Person: SOYSAL, PINAR
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Publication Open Access Orthostatic hypotension and health outcomes: an umbrella review of observational studies(2019-11-07) Veronese, Nicola; Smith, Lee; Torbahn, Gabriel; Jackson, Sarah E.; Yang, Lin; SOYSAL, PINAR; Rivasi, Giulia; Rafanelli, Martina; Petrovic, Mirko; Maggi, Stefania; Isik, Ahmet Turan; Demurtas, Jacopo; SOYSAL, PINARPurpose Orthostatic hypotension (OH) is associated with older age and many negative clinical outcomes in geriatric practice. We aimed to capture the breadth of outcomes that have been associated with the presence of OH and systematically assess the quality, strength and credibility of these associations using an umbrella review with integrated meta-analyses. Methods We systematically searched several major databases from their commencements through to 16th May 2019 for meta-analyses of observational studies of OH and any health-related outcome. We used these metrics to categorize the strength of evidence of significant outcomes (p < 0.05) from class I (convincing) to class IV (weak), according to the pre-established criteria. Results From 975 abstracts, seven meta-analyses of 12 outcomes were included. For each outcome, the median number of studies was four, and the median number of participants was 46,493, with a median of 3630 incident cases. There was suggestive (class III) evidence that OH was associated with significantly higher risk of coronary heart disease (HR = 1.32, 95% CI 1.12-1.56), stroke (HR = 1.22, 95% CI 1.08-1.38), congestive heart failure (HR = 1.30, 95% CI 1.09-1.55), all-cause mortality (RR = 1.50, 95% CI 1.24-1.81), falls (OR = 1.84, 95% CI 1.39-2.44), and dementia (HR = 1.22, 95% CI 1.11-1.35). Conclusion The current evidence base indicates that OH is significantly associated with a range of adverse cardiovascular, cognitive, and mortality outcomes in older people, although the strength of this evidence remains only suggestive. Further research in larger samples and with lower risk of bias is required to build a fuller picture of the impact of OH on health.Publication Metadata only Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis(2016-12-01T00:00:00Z) Soysal, PINAR; Isik, Ahmet Turan; Stubbs, Brendon; Solmi, Marco; Volpe, Marco; Luchini, Claudio; D'Onofrio, Grazia; Pilotto, Alberto; Manzato, Enzo; Sergi, Giuseppe; Schofield, Patricia; Veronese, Nicola; SOYSAL, PINARWe conducted a systematic review and meta-analysis investigating the influence of acetylcholinesterase inhibitors (AChEIs) therapy on nutritional status and weight across observational and interventional studies. Two authors searched major electronic databases from inception until 10/14/2015 for longitudinal, open-label and randomised double-blind placebo controlled (randomised controlled trials (RCTs)) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10 792 patients with dementia were metaanalysed. In longitudinal studies (median follow-up 6 months), a significant cumulative incidence of weight loss between baseline and follow-up evaluation was observed (studies= 2; 5%; 95% CI 1% to 34%, p< 0.0001; I2= 95%). These findings were confirmed in open-label trials (6%; 95% CI 4% to 7%, p< 0.0001; I-2= 78%). In 9 RCTs (median followup 5 months), those taking AChEIs more frequently experienced weight loss than participants taking placebo (OR= 2.18; 95% CI 1.50 to 3.17, p< 0.0001; I-2= 29%). AChEIs therapy contributes to weight loss in patients with dementia, with a 2-fold increased risk observed in the meta-analysis of RCTs. Clinicians should carefully consider the benefit and risk of prescribing AChEIs. Nutritional status should be routinely evaluated in patients with dementia treated with AChEIs.Publication Metadata only Role of physical activity in ameliorating neuropsychiatric symptoms in Alzheimer disease: A narrative review(2019-09-01T00:00:00Z) Veronese, Nicola; Solmi, Marco; Basso, Cristina; Smith, Lee; SOYSAL, PINAR; SOYSAL, PINARObjective Neuropsychiatric symptoms (NPs) affect almost all patients with Alzheimer disease (AD). Because of the complications associated with the pharmacological treatment, nonpharmacological treatment (such as physical activity) can be considered as an additional complementary treatment option for NPs. The aim of this review is to evaluate the impact of physical activity on NPs in patients with AD. Methods We searched Pubmed and Google Scholar for potential eligible articles until March 1, 2018. Results Although there are contradictory results showing the impact of physical exercise on NPs, most of them reported that it had a significant effect on depression and sleep disturbances in patients with AD. The beneficial effects could be explained through several mechanisms, including modulated production of neurotransmitters; increasing neurotrophins, such as brain-derived neurotrophic factor; reduction of oxidative stress and inflammation; elevation of cerebral blood flow; hypothalamic pituitary adrenal axis regulation; and support of neurogenesis and synaptogenesis. Physical activity can also improve cardiovascular risk