Background. This study examines factors associated with physical activity (PA) and sedentary behaviors (SB) in young adults (18–35 years) and compares objective and subjective assessment measures of PA and SB. Methods. 595 young adults (27.7 ± 4.4 years; 25.5 ± 2.6 kg/m2) enrolled in the Study of Novel Approaches to Weight Gain Prevention (SNAP) trial. Hours/day spent in SB (<1.5 METs) and minutes/week spent in bout-related moderate-to-vigorous intensity PA (MVPA; ≥3 METs and ≥10 min) were assessed using self-report and objective measures. Demographic factors associated with SB and MVPA were also explored (i.e., age, gender, BMI, ethnicity, work and relationship status, and number of children). Results. Objective MVPA (263 ± 246 min/wk) was greater than self-report estimates (208 ± 198 min/wk; p < 0.001) and differed by 156 ± 198 min/wk at the individual level (i.e., the absolute difference). Females, overweight participants, African Americans, and those with children participated in the least amount of MVPA. Objective estimates of SB (9.1 ± 1.8 hr/day; 64.5% of wear time) were lower than subjective estimates (10.1 ± 3.5 hr/day; p < 0.001), differing by 2.6 ± 2.5 hr/day for each participant. Conclusion. Young adults interested in weight gain prevention engage in both high levels of MVPA and SB, with participants self-reporting fewer MVPA minutes and more SB compared to objective estimates. This study is registered at ClinicalTrials.gov (NCT01183689).

Aim To compare the cardiovascular (CV) safety of linagliptin with glimepiride in older and younger participants in the CAROLINA trial in both prespecified and post hoc analyses. Materials and Methods People aged 40 to 85 years with relatively early type 2 diabetes, inadequate glycaemic control and elevated CV risk were randomly assigned to linagliptin 5 mg or glimepiride 1 to 4 mg. The primary endpoint was time to first occurrence of three‐point major adverse CV events (MACE: CV death, non‐fatal myocardial infarction, or non‐fatal stroke). We evaluated clinical and safety outcomes across age groups. Results Of 6033 participants, 50.7% were aged <65 years, 35.3% were aged 65 to 74 years, and 14.0% were aged ≥75 years. During the 6.3‐year median follow‐up, CV/mortality outcomes did not differ between linagliptin and glimepiride overall (hazard ratio [HR] for three‐point MACE 0.98, 95.47% confidence interval [CI] 0.84, 1.14) or across age groups (interaction P >0.05). Between treatment groups, reductions in glycated haemoglobin were comparable across age groups but moderate‐to‐severe hypoglycaemia was markedly reduced with linagliptin (HR 0.18, 95% CI 0.15, 0.21) with no differences among age groups (P = 0.23). Mean weight was −1.54 kg (95% CI –1.80, –1.28) lower for linagliptin versus glimepiride. Adverse events increased with age, but were generally balanced between treatment groups. Significantly fewer falls or fractures occurred with linagliptin. Conclusions Linagliptin and glimepiride were comparable for CV/mortality outcomes across age groups. Linagliptin had significantly lower risk of hypoglycaemia and falls or fractures than glimepiride, including in “older‐old” individuals for whom these are particularly important treatment considerations.

