BackgroundThere are many reports that dynapenia, sarcopenia and frailty each have associations with bodily function or with Instrumental Activities of Daily Living (IADL). However, studies that compare all three conditions and their effects on IADL are lacking. The purpose of this study is to examine associations of sarcopenia, frailty, and dynapenia with IADL.MethodsParticipants included 123 community-dwelling older adults (31 men, 92 women,) aged 65 years or older (75.0 ± 5.3 years) who were independent in IADL. In terms of physical function, measurements were performed for muscle mass, grip strength, walking speed, isometric knee extension strength, and unipedal standing. A questionnaire survey was carried out, the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) was administered, and participants were asked about sense of fatigue and amount of activity.ResultsDynapenia was associated with classifications of both frailty and sarcopenia. In addition, sarcopenia had a sensitivity and specificity for dynapenia of 33 and 89%, respectively. Frailty had a sensitivity and specificity for dynapenia of 17 and 98%, respectively. Dynapenia was a significant independent related factor for the TMIG-IC (β = −0.21, P < 0.05).ConclusionsDynapenia, more than sarcopenia or frailty, was related to difficulties with IADL; therefore, assessment of dynapenia should be given greater emphasis in evaluating the physical functioning of older adults.
Transforming growth factor-beta 1 (TGF-beta 1) is a primary determinant of the mesangial expansion observed in diabetic nephropathy. In this study, we quantitated the levels of intraglomerular TGF-beta 1 mRNA in patients with diabetes mellitus using a competitive polymerase chain reaction (PCR) method. Renal biopsy specimens were obtained from 29 patients with non-insulin-dependent diabetes mellitus. Total RNA was extracted from the glomeruli and reverse transcribed into cDNA with reverse transcriptase. To prepare samples containing identical amounts of beta-actin cDNA (8 pg), we performed competitive PCR by co-amplifying mutant templates of beta-actin with a unique EcoRI site. We also used this competitive PCR method to measure TGF-beta 1 cDNA by co-amplifying mutant templates of TGF-beta 1. We observed higher expression of TGF-beta 1 mRNA in glomeruli of patients with diabetic nephropathy as compared with normal glomeruli. Intraglomerular TGF-beta 1 mRNA was elevated, even in the early stage of diabetic nephropathy. Moreover, levels of intraglomerular TGF-beta 1 mRNA correlated with values of HbA1c. These data suggest that hyperglycemia induces intraglomerular TGF-beta 1 mRNA expression in vivo, and that TGF-beta 1 overproduction may be associated with the progression of diabetic nephropathy.
OBJECTIVE -To investigate whether advanced glycation end products (AGEs) participate in the development of coronary artery disease (CAD) in nondiabetic and diabetic subjects.RESEARCH DESIGN AND METHODS -Serum concentrations of AGEs were measured using a newly established enzyme-linked immunosorbent assay in 48 nondiabetic patients (normal glucose tolerance, n ϭ 20; impaired glucose tolerance, n ϭ 28) who received coronary angiography for the study of chest pain or suspected CAD. Insulin sensitivity was examined by the euglycemic-hyperinsulinemic glucose clamp technique and was estimated as the mean glucose infusion rate during the last 30 min of clamp time (M value).RESULTS -Patients were classified into four groups based on the number of significantly stenosed vessels, defined as 0-, 1-, 2-, or 3-vessel disease. Serum concentrations of AGEs were significantly higher in nondiabetic subjects with CAD than in control subjects (2.42 Ϯ 0.65 vs. 1.96 Ϯ 0.40 mU/ml, P Ͻ 0.01) and significantly correlated with the number of significantly stenosed vessels (r ϭ 0.678, P Ͻ 0.001). M values significantly inversely correlated with serum concentrations of AGEs (r ϭ Ϫ0.490, P Ͻ 0.05). In multiple regression analysis, with the number of significantly stenosed vessels as the dependent variable, serum concentrations of AGEs, 2-h plasma glucose, and areas under the plasma glucose response curve were independently associated.CONCLUSIONS -This pilot study indicates the relation between AGEs and the severity of CAD in nondiabetic patients. The measurement of serum AGE concentrations may be predictive of vascular damage.
The target protein FSP1 identifies human fibroblasts and tubular epithelium undergoing EMT, and distinguishes them from the diaspora of alpha-SMA+ vascular smooth muscle cells. FSP1+ fibroblasts are critically related to the progression of IgAN; consequently, staining FSP1 in renal biopsy specimens provides a valuable histologic index of progression.
To clarify whether beta-cell function and/or insulin resistance contributes to the shape of plasma glucose curve during an oral glucose tolerance test (OGTT), we investigated 583 Japanese subjects with normal glucose tolerance (NGT, n = 306) or impaired glucose tolerance (IGT, n = 277). Each subject was subdivided into three shapes of plasma glucose curve as follows: monophasic pattern (M type), biphasic pattern (B type) and two peaks (T type). Homeostasis model assessment of insulin resistance, quantitative insulin sensitivity check index and insulinogenic index were assessed by plasma glucose and insulin concentrations obtained at fasting or during an OGTT. There was a greater proportion of M type in the IGT group (M = 80.9%, B = 15.5% and T = 3.6%), whereas the prevalence of B and T types was much higher in the NGT group (M = 66.6%, B = 26.5% and T = 6.9%). There were significant differences in the proportions of shape types between the NGT and IGT groups (p = 0.0006). Among the NGT category, insulin sensitivity was significantly higher in the B type than in the M type, and beta-cell function adjusted for insulin resistance was significantly higher in the B and T types than in the M type. Among the IGT category, no significant differences were seen among the three shape types with respect to insulin sensitivity, but the beta-cell function adjusted for insulin resistance was significantly lower in the M type than in the B and T types. In conclusion, both impaired insulin secretion and insulin resistance may contribute to the underlying mechanisms of the shape of plasma glucose curve in Japanese subjects.
Frail older adults had a significant lower HRQOL, as well as lower mental well-being, independent of age, diabetes, macrovascular complication, kidney dysfunction and depressed mood.
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