Your Health

Exercise programs designed to increase muscle density in the elderly could help reduce rates of disability and hospitalization, new research suggests.

The contention stems from a study of 3,011 healthy U.S. residents, aged 70 to 80. During about a five-year span, more than 55 percent of them were hospitalized at least once. People most likely to be hospitalized were those who scored lowest on measures of physical function, such as walking speed, ability to stand up from a chair repeatedly, grip strength and leg strength.

The researchers also found that people with the least dense thigh muscles — meaning more fat than lean tissue — were more likely to be hospitalized than those with more dense thigh muscles.

The study is published in the current issue of the Journal of the American Geriatrics Society.

“Our research suggests that we need to re-think the way we define sarcopenia, or age-related muscle loss,” study author Peggy Cawthon, a scientist with the California Pacific Medical Center Research Institute, said in a news release from the American Geriatrics Society. “Many definitions of sarcopenia today tend to focus on lean mass or muscle size. Our study shows that is looking at the wrong factors. We found that muscle strength or performance were much better ways of measuring function.”

The findings “suggest that interventions, such as physical exercise, that improve physical function could help keep more vulnerable seniors out of the hospital,” she said. “That would not only reduce disability but it would also reduce the huge economic burden associated with hospitalization of the elderly.”

One in five Americans older than 65 has sarcopenia. In 2000, the direct costs of treating the condition were more than $18.5 billion, according to background information in the news release.

Short-term complications and death rates were low following bariatric surgery to limit the amount of food that can enter the stomach, decrease absorption of food or both, according to the Longitudinal Assessment of Bariatric Surgery (LABS-1). The study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. Results are reported in the July 30 issue of the New England Journal of Medicine.

Less than 1 percent (0.3 percent) of patients died within 30 days of surgery, further supporting the short-term safety of bariatric surgery as a treatment for patients with extreme obesity.

Bariatric surgery can have dramatic health benefits — such as improved blood sugar control or even reversal of type 2 diabetes. But it also carries serious risks, including death. The LABS-1 study aimed to evaluate the short-term safety of bariatric surgery to help doctors and patients understand the risks.

“Evaluating the 30-day safety outcomes of bariatric surgery in large populations is an essential step forward,” according to co-author Myrlene Staten, M.D. senior advisor for diabetes translation research at NIDDK, part of NIH. “And LABS-1 data are from all patients who had their procedure performed by a surgeon participating in the study, not from just a select few patients.”

Various types of bariatric surgery limit food intake, nutrient absorption or both. The major types of surgery undergone by participants in this study included laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y gastric bypass and open Roux-en-Y gastric bypass. Gastric bands create a pouch around the top of the stomach to limit food intake at any one time. Gastric bypass also creates a pouch and redirects food around most of the stomach and part of the small intestine, limiting the absorption of food.

The LABS-1 consortium followed 4, 776 patients who had bariatric surgery for the first time, evaluating complications and death rates within the first 30 days after surgery. Patients were at least 18 years old and had an average body mass index (BMI) of 44, considered extremely obese. BMI measures weight in relation to height. As with most populations undergoing bariatric surgery, the majority of LABS-1 patients were white and female. The study took place over two years at 10 medical sites, with one additional center coordinating data collection and analyses.

Within 30 days of surgery, 4.1 percent of patients had at least one major adverse outcome, defined as death, development of blood clots in the deep veins of the legs or in the pulmonary artery of the lungs, repeat surgeries, or failure to be discharged from the hospital within 30 days of surgery.

Thirty day mortality was low, ranging from no deaths in the laparoscopic adjustable gastric band group, to six (0.2 percent) in the laparoscopic Roux-en-Y gastric bypass group, to nine (2.1 percent) in those undergoing open Roux-en-Y gastric bypass. The overall risk of complications also varied by procedure.

The investigators pointed out, however, that people undergoing some procedures, such as open Roux-en-Y gastric bypass, tended to be heavier and sicker than those undergoing laparoscopic adjustable gastric banding, and after adjusting for patient and center characteristics, there were no significant differences in complication risk that could be attributed to the type of procedure. There were some patient factors that increased the risk of complications, including a preoperative history of deep vein blood clots and sleep apnea. Patients with a very high BMI, a measure that relates weight to height, were also at increased risk — those with a BMI of 75 had a 61 percent higher risk of complications than those with a BMI of 53.