factors, which may exaggerate NPs. There is limited evidence for other NPs such as agitation, disinhibition, apathy, hallucinations, and anxiety. Conclusion Physical activity may ameliorate depression and sleep disturbances in patients with AD. Therefore, physical activity can be a -potential- add-on treatment to drugs to reduce or prevent these symptoms onset and recurrence in patients with AD. However, further studies are needed to focus on relationship between physical activity and other NPs.Publication Open Access Association between urinary incontinence and frailty: a systematic review and meta-analysis(2018-10-01T00:00:00Z) Veronese, Nicola; SOYSAL, PINAR; Stubbs, Brendon; Marengoni, Alessandra; Demurtas, Jacopo; Maggi, Stefania; Petrovic, Mirko; Verdejo-Bravo, Carlos; SOYSAL, PINARPurposeUrinary incontinence (UI) and frailty are common geriatric syndromes. Although literature increasingly supports a relationship between these two conditions, no systematic review and meta-analysis has been performed on this topic. Therefore, we aimed to investigate the potential association between UI and frailty, through a meta-analytic approach.MethodsA systematic search in major databases was undertaken until 15th March 2018 for studies reporting the association between UI and frailty. The prevalence of UI in people with frailty (vs. those without) was pooled through an odds ratio (OR) and 95% confidence intervals (CIs), with a random-effects model. The other outcomes were summarized descriptively.ResultsAmong 828 papers, 11 articles were eligible, including 3784 participants (mean age 78.2years; 55.1% women). The prevalence of UI was 39.1% in people with frailty and 19.4% in those without. A meta-analysis with five studies (1540 participants) demonstrated that UI was over twice as likely in frail people versus those without (OR 2.28; 95% CI 1.35-3.86; I-2=61%). One cross-sectional study, adjusting for potential confounders and one longitudinal study confirmed that UI is significantly associated with frailty. In two cross-sectional studies, using adjusted analyses, frailty was more common in people with UI.ConclusionUrinary incontinence is twice as common in older people with frailty compared to older people without frailty. Screening and the development of interventions for UI and frailty could prove useful for this common comorbidity.Publication Open Access Mini Nutritional Assessment Scale-Short Form can be useful for frailty screening in older adults(2019-01-01T00:00:00Z) SOYSAL, PINAR; Veronese, Nicola; Arik, Ferhat; Kalan, Ugur; Smith, Lee; IŞIK, AHMET TURAN; SOYSAL, PINARAim: Mini Nutritional Assessment-Short Form MNA-SF) is used to assess nutritional status in older adults, but it is not known whether it can be used to define frailty. This study was aimed to investigate whether or not MNA-SF can identify frailty status as defined by Fried-s criteria.Publication Open Access Dietary Protein Intake and Falls in Older People: Longitudinal Analyses From the Osteoarthritis Initiative(2019-05-01) SOYSAL, PINAR; Veronese, Nicola; STUBBS, Brendon; Maggi, Stefania; Jackson, Sarah E; DEMURTAS, Jacopo; Celotto, S.; KOYANAGI, AI; Bolzetta, F.; Smith, Lee; SOYSAL, PINARPublication Open Access Association between sarcopenia and diabetes: a systematic review and meta-analysis of observational studies(2019-10-01) Veronese, Nicola; Pizzol, Damiano; Demurtas, Jacopo; Smith, Lee; Sieber, Cornel; Strandberg, Timo; Bourdel-Marchasson, Isabelle; Sinclair, Alan; Petrovic, Mirko; Maggi, Stefania; SOYSAL, PINARAbstract Purpose Sarcopenia and diabetes are two common conditions in older people. Some recent literature has proposed that these two conditions can be associated. However, to date, no attempt has been made to collate this literature. Therefore, we aimed to summarize the prevalence of sarcopenia in diabetes (and vice versa) and the prevalence of sarcopenia in people with diabetes complications, through a systematic review and meta-analysis. Methods Two authors searched major electronic databases from inception until March 2019 for case control/cross-sectional/longitudinal studies investigating sarcopenia and diabetes. The strength of the reciprocal associations between sarcopenia and diabetes was assessed through odds ratios (ORs) with 95% confidence intervals (CIs), adjusted for potential confounders, where possible. Results From 953 potential eligible articles, 20 were included in the systematic review, with 17 providing data for meta-analysis. Overall, 54,676 participants were included (mean age = 65.4 years). Diabetic participants had an increased prevalence of sarcopenia compared to controls (n = 10; OR = 1.635; 95% CI 1.204-2.220; p = 0.002; I-2 = 67%), whilst, after adjusting for potential confounders, sarcopenia was associated with an increased odds of having diabetes (OR = 2.067; 95% CI 1.396-3.624; p < 0.0001; I-2 = 0%). In 1868 diabetic participants with a complication, there was an increased prevalence of sarcopenia (OR = 2.446; 95% CI 1.839-3.254; p < 0.0001; I-2 = 0%), as compared with those with no complication. Very limited data existed regarding studies with