1. Terry Son Mercer University PharmD Candidate October 21, 2011
Metabolic Syndrome and Physical Performance in Elderly Men: The Osteoporotic Fractures in Men Study Everson-Rose SA, Paudel M, Taylor BC, et al. The American Geriatrics Society 2011; 59: Authors had no financial or any other kind of personal conflicts with this publication
Terry Son
Mercer University
PharmD Candidate
October 21, 2011

2. Background
2: Background
MetS clustering of cardiovascular risk factors including central adiposity, altered glucose and insulin metabolism, hypertension, and dyslipedemia.
Increases risk for stroke, cardiovascular diseas, DM, and mortality

3. Metabolic Syndrome (MetS)
Background
Metabolic Syndrome (MetS)
Age-adjusted prevalence of MetS is nearly 24% in the United States and increases with age
Adults age 60 or older, the prevalence exceeds 40%
Increases risk for stroke, cardiovascular diseases, DM, and mortality
Is related to cognitive decline
Slide 2: increases risk fo

4. Background Metabolic Syndrome (defined in study):
Glucose dysregulation or insulin resistance
Impaired fasting glucose (IFG) < 126 mg/dl
Diabetes mellitus
Fasting glucose ≥ 126 mg/dl
History of diabetes or use of hypoglycemic medications at baseline, or hyperinsulinemia

5. Background Metabolic Syndrome (defined in study) continued:
Two of the 4 characteristics
SBP ≥ 140 mmHg or drug treatment for HTN
HDL-C < 35 mg/dl
Triglyceride ≥ 150 mg/dl
BMI ≥ 30 kg/m²

6. Objective
To examine the association between metabolic syndrome (MetS) and objective measures of physical performance

7. Design
Cross-sectional analysis of cohort study, The Osteoporotic Fractures in Men Study
March 2000 to April 2002

8. Setting/Patients Six clinical sites in the United States
Ambulatory men 65 yo and older
5995 enrolled; 5,457 analyzed

9. Inclusion/Exclusion Inclusion: Exclusion: ≥ 65 yo
w/o bilateral hip replacement
Able to walk w/o assistance of another person
Healthy aging and fracture risk
Exclusion:
Not specified

10. Intervention
Association between metabolic syndrome (MetS) and physical performance was evaluated in 3 ways:
Performance scores were examined in relation to individual MetS components
Performance examined according to number of MetS components a person had
Performance for men with and w/o MetS was evaluated based on WHO criteria

11. Intervention
Physical Performance assessed upper and lower body strength, gait speed, and balance
Grip strength
Narrow walk speed
Walking speed
Time to complete five repeated chair stands
Physical performance measured at baseline

12. Intervention Individual scores were converted to quintiles Worst = 1
Best = 5
Unable to compete = 0
Scores were summed for all overall score
Mean 11.6 ± 4.3, range 1-20

13. Outcomes Primary Analyses:
Evaluate the individual MetS components in relation to physical performance
Evaluate overall performance scores for men with and without MetS (according to WHO criteria)

14. Outcomes Secondary Analyses:
Evaluate the individual physical performance measures
Grip strength
Narrow walk speed
Walking speed
Repeated chair stands

15. Statistics Descriptive statistics t-test for continuous variables
Chi-square tests for categorical variables
Linear Regression models
Model 1 (minimally adjusted model)
Included covariates for age, race, education, clinic site
Model 2: (multivariable-adjusted model)
Included additional covariates for smoking status, alcohol consumption, physical activity, history of falls or fractures, self-rated health , and # of chronic medical conditions.
Descriptive statistics were computed to compare men with and without MetS on baseline characteristics
Linear regression to assess the association between metsS and physical performance.

16. Statistics t-test Used for 2 independent samples
Men with and w/o MetS
Contained continuous data
Can take on any value within a finite or infinite
interval
Can be counted, ordered, and measured
Examples: SBP, BMI, physical activity scale, and age
Example: men with

17. Results Participant Characteristics * Component
Glucose dysregulation or insulin resistance *
Obese
HTN
or Using Anti-HTN Medications
Low HDL-C
High Triglycerides N
3,262
1,187
2,458
733
1,992
% tage 60 22 45 13
36.5 *
Subcomponent DM
Hyperinsulinemia
IFG N
840
1,143
1,279

18. Results Participant Characteristics # of MetS Components 3 or more 2 1N
1,495
1,447
1,614
901
1,437 (26.3%) participants met WHO criteria for MetS
IFG, DM, hyperinsulinemia, and
At least 2 of 4 characteristics (HTN, low HDL-C, obese, low triglycerides)

19. Baseline Demographics
Slide 16: baseline demographics
Men with and without MetS differ significantly on all characteristics except race or ethnicity and history of falls and fractures
11% minority

20. Results SBP or HTN is not associated with physical performance
Low HDL-C is not significantly associated with physical performance after adjustment for multiple variables

21. Results
Figure 1: Mean Physical Performance score according to number of MetS components
P = < 0.001
Results adjusted using multivariable model
The greater # of MetS components, the lower the physical performance score
Results when minimally adjusted had similar trend across component categories (P< 0.001)

22. Results
Participants without MetS did statistically better on physical performance measures whether adjusted minimally or multivariablely

23. Results
Physical performance was affected in participants with MetS on:
Narrow walk speed
Walking speed
Repeated chair stands
Whether or not the participants have MetS, grip strength performance was not significantly affected

24. Authors’ Conclusion
Metabolic dysregulation is related to objectively assessed poorer physical performance in relatively healthy older men
Participants with MetS had significantly worse performance of objective indicators on physical function than their peers without MetS

25. Commentary Strengths Physical performances were assessed objectively
Well-characterized cohort of community-dwelling, older men
Performance-based measures served as more valid measures than self-reported measures

26. Commentary Limitations
May not be generalized to men from other demographics
WHO criteria were adapted to define MetS because data on DBP or microalbuminuria were lacking, and BMI was used instead of waist circumference
Did not address mechanism by which MetS contributes to poorer performance
Data were cross-sectional only and did not address the temporal association

27. Metabolic syndrome