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Background. Different factors may predict loss of appendicular muscle mass (LossAMM) and loss of muscle strength (LossMS). We investigated the relationship between LossAMM or LossMS and baseline anthropometric measures, lifestyle habits, hormones, lipid profiles, and inflammatory markers in 49 healthy postmenopausal women (54.1 [+ or -] 4.3 years) in a 24-36-month prospective study. Methods. We measured parameters of lifestyle habits, anthropometry, lipid profiles, and blood levels of testosterone, estrone, estradiol, cortisol, dihydroepiandrostenedione, luteinizing hormone, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D, thyroxine, leptin, adiponectin, C-reactive protein (CRP), and interleukin-6 and interleukin-2 receptors. Percentage of loss per year of isometric knee extensor strength defined LossMS, and percentage of loss of AMM per year (dual x-ray absorptiometry) defined LossAMM. Results. The means (standard deviation) for LossMS and LossAMM were 1.17%/y (2.03) and 0.60%/y (0.74) and did not correlate (r = -0.001;p = .99). LossMS correlated negatively with level of physical activity (r = -0.28), femoral BMD (r = -0.30), alcohol consumption (r = -0.30), and luteinizing hormone (r = -0.32) and positively with estrone (r = 0.29) and iPTH (r = 0.32) (each at p < .05). LossAMM correlated negatively with AMM (r = -0.41; p < .01). Stepwise regression analyses showed that LossMS was significantly predicted by baseline physical activity (beta = -0.39) with an explanation of variation of the model ([R.sup.2]) of 6%, body mass index (BMI) (-0.40; 3%), high-density lipoprotein cholesterol (-0.29; 3%), estrone (0.32; 6%), iPTH (0.27; 7%), and interleukin-2 receptor (0.32; 5%). LossAMM was predicted by baseline height (0.56; 47%), body mass index (1.04; 83%), AMM (-0.92; 76%), thyroxine (-0.33; 8%), estrone (-0.61; 30%), and dihydroepiandrostenedione (0.44; 28%). Conclusions. LossMS and LossAMM in young postmenopausal women were not correlated with one another, and were determined by different factors.

Background. The impact of diabetes on disability and physical functioning in older African Americans and potential causes of the excessive disability associated with diabetes in other studies have been inadequately investigated. Methods. A population-based survey was performed comparing 116 self-reported diabetic inner-city African Americans aged 70 years and older to 522 nondiabetic persons from the same population. A subsample (n = 168) received a physical examination focused on body habitus, upper and lower body strength, balance, and timed physical performance tasks. Blood tests were obtained from 173 subjects. Results. Diabetic individuals reported worse general health (p = .01), instrumental activities of daily living (p = .02), and modified versions of the Rosow-Breslau scale (p < .001) and the Stanford Health Assessment Questionnaire (p = .002). Diabetic persons also reported more falls (0.59 per person vs 0.20, p = .019) and injurious falls (12% vs 6%, p = .025). There were minimal differences in the strength, balance, and timed performance measures (analyzed separately by gender). In multivariable analyses, impairments in visual function and pain and light touch perception appeared to explain some of the association between diabetic status and poor general health, disability, and falls, with lesser contribution from the number of medical problems, number of medications, and glycemic control. Conclusions. Older inner-city diabetic blacks demonstrated worse general health, excess disability, and more falls compared to controls, although deficits in strength, balance, and timed performance could not be demonstrated. The cause of decreased functional status in diabetic elders deserves additional investigation, focusing especially on sensory function, glycemic control, and contribution from specific medical problems and medications.

Background. One of the major goals of home care is the prevention of hospitalization. The objective of this study was to examine the relation between medication use (number, type, and inappropriateness) and hospitalization among home care patients older than 65 years. Methods. A retrospective chart review of 833 discharged older home care patients was performed. These patients were consecutive discharges from a single home care agency who either (a) returned to independent self-care or care of the family (S/F Care group) or (b) were admitted to the hospital (Hospitalized group). Medication assessment within these two groups included total number of medications (prescription and nonprescription); degree of polypharmacy (percentage of patients taking 5 or more, 7 or more, and 10 or more medications); and prevalence for different types of medications, including different types of inappropriate medications. Inappropriate medications were designated according to a list that was previously developed through a modified Delphi consensus technique by a panel of 13 experts in geriatric pharmacology and has been utilized in other studies. Student's t test was used for continuous variables and chi-square test was used for categorical variables to evaluate for differences between the S/F Care group and the Hospitalized group (p [is less than] .05). For comparisons of types of medications, p [is less than] .01 was used for significant differences, because of the high number of comparisons made. Results. Of 833 discharges, 644 (77.3%) returned to self-care or care of the Family (S/F Care group) and 189 (22.7%) were hospitalized. The Hospitalized group, compared with the S/F Care group, was taking a higher number of medications (mean [+ or -] SD: 6.6 [+ or -] 3.9 vs 5.7 [+ or -] 3.4, p = .004), and had a higher percentage of patients taking 7 or more medications (46% vs 26%, p = .002) and 10 or more medications (21% vs 10%, p = .005), but not 5 or more medications. Only three types of medications were more commonly used among patients in the Hospitalized group than among patients in the S/F Care group: clonidine (4.2% vs 1.1%, p = .004); mineral supplements (23.8% vs 14.8%, p = .003); and metoclopramide (5.8% vs 2.0%, p = .006). The Hospitalized group had a lower percentage of patients taking inappropriate medications than did the S/F Care group (20% vs 27%, p = .040), but none of the types of inappropriate medications was used more often in either group. Conclusions. This study shows a relationship between high levels of polypharmacy and hospitalization. Although it cannot be determined from this study whether a higher number of medications was an indicator of sicker patients at risk for hospitalization, or whether a higher number of medications might have directly led to hospitalization, polypharmacy should still be considered a marker for older home care patients for whom prevention of hospitalization is the goal.

Tami Wolden-Hanson and associates conducted studies on the relationship between adiposity and leptin in the aging male Brown Norway rats. They associated leptin and fat mass directly with age while testosterone was associated to decreased skeletal muscle mass. Their experiments also prove that the age-related decline in testosterone may be responsible in part for the rise in leptin levels that take place in aging males.