Maturitas

Publications in this journal

• Article: Mechanism and novel therapeutic approaches to wasting in chronic disease.

  Nicole Ebner, Jochen Springer, Kamyar Kalantar-Zadeh, Mitja Lainscak, Wolfram Doehner, Stefan D Anker, Stephan von Haehling
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  ABSTRACT: Cachexia is a multifactorial syndrome defined by continuous loss of skeletal muscle mass - with or without loss of fat mass - which cannot be fully reversed by conventional nutritional support and which may lead to progressive functional impairment and increased death risk. Its pathophysiology is characterized by negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. Muscle wasting is encountered in virtually all chronic disease states in particular during advanced stages of the respective illness. Several pre-clinical and clinical studies are ongoing to ameliorate this clinical problem. The mechanisms of muscle wasting and cachexia in chronic diseases such as cancer, chronic heart failure, chronic obstructive pulmonary disease and chronic kidney disease are described. We discuss therapeutic targets and such potential modulators as appetite stimulants, selective androgen receptor modulators, amino acids and naturally occurring peptide hormones.
  Maturitas 05/2013;
• Article: Factors associated with increasing functional decline in multimorbid independently living older people.

  Wijnand Laan, Nienke Bleijenberg, Irene Drubbel, Mattijs E Numans, Niek J de Wit, Marieke J Schuurmans
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  ABSTRACT: OBJECTIVES: With increasing age the levels of activities of daily living (ADL) deteriorate. In this study we aimed to investigate which demographic characteristics and disorders are associated with ADL disabilities in multi-morbid older people. STUDY DESIGN: We performed a cross-sectional study with baseline patient data from a large Dutch trial in independently living multi-morbid older people combined with the reimbursed healthcare data for the same subjects. MAIN OUTCOME MEASURES: The primary outcome of our study was the level of independence of activities of daily living (ADL) as assessed with the Modified Katz Activities of Daily Living (KATZ-15) scale. RESULTS: In our study we were able to include 1187 persons (63.0% female) for whom both questionnaire data and reimbursed healthcare data was available. In total, 59% had a Katz-15 score of 1 or higher. The strongest associations with ADL disabilities in women were psychiatric disorders, with prevalence rate (PR) estimates of 1.37 (95% confidence interval (CI): 1.17-1.60) and transient ischaemic attacks and cerebrovasculair accidents in men, with PR estimates of 1.94 (95% CI: 1.41-2.66). Although univariate analysis seemed to also reveal associations with socio-demographic factors such as living together with a partner or the socio-economic status, these factors were not independently associated with ADL disabilities. CONCLUSIONS: In this cross-sectional study we found that 71% of the multi-morbid female elderly had a sub-optimal level of activities of daily living, as assessed with the Katz-15 scale. The results of our study show that multiple disorders are associated with ADL disabilities in multi-morbid older men and women. We found socio-demographic characteristics not to be independently associated ADL disabilities.
  Maturitas 05/2013;
• Article: Routine health screens: A time for reflection.

  Richard Lehman
  Maturitas 05/2013;
• Article: The DietCompLyf study: A prospective cohort study of breast cancer survival and phytoestrogen consumption.

  Ruth Swann, Katherine A Perkins, Louiza S Velentzis, Cristian Ciria, Susan J Dutton, Angela A Mulligan, Jayne V Woodside, Marie M Cantwell, Anthony J Leathem, Claire E Robertson, Miriam V Dwek
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  ABSTRACT: DietCompLyf is a multi-centre prospective study designed to investigate associations between phytoestrogens - naturally occurring plant compounds with oestrogenic properties - and other diet and lifestyle factors with breast cancer recurrence and survival. 3159 women with grades I-III breast cancer were recruited 9-15 months post-diagnosis from 56 UK hospitals. Detailed information on clinico-pathological, diet, lifestyle and quality of life is collected annually up to 5 years. Biological samples have also been collected as a resource for subsequent evaluation. The characteristics of the patients and associations between pre-diagnosis intake of phytoestrogens (isoflavones and lignans; assessed using the EPIC-Norfolk UK 130 question food frequency questionnaire) and breast cancer (i) risk factors and (ii) prognostic factors are described for 1797 women who had complete data for all covariates and phytoestrogens of interest. Isoflavone intakes were higher in the patients who were younger at diagnosis, in the non-smokers, those who had breast-fed and those who took supplements. Lignan intakes were higher in patients with a higher age at diagnosis, in ex-smokers, those who had breast-fed, who took supplements, had a lower BMI at diagnosis, lower age at menarche and were nulliparous. No significant associations between pre-diagnosis phytoestrogen intake and factors associated with improved breast cancer prognosis were observed. The potential for further exploration of the relationship between phytoestrogens and breast cancer recurrence and survival, and for the establishment of evidence to improve dietary and lifestyle advice offered to patients following breast cancer diagnosis using DietCompLyf data is discussed.
  Maturitas 05/2013;
• Article: Pregnancy-induced hypertension is associated with maternal history and a risk of cardiovascular disease in later life: A Japanese cross-sectional study.

