Objective:To summarize the best available evidence regarding the effectiveness of interventions for preventing frailty progression in older adults.Introduction:Frailty is an age-related state of decreased physiological reserves characterized by an increased risk of poor clinical outcomes. Evidence supporting the malleability of frailty, its prevention and treatment, has been presented.Inclusion criteria:The review considered studies on older adults aged 65 and over, explicitly identified as pre-frail or frail, who had been undergoing interventions focusing on the prevention of frailty progression. Participants selected on the basis of specific illness or with a terminal diagnosis were excluded. The comparator was usual care, alternative therapeutic interventions or no intervention. The primary outcome was frailty. Secondary outcomes included: (i) cognition, quality of life, activities of daily living, caregiver burden, functional capacity, depression and other mental health-related outcomes, self-perceived health and social engagement; (ii) drugs and prescriptions, analytical parameters, adverse outcomes and comorbidities; (iii) costs, and/or costs relative to benefits and/or savings associated with implementing the interventions for frailty. Experimental study designs, cost effectiveness, cost benefit, cost minimization and cost utility studies were considered for inclusion.Methods:Databases for published and unpublished studies, available in English, Portuguese, Spanish, Italian and Dutch, from January 2001 to November 2015, were searched. Critical appraisal was conducted using standardized instruments from the Joanna Briggs Institute. Data was extracted using the standardized tools designed for quantitative and economic studies. Data was presented in a narrative form due to the heterogeneity of included studies.Results:Twenty-one studies, all randomized controlled trials, with a total of 5275 older adults and describing 33 interventions, met the criteria for inclusion. Economic analyses were conducted in two studies. Physical exercise programs were shown to be generally effective for reducing or postponing frailty but only when conducted in groups. Favorable effects on frailty indicators were also observed after the interventions, based on physical exercise with supplementation, supplementation alone, cognitive training and combined treatment. Group meetings and home visits were not found to be universally effective. Lack of efficacy was evidenced for physical exercise performed individually or delivered one-to-one, hormone supplementation and problem solving therapy. Individually tailored management programs for clinical conditions had inconsistent effects on frailty prevalence. Economic studies demonstrated that this type of intervention, as compared to usual care, provided better value for money, particularly for very frail community-dwelling participants, and had favorable effects in some of the frailty-related outcomes in inpatient and outpatient management, without increasing costs.Conclusions:Th...

The possible relationship between diabetes mellitus and cancer risk has long been discussed (Kessler, 1970(Kessler, , 1971 Armstrong et al., 1976;Ragozzino et al., 1982;Green & Hougaard, 1984;O'Mara et al., 1985;Levine et al., 1990;Moss et al., 1991; Davey Smith et al., 1992), but there is still a need for quantitative and precise assessment of the risk. This is not surprising, since several studies were based only on anecdotal reports, and most prospective studies of diabetics are based on at most a few hundred cases of all cancers combined (Armstrong et al., 1976;Ragozzino et al., 1982;Green & Hougaard, 1984;Levine et al., 1990;Moss et al., 1991), thus making any precise inference about specific cancer sites difficult.The largest data set, and hence the most informative study from the viewpoint of statistical power, was based on 8,220 male and 6,690 female cancer cases and about 5,000 controls admitted to the Roswell Park Memorial Institute between 1957 and 1965(O'Mara et al., 1985. In that study, there was a significant risk of endometrial cancer among subjects with a history of diabetes (relative risk, RR 2.0). Significntly elevated nsks of kidney and non-melanomatous skin cancers also emerged in females, but not in males. There was no significnt excess of pancreatic cancer, which however was associated with diabetes mellitus in a few other studies (Kessler, 1970;Wynder et al., 1973;Whittemore et al., 1983;Cuzick & Babiker, 1989 An association between diabetes and primary liver cancer has also been reported in some studies (Lawson et al., 1986; La Vecchia et al., 1990a;Yu et al., 1991) To provide further quantitative information on the issue, and give a further summary overview of the impact of diabetes on the risk of cancers of several sites, we consider in this article data from a case-control study conducted in Northern Italy. S andThe data were derived from an ongoing integrated series of case-control studies, based on a network of teaching and general hospitals in the Greater Milan area. Recruitment of cases with cancer of various sites and of the corresponding controls started between 1983 and 1985, and the present report includes data collected until December, 1992.The general design of this investigation has already been described , and papers on selected cancer sites have already included some information on diabetes (Paramni et al., 1989; Franceschi et al., 1990; La Vecchia et al., 1990a. Briefly, trained interviewers identified and questioned cases with cancer of a number of selected sites and controls admitted to hospital for a wide spectrum of acute, non-neoplastic, non-metabolic, non-hormone-related conditions. On average, less than 4% of eligible subjects (cases and controls) refused to be interviewed. Over 85% of both cases and controls resided in the same region, Lombardy. The same scheme, criteria for identification and recruitment of cases and controls and interview setting (in hospital) was utilised for all the studies considered. All questionnaires included the same structured secti...

