Inflammatory markers and occurrence of falls: Bambuí Cohort Study of Aging

Amorim, Juleimar Soares Coelho de; Torres, Karen Cecília Lima; Teixeira-Carvalho, Andréa; Martins-Filho, Olindo Assis; Lima-Costa, Maria Fernanda; Peixoto, Sérgio Viana

doi:10.11606/S1518-8787.2019053000855

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Original Article • Rev. Saúde Pública 53 • 2019 • https://doi.org/10.11606/S1518-8787.2019053000855 copy

Inflammatory markers and occurrence of falls: Bambuí Cohort Study of Aging

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

Analyze whether inflammatory markers are associated with falls among older adults living in Bambuí.

METHODS

Study that analyzed baseline data from a Bambuí Cohort Study of Aging, involving 1,250 participants. Data about falls were collected from previous 12 months, classified as single or multiple occurrence and severity (participant seeking health services). Information about sociodemographic characteristics, health behaviors and health condition was also collected and used as confounding factors. The exposures of interest included interleukins (IL-1β, IL-6, IL-8, IL-10, IL-12), tumor necrosis factor (TNF), ultra-sensitive C-reactive protein (us-CRP) and chemokines (CXCL9, CCL5, CCL10, MCP1). Data were processed through logistic regression, obtaining odds ratio and 95% confidence interval (95%CI).

RESULTS

The prevalence of falls was 27.1%; 40.1% of the older adults reported multiple falls and 33.3% sought health services. After adjustments, the following elevated levels were associated with falls: us-CRP (OR = 1.46, 95%CI 1.04–2.03), CCL5 (OR = 1.38, 95%CI 1.01–1.90) and CXCL9 (OR = 1.43, 95%CI 1.02–2.02). An association was observed between the number of elevated markers and the occurrence of falls: two (OR = 1.47, 95%CI 1.02–2.12) and three (OR = 2.08, 95%CI 1.12–3.87) elevated biomarkers indicated fall probability of 32.0% and 39.4%, respectively.

CONCLUSIONS

Elevated levels of us-CRP, CCL5 and CXCL9, which were associated with falls, may contribute to a proper understanding of the mechanism associated with the occurrence of falls among older people.

Aged; Aging; Accidental Falls; Risk Factors; Biomarkers; Inflammation Mediators

Characteristics	Total	Falls		p^a

		No	Yes

	(n = 1,250)	(n = 911)	(n = 339)
Sociodemographic condition

Age (years) (mean and standard deviation)	68.8 (6.9)	68.4 (6.7)	69.8 (7.4)	0.001
Female	61.7	56.6	75.2	< 0.001
Schooling < 4 years	63.2	62.5	64.5	0.743

Health behaviors

Current smoker	17.3	18.4	14.2	0.001
Alcohol consumption (≥ 7 amounts/week)	4.7	5.2	3.5	0.001
Insufficiently active	26.8	26.0	28.9	0.305

Health condition and medication use

Nutritional status (BMI)				0.210
Well nourished (18–22 kg/m²)	39.7	40.9	36.3
Underweight (< 18 kg/m2)	27.8	27.9	27.7
Overweight (> 22 kg/m²)	32.5	31.2	36.0
Number of chronic diseases^b				0.130
One	35.4	33.9	39.5
Two or more	46.7	47.3	45.1
Positive serology for T. cruzi	37.0	36.0	39.5	0.251
Cognitive impairment (MMSE < 22)	22.1	20.8	25.7	0.062
Limitation in ADL				< 0.001
None or some	52.7	56.3	43.1
Large	20.0	20.4	18.9
Unable to perform	27.3	23.3	38.1
Limitation in mobility				0.001
None or some	57.9	60.0	52.2
Large	16.6	17.3	14.5
Unable to perform	25.5	22.6	33.3
Polypharmacy (use of 5 medications or more)	22.6	21.0	26.8	0.027

Inflammatory markers	Total	Falls		p*

		No	Yes
IL-1β (> 0.01 pg/mL), %	22.6	21.8	24.5	0.321
IL-6 (median and IQR)	1.0 (0.4–2.1)	1.0 (0.4–2.0)	1.2 (0.5–2.2)	0.121
TNF (> 0.02 pg/mL), %	17.5	16.5	20.4	0.108
IL-12 (> 0.02 pg/ml), %	7.8	7.2	9.1	0.264
IL-10 (> 0.01 pg/mL), %	42.6	42.8)	41.9	0.769
CXCL8 (median and IQR), pg/mL	3.0 (1.5–5.4)	2.9 (1.6–5.4)	3.0 (1.7–5.6)	0.268
CXCL9 (median and IQR), pg/mL	2,118.9 (1,231.0–4,141.8)	2,156.7 (1,145.7–3,804.1)	2,851.8 (1,465.0–5,104.1)	< 0.001
CXCL10 (median and IQR), pg/mL	3,026.8 (1,982.4–4,712.2)	2,906.6 (1,939.3–4,489.8)	3,318.1 (2,145.6–5,204.9)	0.017
CCL2 (median and IQR), pg/mL	38.4 (25.3–56.8)	39.0 (25.4–56.6)	37.1 (24.3–57.9)	0.697
CCL5 (median and IQR), pg/mL	863.1 (547.6–1,612.4)	831.9 (527.0–1,598.7)	950.5 (594.2–1,712.4)	0.055
us-CRP (median and IQR), mg/mL	3.2 (1.4–6.5)	3.1 (1.3–6.1)	3.9 (1.6–7.6)	0.003

