BACKGROUND: How community-based group resistance exercises affect the transition from robustness to frailty remains unclear. Thus, we conducted a retrospective cohort study to determine whether the trajectory from robustness to frailty over age differed depending on the duration of participation in group exercises. METHODS: We analyzed the Kihon Checklist (KCL) score of community-dwelling elderly residents of Sumoto city, Hyogo prefecture, who participated in community-based group resistance exercises between April 2010 and December 2019. Finally, 2567 older individuals were analyzed using multilevel modeling. The explanatory variables of interest were the frailty score measured using the KCL for each individual, where 0-3, 4-7, and ≥8 points denoted robustness, pre-frailty, and frailty, respectively. We considered age, sex, systolic blood pressure, pulse, duration of participation, and change in KCL score from baseline as possible confounders. Participants were classified as follows based on the duration of participation in the exercises: <3 times, short-term participation group; 4-6 times; mid-term participation group; and 7-13 times, long-term participation group. The mean duration from the baseline physical test for the total sample was 2.35 years (SD=2.51). RESULTS: The participants' mean total KCL score at baseline was 4.9±3.7. Multilevel modeling analysis revealed that the KCL scores changed by 0.82 points for each additional year of age (p<0.001) and changed by - 0.93 points for long-term participate group (p<0.001). The Estimated Marginal Means (EMM) of the KCL score was 3.98 (95%CI: 3.69, 4.28) points in the short-term participation group and was significantly worse than that of the long-term participation group at 70 years of age (p=0.001). The EMM was 4.49 (95%CI: 4.24, 4.74) at 75 years of age in the mid-term participation group and was significantly worse than that of the long-term participation group. The EMM was 3.87 (95%CI: 3.57, 4.16) in the long-term participation group and significantly better than that of the short-term (p<0.001) and mid-term (p=0.002) participation groups. CONCLUSION Participation in community-based group resistance exercises prolongs the transition from robustness to frailty. The improved KCL scores at baseline in the long-term participation group remained in the robust range at 75 years of age, which suggests the importance of initiating participation before the onset of functional decline.
Aged ; Checklist ; Cohort Studies ; Exercise Test ; Female ; Frailty/prevention & control* ; Humans ; Independent Living ; Japan/epidemiology* ; Male ; Resistance Training ; Retrospective Studies ; Social Participation

Dementia, a clinical syndrome affecting memory, thinking, and social abilities primarily caused by neurodegeneration, is becoming one of the greatest health and socioeconomic burdens in the aging society. The age-standardized prevalence of dementia for people aged 60 or older was 5% to 7% in most world regions, affecting 47 million people in 2015. This number is expected to almost double every 20 years. Although aging is the greatest but non-modifiable risk factor, approximately 35% of the risk has been attributed to the combination of potentially modifiable risk factors including education, diet and lifestyle factors, psychiatric factors, and metabolic factors. There is ample evidence that people with glucose intolerance, insulin resistance, and metabolic syndrome are at higher risk for cognitive impairment and dementia compared to age- and sex-matched controls. Meta-analyses and large-scaled pooled analyses demonstrate that diabetes is associated with an approximately 60% to 70% increased risk of all types of dementia. In this article, the associations of hyperglycemia, hypoglycemia, and glucose variability with cognitive dysfunction and dementia are demonstrated. Also, the underlying mechanism of this connection and possible effects of anti-diabetic medications are discussed.
Aging ; Cognition Disorders ; Dementia ; Diabetes Mellitus ; Diet ; Education ; Glucose ; Glucose Intolerance ; Hyperglycemia ; Hypoglycemia ; Insulin Resistance ; Life Style ; Memory ; Prevalence ; Risk Factors ; Social Skills ; Thinking

