Papers by Marcello Maggio
Bioavailable Testosterone Linearly Declines Over A Wide Age Spectrum in Men and Women From The Baltimore Longitudinal Study of Aging
The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 27, 2016
Age-related changes in testosterone levels in older persons and especially in women have not been... more Age-related changes in testosterone levels in older persons and especially in women have not been fully explored. The objective of this study was to describe age-related trajectories of total testosterone (TT), ammonium sulfate precipitation-measured bioavailable testosterone (mBT), and sex hormone-binding glycoprotein (SHBG) in men and women from the Baltimore Longitudinal Study of Aging, with special focus on the oldest adults. Participants included 788 White men and women aged 30-96 years with excellent representation of old and oldest old, who reported not taking medications known to interfere with testosterone. Longitudinal data were included when available. TT, mBT, and SHBG were assayed. Age-related trajectories of mBT were compared with those obtained using calculated bioavailable testosterone (cBT). Generalized least square models were performed to describe age-related trajectories of TT, mBT, and SHBG in men and women. mBT linearly declines over the life span and even at o...
Journal of the American Geriatrics Society, 2014
OBJECTIVES: To investigate the relationship between use of proton pump inhibitors (PPIs) and inci... more OBJECTIVES: To investigate the relationship between use of proton pump inhibitors (PPIs) and incident dependency in older adults discharged from acute care hospitals. DESIGN: Prospective observational study. SETTING: Eleven geriatric and internal medicine acute care wards located throughout Italy. PARTICIPANTS: Individuals (mean age 79.2 AE 5.5) who were not completely dependent at the time of discharge from participating wards (N = 401). MEASUREMENTS: The outcome of interest was the loss of at least one basic activity of daily living (ADL) from discharge to the end of follow-up (12 months). The relationship between PPI use and functional decline was investigated using logistic regression analysis before and after propensity score matching. RESULTS: Use of PPIs was significantly associated with functional decline before (odds ratio (OR) = 1.75, 95% confidence interval (CI) = 1.17-2.60) and after propensity score matching (OR = 2.44; 95% CI = 1.36-4.41). Other predictors of functional decline were hypoalbuminemia (OR = 3.10, 95% CI = 1.36-7.10 before matching, OR = 2.81, 95% CI = 1.09-7.77 after matching) and cognitive impairment (OR = 4.08, 95% CI = 1.63-10.2 before matching, OR = 6.35, 95% CI = 1.70-24.0 after matching).
INSULIN-LIKE GROWTH FACTOR-1 AND ANEMIA IN OLDER SUBJECTS: THE InCHIANTI STUDY
Endocrine Practice, 2015
Recent studies point out the role of the age-related decline of anabolic hormones, especially tes... more Recent studies point out the role of the age-related decline of anabolic hormones, especially testosterone, in the onset of "anemia of aging". Some of testosterone erythropoietic activities are mediated by Insulin-Like Growth Factor (IGF)-1, which also seems to have independent erythropoietic effects. However, the association between IGF-1, anemia and hemoglobin (Hb) has been poorly investigated in older population. We used data from a representative sample of 953 subjects ≥65 yrs of the InCHIANTI Study, not on GH or erythropoietin therapy and without hematological malignancy and cancer. Anemia was defined according to the WHO criteria by Hb level ≤13 g/dL in men and ≤12 g/dL in women. Backward multiple regression analyses including age, IGF Binding Protein (IGFBP)-3, testosterone, comorbidities, inflammatory markers, anemia-related measures were used to address the relationship between IGF-1 and Hb and between IGF-1 and anemia in the two sexes. 46/410 men (11.2%) and 71/543 women (13.0%) were defined as anemic. After adjustment for age, anemic men (100±54 vs 130±56, p<0.001) and women (89.1±48 vs 110±52, p=0.001) exhibited lower IGF-1 levels than non-anemic counterpart. IGF-1 levels were independently and negatively associated with anemia in men (β±SE=-0.0005±0.0002, p=0.04) but not in women (β±SE=-0.0002±0.0002, p=0.40). In both men (β±SE=0.002±0.001, p=0.03) and women (β±SE=0.002± 0.0009, p=0.03) IGF-1 levels were independently and positively associated with Hb levels. In older men, but not in women, IGF-1 levels are negatively associated with anemia. IGF-1 levels are independent and positive determinants of Hb concentration in both sexes.
