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Accelerometer-measured sedentary time accumulation patterns and cardiometabolic risk severity in community-dwelling older adults: A cross-sectional study | BMC Geriatrics

by Dr. Michael Lee – Health Editor
written by Dr. Michael Lee – Health Editor

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    Health

    The association between neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, red blood cell distribution width, and physical function in elderly non-dialysis patients with chronic kidney disease | BMC Geriatrics

    by Dr. Michael Lee – Health Editor
    written by Dr. Michael Lee – Health Editor

    Inflammation Linked to Decline in Physical Function for Kidney Patients

    New research highlights role of inflammatory markers in compromised health

    A growing body of scientific literature suggests a significant connection between chronic inflammation and a decline in physical capabilities among individuals with chronic kidney disease (CKD). This connection impacts daily living activities and overall health outcomes.

    Understanding the Inflammation-Frailty Nexus

    Several studies point to the role of systemic inflammation in exacerbating frailty and sarcopenia, conditions characterized by loss of muscle mass and strength. Research by T.J. Wilkinson and colleagues in 2022 explored the relationship between frailty trajectories and outcomes in CKD patients, finding associations with cardiovascular, renal, and mortality risks. Similarly, a 2021 study by M.D. Yu and team established a link between CKD and sarcopenia, further underscoring the muscle-wasting aspect of the disease.

    The body’s inflammatory response, often measured by specific biomarkers, appears to play a crucial role. Studies have investigated ratios like the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as indicators of inflammation. For instance, a 2021 meta-analysis by G. Ao and colleagues found that an elevated NLR is associated with increased risk of cardiovascular and all-cause mortality in those with CKD.

    Key Inflammatory Markers and Their Impact

    Specific markers like C-reactive protein (CRP) and red blood cell distribution width (RDW) are also being examined. Research published in 2022 by Q. Hu and associates indicated that high NLR and PLR are linked to sarcopenia risk in renal cell carcinoma patients. Another study in 2021 by Y. Sakai and team revealed that elevated RDW is associated with poorer outcomes in osteoporotic vertebral fractures, a condition that can affect individuals with CKD.

    Furthermore, findings from a 2020 study by C.M. Li and colleagues demonstrated that elevated RDW is independently linked to a higher risk of frailty in community-dwelling older adults. The concept of “inflammaging,” or age-related chronic low-grade inflammation, as proposed by C. Franceschi and team in 2000, provides a broader context for understanding these associations.

    Assessing Functional Independence

    The impact of these conditions on daily life is significant. Studies have utilized tools like the Barthel Index to measure functional independence in various patient groups. For example, a 2022 study by V. Dos Santos Barros and colleagues found the Barthel index to be a valid measure for cancer patients in palliative care. In the context of CKD, preserving activities of daily living (ADLs) is crucial for patient outcomes. Research by Y. Uemura and team in 2018 highlighted the prognostic impact of preserved ADLs in patients with acute heart failure.

    Future Directions and Clinical Applications

    The ongoing investigation into these inflammatory markers and their connection to physical function in CKD patients could lead to improved diagnostic tools and therapeutic strategies. Understanding these relationships is vital for developing interventions aimed at preserving physical function and improving the quality of life for individuals managing chronic kidney disease.

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    Health

    Content Writing Tips: Improve Your Skills & Productivity

    by Dr. Michael Lee – Health Editor
    written by Dr. Michael Lee – Health Editor

    In this study, we investigated the association of general and central obesity with bone strength and compared their association with vertebral fractures. We found that obesity indices were positively associated with bone density, but negatively associated with TBS. Among the different combinations of general and central obesity, general obesity measured using body fat percentage without central obesity was not associated with vertebral fractures. Furthermore, central obesity, assessed by waist circumference and waist-hip ratio, was still associated with vertebral fractures, irrespective of general obesity. Therefore, central obesity was more strongly associated with vertebral fractures than general obesity.