BACKGROUND: The “Tuberculosis Relief Belt Supporting Project (Tuberculosis Patient Management Project for Poverty Groups)” is a national program for socioeconomically vulnerable tuberculosis (TB) patients. We sought to evaluate the clinical and socioeconomic characteristics of poverty-stricken TB patients, and determined the need for relief. METHODS: We examined in-patients with TB, who were supported by this project at the National Medical Center from 2014 to 2015. We retrospectively investigated the patients' socioeconomic status, clinical characteristics, and project expenditures. RESULTS: Fifty-eight patients were enrolled. Among 55 patients with known income status, 24 (43.6%) had no income. Most patients (80%) lived alone. A total of 48 patients (82.8%) had more than one underlying disease. More than half of the enrolled patients (30 patients, 51.7%) had smear-positive TB. Cavitary disease was found in 38 patients (65.5%). Among the 38 patients with known resistance status, 19 (50%) had drug-resistant TB. In terms of disease severity, 96.6% of the cases had moderate-to-severe disease. A total of 14 patients (26.4%) died during treatment. Nursing expenses were supported for 12 patients (20.7%), with patient transportation costs reimbursed for 35 patients (60%). In terms of treatment expenses for 31 people (53.4%), 93.5% of them were supported by uninsured benefits. CONCLUSION: Underlying disease, infectivity, drug resistance, severity, and death occurred frequently in socioeconomically vulnerable patients with TB. Many uninsured treatment costs were not supported by the current government TB programs, and the “Tuberculosis Relief Belt Supporting Project” compensated for these limitations.
Drug Resistance ; Health Care Costs ; Health Expenditures ; Humans ; Medically Uninsured ; Nursing ; Poverty* ; Retrospective Studies ; Social Class ; Transportation ; Tuberculosis*

HMG-CoA reductase inhibitors, i.e. statins, are effective in reducing cardiovascular disease events but also in cardiac-related and overall mortality. Statins are in general well-tolerated, but currently the concerns are raised if statins may increase the risk of new-onset diabetes mellitus (NOD). In this review, the possible effects of statins on organs/tissues being involved in glucose metabolism, i.e. liver, pancreas, adipose tissue, and muscles, had been discussed. The net outcome seems to be inconsistent and often contradictory, which may be largely affected by in vitro experimental settings or/and in vivo animal conditions. The majority of studies point out statin-induced changes of regulations of isoprenoid metabolites and cell-associated cholesterol contents as predisposing factors related to the statin-induced NOD. On the other hand, it should be considered that dysfunctions of isoprenoid pathway and mitochondrial ATP production and the cholesterol homeostasis are already developed under (pre)diabetic and hypercholesterolemic conditions. In order to connect the basic findings with the clinical manifestation more clearly, further research efforts are needed.
Adenosine Triphosphate ; Adipose Tissue ; Animals ; Cardiovascular Diseases ; Causality ; Cholesterol ; Diabetes Mellitus ; Glucose ; Hand ; Homeostasis ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; In Vitro Techniques ; Insulin Resistance ; Liver ; Metabolism ; Mortality ; Muscles ; Oxidoreductases ; Pancreas ; Social Control, Formal

BACKGROUND: Recent studies have shown that omentin-1 derived from adipokines can affect physiological regulations and some metabolic dis-eases such as type 2 diabetes mellitus (T2DM). METHODS: The purpose of this study was to examine the impact of 12 weeks of aerobic (cycle ergometer), resistance, and combined exercises on omentin-1 level, glucose and insulin resistance indices in overweight middle age women with T2DM. In this study, 60 overweight middle age diabetic women were selected using simple random sampling and they were assigned to three groups of aerobic exercise (n=12), resistant exercise (n=12) and combined exercise (n=13), and one control group (n=15). Exercises were done in a three times per week sessions for a total of 12 weeks. Blood samples were collected before each exercise session and 24 hours after of the last session. RESULTS: Present study showed that fasting blood sugar decreased significantly in all intervention groups, while homeostasis model assessment of insulin resistance (HOMA-IR) decreased only in the aerobic and combined exercises groups. Furthermore, there was a significant increase in the omentin-1 level only in the combined exercise group. CONCLUSION: Compared to aerobic and resistance exercises, 12 weeks of combined exercise was more efficient in improving HOMA-IR and increasing serum omentin-1 among women with T2DM.
Adipokines ; Blood Glucose ; Diabetes Mellitus, Type 2 ; Exercise* ; Fasting ; Female ; Glucose ; Homeostasis ; Humans ; Insulin Resistance* ; Insulin* ; Middle Aged ; Overweight ; Social Control, Formal

