BackgroundWe assessed the association between activities of daily living (ADL) and mortality among nursing home residents in Japan.MethodsThis 1-year prospective cohort study investigated 8902 elderly adults in 140 nursing homes. Baseline measurements included age, sex, height, weight, body mass index (BMI), ADL, and dementia level. ADL levels were obtained by caregivers, using the Barthel Index (BI), after which total BI scores were calculated (higher scores indicate less dependence). Information on dates of discharge and mortality was also obtained to calculate person-years. The Cox proportional hazards model was used to estimate hazard ratios (HRs).ResultsMean age was 84.3 years, and mean total BI score was 38.5. The HRs of mortality adjusted for sex, age, BMI, and type of nursing home were 7.6 (95% CI: 3.3–17.8) for those with a BI score of 0 (totally dependent), 3.9 (1.7–9.0) for those with a score of 1 to 10, 3.5 (1.4–8.7) for those with a score of 11 to 40, 2.7 (1.4–5.1) for those with a score of 41 to 70, and 1.3 (0.7–2.4) for those with a score of 71 to 99 (P for trend <0.001), as compared with those with a score of 100. Multivariate analysis revealed that BI, sex, age, and BMI were significantly associated with mortality rate.ConclusionsThere was a clear inverse association between ADL level and mortality. In conjunction with other risk factors, ADL level might effectively predict short-term mortality in institutionalized elderly adults.
This 2-year cohort study has demonstrated that a decrease in serum albumin levels is associated with a decrease in ADL levels. A third factor may play a role in adversely affecting both serum albumin and ADL levels in frail elderly people.
Background: Growth pattern in early life is one of the most important factors affecting the pathogenesis of metabolicassociated diseases. The associations between serum uric acid (SUA) and hypertension, kidney disease, and coronary heart disease have been recognized. We investigated the association between increased BMI during childhood and adult SUA levels in Japan. Methods: We included 298 children with health examination data between 1981 and 2002 who had also undergone physical examinations after reaching early adulthood (approximately 27 y old). Subjects were divided into sex-specific tertiles based on the difference in their BMI (DBMI) over a 6-y period (6-12 y of age). The association between the three DBMI groups and SUA in adults was analyzed. results: The predicted average SUA level in adults from the high DBMI group was 5.32 mg/dl after adjustment for related factors in a combined sex analysis. This was significantly higher than among the low DBMI group. conclusion: Excessive BMI increases during childhood led to young adult SUA elevation even after adjusting for several factors. Lifestyle in early life may be a strong predictor of future uric acid metabolism and the resulting disease risk. i t has been well recognized that uric acid causes gout and is one of the markers for several lifestyle-related diseases. Since the 1950s, the associations between serum uric acid (SUA) and hypertension (1), kidney diseases (2), and coronary heart disease (3) have been recognized. Increased SUA level may be an independent risk factor for chronic kidney disease (4,5), stroke (6), coronary heart disease (7), and cardiovascular diseases (8). Moreover, some studies have shown that SUA is a risk factor for metabolic syndrome among children and adolescents (9,10). These findings suggest that prevention of SUA level elevation in early life has a potential protective effect.The association between SUA and obesity is also well known. Overweight and obesity among children have been globally recognized as a public health concern. Recently, growth pattern during early life, not merely a single assessment of childhood body weight or BMI, is considered to be one of the most important risk factors for the pathogenesis of metabolic-associated diseases (11)(12)(13)(14)(15)(16)(17). However, to the best of our knowledge, no study has evaluated the association between early-life growth patterns and SUA levels later in life. Therefore, we investigated the association between increased BMI during childhood and subsequent SUA level during early adulthood in Japan. METHODS Study Population and DesignThe Japanese law mandates annual physical examinations for students in all schools in Japan. We obtained anonymous secondary data from these examinations from towns A and B in Nagano Prefecture, with populations of approximately 11,000 and 5,000, respectively, in 2015. Previously, we performed a similar linkage study in town A to investigate the association between an increase in BMI during 6 y of primary school and blood pressure in adolesce...
There was a clear inverse dose-dependent relationship between BMI and mortality. Future studies should be conducted to determine the effects of nutritional intervention on mortality in institutionalized elderly adults.
The aim of this study was to clarify the relationship between long-term changes in body mass index (BMI) during childhood and adolescent blood-pressure levels in a general Japanese population. We used health report data from 900 Japanese children between 1983 and 2007. After adjusting for baseline BMI and other confounding factors multivariate linear regression analyses were performed to examine the relationship between changes in BMI (ΔBMI) over a 6-year period (6-12 years) and blood pressure once children reached ages 14 or 15. Sub-group analyses were also performed to ascertain the relationship between ΔBMI and blood pressure at 9th grade for children who had been in the bottom BMI tertile at 1st grade. Endpoint blood-pressure levels in boys (systolic and diastolic) and girls (systolic) from the group whose BMIs increased the most were significantly higher than those from the group whose BMIs increased the least (P<0.05, analysis of variance). After adjustment for baseline BMI and school-entrance year, the former group showed higher blood pressure at the endpoint than the latter (P<0.05, multiple regression analysis). Further adjustment for baseline blood pressure also showed similar results in a combined-sex analysis (n=592). Higher ΔBMI was associated with higher SBP9 even in children whose BMI was in the lowest tertile at baseline after adjustment for sex and school-entrance year (P=0.02, multiple regression analysis). Steeper BMI increases during primary school lead to adolescent increases in blood pressure even if baseline BMI is low. Growth during childhood should be carefully managed.
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