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In men looking older than you should is related to a high serum cholesterol and haemoglobin. In women looking older may be related to a high ESR and a low serum bilirubin. Predictably looking older was related to baldness, greying of the hair, arcus senilis, and skin inelasticity.
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Learn More »It is well recognised that people look older in the face when they have more than the expected number and extent of wrinkles and a corresponding lack of skin elasticity.1 Elastic fibres in the skin degenerate and thicken when the skin is exposed to sunlight.2 3 Warren et alreported that estimated age was increased by solar exposure in middle aged but not young women. The increase in an age group 45–51 years was four years.1 In addition it has long been recognised that smokers look older,4-9 although the relative contribution of say, wrinkles and less subcutaneous fat has to be determined. Intuitively looking older should also be associated with markers of ageing such as having more grey hair or becoming bald. Moreover other variables should be associated with higher estimated ages when they are either causally related to loss of skin elasticity or simply associated with greying of hair, baldness, exposure to sun, etc. This article reports the association of many of these variables and biochemical measures to looking older in subjects in the Department of Environment study.10 This study of London civil servants was directed at determining differences in social class (employment grade) and included measures of ageing. Methods The selection of subjects has been described. The subjects were a sample, stratified by age, gender, and employment grade and randomly selected using different sampling fractions to provide equal numbers in each age and grade group.11 Of the 397 men in the study 318 had an estimated (perceived) age recorded when first seen by the research staff and of the 130 women, 129 had this investigation. Chronological age ranged from 37 to 58 years. ASSESSMENT OF AGEING The following measures were made specifically for this purpose: Estimated or perceived age One observer “guessed” the age of the subject when first seen, fully dressed, without reference to the records. First impression had to be recorded before interview or examination and the observers were two female research nurses and one male doctor between the ages of 25 and 35 years. Baldness This was assessed on a four point scale between 1 = no hair loss, and 4 = only sparse hair over the ears and a fringe round the back. Greyness of hair A sample of hair was taken from the back of the head, and the percentage of hairs that were grey was calculated in 50 hairs. The results were excluded in 45 women, who were thought to have dyed their hair. The percentage of subjects having any grey hair and among those with grey hair, the percentage of hairs that were grey were used as separate and independent measures of the effect of grey hair. Skin inelasticity The skin over the “snuff box”, the area between the right first and second proximal metacarpals, was pinched for 50 seconds, using an ordinary spring assisted wooden clothes peg. On release of the peg, the number of seconds the pinched skin took to return to normal was measured. Arcus senilis The presence of arcus senilis was graded as 1 = absent, 2 = extending for less than a semicircle, 3 = extending more than a semicircle but not a full circle, and 4 = present as a full circle. OTHER Blood pressure A standard mercury sphygmomanometer and cuff (inflatable section 11 × 2.5 cm) was employed on the right arm after the subject had been lying down for five minutes. Blood tests These consisted of measurements of serum albumin, calcium, bilirubin, cholesterol, high density lipoprotein (HDL) cholesterol, creatinine, urate, glucose; erythrocyte sedimentation rate (ESR), and haemoglobin. These biochemical and haematological methods and results have been reported previously.12 STATISTICAL METHODS There was a strong correlation between estimated age and actual age. Because of measurement error related to regression to the mean, one would expect differences between the estimated minus actual age to be negatively associated with actual age. To overcome this dependency, estimated age was regressed on actual age using linear regression. The residuals from this regression give the difference between each subject's estimated age and that predicted from their actual age. A high residual indicates that an individual looks older than their actual age. The study population was partitioned into four equal groups using the residual quartiles, separately for men and women. Subjects who looked youngest were in quarter 1 and those looking oldest were in quarter 4. The means of the ageing variables for each of these four groups were adjusted for actual age to remove the slight effect of any remaining confounding of actual age. Regressions of the ageing variables on the estimated age residuals with adjustment for actual age (individual data) were used to test for linear trend in preference to testing for linear trend in the means or proportions in the four groups. For ease in reading the text the “estimated age residuals” will be termed “excess perceived age”. As previously described the percentage of hairs that were grey, skin inelasticity, blood ESR, and serum bilirubin were all better represented by a logarithmic transformation. These measurements were transformed to a log scale (after adding one for skin elasticity) and these values were used in all analyses. All other factors could be described using a normal distribution. Tests for heterogeneity in guessing age between the three observers were statistically significant for the female subjects (p=0.02) but not for the men (p= 0.30). Adjusting for differences between the observers did not importantly alter the results and the slight differences are discussed. Results The 318 men had an estimated age that averaged 48.19 years with a range of 28–65 years. This was 0.37 years higher than the average chronological age of 47.82 years (range 37–58 years). In contrast the 129 women had a lower average estimated age of 46.93 years (range 30–62 years) compared with an average chronological age of 47.47 years and range of 38–57 years. In women, therefore, the mean estimated age was 0.54 years lower than their actual age. The estimated age minus actual age difference decreased with age from 0.8 years in men aged 37–44 to −0.9 years in men aged 55–58. In women this expected effect was not observed and women aged 38–44 had an average estimated actual age of −1.1 years whereas women of 55–57 years had an estimated actual age difference of 0.1 years. Estimated age naturally increased with the age residuals. Nevertheless the mean estimated age in men and women was similar for each quarter of “excess perceived age” (table 1). Table 1 also demonstrates that the four strata of excess perceived age were independent of actual chronological age. Table 1 Estimated age residuals (excess perceived age), chronological age, and estimated age in four quarters of “estimated age residuals” in men and women separately. The results show that the four strata of excess perceived age were independent of chronological age. Estimated ages were similar in both men and women in the four quarters Tables 2 and 3 gives means and percentages for the four excess perceived age groups, for 20 variables that were of interest in connection with estimated age. In men, the proportion of hairs that were grey, and in women, the proportion having any grey hair were both higher in the higher estimated age groups. Men looked older than their chronological age when blood haemoglobin was higher, serum cholesterol higher, arcus senilis and baldness greater. These associations could not be confirmed in the smaller number of women. In men associations of skin inelasticity and lying systolic blood pressure with higher age could not be excluded with any confidence (p=0.09) and in both sexes an association with serum creatinine (negative) could not be excluded with any certainty. In women, there was evidence that a higher ESR and a lower serum bilirubin was associated with looking older. The “oldest looking” groups of both men and women had the highest percentages of current smokers, although the linear trends were not statistically significant. Table 2 Means and percentages (adjusted for chronological age) according to quarter of estimated age residuals (excess perceived age) in both men and women. Men and women who looked the oldest (quarter 3–4) tended to have more grey hair and the men were more bald and had more developed arcus senilis Table 3 Mean biochemical and haematological factors (adjusted for chronological age) according to quarters of estimated age residuals in both men and women. Men who looked oldest (quarter 3–4) had a higher average haemoglobin and cholesterol, and women had a higher average ESR Alcohol intake, employment grade, serum calcium, albumin, HDL cholesterol, and glucose concentrations are included in the tables as examples of variables that were not associated with looking older in either men or women.
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