Frailty is identified in middle-aged and older adults, and frail individuals are vulnerable to dependency and poor health. In this study, we analyzed nationally representative data that includes 5592 participants aged 40 years and above to determine the prevalence and factors associated with frailty among community-dwelling middle-aged and older adults in Malaysia. Using a 40-item Frailty Index, the overall prevalence of frailty and prefrailty was 19.5% and 64.1%, respectively. A total of 38.6% of older adults (≥60 years) were frail and 56.2% were prefrail. Among middle-aged adults (<60 years), the prevalence of frailty was 10.4% and that of prefrailty was 67.9%. Factors associated with frailty include older age, ethnicity, low education and income level, moderate to poor self-rated health, abdominal obesity, absence of a spouse, and previous history of falls. These findings may serve as evidence for the implementation of a frailty policy and health care planning in Malaysia.

UNASSIGNED: Though considered a late-onset disease, the 2020 report of the Lancet Commission emphasizes the necessity of conducting primary prevention trials with an approach of never too early in the life course for dementia prevention. Driven by the same notion, we hereby aim to compare the dementia risk reduction potential of two potential interventions, 48 weeks (12 months) of yoga and brisk walking, in middle-aged high-risk subjects.
UNASSIGNED: A randomized controlled trial.
UNASSIGNED: Community in India.
UNASSIGNED: In total, 323 at-risk dementia subjects will be recruited from community settings through health awareness camps and door-to-door surveys across Delhi, India. Participants will be randomized into yoga or brisk-walking groups (1:1). The yoga intervention group will receive 60 contact yoga sessions per 60-min/day at the community parks, followed by continued tele-supervised home practice, further followed by at-home self-practice, and will be tested at 3-time points (baseline, 24-week and 48-week, post-randomization) to test the efficacy of the intervention. The control group will be asked to do brisk walking daily for 45 minutes at their convenience, followed by weekly telephone follow-ups. Applying the intention-to-treat principle, the primary endpoint will be the change from baseline at the 12th month in the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) Scores. Secondary outcomes will include the composite scores derived from a comprehensive neuropsychology battery, comprising the Trail Making Test, Digit Span Test, N Back, Color Trail, Animal Fluency Test, COWA (Controlled Oral Word Association Test), and Digit Symbol Substitution. The primary outcome will be analyzed using mixed-effect models for repeated measures, adjusted for covariates as fixed effects. The study has been prospectively registered (CTRI/2023/02/049746) on February 15, 2023. The protocol was conceptualized in 2021 and approved by the Institutional Ethics Committee of SVYASA. Recruitment began in February 2023 and is underway with patient enrollment.
UNASSIGNED: To our knowledge, this is the first controlled trial to investigate the longitudinal effects of a yoga-based intervention on dementia risk reduction using the CAIDE risk score. The findings of this trial will also provide insight into a better understanding of genotype-dependent responses to yoga intervention and open up avenues for understanding the implications of gene-intervention interactions for precision prevention using yoga.

Oral iron supplementation is the first-line treatment for addressing iron deficiency, a concern particularly relevant to women who are susceptible to sub-optimal iron levels. Nevertheless, the impact of iron supplementation on the gut microbiota of middle-aged women remains unclear. To investigate the association between iron supplementation and the gut microbiota, healthy females aged 40-65 years (n = 56, BMI = 23 ± 2.6 kg/m2) were retrospectively analyzed from the Alberta\'s Tomorrow Project. Fecal samples along with various lifestyle, diet, and health questionnaires were obtained. The gut microbiota was assessed by 16S rRNA sequencing. Individuals were matched by age and BMI and classified as either taking no iron supplement, a low-dose iron supplement (6-10 mg iron/day), or high-dose iron (>100 mg/day). Compositional and functional analyses of microbiome data in relation to iron supplementation were investigated using various bioinformatics tools. Results revealed that iron supplementation had a dose-dependent effect on microbial communities. Elevated iron intake (>100 mg) was associated with an augmentation of Proteobacteria and a reduction in various taxa, including Akkermansia, Butyricicoccus, Verrucomicrobia, Ruminococcus, Alistipes, and Faecalibacterium. Metagenomic prediction further suggested the upregulation of iron acquisition and siderophore biosynthesis following high iron intake. In conclusion, adequate iron levels are essential for the overall health and wellbeing of women through their various life stages. Our findings offer insights into the complex relationships between iron supplementation and the gut microbiota in middle-aged women and underscore the significance of iron dosage in maintaining optimal gut health.