Late-life ambient air pollution is a risk factor for brain aging, but it remains unknown if improved air quality (AQ) lowers dementia risk. We studied a geographically diverse cohort of older women dementia free at baseline in 2008 to 2012 (n = 2,239, aged 74 to 92). Incident dementia was centrally adjudicated annually. Yearly mean concentrations of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) were estimated using regionalized national universal kriging models and averaged over the 3-y period before baseline (recent exposure) and 10 y earlier (remote exposure). Reduction from remote to recent exposures was used as the indicator of improved AQ. Cox proportional hazard ratios (HRs) for dementia risk associated with AQ measures were estimated, adjusting for sociodemographic, lifestyle, and clinical characteristics. We identified 398 dementia cases during follow up (median = 6.1 y). PM2.5 and NO2 reduced significantly over the 10 y before baseline. Larger AQ improvement was associated with reduced dementia risks (HRPM2.5 0.80 per 1.78 μg/m3, 95% CI 0.71–0.91; HRNO2 0.80 per 3.91 parts per billion, 95% CI 0.71–0.90), equivalent to the lower risk observed in women 2.4 y younger at baseline. Higher PM2.5 at baseline was associated with higher dementia risk (HRPM2.5 1.16 per 2.90 μg/m3, 95% CI 0.98–1.38), but the lower dementia risk associated with improved AQ remained after further adjusting for recent exposure. The observed associations did not substantially differ by age, education, geographic region, Apolipoprotein E e4 genotypes, or cardiovascular risk factors. Long-term AQ improvement in late life was associated with lower dementia risk in older women.

Background Indices of multimorbidity and deficit accumulation (i.e. frailty indices) have been proposed as markers of biological aging. If true, changes in these indices over time should predict downstream changes in cognition and physical function, and mortality. Methods We examined associations that 8-year changes in 1) a multimorbidity index comprised of nine chronic diseases and 2) a frailty index (FI) based on deficit accumulation in functional, behavioral, and clinical characteristics had with subsequent measures of cognitive and physical function over 10 years. We drew data from 3841 participants in the Look AHEAD clinical trial. They were aged 45-76 years at baseline and at risk for accelerated biological aging due to overweight/obesity and type 2 diabetes mellitus. Results 1501 (39%) of the cohort had 8-year increases of one among the nine diseases tracked in the multimorbidity index and 868 (23%) had increases of &gt;2. Those with greatest increases in multimorbidity tended to be older individuals, males, and non-Hispanic whites. Greater FI increases tended to occur among individuals who were older, non-Hispanic white, heavier, and who had more baseline morbidities. Changes in multimorbidity and FI were moderately correlated (r=0.26; p&lt;0.001). Increases in both multimorbidity and FI were associated with subsequently poorer composite cognitive function and 400m walk speed and increased risk for death (all p&lt;0.001). Conclusions Accelerated biological aging, as captured by multimorbidity and frailty indices, predicts subsequent reduced function and mortality. Whether intensive lifestyle interventions generally targeting multimorbidity and FI reduce risks for downstream outcomes remains to be seen.

Background Individuals with diabetes have a high frailty burden and increased risk of heart failure (HF). In this study, we evaluated the association of baseline and longitudinal changes in frailty with risk of HF, HF with preserved ejection fraction (HFpEF), and HF with reduced ejection fraction (HFrEF). Methods Participants (age: 45-76 years) of the Look AHEAD trial without prevalent HF were included. The frailty index (FI) was used to assess frailty burden using a 35-variable deficit model. The association between baseline and longitudinal changes (1-year, 4-year follow-up) in FI with risk of overall HF, HFpEF (ejection fraction (EF)≥50%)], and HFrEF (EF&lt;50%) independent of other risk factors and cardiorespiratory fitness was assessed using adjusted Cox models. Results The study included 5,100 participants, of which 257 developed HF. In adjusted analysis, higher frailty burden was significantly associated with a greater risk of overall HF. Among HF subtypes, higher baseline FI was significantly associated with risk of HFpEF (HR[95% CI] per 1-SD higher FI: 1.37[1.15-1.63]) but not HFrEF (HR[95% CI]: 1.19[0.96-1.46]) after adjustment for potential confounders, including traditional HF risk factors. Among participants with repeat measures of FI at 1-year and 4-year follow-up, an increase in frailty burden was associated with a higher risk of HFpEF (HR[95%CI] per 1-SD increase in FI at 4-year: 1.78[1.35-2.34]) but not HFrEF after adjustment for other confounders. Conclusions Among individuals with T2DM, higher baseline frailty and worsening frailty burden over time were independently associated with higher risk of HF, particularly HFpEF after adjustment for other confounders.