InCHIANTI Study

• About InCHIANTI
• InCHIANTI study design
• Accessing InCHIANTI Data

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About InCHIANTI

Older patients are often referred to geriatricians because of complaints of progressive difficulties in walking. The diagnostic and therapeutic approach to treating these patients is complex. Multiple systems may influence a person’s ability to walk, and there are currently no standard criteria to establish whether these walking-related systems are functioning within the “normal” range. 

To address this gap and build scientific knowledge in this area, Luigi Ferrucci, M.D. and Stefania Bandinelli, M.D. conducted InCHIANTI, a population-based study of older persons living in the Chianti geographic area (in the Tuscany region of Italy). 

The design of InCHIANTI assumed that the factors that influence walking ability are found in six primary physiologic subsystems: the central nervous system, the peripheral nervous system, the perceptual system, the muscles, the bones and joints, and in energy production and delivery. Measures of the integrity and functioning of each of these proposed subsystems were identified and administered to 1,453 participants (age 20-102 years) selected from the populations of Greve in Chianti and Bagno a Ripoli, using a multistage sampling method. Follow-up studies were supported by NIA. 

The goal of the study was to translate epidemiological research into clinical tools for more precise diagnosis and more effective treatment in patients with trouble walking. In particular, the research: 

1. Studied how the various physiological subsystems that are important for mobility interact with age in causing disability; 
2. Developed reference values for the integrity and functionality of the different physiologic subsystems that are implicated in mobility to be used in clinical practice; 
3. Looked at risk factors for the development of "soft" neurological impairments in the absence of clinically evident neurological disease;
4. Identified risk factors for accelerated sarcopenia and osteoporosis, including biomarkers of chronic inflammation, genetic polymorphisms, and circulating levels of specific vitamins and hormones; 
5. Studied how intake of macro- and micro-nutrients influence health status.

Learn more about the study background and population.

Research Conducted with InCHIANTI Data

Over 1,000 papers using InCHIANTI data have been published. View a list of published papers conducted with InCHIANTI data.

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InCHIANTI Study Design

The design of InCHIANTI assumed the factors influencing walking ability are found in six primary physiologic subsystems: the central nervous system, the peripheral nervous system, the perceptual system, the muscles, the bones and joints, and in energy production and delivery. The central nervous system provides the motivation for mobility and creates a motor plan, which is defined in the basal ganglia before being wired through the peripheral nerves. The motor program is executed by the muscles, which  move the bone and joints. Movement required for mobility requires energy production and delivery to the appropriate site plus interpretation of constant feedback from the constantly changing environment. Although this is a simplified interpretation of the resources required for mobility, measures of the integrity and functioning of each of these proposed subsystems provided an overall measure of mobility. Measures that approximated these physiological functions were operationalized in the InCHIANTI study and administered to the study participants using a multistage sampling method.

Data collection began in September 1998 and was completed in March 2000. Subsequent visits were conducted:

• November 2001 to March 2003 (follow-up 1; n=1167), 
• December 2004 to March 2006 (follow-up 2; n=1067), 
• November 2007 to May 2009 (follow-up 3; n=900), 
• January 2013 to October 2014 (follow-up 4; n=708), and 
• January 2016 to July 2017 (follow-up 5; n=575).

The population sample

InCHIANTI was performed at two sites: Greve in Chianti (known as area one) and Bagno a Ripoli (known as area two). Area one had 11,709 inhabitants, 19.3% of whom were age 65 or over. Area two, in the Village of Antella had 4,704 inhabitants20.3% of whom were age 65 and over.  The exact same two-stage sampling procedure was used in each area to obtain two representative sample populations.  In August 1998, a random sample of 650 individuals age 65 or over was drawn from the population registry. Anyone  in this sample who was born in Italy was considered a potential participant. Then, random samples of 50 men and 50 women were drawn from the following age strata 20-29, 30-39, 40-49, 50-59, 60-64 years from each area. These individuals were all invited to participate in the study. Enrollment was considered complete when at least 30 men and 30 women for each age strata under 60, and 10 men and 10 women in the 60-64 age group had agreed to participate. The final study population included a representative sample of the older population and at least 30 men and 30 women for each 10-year age group from 20 to 100 years old. 

InCHIANTI data collection

Interviews were conducted at the participants’ homes by three experienced interviewers. Participants received a detailed description of the study protocol and provided a signed consent that included permission for researchers to consult past and future administrative databases and medical charts and to conduct analyses on the blood cells, DNA, and urine samples stored in the biological bank. Before leaving the participant’s home, the interviewer scheduled two additional appointments and explained the proper procedure for the 24-hour urine collection, including listing the food to be avoided (meat and fish) during the day of the urine collection and over the previous 48 hours. 

Within three weeks of the home interview, the participants fasted for at least 8 hours, completed a 24-hour urine collection, and visited the study clinic. At the clinic, the participants received a series of examinations, including: a 5-slice peripheral quantitative computed tomography (pQCT), a surface electroneurography assessing nerve conduction velocity of the right peroneal nerve, a standard electrocardiogram, an ultrasound color doppler examination of the carotid and vertebral arteries and the veins of the lower limbs, and an assessment of the ankle-brachial index.

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Accessing InCHIANTI Data

The InCHIANTI database is available to any researcher who presents a detailed and scientifically sound project. Data available through InCHIANTI cover a range of factors that influence walking ability that are classified into the six subsystems listed above. Measures of the integrity and functioning of each of these subsystems were identified and administered to all participants.

InCHIANTI Data Use Requirements

To use InCHIANTI data, you must submit a proposal via email and agree to the following requirements:

• Any publication that includes analyses of the InCHIANTI project database should include at least two members of the InCHIANTI Publications Committee as potential co-authors. These individuals will be listed as authors only if they contribute substantially to the analysis and writing of the manuscript. 
• Authors should acknowledge InCHIANTI as their data source.
• Affirmation that you will seek and receive approval from the InCHIANTI steering committee prior to starting the analysis. 
• Agreement that you will obtain permission from InCHIANTI steering committee before reporting data from the InCHIANTI project in scientific papers or public presentations. 
• Uponrequest, you agree to submit the code used to perform your analysis to the InCHIANTI steering committee to ensure results coming from this collaboration are scientifically and statistically correct.
• Commitment not to share share data from the InCHIANTI study with collaborators or deposit them in public domains without the explicit written permission of the InCHIANTI steering committee.

How to Submit a Proposal

Proposals will be accepted via email to Inchiantistudy@mail.nih.gov. With your proposal, you must include the following information:

• Name and institution of the proposed first author (Note: If the first author is not a member of the InCHIANTI group, the name of a sponsoring member should also be provided)
• Names and institutions of any proposed co-authors
• Email address
• Descriptive title of the research proposal
• Background and rationale
• Analytical plan
• Expected results
• Deadline for abstract submission (if applicable)
• Journal to which the manuscript will be submitted (if applicable)

By emailing your proposal, you are agreeing to all of the requirements outlined in the InCHIANTI Data Use Requirements section listed above. If the object and methods of your analysis change after it is approved, an updated proposal should be submitted to the Publications Committee. Each approved proposal should cover one project or publication. Multiple analyses should be supported by multiple specific proposals. An approved proposal is valid for one year and can only be renewed by writing to the InCHIANTI steering committee.
 

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