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Context The Study to Understand Fall Reduction and Vitamin D in You (STURDY), a randomized trial enrolling older adults with low 25-hydroxyvitamin D [25(OH)D], demonstrated vitamin D supplementation ≥ 1000 IU/day did not prevent falls compared with 200 IU/day, with doses ≥ 2000 IU/day potentially showing safety concerns. Objective To examine associations of achieved and change in 25(OH)D concentrations after 3 months of vitamin D supplementation with fall risk. Design Observational analysis of trial data. Setting General community. Participants A total of 637 adults aged ≥ 70 with baseline 25(OH)D concentrations 10 to 29 ng/mL and elevated fall risk. Three-month on-treatment absolute 25(OH)D; absolute and relative changes from baseline. Main Outcome Measures Incident first fall (primary) and first consequential fall (injury or sought medical care) up to 24 months. Cox models were adjusted for sociodemographics, season, Short Physical Performance Battery, and body mass index. Results At baseline, mean (SD) age was 77.1 (5.4) years and 25(OH)D was 22.1 (5.1) ng/mL; 43.0% were women and 21.5% non-White. A total of 395 participants experienced ≥ 1 fall; 294 experienced ≥ 1 consequential fall. There was no association between absolute achieved 25(OH)D and incident first fall (30-39 vs Conclusion Achieved 25(OH)D concentration after supplementation was not associated with reduction in falls. Risk of consequential falls may be increased with achieved concentrations ≥ 40 ng/mL. Trial Registration ClinicalTrials.gov: NCT02166333

Background Body composition often changes with age. While body mass index (BMI) is used to define obesity, the degree to which BMI accurately or consistently reflects fatness in older versus younger adults remains unclear. Importantly, it is uncertain whether diabetes risk is similar for older versus younger adults within BMI-defined categories. Objectives We evaluated the relationship of older (≥65 years) versus younger age ( Design: Participants without diabetes at first DXA visit in the Baltimore Longitudinal Study of Aging were included. Linear regression models were used to investigate the association of age categories to body composition at baseline, and Cox proportional hazard models were used to study the relationship of age categories to incident diabetes, within BMI categories for men and women. Diabetes was defined based on self-reported history, medication use, and/or ADA diagnostic criteria (fasting or 2-hour OGTT glucose levels). Results A total of 993 men (n=463 older, n=530 younger) and 1109 women (n=385 older, n=724 younger) were examined. Comparing older versus younger participants, body weight was significantly lower across all BMI categories for both men and women (all p Conclusions In our study, sex differences were observed in the relationship of older versus younger age to several measures of body composition, suggesting greater relative fat mass with aging, particularly in men. Further, our results suggest that BMI-defined categories for overweight and obesity do not fully account for changes in fat mass with aging and that the risk for diabetes is significantly greater for older compared to younger obese men. Further studies are needed to investigate the optimal BMI thresholds that predict diabetes risk in older adults. Presentation: Sunday, June 12, 2022 12:15 p.m. - 12:30 p.m.

ObjectiveTo develop clinical practice guidelines for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) and type 2 diabetes mellitus (T2DM) in individuals at metabolic risk for developing these conditions.ConclusionsHealth care providers should incorporate regular screening and identification of individuals at metabolic risk (at higher risk for ASCVD and T2DM) with measurement of blood pressure, waist circumference, fasting lipid profile, and blood glucose. Individuals identified at metabolic risk should undergo 10-year global risk assessment for ASCVD or coronary heart disease to determine targets of therapy for reduction of apolipoprotein B–containing lipoproteins. Hypertension should be treated to targets outlined in this guideline. Individuals with prediabetes should be tested at least annually for progression to diabetes and referred to intensive diet and physical activity behavioral counseling programs. For the primary prevention of ASCVD and T2DM, the Writing Committee recommends lifestyle management be the first priority. Behavioral programs should include a heart-healthy dietary pattern and sodium restriction, as well as an active lifestyle with daily walking, limited sedentary time, and a structured program of physical activity, if appropriate. Individuals with excess weight should aim for loss of ≥5% of initial body weight in the first year. Behavior changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers. Pharmacological and medical therapy can be used in addition to lifestyle modification when recommended goals are not achieved.

Context Older adults have the greatest burden of diabetes; however, the contribution of age-related muscle loss to its development remains unclear. Objective We assessed the relationship of lean body mass with aging to incident diabetes in community-dwelling adults. Design and Setting We studied participants in the Baltimore Longitudinal Study of Aging with median follow-up of 7 years (range 1-16). Cox proportional hazard models with age as the time scale were used. Time-dependent lean body mass measures were updated at each follow-up visit available. Participants Participants included 871 men and 984 women without diabetes who had ≥ 1 assessment of body composition using dual x-ray absorptiometry. Main Outcomes Incident diabetes, defined as self-reported history and use of glucose-lowering medications; or fasting plasma glucose ≥ 126 mg/dL and 2-hour oral glucose tolerance test glucose ≥ 200 mg/dL either at the same visit or 2 consecutive visits. Results The baseline mean [standard deviation] age was 58.9 [17.3] years. Men and women with a higher percentage of total lean body mass had lower fasting and 2-hour glucose levels, and less prediabetes (all P Conclusions Relatively lower lean body mass with aging is associated with incident diabetes in men and partially related to anthropometrics, but not so in women.