  Takumi Kurabayashi, Hideki Mizunuma, Toshiro Kubota, Yutaka Kiyohara, Kazue Nagai, Kunihiko Hayashi
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  ABSTRACT: OBJECTIVE: To clarify the associations between pregnancy-induced hypertension (PIH) with heritability of PIH from mother to daughter and the risk of cardiovascular disease in later life in Japanese women. STUDY DESIGN: The Japan Nurses' Health Study (JNHS) is a cohort study of Japanese women's health. Data from the JNHS baseline survey between 2001 and 2007 were used to conduct a cross-sectional analysis. Of the 49,927 respondents in the baseline survey, 10,456 parous women who were ≥45 years old at baseline were included in the analysis. MAIN OUTCOME MEASURES: The age-adjusted odds ratio (OR) of PIH in women whose mother had a history of PIH, and the age-adjusted OR of PIH in participants for hypertension, hypercholesterolemia and diabetes mellitus (DM). RESULTS: The age-adjusted OR of PIH was 2.72 (95% confidence interval [CI]: 2.14-3.46) in women whose mother had a history of PIH compared with those whose mother did not have PIH. PIH was a risk factor for hypertension (age adjusted OR: 2.85, 95% CI: 2.45-3.11), hypercholesterolemia (age-adjusted OR: 1.49, 95% CI: 1.29-1.72) and DM (age-adjusted OR: 1.53, 95% CI: 1.11-2.11), as determined by logistic regression analysis. CONCLUSIONS: In Japanese women, the risk of PIH is approximately 2.7-fold greater in those whose mothers also had PIH compared with those whose mothers did not. PIH is a risk factor for hypertension, hypercholesterolemia, and diabetes mellitus in later life.
  Maturitas 05/2013;
• Article: Age at natural menopause in relation to all-cause and cause-specific mortality in a follow-up study of US black women.

  Se Li, Lynn Rosenberg, Lauren A Wise, Deborah A Boggs, Michael Lavalley, Julie R Palmer
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  ABSTRACT: OBJECTIVES: Early age at natural menopause has been associated with increased all-cause mortality in several studies, although the literature is not consistent. This relation has not been examined among African American women. STUDY DESIGN: Data were from the Black Women's Health Study, a follow-up study of African-American women enrolled in 1995. Among 11,212 women who were naturally menopausal at entry to the study or during follow-up through 2008, we assessed the relation of age at natural menopause to all-cause and cause-specific mortality. At baseline and biennially, participants reported on reproductive and medical history, including gynecologic surgeries and exogenous hormone use. Mortality data were obtained from the National Death Index. Multivariable Cox proportional hazard models were used to estimate mortality rate ratios (MRR) and 95% confidence intervals (CI) for categories of age at menopause. RESULTS: Of 692 deaths identified during 91,829 person years of follow-up, 261 were due to cancer, 199 to cardiovascular diseases and 232 to other causes. Natural menopause before age 40 was associated with increased all-cause mortality (MRR=1.34, 95% CI 0.96-1.84, relative to menopause at 50-54 years; P-trend=0.04) and with the subcategories of death considered - cancer, cardiovascular disease, and all other causes. The associations were present among never and ever users of postmenopausal female hormones and among never and ever smokers. CONCLUSIONS: In this large prospective cohort of African-American women, natural menopause before age 40 was associated with a higher rate of all-cause and cause-specific mortality. These findings provide support for the theory that natural menopause before age 40 may be a marker of accelerated somatic aging.
  Maturitas 05/2013;
• Article: Models for estimating the biological age of five organs using clinical biomarkers that are commonly measured in clinical practice settings.