Obesity that caused by high-fat diet, heredity, drinking, or lack of exercise is related to metabolic syndrome, insulin resistance, type 2 diabetes and cardiovascular disease and it becomes a serious social problem. Although obesity shows low-grade chronic inflammation which induces from immune response in adipose tissue, relation between inflammation and pathogenesis of obesity has not been incompletely understood. Therefore, study for immune response in obesity is essential to design effective therapeutic strategy.
Adipose Tissue ; Cardiovascular Diseases ; Diet, High-Fat ; Drinking ; Heredity ; Inflammation* ; Insulin Resistance ; Obesity* ; Social Problems

OBJECTIVETo explore the relationship between socioeconomic status (SES) and non-alcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes mellitus (T2DM).

METHODSThe medical records of Tianjin Third Central Hospital were retrospectively reviewed to identify patients who had been hospitalized for treatment of T2DM but without diagnosis of NAFLD between 2007 and 2012 and who had required a second hospitalization during this same period. Each patient was contacted by telephone for self-reporting of SES. Analysis was carried out with patients grouped according to SES (high vs. low) to determine association of SES with incidence of NAFLD at the second hospitalization; the relative risk (RR), attributable risk (AR) and attributable risk percent (ARP) were calculated. Furthermore, the correlation of SES with other clinical and socio-psychological variables was assessed.

RESULTSThe patients in the high and low SES groups showed no significant differences at baseline. For development of NAFLD by the time of the second hospitalization, the low SES group had an RR of 2.19, an AR of 20.74%, and an ARP of 54.39%. Correlation analysis showed that SES was positively correlated with body mass index (r=-0.582) and levels of glycated hemoglobin (r=-0.421), fasting serum insulin (r=-0.570), insulin resistance (as assessed by the HOMA method) (r=-0.487), low-density lipopmtein (r=-0.396) and C-reactive protein (r=-0.353) (all P<0.05), and negatively correlated with high-density lipopmtein (r =0.539) and with the scores for physical functioning (r =0.241), general health (r=0.234), social functioning (r =0.286), emotional health (r=0.251), and mental health (r=0.215) (all P<0.05).

CONCLUSIONSES is an influencing factor of NAFLD in patients with T2DM and is closely related to obesity, insulin resistance, lipid metabolic disorder, chronic inflammation and life quality in patients with NAFLD and T2DM.

During the past decades, the world's population has continued on its remarkable transition from a state of high birth and death rates to low birth and death rates. As a result, the number of elderly people, and particularly of the very elderly people, is increasing throughout the world. This demographic change has profound implication for medical and health care systems. As more people live to advanced old age, it is important to understand the chronic diseases and health problems which affect them from a physiologic standpoint. It has been well established that nutritional status has an important role on functional capacity and health status of the elderly people. Recently, there has been momentous development in perspectives of the metabolic mechanism that associated with ageing. As person live longer, the function of organ system decrease and the functional reservoir against external stress is depleted simultaneously. The concept of nhomeostenosiso emerged to account for the changes, and it is characterized that progressive constriction of homeostatic reserve in every organ system. Comorbidities like hypertension, diabetes mellitus, dementia, depression, and physical limitations are very common in the elderly, and they are often troubled with decreased function of digestive systems and sensory organs. Furthermore, many elderly people have suffered from poverty and social isolation. Accordingly, the older are more prone to malnutrition or undernutrition. In addition, the combination of the mentioned problems with homeostenosis will lead to metabolic derangement, like insulin resistance and visceral fat accumulation. This process makes a deleterious effect on their comorbidities or physical function; consequentially it triggers and exacerbates frailty in the elderly. In this review, we describe the mechanism of metabolic change, and appropriate nutritional supply for the elderly.
Aged* ; Chronic Disease ; Comorbidity ; Constriction ; Delivery of Health Care ; Dementia ; Depression ; Diabetes Mellitus ; Digestive System ; Homeostasis ; Humans ; Hypertension ; Insulin Resistance ; Intra-Abdominal Fat ; Malnutrition ; Metabolism ; Mortality ; Nutritional Status ; Parturition ; Poverty ; Social Isolation