The current study aimed to compare the effects of Pilates versus Zumba training on postural performance in middle-aged postmenopausal women. Fifty-seven eligible women, aged between 50 and 60 years, were randomized into three groups: Zumba (ZG) group, Pilates (PG) group or control (CG) group. Postural control was assessed using a force platform under 4 sensory manipulation conditions: on firm and foam surfaces with eyes opened (EO) and closed (EC). Our results showed more marked adaptations in favor of ZG concerning postural performance compared to PG. For the PG, postural control was significantly improved only in simple postural conditions on the firm surface with EO (p < 0.1) and EC (p < 0.05) conditions. However, postural control of the ZG significantly improved in both the simple and complex postural conditions, even under conflicting sensory situations (firm surface/EO (p < 0.001; 95 % CI: [1.34, 4.46]), EC (p < 0.001; 95 % CI: [2.13, 5.24])); foam surface/EO (p < 0.01; 95 % CI: [0.70, 8.57]), EC (p < 0.01; 95 % CI: [0.65, 8.52])). In conclusion, Zumba training seems to be more effective and a better strategy to promote postural control in daily living activities and autonomy in postmenopausal women than Pilates training. These findings are useful for public health practitioners in designing physical interventions for balance disorders.

Calorie restriction (CR) is a non-invasive and economic approachknown to increase healthspan and life expectancy, through a decrease in oxidative stress, an increase in neurotrophins, among other benefits. However, it is not clear whether its benefit could be noted earlier, as at the beginning of middle-age. Hence, weaimed to determine whether six months of long-term CR, from early adulthood to the beginning of middle age (10 months of age) could positively affect cognitive, neurochemical, and behavioral parameters. Male C57BL6/J mice were randomly distributed into Young Control (YC, ad libitum food), Old Control (OC, ad libitum food), and Old Restricted (OR, 30 % of caloric restriction) groups. To analyze the cognitive and behavioral aspects, the novel object recognition task (NOR), open field, and elevated plus maze tests were performed. In addition, immunohistochemistry targetingΔFosB (neuronal activity), brain-derived neurotrophic factor (BDNF) and the DNA oxidative damage (8OHdG) in hippocampal subfields CA1, CA2, CA3, and dentate gyrus (DG), and in basolateral amygdala and striatum were performed. Our results showed that long-term CR prevented short-term memory impairment related to aging and increased 8OHdG in hippocampal DG. BDNF was not involved in the effects of either age or CR on memory at middle-age, as it increased in CA3 of the OC group but was not altered in OR. Regarding anxiety-type behavior, no parameter showed differences between the groups. In conclusion, while the effects of long-term CR on anxiety-type behavior were inconclusive, it mitigated the memory deficit related to aging, which was accompanied by an increase in hippocampal 8OHdG in DG. Future studies should investigate whether the benefits of CR would remain if the restriction were interrupted after this long-term protocol.

Though we all age, some age more successfully than others. Health and social connections have been identified as cornerstones to successful aging, yet the contributions from psychological factors are less clear. Our goal was to examine the influence of grit and growth mindset in successful aging in middle and older age. We also assessed whether grit or growth mindset mediated the lifestyle-successful aging relationship.
We used a telephone questionnaire to measure grit and growth mindset, successful aging, and lifestyle for 263 adults, ages 40-80 years.
Higher grit-effort and growth mindset predicted more successful aging in younger (40-64 years) and older groups (65-80 years). Additionally, exercise frequency predicted successful aging for the combined sample and partially mediated the relationship between growth mindset and successful aging.
Our findings reveal grit-effort and a growth mindset as important contributors to successful aging in middle and older adulthood. Because psychological constructs are malleable, continued study of grit and growth mindsets is essential to enable their eventual application in changing the aging process.