Context The degree to which changes in visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) relate to corresponding changes in plasma sex steroids is not known. Objective We examined whether changes in VAT and SAT areas assessed by computed tomography were associated with changes in sex hormones [dehydroepiandrosterone sulfate (DHEAS), testosterone, estradiol, estrone, and sex hormone binding globulin (SHBG)] among Diabetes Prevention Program participants. Design Secondary analysis of a randomized trial. Participants Overweight and glucose-intolerant men (n = 246) and women (n = 309). Interventions Intensive lifestyle change with goals of weight reduction and 150 min/wk of moderate intensity exercise or metformin administered 850 mg twice a day or placebo. Main outcome measures Associations between changes in VAT, SAT, and sex hormone changes over 1 year. Results Among men, reductions in VAT and SAT were both independently associated with significant increases in total testosterone and SHBG in fully adjusted models. Among women, reductions in VAT and SAT were both independently associated with increases in SHBG and associations with estrone differed by menopausal status. Associations were similar by race/ethnicity and by randomization arm. No significant associations were observed between change in fat depot with change in estradiol or DHEAS. Conclusions Among overweight adults with impaired glucose intolerance, reductions in either VAT and SAT were associated with increased total testosterone in men and higher SHBG in men and women. Weight loss may affect sex hormone profiles via reductions in visceral and subcutaneous fat.

Serum aldosterone increases risk of cardiometabolic disease. Pre-clinical studies suggest adipocytes produce aldosterone, independent of adrenal synthesis. Human studies have linked obesity and aldosterone, but mixed results exist between body fat distribution and aldosterone (1, 2). Body fat distribution varies by race with African Americans (AAs) having more subcutaneous adipose tissue (SAT) than visceral adipose tissue (VAT) compared to whites adjusted for total body fat (3). Thus, we examined the association of anthropometric, imaging and biological markers of adiposity with aldosterone among AAs. We used data from Exams 1 (2000-2004) and 2 (2005-2008) of the Jackson Heart Study, a large prospective study of AA adults. Descriptive statistics were obtained for demographic and clinical characteristics including mean and standard deviation (SD) for the continuous variables and frequencies for the categorical variables. Aldosterone, adiponectin, and leptin were log-transformed due to skewed distribution. Multivariable linear regression models were used to assess the associations of adiposity markers at Exam 1 (body mass index [(BMI]), waist circumference [(WC)], waist-to-height ratio [(WHR)], leptin, adiponectin) and at Exam 2 (VAT, SAT and liver attenuation [liver fat]) with aldosterone levels assessed at Exam 1. Models were adjusted for age, sex, education, occupation, systolic blood pressure, smoking and physical activity. Among 4994 adults (mean age 55.1 years ± 12.8, 63% female), the average BMI was 31.8 ± 7.3 kg/m2. After full adjustment, a 1 unit increase in WC (cm) and BMI (kg/m2) were associated with a 0.5% and 0.8% higher aldosterone, respectively (both p

Context:Total pancreatectomy with islet auto transplantation (TPIAT) is a treatment for medically refractory chronic pancreatitis that can prevent postsurgical diabetes in some patients. Predictors of insulin independence are needed for appropriate patient selection and counseling.Objective:To explore glycemic predictors of insulin independence after TPIAT.Design:A prospective cohort of patients.Methods:We investigated 34 patients undergoing TPIAT from 2011-2016 at Johns Hopkins Hospital, all had a 75-g oral glucose tolerance test (OGTT) administered prior to their TPIAT. The primary outcome was insulin independence 1 year after TPIAT.Results:Ten of 34 (29%) patients were insulin independent 1 year after TPIAT. All patients with impaired fasting glucose and/or impaired glucose tolerance preoperatively were insulin dependent at 1 year. In age-adjusted regression analyses, fasting glucose ≤ 90 mg/dL [odds ratio (OR) = 6.56; 1.11 to 38.91; P = 0.04], 1-hour OGTT glucose ≤ 143 mg/dL (OR = 6.65; 1.11 to 39.91; P = 0.04), and 2-hour OGTT glucose ≤ 106 mg/dL (OR = 11.74; 1.46 to 94.14; P = 0.02) were significant predictors of insulin independence. In receiver operating characteristic analyses, homeostatic model assessment of β-cell function (HOMA-β) was the most robust predictor of insulin independence [area under the curve (AUC) = 0.88; 0.73 to 1.00].Conclusions:Normal preoperative glucose status and lower fasting and postchallenge OGTT glucose values are significant predictors of insulin independence after TPIAT. Higher islet function (HOMA-β) was the strongest predictor. OGTT testing may be a useful tool to aid in patient counseling prior to TPIAT and should be further investigated.

Context: In postmenopausal women, endogenous bioavailable testosterone (T) and estradiol (E2) have been positively associated, and SHBG has been negatively associated, with incident type 2 diabetes (T2DM). Previous studies have not explored possible factors explaining these relationships. Objective: Our objective was to examine the association of endogenous sex hormones with incident T2DM in postmenopausal women and possible explanatory factors. Design, Setting, and Participants: The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective study that included 1612 postmenopausal women aged 45–84 yr, followed between the years 2000-2006, who were not taking hormone replacement therapy, had no prevalent cardiovascular disease or diabetes, and had complete ascertainment of sex hormones. Main Outcome Measures: T2DM was defined based on fasting glucose and/or treatment for diabetes. Results: There were 116 incident cases of diabetes during follow-up. Across higher quartiles of bioavailable T and E2 and lower quartiles of SHBG, we found significantly greater hazards of developing incident T2DM (all P for trend ≤ 0.001). After adjustment for body mass index and insulin resistance estimated by homeostasis model assessment of insulin resistance, bioavailable T was no longer associated with incident T2DM. The associations of E2 and SHBG with incident T2DM were partially explained by body mass index and insulin resistance but persisted in fully adjusted models (both P for trend < 0.02). Dehydroepiandrosterone had no relationship with incident T2DM. Conclusions: Adiposity and insulin resistance explained most of the association of bioavailable T but only partially explained the associations of E2 and SHBG with incident T2DM among postmenopausal women.