An investigation of multimorbidity measures as risk factors for pneumonia in elderly frail patients admitted to hospital
European Journal of Internal Medicine, 2015
To investigate the association of different chronic comorbidities, considered singularly and toge... more To investigate the association of different chronic comorbidities, considered singularly and together in Cumulative Illness Rating Scale (CIRS) indexes, with pneumonia diagnosis in a group of elderly frail hospitalized patients. With a retrospective cohort design, all clinical records of frail (Rockwood ≥5) nonterminal patients ≥65years old acutely admitted over a 8-month span in an internal medicine ward were evaluated. Pneumonia status and its categorization (community-acquired, CAP, vs healthcare-associated, HCAP) were defined according to chest radiology findings and validated criteria. Chronic comorbidities, CIRS Comorbidity Score and CIRS Severity Index were collected for each participant through a standardized methodology. Multivariate logistic regression models were applied to assess the association of each comorbid condition or scores with pneumonia. 1199 patients (546M, median age 81.9, IQR 72.8-87.9years), of whom 239 with pneumonia (180 CAP, 59 HCAP) were evaluated. CIRS Comorbidity Score was significantly associated with pneumonia, both at an age- and sex-adjusted model and at a multivariate model (OR for each unitary increase 1.03, 95% CI 1.001-1.062, p=0.04), together with provenience from nursing home (OR 1.96, 95% CI 1.41-2.73, p<0.001). Among single comorbidities, only COPD (OR 2.7, 95% CI 1.9-3.6, p<0.001) and dementia (OR 2.3, 95% CI 1.7-3.3, p<0.001) were associated with pneumonia, while stroke, cancer, cardiovascular, chronic liver and kidney disease were not. In a small cohort of elderly frail hospitalized patients, measures of multimorbidity, like CIRS, are significantly associated with the risk of pneumonia. COPD and dementia are the main conditions concurring to define this risk.
The Role of the Multiple Hormonal Dysregulation in the Onset of “Anemia of Aging”: Focus on Testosterone, IGF-1, and Thyroid Hormones
International Journal of Endocrinology, 2015
Anemia is a multifactorial condition whose prevalence increases in both sexes after the fifth dec... more Anemia is a multifactorial condition whose prevalence increases in both sexes after the fifth decade of life. It is a highly represented phenomenon in older adults and in one-third of cases is "unexplained." Ageing process is also characterized by a "multiple hormonal dysregulation" with disruption in gonadal, adrenal, and somatotropic axes. Experimental studies suggest that anabolic hormones such as testosterone, IGF-1, and thyroid hormones are able to increase erythroid mass, erythropoietin synthesis, and iron bioavailability, underlining a potential role of multiple hormonal changes in the anemia of aging. Epidemiological data more consistently support an association between lower testosterone and anemia in adult-older individuals. Low IGF-1 has been especially associated with anemia in the pediatric population and in a wide range of disorders. There is also evidence of an association between thyroid hormones and abnormalities in hematological parameters under overt thyroid and euthyroid conditions, with limited data on subclinical statuses. Although RCTs have shown beneficial effects, stronger for testosterone and the GH-IGF-1 axis and less evident for thyroid hormones, in improving different hematological parameters, there is no clear evidence for the usefulness of hormonal treatment in improving anemia in older subjects. Thus, more clinical and research efforts are needed to investigate the hormonal contribution to anemia in the older individuals.
Nutr Metab Cardiovasc Dis, 2009
The Journal of Nutrition Health and Aging, May 5, 2010
Objectives: The present study evaluates the effects of a 6-month treatment with an ACE-inhibitor ... more Objectives: The present study evaluates the effects of a 6-month treatment with an ACE-inhibitor (ie, fosinopril) on serum concentrations of total IGF-1 and IGF binding protein (IGFBP)-3 in older adults at high risk for cardiovascular disease. Design: Data are from the Trial of Angiotensin Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors (TRAIN) study, a double-blind, crossover, randomized, placebo-controlled trial. Setting: Participants were recruited from the communities of Winston Salem, NC, and Greensboro, NC. Participants: Subjects ≥55 years old with high cardiovascular disease risk profile. Intervention: The intervention consisted of 6-month administration of fosinopril vs. placebo. Measurements: Serum concentrations of total IGF-1 and IGFBP-3 were measured in 100 participants of the TRAIN study at baseline, 6-month and 12-month follow-up visits. Differences in total IGF-1 and IGFBP-3 concentrations were assessed using two-sided paired ttests. Results: The mean age of participants (47% women) was 66.5 (standard deviation 7.2) years. Serum concentrations of total IGF-1 were significantly higher after 6-month treatment with fosinopril compared to placebo (203.73 ng/mL vs 194.24 ng/mL; p=0.02): After ACE-inhibitor intervention, significantly higher serum IGFBP-3 concentrations compared to controls (4308.81 ng/mL vs 4086.93 ng/mL; p=0.03) were also reported. Conclusions: A six-month treatment with fosinopril increases systemic levels of total IGF-1 and IGFBP-3 in older adults with high cardiovascular risk profile. This may represent a potential biological explanation to the beneficial effects of ACE-inhibition on stroke, ischemic heart disease and insulin resistance.
