index (TyG), triglyceride-to-glucose fasting related to BMI (TyG-BMI), triglyceride-to-glucose fasting related to WC (TyG-WC), and triglyceride-to-glucose fasting related to WtHR (TyG-WtHR), to identify patients from an elderly Colombian population with a high risk of prediabetes according to the 2016 American Diabetes Association criteria. The data were obtained from the 2015 Colombian Health and Wellbeing and Aging Survey. A total of 3307 elderly Colombian individuals (aged over 60 years) were included. Anthropometric data, fasting plasma glucose, blood lipid profiles, family history, and health-related behaviors were assessed, and prediabetes was defined as a fasting plasma glucose of 100 to 125 mg/dL. The areas under the receiver operating characteristic (ROC) curves (AUCs) were calculated for each anthropometric indicator, using the prediabetes classification to identify their sensitivity and specificity, and these indicated that the prevalence of prediabetes was 25.3% in this population. After adjusting for potential confounding factors, the TyG index was strongly associated with the odds of having prediabetes in both sexes, and multivariate logistic regression analysis showed that the ORs for prediabetes increased across quartiles (p < 0.001). The TyG index was best able to identify prediabetes in either sex (AUC and optimal cut-off = 0.700 and 8.72, and 0.695 and 8.92 for men and women, respectively), suggesting that compared to the other parameters, the TyG index has the best discriminative power to predict prediabetes in the whole population. Thus, we propose the TyG index be used as a complementary marker for assessing prediabetes in older adults.