  Chul-Young Bae, Young Gon Kang, Mei-Hua Piao, Belong Cho, Kyung Hee Cho, Yong Kyu Park, Byung Yeon Yu, Sang-Wha Lee, Moon Jong Kim, Sang Hyun Lee, Yun-Jin Kim, Dae-Hyun Kim, Jong Sung Kim, Jeong Eun Oh
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  ABSTRACT: OBJECTIVES: To date, no worldwide studies have been conducted to estimate the biological age of five organs using clinical biomarkers that are associated with the aging status. Therefore, we conducted this study to develop the models for estimating the biological age of five organs (heart, lung, liver, pancreas, and kidney) using clinical biomarkers which are commonly measured in clinical practice. DESIGN: A cross sectional study. METHODS: Subjects were recruited from the routine health check-up centers in Korea from 2004 through 2010. Data obtained from 121,189 subjects (66,168 men and 55,021 women) were used for clinical evaluation and statistical analysis. We examined the relations between clinical biomarkers associated with five organs and the chronological age and proposed a model for estimating the biological age of five organs. RESULTS: In the models for predicting the biological ages of the heart, lung, liver, pancreas and kidney in men, 12, 2, 8, 3, and 5 parameters were respectively included (R(2)=0.652, 0.427, 0.107, 0.245, and 0.651). In contrast to men, 10, 2, 8, 3, and 5 parameters in women were respectively included (R(2)=0.780, 0.435, 0.140, 0.384, and 0.501). CONCLUSION: We first proposed the models for predicting the biological age of five organs in the current study. We developed those using clinical parameters that can be easily obtained in clinical practice settings. Our biological age prediction models may be used as supplementary tools to assess the aging status of five organs in clinical practice settings.
  Maturitas 04/2013;
• Article: Improved femoral neck BMD in older Finnish women between 2002 and 2010.

  Kirsti Uusi-Rasi, Saija Karinkanta, Ari Heinonen, Harri Sievänen
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  ABSTRACT: PURPOSE: The number of hip fractures among Finns over 50-years of age rose constantly between 1970 and 1997, but since then, there has been a nationwide decline in incidence of hip fractures. One possible explanation, although not the only one, for the declining fracture rates, could be improved bone mineral density (BMD). The aim of this study was to evaluate differences in femoral neck BMD between older Finnish women born about a decade apart. METHODS: We compared the baseline data of two population-based samples of home-dwelling 70-80-year-old women who were initially recruited in exercise intervention studies (N=216 in Cohort1, and N=389 in Cohort 2). Femoral neck BMD was measured with DXA. Between-cohort differences were evaluated with analysis of covariance using age, height, weight, and use of hormone therapy as covariates. RESULTS: The later-born Cohort 2 was somewhat older and taller than Cohort 1. Adjusted mean difference (95% CI) in femoral neck BMD between the cohorts was 0.043g/cm(2) (0.023-0.064) corresponding the mean difference of 0.36 (0.19-0.53) in T-score in favor of Cohort 2. CONCLUSIONS: Despite several factors that basically could have indicated lower mean BMD in Cohort 2, the finding was the opposite. This suggests that the mean femoral neck BMD has increased substantially among older Finnish women within a decade, but primary reason for this improvement remains unclear, but improved social and economic resources may have at least partly accounted for this favorable phenomenon.
  Maturitas 04/2013;
• Article: Relationship between postmenopausal osteoporosis and the components of clinical sarcopenia.

