Relationship of homocysteine levels to quadriceps strength, gait speed, and late-life disability in older adults
Relationship of homocysteine levels to quadriceps strength, gait speed, and late-life disability in older adults
复制标题
DOI：
10.1093/gerona/62.4.434
复制
发表时间：
2007-04-01
影响因子：
5.1
通讯作者：
Tail, Tong-Yuan
中科院分区：
文献类型：
--
作者：
Kuo, Hsu-Ko;Liao, Kuo-Chen;Tail, Tong-Yuan
背景高同型半胱氨酸通过氧化应激、内皮损伤和蛋白质同型半胱氨酸化等机制引起组织损伤，与多种年龄相关问题相关，包括心血管疾病、痴呆和骨质疏松性骨折。残疾是老年人最常见的特征之一。然而，关于同型半胱氨酸在老年人身体残疾中的作用知之甚少。参与者（>60岁，N = 1677）来自1999-2002年国家健康和营养调查（NHANES）。在五个主要领域的19份问卷进行管理，以评估执行各种任务的困难程度：日常生活活动（ADL），工具性ADL（IADL），休闲和社会活动（LSA），下肢活动（LEM），和一般体力活动（GPA）。峰值股四头肌力量通过使用等速测力计获得。从20英尺定时步行中获得习惯性步态速度。同型半胱氨酸水平采用自动荧光偏振免疫分析法（FPIA）测定。多变量校正后，同型半胱氨酸升高与ADL、IADL、LSA和GPA残疾相关。同型半胱氨酸水平最高四分位数的参与者与最低四分位数的参与者相比，这些领域残疾的优势比（OR）为2.18（95%置信区间[CI]，1.32-3.59）; IADL为1.62（95% CI，1.02-2.57）; LSA为2.00（95% CI，1.14-3.51）; GPA为1.52（95% CI，1.05-2.21）。在额外调整股四头肌力量和/或步态速度后，协会的强度有所减弱，这表明股四头肌力量和步态速度在同型半胱氨酸与残疾之间的关联中起介导作用。同型半胱氨酸与股四头肌力量和步态速度呈负相关。同样，股四头肌力量似乎介导同型半胱氨酸和步态速度之间的负相关。高同型半胱氨酸与部分由肌肉力量和步态速度介导的多个残疾领域相关。结果表明，同型半胱氨酸水平可能是老年人的性能状态的重要指标。
Background. Elevated homocysteine, causing tissue injury by such mechanisms as oxidative stress, endothelial damage, and protein homocysteinylation, is associated with multiple age-related problems including cardiovascular diseases, dementia, and osteoporotic fracture. Disability is one of the most common features in older adults. However, little is known about the role of homocysteine in physical disability among older adults.Methods. Participants (>60 years, N = 1677) were from the National Health and Nutrition Examination Survey (NHANES) 1999-2002. Nineteen questionnaires in five major domains were administered to assess the level of difficulty in performing various tasks: activities of daily living (ADL), instrumental ADL (IADL), leisure and social activities (LSA), lower extremity mobility (LEM), and general physical activities (GPA). Peak quadriceps strength was obtained by using an isokinetic dynamometer. Habitual gait speed was obtained from a 20-foot timed walk. Homocysteine levels were measured by the Abbott homocysteine assay, an automated fluorescence polarization immunoassay (FPIA).Results. Elevated homocysteine was associated with disability in ADL, IADL, LSA, and GPA after multivariate adjustment. The odds ratios (ORs) for disability in these domains comparing participants in the highest quartile of homocysteine to those in the lowest were 2.18 (95% confidence interval [CI], 1.32-3.59) for ADL; 1.62 (95% CI, 1.02-2.57) for IADL; 2.00 (95% CI, 1.14-3.51) for LSA; and 1.52 (95% CI, 1.05-2.21) for GPA. The strength of associations weakened somewhat after additional adjustment of quadriceps strength and/or gait speed, suggesting a mediating role of quadriceps strength and gait speed in the association between homocysteine and disability. Homocysteine had an inverse relationship to quadriceps strength and gait speed. Likewise, quadriceps strength seemed to mediate the inverse association between homocysteine and gait speed.Conclusions. Elevated homocysteine is associated with multiple domains of disability mediated in part by muscle strength and gait speed. The results suggest that homocysteine levels may be important indicators of performance status in older adults.