a longitudinal design. Conclusions Our study suggests a bidirectional association between diabetes and sarcopenia, particularly when diabetic complications are present.Publication Open Access Sarcopenia and health-related outcomes: an umbrella review of observational studies(2019-12-01) Veronese, Nicola; Demurtas, Jacopo; SOYSAL, PINAR; Smith, Lee; Torbahn, Gabriel; Schoene, Daniel; Schwingshackl, Lukas; Sieber, Cornel; Bauer, Jurgen; Cesari, Matteo; Bruyere, Oliviere; Reginster, Jean-Yves; Beaudart, Charlotte; Cruz-Jentoft, Alfonso J.; Cooper, Cyrus; Petrovic, Mirko; Maggi, Stefania; SOYSAL, PINARKey summary pointsAimTo investigate associations of sarcopenia with adverse health-related outcomes, through an umbrella review method.FindingsSarcopenia appears to be significantly associated with several adverse outcomes in older people, with a strong evidence for increased risk of mortality, disability, and falls.MessageSarcopenia is associated with several adverse health-related outcomes in older people, indicating the need of assessing this condition in daily practice. AbstractBackgroundThe clinical relevance of sarcopenia has increasingly been recognized. However, whether it is associated with the development of other medical conditions is still unclear. Therefore, we aimed to capture the scale of outcomes that have been associated with the presence of sarcopenia and systematically assess the quality, strength, and credibility of these associations using an umbrella review methodology.MethodsA systematic review in several databases was carried out, until 20th February 2019. For each association, random-effects summary effect size, 95% confidence intervals (CIs), heterogeneity (I-2), evidence for small-study effect, evidence for excess significance bias, and 95%-prediction intervals were estimated. We used these metrics to categorize the evidence of significant outcomes (p<0.05) from class I (convincing) to class IV (weak), according to pre-established criteria.ResultsFrom 358 abstracts, 6 meta-analyses with 14 associations were included. Sarcopenia was associated with higher risk of other comorbidities and mortality in 11 of 14 outcomes explored. However, only 3 outcomes (i.e., association between sarcopenia and increased risk of death in community-dwelling older people [odds ratio, OR=3.60; 95% CI 2.96-4.37; n=14,305], disability [OR=3.04; 95% CI 1.80-5.12; n=8569], and falls [OR=1.60; 95% CI 1.31-1.97; n=12,261]) presented a highly suggestive evidence (class II). Other association was classified as having only a weak evidence.ConclusionSarcopenia is associated with several adverse health-related outcomes in older people, and its associations with mortality, disability, and falls are supported by a highly suggestive evidence. The effect of interventions on sarcopenia to improve these outcomes needs to be investigated.Publication Open Access Associations between sexual activity and weight status: Findings from the English Longitudinal Study of Ageing(2019-09-01T00:00:00Z) Smith, Lee; Yang, Lin; Forwood, Suzanna; Lopez-Sanchez, Guillermo; Koyanagi, Ai; Veronese, Nicola; SOYSAL, PINAR; Grabovac, Igor; Jackson, Sarah; SOYSAL, PINARObjectivePublication Metadata only Inflammation and frailty in the elderly: A systematic review and meta-analysis(2016-11-01T00:00:00Z) Soysal, PINAR; Stubbs, Brendon; Lucato, Paola; Luchini, Claudio; Solmi, Marco; Peluso, Roberto; Sergi, Giuseppe; Isik, Ahmet Turan; Manzato, Enzo; Maggi, Stefania; Maggio, Marcello; Prina, A. Matthew; Cosco, Theodore D.; Wu, Yu-Tzu; Veronese, Nicola; SOYSAL, PINARThe pathogenesis of frailty and the role of inflammation is poorly understood. We examined the evidence considering the relationship between inflammation and frailty through a systematic review and meta-analysis. A systematic literature search of papers providing data on inflammatory biomarkers and frailty was carried out in major electronic databases from inception until May 2016. From 1856 initial hits, 35 studies (32 cross-sectional studies n =3232 frail, n = 11,483 pre-frail and n = 8522 robust, and 563 pre-frail + robust; 3 longitudinal studies n = 3402 participants without frailty at baseline) were meta-analyzed. Cross-sectional studies reported that compared to 6757 robust participants, both 1698 frail (SMD = 1.00, 95%CI: 0.40-1.61) and 8568 pre-frail (SMD = 0.33, 95%CI: 0.04-0.62) participants had significantly higher levels of C-reactive protein (CRP). Frailty (n = 1057; SMD = 1.12, 95%CI: 0.27-2.13) and pre-frailty (n = 4467; SMD = 0.56, 95%CI: 0.00-1.11) were associated with higher serum levels of interleukin-6 compared to people who were robust (n = 2392). Frailty and pre-frailty were also significantly associated with elevated white blood cell and fibrinogen levels. In three longitudinal studies, higher serum CRP (OR = 1.06, 95%CI: 0.78-1.44,) and IL-6 (OR = 1.19, 95%CI: 0.87-1.62) were not associated with frailty. In conclusion, frailty and pre-frailty are associated with higher inflammatory parameters and in particular CRP and IL-6. Further longitudinal studies are needed. (C) 2016 The Authors. Published by Elsevier B.V.