  Sjöblom Samu, Suuronen Juha, Rikkonen Toni, Honkanen Risto, Kröger Heikki, Joonas Sirola
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  ABSTRACT: PURPOSE: The aim of the study was to determine the relationship between the components of clinical sarcopenia and osteoporosis in postmenopausal women. METHODS: A population-based cohort of 590 Finnish postmenopausal women (mean age 67.9; range 65-72) was selected from the Osteoporosis Fracture Prevention (OSTPRE-FPS) study in 2002. Bone mineral density (BMD) and lean tissue mass were assessed by dual X-ray absorptiometry (DXA). The study sample was divided into three categories according to the WHO BMD classification: normal, osteopenia and osteoporosis. The study sample was divided into non-sarcopenic, presarcopenic, sarcopenic and non-classified groups according to quartiles of RSMI i.e. relative skeletal muscle index (appendicular muscle mass (kg)/square of height (m)), hand grip strength (kPa) and walking speed. RESULTS: In logistic regression analysis sarcopenic women had 12.9 times higher odds of having osteoporosis (p≤0.001, OR=12.9; 95% CI=3.1-53.5) in comparison to non-sarcopenic women. In comparison to women in the highest grip strength quartile, women within the lowest quartile had 11.7 times higher odds of having osteoporosis (p=0.001, OR=11.7; 2.6-53.4). Sarcopenic women had 2.7 times higher odds of having fractures than their non-sarcopenic counterparts (p=0.005, OR=2.732; 1.4-5.5). Sarcopenic women had also 2.1 times higher risk of falls during the preceding 12 months compared to non-sarcopenic women (p=0.021, OR=2.1; 1.1-3.9). Adjustment for age, body mass index (BMI), physical activity and hormone therapy (HT) did not significantly alter these results. CONCLUSIONS: The components of clinical sarcopenia are strongly associated with osteoporosis. Grip strength is the most significant measurement to reveal the association between sarcopenia and osteoporosis, falls and fractures.
  Maturitas 04/2013;
• Article: Management of women with systemic lupus erythematosus.

  Preeta Kaur Chugh
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  ABSTRACT: With improvements in survival rates for women with systemic lupus erythematosus (SLE) in the last few decades, the focus has now shifted towards the management of the associated complications. These include cancer, cardiovascular disease, osteoporosis and early menopause. These co-morbidities are believed to be the result of a complex interplay between the inflammatory process and disease treatment, and they complicate the management. A majority of women with SLE suffer considerable morbidity in the prime of their life. A team of multidisciplinary specialists is required to ensure aggressive and comprehensive management of risk factors, treatment of symptoms and prevention of complications to ensure successful outcomes.
  Maturitas 04/2013;
• Article: Diabetes and bone health.

  Marianna Antonopoulou, Gül Bahtiyar, Mary Ann Banerji, Alan S Sacerdote
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  ABSTRACT: The increasing prevalence of diabetes especially type 2 diabetes worldwide is indisputable. Diabetics suffer increased morbidity and mortality, compared to their non-diabetic counterparts, not only because of vascular complications, but also because of an increased fracture incidence. Both types 1 and 2 diabetes and some medications used to treat it are associated with osteoporotic fractures. The responsible mechanisms remain incompletely elucidated. In this review, we evaluate the role of glycemic control in bone health, and the effect of anti-diabetic medications such as thiazolidinediones, sulfonylureas, DPP-4 inhibitors, and GLP-1 agonists. In addition, we examine the possible role of insulin and metformin as anabolic agents for bone. Lastly, we identify the current and future screening tools that help evaluate bone health in diabetics and their limitations. In this way we can offer individualized treatment, to the at-risk diabetic population.
  Maturitas 04/2013;
• Article: EMAS clinical guide: Assessment of the endometrium in peri and postmenopausal women.

  Eva Dreisler, Lars Grønlund Poulsen, Sofie Leisby Antonsen, Iuliana Ceausu, Herman Depypere, C Tamer Erel, Irene Lambrinoudaki, Faustino R Pérez-López, Tommaso Simoncini, Florence Tremollieres, Margaret Rees, Lian G Ulrich
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  ABSTRACT: INTRODUCTION: Invasive as well as non-invasive methods are available for assessment of the endometrium. AIMS: The purpose of this clinical guide is to provide evidence-based advice on endometrial assessment in peri and postmenopausal women. MATERIAL AND METHODS: Literature review and consensus of expert opinion. RESULTS AND CONCLUSIONS: Presuming speculum examination and cervical cytology are assessed, transvaginal ultrasound should be undertaken initially as it is non-invasive and will not only measure endometrial thickness, but will also detect other pelvic pathology such as leiomyomas and ovarian tumours. The main indication for invasive methods is to obtain endometrial tissue to diagnose or exclude the presence of endometrial cancer or pre-malignancies. Biopsy is mainly undertaken as an outpatient procedure, but sampling is 'blind'. Hysteroscopy is used when focal lesions affecting the uterine cavity are suspected such as endometrial polyps or sub-mucous fibroids. None of the available methods are perfect. Ultrasound evaluation is dependent on the experience of the examiner, the equipment and the quality of visualization. Hysteroscopy too is dependent on the examiner and fibroids may obstruct visualization. Blind endometrial biopsy procedures often miss focal lesions. Thus re-examination is necessary when symptoms persist and no explanation for these has been identified. This clinical guide will evaluate the different methods of endometrial assessment, their indications and limitations. Guidance is also given about dealing with inconclusive investigations and persistent symptoms.
  Maturitas 04/2013;
• Article: Reply to Dal Moro.

