The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes. Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality. The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03–1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01–2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48–1.13, P = .15). Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.
Este estudo visou verificar se havia associação entre o nível de atividade físico-funcional auto-referido e o desempenho físico de idosas em centro de reabilitação. Foram selecionadas 37 mulheres idosas (com em média 72,7±5,9 anos) pelas fichas de admissão em serviço de atividade física de um centro de referência em reabilitação. Para a avaliação do nível de atividade física auto-referido empregou-se o Perfil de Atividade Humana (PAH); na observação direta de desempenho físico aplicaram-se os testes de caminhada em 6 minutos (TC6') e levantar da cadeira em 30 segundos (TSL30"). Foi encontrada correlação positiva fraca (r=0,41) e estatisticamente significante (p=0,01) entre os valores do PAH e o TC6'; e uma tendência de associação entre a classificação do nível de atividade e a variável categórica TC6' (p=0,08). Também foi encontrada correlação positiva fraca (r=0,36) e estatisticamente significante (p=0,02) entre o PAH e o TSL30". Pode-se afirmar que o auto-relato de nível de atividade física das idosas estudadas correlaciona-se, porém fracamente, ao desempenho físico observado. Sugerem-se novas pesquisas com amostras representativas da população idosa em uma comunidade, não apenas de pacientes de centro de reabilitação, para averiguar possíveis tendências à subestimação ou superestimação do nível de atividade física em avaliações auto-referidas.
Background There is considerable variability in the incidence of hip fracture among countries, even among different geographical areas within the same country. In Brazil, population differences in occurrence of hip fracture are probably related to the huge size of the country, the substantial ethnical miscegenation and distinct lifestyle habits within the Brazilian territory. Longitudinal studies on incidence of hip fracture in the Brazilian population are scarce and the results are hampererd by incomplete capture of cases and short follow-up time. Moreover, there is no prospective study on incidence of non-vertebral fractures beyond the hip. Objectives To describe the incidence of hip and non-vertebral fracture in elderly community from a prospective population-based study. Methods Incidence of hip and non-vertebral fracture were determined in 707 women and men from community, aged 65 years or older. Specific questionnaire (clinical and anthropometric data), including personal history of fragility fracture in non-vertebral osteoporotic sites (hip, humerus, wrist, rib) was performed at baseline and after an average of 4.3 years. All incident fractures during the study period were confirmed by radiograph of the affected site. Results 449 women (mean age 72.9±4.8 years) and 258 men (mean age 72.3±4.7 years) were included in the study. The age-adjusted incidence of non-vertebral fracture was 1710/100,000 person-years in women and 630/100,000 person-years in men (female/male ratio: 2.6). The age-adjusted incidence of hip fracture was 420/100.000 person-years in women and 90/100,000 person-years in men (female/male ratio: 4.7). The incidence increases with age, particularly in women. Conclusions The incidence of non-vertebral osteoporotic fracture in the elderly population was high, especially among women. Concerning hip fracture, these results emphasize that the incidence in the southern and southeastern regions of the country seems to be higher than the rates in the northern/northeastern population. Furthermore, our results reinforce the notion that the incidence of hip fracture in Brazilian older adults, particularly in women, is higher than in other Latin American populations, except Argentina. References Kanis JA, Odén A, McCloskey EV, Johansson H, Wahl DA, Cooper C; IOF WorkingGroup on Epidemiology and Quality of Life. A systematic review of hip fractureincidence and probability of fracture worldwide. Osteoporos Int. 2012;23(9):2239-56. Schwartz AV, Kelsey JL, Maggi S, Tuttleman M, Ho SC, Jόnsson PV, Poόr G,Sisson de Castro JA, Xu L, Matkin CC, Nelson LM, Heyse SP. International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for Research on Aging. Osteoporos Int. 1999;9(3):242-53. Castro da Rocha FA, Ribeiro AR. Low incidence of hip fractures in an equatorial area. Osteoporos Int. 2003;14(6):496-9. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5061
Background In contrast to hip fracture, prospective data about the incidence of osteoporotic vertebral fracture are scarce and all studies were originated from developed countries. No consistent data on incidence of vertebral fractures have been reported in low and middle income countries where the population ageing has been faster. Objectives To describe the incidence and predictors of radiographic vertebral fracture in a population-based cohort of Brazilian older adults. Methods 707 community-dwelling older subjects aged over 65 years (449 women, mean age 72.9±4.8 years, and 258 men, mean age 72.3±4.7 years), were studied. Spinal radiographs were obtained at baseline and after a mean follow-up of 4.3 years. Using the semiquantitative method, new vertebral fracture was considered as a distinct alteration in morphology of vertebral body resulting in higher grade (grade 1–3) when the radiograph was compared to the same vertebrae on the baseline. Clinical data obtained by specific questionnaire, bone mineral density measurement (BMD) by DXA and laboratorial bone exams were also performed at baseline. Multivariate Poisson regression models were used to identify independent predictors of vertebral fracture. Results After a mean 4.3±0.8 years of follow-up, the age standardized incidence of vertebral fracture was 40.3/1000 person years (pyr) in women and 30.6/1000 pyr in men. The incidence increased with age, mainly in women. In women, the final Poisson regression revealed three possible models of independent predictors of fracture: 1. age (RR 2.46, 95% CI 1.66-3.65, p<0.001, per each 10-year increase), prior osteoporotic fracture (RR 1.65, 95% CI 1.00-2.71, p=0.049) and BMD at lumbar spine (RR 1.21, 95% CI 1.03-1.41, p=0.017, per each 1 SD reduction at BMD); 2. age (RR 2.25, 95% CI 1.52-3.34, p<0.001) and femoral neck BMD (RR 1.42, 95% CI 1.11-1.81, p=0.006); and 3. age (RR 2.11, 95% CI 1.41-3.15, p<0.001) and BMD at total hip (RR 1.56, 95% CI 1.21-2.01, p=0.001). Although the risk ratios were of borderline significance, highest quartile of serum CTX (>0.440ng/mL) (RR 1.96, 95% CI 0.98-3.91, p=0.057) and prior osteoporotic fracture (RR 2.10, 95% CI 1.00-4.39, p=0.050) were independent predictors of new fracture in men. A new multivariate analysis excluding mild (grade 1) vertebral deformities retained total hip BMD (RR 1.46, 95% CI 1.02-2.09, p=0.038) and calcium intake from dairy product consumption (RR 1.19, 95% CI 1.02-1.39, p=0.028, per each decrease of 100mg/day) as independent risk factors for moderate/severe fracture in women, whereas BMD at total hip (RR 2.01, 95% CI 1.04-3.88, p=0.038) was the strongest predictor of moderate/severe fracture in men. Conclusions This is the first population-based study to ascertain the incidence of vertebral fracture in elderly in Latin America. The data confirm the high frequency of the disorder in Brazilian older adults and the rise in incidence with age. Age, BMD, prior fracture and bone turnover were predictors of short-term incidence of vertebral fracture. These r...
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