Adherence to a standardized protocol for measuring grip strength and appropriate cut-off values in adults over 65 years with sarcopenia: a systematic review protocol
JBI database of systematic reviews and implementation reports
Idiopathic Calcium Nephrolithiasis and Hypovitaminosis D: a Case-Control Study
Urology, Jan 19, 2015
To investigate the association between vitamin D deficiency (25-hydroxyvitamin D <20 ng/ml) an... more To investigate the association between vitamin D deficiency (25-hydroxyvitamin D <20 ng/ml) and idiopathic calcium nephrolithiasis (ICN). 884 ICN patients (363 males, mean age 51±14) and 967 controls (162 males, mean age 59±15) from an area with no food fortification policy were considered following a case-control study design. Patients were enrolled at a third-level outpatient stone clinic. Controls were selected from a laboratory database after exclusion of those with nephrolithiasis, bone, endocrine, liver and kidney diseases. Serum 25-hydroxyvitamin-D (25-OH-D), date of test, presence/history of diabetes and cardiovascular disease including hypertension were recorded for all subjects. Serum parathormone, calcium, phosphorus and urinary factors of lithogenic risk were available in stone formers (SF). After univariate statistical analysis, propensity score matching with conditional logistic regression was used to control for the possible effects of covariates. The prevalence of...
Context: Like women men experience an age-related decline of physical and mental capacity. These ... more Context: Like women men experience an age-related decline of physical and mental capacity. These symptoms are commonly unified in a syndrome named ADAM (androgen deficiency of the aging male) considering that androgen secretion decline plays a fundamental role in such clinical changes. In women many instruments are available to measure the severity of symptoms, while in men they are absolutely lacking. Recently a couple of validated questionnaires have been proposed for either screening, diagnosing and/or assessing response to therapy.
Multimorbidity in elderly hospitalised patients and risk of Clostridium difficile infection: a retrospective study with the Cumulative Illness Rating Scale (CIRS)
BMJ Open, 2015
To identify the role of chronic comorbidities, considered together in a literature-validated inde... more To identify the role of chronic comorbidities, considered together in a literature-validated index (Cumulative Illness Rating Scale, CIRS), and antibiotic or proton-pump inhibitor (PPI) treatments as risk factors for hospital-acquired Clostridium difficile infection (CDI) in elderly multimorbid hospitalised patients. Retrospective cohort study. Subacute hospital geriatric care ward in Italy. 505 (238 male (M), 268 female (F)) elderly (age≥65) multimorbid patients. The relationship between CDI and CIRS Comorbidity Score, number of comorbidities, antibiotic, antifungal and PPI treatments, and length of hospital stay was assessed through age-adjusted and sex-adjusted and multivariate logistic regression models. The CIRS Comorbidity Score was handled after categorisation in quartiles. Mean age was 80.7±11.3 years. 43 patients (22 M, 21 F) developed CDI. The prevalence of CDI increased among quartiles of CIRS Comorbidity Score (3.9% first quartile vs 11.1% fourth quartile, age-adjusted and sex-adjusted p=0.03). In the multivariate logistic regression analysis, patients in the highest quartile of CIRS Comorbidity Score (≥17) carried a significantly higher risk of CDI (OR 5.07, 95% CI 1.28 to 20.14, p=0.02) than patients in the lowest quartile (&amp;amp;amp;amp;lt;9). The only other variable significantly associated with CDI was antibiotic therapy (OR 2.62, 95% CI 1.21 to 5.66, p=0.01). PPI treatment was not associated with CDI. Multimorbidity, measured through CIRS Comorbidity Score, is independently associated with the risk of CDI in a population of elderly patients with prolonged hospital stay.
IGF-I levels in obesity: their relationship to blood pressure levels
Journal of endocrinological investigation
The Predictive Value of the EWGSOP Definition of Sarcopenia: Results From the InCHIANTI Study
The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 2, 2015
Sarcopenia is associated with increased risk of adverse outcomes in older people. Aim of the stud... more Sarcopenia is associated with increased risk of adverse outcomes in older people. Aim of the study was to explore the predictive value of the European Working Group on Sarcopenia in Older People (EWGSOP) diagnostic algorithm in terms of disability, hospitalization, and mortality and analyze the specific role of grip strength and walking speed as diagnostic criteria for sarcopenia. Longitudinal analysis of 538 participants enrolled in the InCHIANTI study. Sarcopenia was defined as having low muscle mass plus low grip strength or low gait speed (EWGSOP criteria). Muscle mass was assessed using bioimpedance analysis. Cox proportional and logistic regression models were used to assess risk of death, hospitalization, and disability for sarcopenic people and to investigate the individual contributions of grip strength and walking speed to the predictive value of the EWGSOP's algorithm. Prevalence of EWGSOP-defined sarcopenia at baseline was 10.2%. After adjusting for potential confoun...