  A Cano-Marquina, J J Tarín, A Cano
  Maturitas 04/2013;
• Article: Adolescence as a gateway to adult health outcomes.

  Dennis Raphael
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  ABSTRACT: Adolescence has long been regarded as a transition from childhood to adulthood. More recently it is become a concern of those wishing to avoid adverse health outcomes during middle and late adulthood. Most of this effort has been focused on behavioural risk factors such as tobacco and excessive alcohol use, physical exercise habits, dietary habits, as well as sexual and injury-related behaviours. The concern is that these habits are established during adolescence, continue into adulthood, and come to constitute ongoing risk factors for adverse health outcomes during middle and late adulthood. There is good reason to criticize this approach. These behaviours are themselves shaped by adolescents' living and working conditions and even then constitute a small proportion of the variance predicting adverse health outcomes during adulthood. More complex models of how adolescence serves as a gateway to adult health outcomes are presented. These are the socio-environmental, public policy, and political economy approaches. The argument is made that adolescence is a period during which public policy plays an especially important role in predicting future health outcomes. Yet, these public policies influence health all across the life span with adolescence providing only one of many important periods during which public policy shapes health prospects during middle and later adulthood. Ultimately one should consider a range of approaches ranging from the behavioural to the political to examine how adolescence serves as a gateway towards future adult prospects. An Adolescent Gateway Towards Adult Health Model is provided to assist in this process.
  Maturitas 04/2013;
• Article: Duloxetine for major depressive disorder and daytime and nighttime hot flashes associated with the menopausal transition.

  Marlene P Freeman, April M Hirschberg, Betty Wang, Laura F Petrillo, Stephanie Connors, Susan Regan, Hadine Joffe, Lee S Cohen
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  ABSTRACT: BACKGROUND: We sought to obtain preliminary data regarding the efficacy of duloxetine for major depressive disorder (MDD) during the menopausal transition. The secondary outcomes were vasomotor symptoms (VMS, or hot flashes), specifically assessed as daytime or nighttime, and anxiety. METHODS: After a single-blind placebo lead-in, peri- and postmenopausal women with MDD (n=19) received eight weeks of open-label treatment with duloxetine (60mg/day). The Hamilton Rating Scale for Depression (17-item) (HAM-D) was the primary outcome measure. Hot flashes were monitored prospectively using daily diaries, the Greene Climacteric Scale (GCS), and the Hot Flash-Related Daily Interference Scale (HFRDIS). Anxiety was measured with the Generalized Anxiety Disorder scale (GAD-7). RESULTS: Of 19 participants treated with duloxetine, 16 (84.2%) were evaluable (returned for ≥1 follow up), and 13 (68.4%) completed the study. Three discontinued due to side effects. The pre-treatment and final median HAM-D scores were 15 (interquartile range [IQR] 14-18), and 6.5 (IQR 4-11.5), respectively, reflecting a significant decrease (p=.0006). The response and remission rates were 56.3% (all responders were also remitters, having ≥50% decrease in HAM-D scores and final scores ≤7). Anxiety improved with treatment (p=.012). GCS and HFRDIS scores decreased significantly. Among those who reported hot flashes at baseline, number and severity of hot flashes improved significantly overall (p=.009 and p=.008, respectively). Daytime but not nighttime hot flashes improved significantly. CONCLUSIONS: These data support further study of duloxetine for the treatment of a spectrum of symptoms associated with the menopausal transition.
  Maturitas 04/2013;
• Article: Coffee and cognitive stimulation.

  Fabrizio Dal Moro
  Maturitas 04/2013;
• Article: Knee replacement for osteoarthritis.