Inflammatory markers	Odds ratio (95% confidence interval)

	Unadjusted	Model 1	Model 2	Model 3
IL-1β^a	1.16 (0.87–1.56)	1.10 (0.82–1.49)	1.09 (0.80–1.47)	1.09 (0.79–1.50)
IL-6^b in pg/mL (ref.: < 0.45)
0.45–218	1.28 (0.94–1.74)	1.19 (0.87–1.63)	1.19 (0.87–1.63)	1.17 (0.84–1.62)
> 2.18	1.40 (1.02–1.91)	1.34 (0.98–1.85)	1.35 (0.98–1.87)	1.30 (0.93–1.80)
TNF^a	1.30 (0.94–1.78)	1.32 (0.79–1.34)	1.30 (0.94–1.80)	1.23 (0.88–1.72)
IL-12^a	1.29 (0.82–2.01)	1.32 (0.79–1.34)	1.31 (0.83–2.07)	1.19 (0.74–1.90)
IL-10^a	0.96 (0.75–1.24)	0.95 (0.74–1.23)	0.95 (0.73–1.23)	0.96 (0.74–1.25)
CXCL8^b in pg/mL (ref.: < 1.6)
1.6–5.66	1.31 (0.97–1.78)	1.26 (0.93–1.73)	1.25 (0.92–1.71)	1.29 (0.94–1.77)
> 5.66	1.24 (0.91–1.69)	1.22 (0.88–1.68)	1.20 (0.87–1.65)	1.19 (0.85–1.65)
CXCL9^b in pg/mL (ref.: < 1,231.86)
1,231.86–4,279.89	1.23 (0.90–1.69)	1.21 (0.88–1.67)	1.21 (0.88–1.68)	1.23 (0.89–1.71)
> 4,278.89	1.68 (1.24–2.29)	1.46 (1.05–2.02)	1.45 (1.05–2.02)	1.43 (1.02–2.02)
CXCL10^b in pg/mL (ref.: < 1,984.25)
1,984.25–4,847.78	1.27 (0.93–1.73)	1.14 (0.83–1.57)	1.14 (0.82–1.57)	1.14 (0.82–1.58)
> 4,847.78	1.58 (1.16–2.16)	1.35 (0.98–1.85)	1.35 (0.98–1.86)	1.36 (0.98–1.89)
CCL2^b in pg/mL (ref.: < 25.41)
25.41–57.56	0.84 (0.62–1.14)	0.86 (0.63–1.17)	0.85 (0.63–1.16)	0.89 (0.65–1.23)
> 57.56	0.95 (0.70–1.29)	0.95 (0.69–1.29)	0.95 (0.70–1.30)	0.93 (0.68–1.28)
CCL5^b in pg/mL (ref.: < 553.37)
553.37–1,622.97	1.13 (0.83–1.53)	1.26 (0.92–1.73)	1.25 (0.91–1.72)	1.26 (0.91–1.74)
> 1,622.97	1.23 (0.91–1.67)	1.39 (1.01–1.90)	1.39 (1.01–1.90)	1.38 (1.01–1.90)
us-CRP^b in mg/L (ref.: < 1.42)
1.42–6.7	1.24 (0.91–1.70)	1.23 (0.89–1.70)	1.24 (0.90–1.72)	1.20 (0.86–1.67)
> 6.7	1.62 (1.19–2.21)	1.54 (1.12–2.10)	1.55 (1.13–2.13)	1.46 (1.04–2.03)

Number of markers showing increased levels	Odds ratio (95% confidence interval)

	Unadjusted	Model 1	Model 2	Model 3
None	1.00	1.00	1.00	1.00
One	1.15 (0.85–1.56)	1.08 (0.79–1.49)	1.08 (0.79–1.48)	1.02 (0.74–1,41)
Two	1.70 (1.21–2.39)	1.57 (1.10–2.23)	1.57 (1.10–2.24)	1.47 (1.02–2.12)
Three	2.59 (1.44–4.68)	2.29 (1.25–4.19)	2.29 (1.25–4.20)	2.08 (1.12–3.87)

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[1] Correspondence: Sérgio Viana Peixoto Instituto René Rachou – FIOCRUZ Av. Augusto de Lima, 1715 30190-009 Belo Horizonte, MG, Brasil E-mail: sergio@minas.fiocruz.br