BACKGROUND: Prenatal alcohol exposure (PAE) impacts cognition in childhood and early adulthood. Here we evaluate the cognitive abilities of middle-aged adults with and without a history of PAE.
METHODS: Participants (N = 200) were recruited from longitudinal cohorts in the Atlanta and Seattle metropolitan areas and completed measures comprising the National Institutes of Health Toolbox\'s Fluid Cognition Composite.
RESULTS: We found that individuals with PAE had lower Fluid Cognition Summary scores and lower Dimensional Change Card Sort and Flanker task subtest scores than non-PAE controls, after accounting for both potentially confounding demographic variables using propensity scores and the effects of study site. When we evaluated the effects of PAE with and without dysmorphic physical features, we found that middle-aged adults in both groups had lower fluid cognition scores than non-PAE controls. However, only the presence of PAE with dysmorphic features was associated with lower performance on the Dimensional Change Card Sort Test and Flanker tasks.
CONCLUSIONS: While all participants with PAE had lower fluid cognition, those with PAE and dysmorphic features also exhibited specific deficits in their performance on measures of inhibition, attention, and cognitive flexibility. Thus, PAE is associated with ongoing cognitive deficits in middle adulthood, which can be observed most clearly among individuals with dysmorphic features.

OBJECTIVE: Vertebral dimensions may constitute a potential risk factor for degenerative changes in the spine. Previous studies have found a positive association between vertebral height and both type 2 Modic changes and intervertebral disc height loss. Also, vertebral endplate size has been associated with disc degeneration. However, only a few studies have investigated the association between vertebral dimensions and lumbar disc displacement (LDD). This study aimed to investigate the association between vertebral cross-sectional area (CSA) and LDD among the general middle-aged Finnish population. We hypothesized that larger vertebral CSA is associated with LDD.
METHODS: The study was conducted by using data from the Northern Finland Birth Cohort 1966 (NFBC1966). At the age of 46, a subpopulation of NFBC1966 underwent clinical examinations including magnetic resonance imaging (MRI) (n = 1249). MRI scans were used to measure L4 CSA and evaluate the presence of LDD (bulge, protrusion, and extrusion/sequestration) in the adjacent discs. The association between L4 CSA and LDD was analysed using logistic regression, with adjustment for sex, education, body mass index, leisure-time physical activity, smoking, diet, and L4 height.
RESULTS: Larger L4 CSA was associated with LDD; an increase of 1 cm2 in vertebral CSA elevated the odds of LDD relative to no LDD by 10% (adjusted odds ratio 1.10, 95% CI 1.01-1.19). The association was similar among either sex.
CONCLUSIONS: Larger L4 vertebral CSA was associated with LDD in our study sample. Even though smaller vertebral size exposes our vertebrae to osteoporotic fractures, it simultaneously seems to protect us from LDD.

For Black men of middle-age, the overdose mortality statistics are increasingly dire. To better understand the severity of the crisis, we estimated the cumulative risk of drug overdose deaths among non-Hispanic Black men in mid-life using a period life table approach. We report the chances of Black men aged 45 years dying of a drug overdose before age 60.
A period life table reflects what would happen to a hypothetical cohort if it experienced the prevailing age-specific probabilities of death. In our hypothetical cohort, we followed 100,000 non-Hispanic Black men aged 45 years for 15 years. All-cause death probabilities were obtained from the National Center for Health Statistics (NCHS) 2021 life table series. Overdose mortality rates were obtained from the National Vital Statistics System through the Wide-Ranging Online Data for Epidemiologic Research of the Centers for Disease Control and Prevention (CDC WONDER) database. We also constructed a period life table for a comparison group of White men.
The life table shows that, for Black men who are 45 years of age in the United States, 1 in 52 (nearly 2%) is expected to die of drug overdose before reaching age 60, if current mortality rates persist. For White men, the estimate is 1 in 91 men (about 1%). The life table also shows that from age 45 to 59 years, the number of overdose deaths increased in the cohort of Black men but decreased in White men.
This study extends our understanding of the immense loss to Black communities from the preventable drug deaths of Black men in middle-age.

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