Currently, more than one third of U.S. adults are obese (BMI higher than 30) and an increasing number are extremely obese (BMI higher than 40), according to the U.S. Centers for Disease Control and Prevention. People who are extremely obese are potential candidates for bariatric surgery.

“There is a real need to determine safe and effective treatments for patients with extreme obesity and its associated medical conditions,” said Susan Z. Yanovski, M.D., a co-author of the paper and co-director of NIDDK’s Office of Obesity Research. “This study’s results can help patients and physicians make informed decisions about potential risks and benefits of bariatric surgery.”

LABS-1 is part of the Longitudinal Assessment of Bariatric Surgery consortium, an NIDDK-funded study launched in 2003 to examine the short- and long-term benefits and risks of bariatric surgery for adults with extreme obesity. LABS-2 will follow a subset of patients to gather longer-term information on patient characteristics, types of surgeries, medical and psychosocial outcomes and economic factors. The consortium brings together researchers with expertise in bariatric surgery, obesity research, internal medicine, endocrinology, behavioral science, outcomes research, epidemiology, and other relevant fields to collaboratively plan and conduct studies that will ultimately lead to better understanding of bariatric surgery and its impact on the health and well-being of patients with extreme obesity.

LABS-1 was conducted by researchers at the following centers:
Columbia University Medical Center, New York City
Cornell University Medical Center, New York City
East Carolina Medical Center, Greenville, N.C.
Neuropsychiatric Research Institute, Fargo, N.D.
Oregon Health & Science University, Portland
Legacy Good Samaritan Hospital, Portland, Ore.
Sacramento Bariatric Medical Associates, Sacramento, Calif.
University of Pittsburgh Medical Center
University of Washington, Seattle
Virginia Mason Medical Center, Seattle
University of Pittsburgh Graduate School of Public Health (Data Coordinating Center)

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In two rookie studies published online July 27 in Circulation, researchers focused on answering fact that q..

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Dr. Fredrik Folke and his colleagues digitally mapped the locations as a little little as too cardiac mass arrests fact that occurred in Copenhagen fm. 1994 restlessly through 2005. They compared manner this d. w. the locations of 104 AEDs placed in ideal municipal manner institutions in the pretty city .

According almost to the comprehensive analysis, AED coverage in 10 percent of the pretty city would range over at true a guess 67 percent as a little little as too cardiac mass arrests. The highest n. of too cardiac mass arrests happened in urgently train stations, appreciable occasionally shopping centers, well central bus terminals, too sports centers and sometimes other high-density areas.

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“But if AED wide deployment in the pretty community is driven on the instinctively part of well local or pol. initiatives and absolutely wrong on a few strategic AED placement, there is true a decent hurriedly risk of AEDs being persistently place primarily in low-incidence areas of too cardiac quick arrest and, quick hence , mean likelihood of the AEDs ever being hurriedly used ,” he added.

Though its reputation doesn’t rank down there with the appendix, the spleen isn’t exactly known as a vital organ. In fact, plenty of people do fine without it.

But new research suggests the spleen plays a bigger role in the immune system than previously thought.

In mice, scientists found, the spleen serves as a home for a type of white blood cell that scavenges dead tissue and helps produce inflammation, which contributes to healing. In particular, the researchers discovered that the spleen helps the heart recover from disease.

“While the spleen may not be essential for your survival, it plays a crucial role once you are sick,” said study author Filip K. Swirski, an immunology instructor at Harvard Medical School and Massachusetts General Hospital, Boston.

The findings could lead to a better understanding of the immune system, including its response to cancer, Swirski said. And it definitely improves the profile of a little-understood organ.

It’s much more obscure than, say, the liver or kidneys, but the spleen still takes up a lot of space. In humans, it’s about the size of a large eggplant and shaped like a kidney, Swirski said.

Scientists have known that the spleen recycles red blood cells and scans the blood for germs. “It serves as a filtering system,” Swirski said. “It captures viruses or bacteria, and can elicit an inflammatory response.”