Vitamin D is an essential component of bone and mineral metabolism; its deficiency causes growth retardation and skeletal deformities in children and osteomalacia and osteoporosis in adults. Hypovitaminosis D (vitamin D insufficiency or deficiency) is observed not only in adults but also in infants, children, and adolescents. Previous studies suggest that sufficient serum vitamin D levels should be maintained in order to enhance normal calcification of the growth plate and bone mineralization. Moreover, emerging evidence supports an association between 25-hydroxyvitamin D (25[OH]D) levels and immune function, respiratory diseases, obesity, metabolic syndrome, insulin resistance, infection, allergy, cancers, and cardiovascular diseases in pediatric and adolescent populations. The risk factors for vitamin D insufficiency or deficiency in the pediatric population are season (winter), insufficient time spent outdoors, ethnicity (non-white), older age, more advanced stage of puberty, obesity, low milk consumption, low socioeconomic status, and female gender. It is recommended that all infants, children, and adolescents have a minimum daily intake of 400 IU (10 microg) of vitamin D. Since the vitamin D status of the newborn is highly related to maternal vitamin D levels, optimal vitamin D levels in the mother during pregnancy should be maintained. In conclusion, given the important role of vitamin D in childhood health, more time spent in outdoor activity (for sunlight exposure) and vitamin D supplementation may be necessary for optimal health in infants, children, and adolescents.
Adolescent ; Calcification, Physiologic ; Cardiovascular Diseases ; Child ; Congenital Abnormalities ; Female ; Growth Plate ; Humans ; Hypersensitivity ; Infant ; Infant, Newborn ; Insulin Resistance ; Milk ; Mothers ; Obesity ; Osteomalacia ; Osteoporosis ; Pregnancy ; Puberty ; Risk Factors ; Seasons ; Social Class ; Sunlight ; Vitamin D Deficiency ; Vitamin D* ; Vitamins

The emergence of penicillin-resistant S. pneumoniae has issued in the management of community-acquired pneumonia (CAP). However, the clinical outcome did not match with penicillin resistance. Thus, recent (Jan/2008) change of penicillin breakpoints for nonmeningeal strain was done and this made prevalence of penicillin resistance under 5% worldwide. Macrolide resistance of S. pneumoniae in Korea is prevalent (70-80%). Thus, the Korean CAP guideline did not include macrolide monotherapy as empiric therapy. Fluoroquinolone resistance of pneumococcus is very low, however, concerning of the increase of resistance is present.Some new antibiotics for the multidrug resistant S. pneumoniae should be reserved for the future. Macrolide resistance of Mycoplasma pneumoniae is reported in various regions in the world, however, data of the clinical significance is rare. Increased beta-lactamase production of Haemophilus influenzae urges us to use beta-lactam/beta-lactamase or 3rd generation cephalosporin if Haemophilus is pathogen. Pneumococcal vaccine usage is an effective way to prevent invasive diseases by S. pneumoniae (including resistant pathogen). The rate of pneumococcal vaccination in Korea is very low (0.8% in adult). Strategies to control resistance that include effective antimicrobial treatment, vaccination, infection control, appropriate policies and regulations, 'antibiotic stewardship' and education of appropriate antibiotic use, are greatly in need.
Anti-Bacterial Agents ; beta-Lactamases ; Drug Resistance, Microbial ; Haemophilus ; Haemophilus influenzae ; Infection Control ; Korea ; Mycoplasma pneumoniae ; Penicillin Resistance ; Penicillins ; Pneumonia ; Pneumonia, Mycoplasma ; Prevalence ; Social Control, Formal ; Sprains and Strains ; Streptococcus pneumoniae ; Vaccination