  Alexander D Liddle, Elise C Pegg, Hemant Pandit
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  ABSTRACT: Knee replacement is one of the commonest surgical procedures performed in older adults, and its incidence is increasing rapidly. It is the only curative procedure for knee osteoarthritis, and it has excellent outcomes overall in terms of reoperation, functional outcomes and cost-effectiveness. However, a significant proportion of patients are dissatisfied after knee replacement surgery and there is a growing body of research into predictors of poor outcome and dissatisfaction.In this review, we discuss the place of total knee replacement (TKR) in the management of osteoarthritis, together with operative and non-operative alternatives to TKR. We discuss the different ways in which outcome can be measured, and the influence of patient and surgical factors on the success or failure of knee replacement surgery.
  Maturitas 04/2013;
• Article: Leukocyte telomere length is independently associated with gait speed in elderly women.

  Jee-Yon Lee, Hyo-Weon Bang, Jae-Hong Ko, Jung-Ha Kim, Duk-Chul Lee
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  ABSTRACT: OBJECTIVES: Declining gait speed is common in the elderly population and is associated with age-related conditions. Because telomere length is a reflection of aging and known to affect degenerative changes in organ systems, gait speed may be associated with telomere length. We therefore investigated the relationship between gait speed and leukocyte telomere length in elderly Korean women. STUDY DESIGN: Cross-sectional study. MAIN OUTCOME MEASURES: A total of 117 Korean elderly women participated. Metabolic variables were assessed along with gait speed calculated as walking distance (6m) divided by time. Leukocyte telomere length was measured by real-time quantitative polymerase chain reaction. RESULTS: Gait speed correlated with telomere length (r=0.38, p<0.01), fasting insulin (r=-0.19, p=0.04), homeostasis model assessment of insulin resistance index (HOMA-IR; r=-0.22, p=0.02), triglyceride (r=-0.20, p=0.03), and Korean Mini-Mental State Examination (K-MMSE; r=0.20, p=0.03) after adjusting for age. On step-wise multiple regression analysis, telomere length (β=0.35, p<0.01), K-MMSE (β=0.16, p=0.02), age (β=-0.23, p=0.01), and HOMA-IR (β=-0.19, p=0.03) were identified as independent variables associated with gait speed. CONCLUSIONS: This study suggested that telomere length may have a role in maintaining overall health status as well as preserving gait speed in the elderly population. Further studies are required to better understand the significance of our findings.
  Maturitas 04/2013;
• Article: Dietary supplements and prostate cancer: a systematic review of double-blind, placebo-controlled randomised clinical trials.

  Paul Posadzki, Myeong Soo Lee, Igho Onakpoya, Hye Won Lee, Byong Seob Ko, Edzard Ernst
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  ABSTRACT: Dietary supplements are popular among patients with prostate cancer (PC). The objective of this systematic review was to critically examine double-blind, placebo-controlled randomised clinical trials (RCTs) of non-herbal dietary supplements and vitamins (NHDS) for evidence that prostate specific antigen (PSA) levels were reduced in PC patients. Five databases were searched from their inception through December 2012 to identify studies that met our inclusion criteria. Methodological quality was independently assessed by two reviewers using the Cochrane tool. Eight RCTs met the eligibility criteria and were of high methodological quality. The following supplements were tested: isoflavones (genistein, daidzein, and glycitein), minerals (Se) or vitamins (vitamin D) or a combination of antioxidants, bioflavonoids, carotenoids, lycopenes, minerals (Se, Zn, Cu, and Mg), phytoestrogens, phytosterols, vitamins (B2, B6, B9, B12, C, and E), and other substances (CoQ10 and n-acetyl-l cysteine). Five RCTs reported no significant effects compared with placebo. Two RCTs reported that a combination of antioxidants, isoflavones, lycopenes, minerals, plant oestrogens and vitamins significantly decreased PSA levels compared with placebo. One RCT did not report differences in PSA levels between the groups. In conclusion, the hypothesis that dietary supplements are effective treatments for PC patients is not supported by sound clinical evidence. There are promising data for only two specific remedies, which contained a mixture of ingredients, but even for these supplements, additional high quality evidence is necessary before firm recommendations would be justified.
  Maturitas 04/2013;