    Previous studies have shown that general and central obesity indices were positively associated with spinal BMD[[4]and that the correlation coefficient of fat mass was higher than that of other obesity indices, similar to our results. Additionally, we found that ALM was positively associated with BMD and that ALM contributed to BMD in both men and women[[4, 16]. Therefore, maintaining ALM is important for bone health. The National Institutes of Health defines bone strength as the integration of bone density and quality[[17]. TBS is a commonly used non-invasive method for evaluating bone quality. Our results demonstrated that general and central obesity indices were negatively associated with the TBS. In the literature, increased soft tissue over the region of interest (lumbar spine) resulted in differences in the spinal BMD and TBS. Although BMD was affected, it was unlikely to lead to a clinical problem because the change did not exceed the least significant change[[18]. In contrast, increased soft tissue thickness resulted in a lower TBS value[[18, 19]. The correlation with waist circumference was therefore stronger in our study, which was consistent with the results of a previous study[[20]. Shevroja et al. developed a soft tissue-adjusting technique for computing the TBS, and showed that obesity indices were positively correlated with the TBS, indicating better bone quality[[19]. However, accumulating evidence supports the association between obesity and compromised bone quality[[21]. Cohen et al. also reported that central obesity was associated with inferior bone quality, as measured by trans-iliac crest bone biopsy[[22]. Further studies are required to determine which TBS algorithm is the most suitable for evaluating obesity.

    Accumulating evidence has challenged the protective effects of obesity against fractures, and the association between obesity and fractures appears to be site-dependent. However, studies investigating the association between general obesity and vertebral fractures have yielded conflicting results. Prieto-Alhambra et al. reported that general obesity, measured using BMI, was not associated with vertebral fractures[[7], whereas Liu et al. found that general obesity, assessed using BMI, was associated with an increased risk of vertebral fractures[[8]. Additionally, different diagnostic measures for assessing obesity may affect its association with fractures. Gandham et al. reported that general obesity, based on body fat percentage, was associated with fractures, whereas obesity measured using BMI was not;[[23]this finding was consistent with our results.

    Several studies have investigated the association between general obesity and fractures. However, few have examined the association between central obesity and vertebral fractures. In the Nurses’ Health Study, women aged 30–55 years with central obesity (measured using waist circumference ≥ 108 cm) showed an increased risk of vertebral fractures[[24]. Another prospective study in the South Korean population aged ≥ 40 years reported that central obesity (assessed using waist circumference: men ≥ 90 cm and women ≥ 85 cm) was positively associated with the risk of vertebral fracture[[9]. Similarly, in a prospective study with subjects aged > 50 years in China, central obesity (based on waist circumference: men > 90 cm, women > 80 cm; waist-hip ratio: men > 0.9, women > 0.85) was associated with a higher risk of subsequent vertebral fractures[[25]. In our study, postmenopausal women with both general and central obesity showed the highest likelihood of vertebral fractures and central obesity (measured using waist circumference ≥ 80 cm and waist-hip ratio ≥ 0.85) showed a stronger association with vertebral fractures than general obesity.

    Several studies have proposed explanations for the association between central obesity and fractures. First, individuals with obesity, particularly central obesity, may have a higher risk of falling[[26]. Second, central obesity may place a higher burden on the spine and increase impact force despite the protective effect of soft tissue pads[[27, 28]. Third, visceral fat adversely affected bone quality by altering bone-regulating hormone levels, oxidative stress, and inflammation[[21, 22]. Fourth, the distribution of body fat, especially in central obesity, can potentially have different effects on the bone[[2], and compared to general obesity, central obesity may increase the risk of vertebral fracture. The relationship between obesity and fractures is a complex and multifaceted issue, and further studies are required to clarify the underlying mechanisms.

    This study had the strength in using various common diagnostic measures for assessing general and central obesity that can be applied in clinical practice. To the best of our knowledge, this study is the first to compare the association of different combinations of general and central obesity indices with vertebral fractures. However, our study had several limitations. First, this was a cross-sectional study; therefore, the causal inferences between obesity and vertebral fractures could not be made. Second, the participants in our study were limited to the Asian population, and obesity was defined by Asian criteria, which may have affected the generalizability of our results. Third, the association between obesity and fractures is site-specific. In our study, we focused only on vertebral fractures, and further investigation of different fracture sites is required to reveal additional relationships. Fourth, in this study, vertebral compression fractures were confirmed using radiological reports. While X-rays are not sensitive enough to detect occult fractures, they are the most accessible tool for assessing compression fractures, especially when compared to CT or MRI, which are less readily available due to higher costs and limited accessibility. Fifth, our study only included postmenopausal women. Therefore, our results may not apply to men or premenopausal women. Further studies involving diverse populations are needed to confirm our findings.

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