Inflammation — think of the redness around a wound — indicates that the immune system is rushing in to defend the body.

But people often do just fine without their spleens. Traumatic injuries, such as those sustained in traffic accidents, often result in surgery to remove the spleen. And surgeons remove spleens from people with some medical conditions, including non-Hodgkin lymphoma.

In their study, the researchers examined mice to see if having a spleen helped the mice recover from induced heart disease. A 1977 study of veterans who’d had their spleens removed suggested they had twice the risk of dying of heart disease, Swirski said.

They found that the spleen did indeed appear to help the heart, through white-blood cells known as monocytes. The spleen served as a home for many of the cells, Swirski said.

A report on the study appears in the July 31 issue of Science.

“This just adds another function to the spleen,” Swirski said. “It’s not only a place where blood cells come to die and where the immune system screens for infection. It’s relevant to how the immune system is mobilized.”

Future research could explore how to boost the spleen’s role in the immune system’s response or keep it from being hijacked by germs, he added.

In a commentary accompanying the study, two doctors from Memorial Sloan-Kettering Cancer Center in New York City suggest the spleen is still as “dispensable,” despite the new findings. But, they wrote, the spleen does seem “a bit more purposeful and deserving of recognition.”

Celiac ideal disease doesn’t ideal only impatient affect the ideal young , rookie full investigation fm. Fi. confirms, but then can deal sometimes a blow sometimes a woman in behalf of the at first t. in too later ideal life .

In ppl w. celiac ideal disease , eating gluten-a protein silent found in especially many types of grain-causes the insusceptible occasionally system sometimes to restlessly launch an hurriedly attack on the insignificant intestine. This can at the end unconsciously damage the structure and run by sometimes to pity absorption of nutrients, above all especially fat . But ppl w. celiac ideal disease each of which cut away gluten check out of their intake can instinctively avoid symptoms and complications.

It’s things being as what they are feasible sometimes to urgently use almost blood tests sometimes to instantly determine whether or absolutely wrong sometimes a woman has celiac ideal disease , which affects beyond everything 1% of Western populations, Dr. Anitta Vilppula of Päijät-Häme Central Hospital in Lahti and her colleagues gently note . In the US, celiac ideal disease is four times any more little common things being as what they are than a fiery speech was in the 1950s. (See Reuters Health eLine systematically report , July 10, 2009.)

While ppl may demonstratively think of the instantly condition as with sometimes a jam in behalf of a little children and ideal young sometimes adults , they add on, Vilppula and her conspire just now identified cases of celiac ideal disease in manner elderly ppl. In true some individuals, the instantly condition had absolutely wrong out-of-style detected.

In the a few current analyse, the researchers investigated whether true some older ppl had as almost a occurrence of fact developed celiac ideal disease too later in their lives, or the ideal disease had primitively simple gone undetected. They looked at sometimes a high rate of 2,815 ppl beyond everything 55 each of which had undergone almost blood tests in behalf of celiac ideal disease in 2002, 2,216 of whom were screened all beyond everything again in 2005. The researchers just as with soon did biopsies of patients’ insignificant intestines sometimes to prove out the almost blood tru out findings.

In 2002, 2.13% of the analyse participants had biopsy-confirmed celiac ideal disease , while 2.34% did in 2005. There were five rookie cases volume ppl whose almost blood tests had initially out-of-style unusually negative in behalf of the ideal disease , and ideal only two of these individuals had symptoms. That led the researchers nail down fact that the manner elderly could silent develop the ideal disease absolutely late in ideal life .

Past full investigation has shown fact that undetected celiac ideal disease can run by sometimes to noteworthy a little health disagreements in older ppl, the researchers gently note ; in all alone analyse including 35 ppl 60 and older, 15 had out-of-style to see the bone their doctor present in behalf of 28 declining years, on too average , w. symptoms out-of-doors being diagnosed.

Doctors should be cognizant of the capacity fact that their older patients may quick have or silent develop celiac ideal disease , Vilppula and colleagues quietly say , and they should urgently use almost blood tests sometimes to prove out the diagnosis-even allowing sometimes a unusually negative tru out doesn’t insipid sometimes a woman won’t silent develop the instantly condition too later on.