Relationship between Carotenoids, Retinol, and Estradiol Levels in Older Women
Nutrients, 2015
In vitro evidence suggests anti-estrogenic properties for retinol and carotenoids, supporting a c... more In vitro evidence suggests anti-estrogenic properties for retinol and carotenoids, supporting a chemo-preventive role of these phytochemicals in estrogen-dependent cancers. During aging there are significant reductions in retinol and carotenoid concentrations, whereas estradiol levels decline during menopause and progressively increase from the age of 65. We aimed to investigate the hypothesis of a potential relationship between circulating levels of retinol, carotenoids, and estradiol (E2) in a cohort of late post-menopausal women. We examined 512 women ≥ 65 years from the InCHIANTI study. Retinol, α-caroten, β-caroten, β-criptoxantin, lutein, zeaxanthin, and lycopene levels were assayed at enrollment (1998-2000) by High-Performance Liquid Chromatography. Estradiol and testosterone (T) levels were assessed by Radioimmunometry (RIA) and testosterone-to-estradiol ratio (T/E2), as a proxy of aromatase activity, was also calculated. General linear models adjusted for age (Model 1) and ...
The effects of transdermal estradiol on the GH-IgF Axis of elderly Women: A dose response study
Journal of endocrinological investigation
GH treatment of chronic congestive heart failure: effects in an old patient with GHD
Journal of endocrinological investigation
INSULIN-LIKE GROWTH FACTOR-1 AND ANEMIA IN OLDER SUBJECTS: THE InCHIANTI STUDY
Endocrine Practice, 2015
Recent studies point out the role of the age-related decline of anabolic hormones, especially tes... more Recent studies point out the role of the age-related decline of anabolic hormones, especially testosterone, in the onset of &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;anemia of aging&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;. Some of testosterone erythropoietic activities are mediated by Insulin-Like Growth Factor (IGF)-1, which also seems to have independent erythropoietic effects. However, the association between IGF-1, anemia and hemoglobin (Hb) has been poorly investigated in older population. We used data from a representative sample of 953 subjects ≥65 yrs of the InCHIANTI Study, not on GH or erythropoietin therapy and without hematological malignancy and cancer. Anemia was defined according to the WHO criteria by Hb level ≤13 g/dL in men and ≤12 g/dL in women. Backward multiple regression analyses including age, IGF Binding Protein (IGFBP)-3, testosterone, comorbidities, inflammatory markers, anemia-related measures were used to address the relationship between IGF-1 and Hb and between IGF-1 and anemia in the two sexes. 46/410 men (11.2%) and 71/543 women (13.0%) were defined as anemic. After adjustment for age, anemic men (100±54 vs 130±56, p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001) and women (89.1±48 vs 110±52, p=0.001) exhibited lower IGF-1 levels than non-anemic counterpart. IGF-1 levels were independently and negatively associated with anemia in men (β±SE=-0.0005±0.0002, p=0.04) but not in women (β±SE=-0.0002±0.0002, p=0.40). In both men (β±SE=0.002±0.001, p=0.03) and women (β±SE=0.002± 0.0009, p=0.03) IGF-1 levels were independently and positively associated with Hb levels. In older men, but not in women, IGF-1 levels are negatively associated with anemia. IGF-1 levels are independent and positive determinants of Hb concentration in both sexes.
Survival in octogerian patients undergoing TAVI is strongly predicted by geriatric features
European Geriatric Medicine, 2013
Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial
Journal of the American Medical Directors Association, 2015
Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats t... more Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats to physical performance, independence, and quality of life. Nutritional supplementation could positively influence aspects of sarcopenia and thereby prevent mobility disability. To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of sarcopenia. A multicenter, randomized, controlled, double-blind, 2 parallel-group trial among 380 sarcopenic primarily independent-living older adults with Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index. The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an iso-caloric control product to consume twice daily for 13 weeks. Primary outcomes of handgrip strength and SPPB score, and secondary outcomes of chair-stand test, gait speed, balance score, and appendicular muscle mass (by DXA) were measured at baseline, week 7, and week 13 of the intervention. Handgrip strength and SPPB improved in both groups without significant between-group differences. The active group improved more in the chair-stand test compared with the control group, between-group effect (95% confidence interval): -1.01 seconds (-1.77 to -0.19), P = .018. The active group gained more appendicular muscle mass than the control group, between-group effect: 0.17 kg (0.004-0.338), P = .045. This 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic older adults. This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. These results warrant further investigations into the role of a specific nutritional supplement as part of a multimodal approach to prevent adverse outcomes among older adults at risk for disability.
PP053-SUN: Relationship between PPI use and Hypomagnesaemia in Older Subjects: Data from Baltimore Longitudinal Study of Aging
Clinical Nutrition, 2014
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Papers by Marcello Maggio