The relationship between cancer risk and frequency of consumption of green vegetables and fruit has been analyzed using data from an integrated series of case-control studies conducted in northern Italy between 1983 and 1990. The overall dataset included the following histologically confirmed cancers: oral cavity and pharynx, 119; oesophagus, 294; stomach, 564; colon, 673; rectum, 406; liver, 258; gall-bladder, 41; pancreas, 303; larynx, 149; breast, 2,860; endometrium, 567; ovary, 742; prostate, 107; bladder, 365; kidney, 147; thyroid, 120; Hodgkin's disease, 72; non-Hodgkin lymphomas, 173; myelomas, 117; and a total of 6,147 controls admitted to hospital for acute non-neoplastic conditions, unrelated to long-term dietary modifications. Multivariate relative risks (RR) for subsequent tertiles of vegetable and fruit consumption were derived after allowance for age, sex, area of residence, education and smoking. For vegetables, there was a consistent pattern of protection for all epithelial cancers, with RRs in the upper tertile ranging from 0.2 for oesophagus, liver and larynx to 0.7 for breast. All the trends in risk were in the same direction and significant for all carcinomas except gall-bladder. In contrast, no protection was afforded by high vegetable consumption against non-epithelial lymphoid neoplasms. With reference to fruit, strong inverse relationships were observed for cancers of the upper digestive and respiratory tract, with RRs in the upper tertile between 0.2 and 0.3 for oral cavity and pharynx, oesophagus and larynx relative to the lowest tertile. The lower the location of the tumour in the digestive tract, the weaker appeared to be the protection afforded. Significant inverse relationships were observed for liver, pancreas, prostate and urinary sites, but not for rectum, breast and female genital cancers or thyroid. No relationship emerged for lymphomas and myelomas. Even in the absence of a clear biological interpretation, the consistency and strength of the patterns observed indicate that, in this population, frequent green vegetable intake is associated with a substantial reduction of risk for several common epithelial cancers, and that fruit intake has a favourable effect, especially on upper digestive cancers and, probably, also on urinary tract neoplasms.

Dietary factors in the aetiology of stomach cancer were investigated using data from a case-control study conducted in Northern Italy on 206 histologically confirmed carcinomas and 474 control subjects in hospital for acute, non-digestive conditions, unrelated to any of the potential risk factors for gastric cancer. Dietary histories concerned the frequency of consumption per week of 29 selected food items (including the major sources of starches, proteins, fats, fibres, vitamins A and C, nitrates and nitrites in the Italian diet) and subjective scores for condiments and salt intake. Pasta and rice (the major sources of starch), polenta (a porridge made of maize) and ham were positively related with gastric cancer risk, whereas green vegetables and fresh fruit as a whole (and specifically citrus fruit) and selected fibre-rich aliments (such as whole-grain bread or pasta) showed protective effects on gastric cancer risk. Allowance for major identified potential distorting factors (chiefly indicators of socio-economic status) reduced the positive association with pasta or rice consumption, but did not appreciably modify any of the other risk estimates. When a single logistic model was fitted including all food items significant in univariate analysis, the 3 items remaining statistically significant were green vegetables (relative risk, RR = 0.27 for upper vs. lower tertile), polenta (RR = 2.32) and ham (RR = 1.60). Indices of beta-carotene and ascorbate intake were negatively and strongly related with gastric cancer risk, but the association with these micronutrients was no longer evident after simultaneous allowance for various food items. An approximately 7-fold difference in risk was found between extreme quintiles of a scale measuring major positive and negative associations.