Validation of the Clinical Frailty Scale for the Prediction of Mortality in Patients With Liver Cirrhosis.
Clinical and translational gastroenterology
INTRODUCTION:Frailty is a common but often underestimated complication in patients with liver cirrhosis. The Clinical Frailty Scale (CFS) allows the assessment of frailty within a short period of time but has only been investigated in a Canadian cohort of outpatients. The aim of the current study was to evaluate the ability of the CFS to predict mortality in outpatients and nonelectively hospitalized German patients. METHODS:Two hundred outpatients and 99 nonelectively hospitalized patients with liver cirrhosis were prospectively enrolled. Outpatients/inpatients were followed for a median of 364/28 days regarding the primary outcome of death or liver transplantation. Eighty-seven patients of the outpatient cohort and 64 patients of the inpatient cohort had available computed tomography-scans for the quantification of muscle mass. RESULTS:Median CFS was 3 in the outpatient and the inpatient cohort. Twenty-one (10.5%) outpatients were at least prefrail (CFS > 3) and 26 (26.3%) inpatients were frail (CFS > 4). For every one-unit increase, there was an independent association between the CFS and mortality in the outpatient cohort (hazard ratio 1.534, P = 0.007). This association remained significant after controlling for muscle mass in the subcohort with available computed tomography scans. In the inpatient cohort, frailty (CFS > 4) was an independent predictor for 28-day mortality after controlling for acute-on-chronic liver failure, albumin, and infections (odds ratio 4.627, P = 0.045). However, this association did not reach significance in a subcohort after controlling for muscle mass. DISCUSSION:Especially in outpatients, CFS is a useful predictor regarding increased mortality independent of the muscle mass.
10.14309/ctg.0000000000000211
Frailty as Tested by Gait Speed Is a Risk Factor for Liver Transplant Respiratory Complications.
The American journal of gastroenterology
OBJECTIVES:Frailty and sarcopenia are known risk factors for adverse liver transplant outcomes and mortality. We hypothesized that frailty or sarcopenia could identify the risk for common serious transplant-related adverse respiratory events. METHODS:For 107 patients (74 men, 33 women) transplanted over 1 year, we measured frailty with gait speed, chair stands, and Karnofsky Performance Scale (KPS) and sarcopenia with Skeletal Muscle Index on computed tomography at L3. We recorded the stress-tested cardiac double product as an index of cardiac work capacity. Outcomes included days of intubation, aspiration, clinical pneumonia, reintubation/tracheostomy, days to discharge, and survival. We modeled the outcomes using unadjusted regression and multivariable analyses controlled for (i) age, sex, and either Model for End-Stage Liver Disease-Na (MELDNa) or Child-Turcotte-Pugh scores, (ii) hepatocellular carcinoma status, and (iii) chronic obstructive pulmonary disease and smoking history. Subgroup analysis was performed for living donor liver transplant and deceased donor liver transplant recipients. RESULTS:Gait speed was negatively associated with aspiration and pulmonary infection, both in unadjusted and MELDNa-adjusted models (adjusted odds ratio for aspiration 0.10 [95% confidence interval [CI] 0.02-0.67] and adjusted odds ratio for pulmonary infection 0.12 [95% CI 0.02-0.75]). Unadjusted and MELDNa-adjusted models for gait speed (coefficient -1.47, 95% CI -2.39 to -0.56) and KPS (coefficient -3.17, 95% CI -5.02 to -1.32) were significantly associated with shorter intubation times. No test was associated with length of stay or need for either reintubation or tracheostomy. DISCUSSION:Slow gait speed, an index of general frailty, indicates significant risk for post-transplant respiratory complications. Intervention to arrest or reverse frailty merits exploration as a potentially modifiable risk factor for improving transplant respiratory outcomes.
10.14309/ajg.0000000000000609
Frailty and the Risk of Acute Kidney Injury Among Patients With Cirrhosis.
Hepatology communications
Acute kidney injury (AKI) and frailty are major drivers of outcomes among patients with cirrhosis. What is unknown is the impact of physical frailty on the development of AKI. We included adults with cirrhosis without hepatocellular carcinoma listed for liver transplantation at nine US centers (n = 1,033). Frailty was assessed using the Liver Frailty Index (LFI); "frail" was defined by LFI ≥ 4.2. Chronic kidney disease as a baseline estimated glomerular filtration rate <60 mL/min/1.73 m . Our primary outcome, AKI, was defined as an increase in serum creatinine ≥0.3 mg/dL or a serum creatinine ≥1.5-fold increase. Wait-list mortality was defined as either a death on the wait list or removal for being too sick. We performed Cox regression analyses to estimate the hazard ratios (HRs) for AKI and wait-list mortality. Of 1,033 participants, 41% were frail and 23% had CKD. Twenty-one percent had an episode of AKI during follow-up. Frail versus nonfrail patients were more likely to develop AKI (25% vs. 19%) and wait-list mortality (21% vs. 13%) (P < 0.01 for each). In multivariable Cox regression, each of the following groups was associated with a higher risk of AKI as compared with not frail/no CKD: frail/no CKD (adjusted HR [aHR] = 1.87, 95% confidence interval [CI] = 1.29-2.72); not frail/CKD (aHR = 4.30, CI = 2.88-6.42); and frail/CKD (aHR = 4.85, CI = 3.33-7.07). We use a readily available metric, LFI, to identify those patients with cirrhosis most at risk for AKI. We highlight that serum creatinine and creatinine-based estimations of glomerular filtration rate may not fully capture a patient's vulnerability to AKI among the frail phenotype. Conclusion: Our work lays the foundation for implementing physical frailty in clinical practice to identify AKI earlier, implement reno-protective strategies, and expedite liver transplantation.
10.1002/hep4.1840
The relationship between frailty and cirrhosis etiology: From the Functional Assessment in Liver Transplantation (FrAILT) Study.
Liver international : official journal of the International Association for the Study of the Liver
BACKGROUND & AIMS:Cirrhosis leads to malnutrition and muscle wasting that manifests as frailty, which may be influenced by cirrhosis aetiology. We aimed to characterize the relationship between frailty and cirrhosis aetiology. METHODS:Included were adults with cirrhosis listed for liver transplantation (LT) at 10 US centrer who underwent ambulatory testing with the Liver Frailty Index (LFI; 'frail' = LFI ≥ 4.4). We used logistic regression to associate aetiologies and frailty, and competing risk regression (LT as the competing risk) to determine associations with waitlist mortality (death/delisting for sickness). RESULTS:Of 1,623 patients, rates of frailty differed by aetiology: 22% in chronic hepatitis C, 31% in alcohol-associated liver disease (ALD), 32% in non-alcoholic fatty liver disease (NAFLD), 21% in autoimmune/cholestatic and 31% in 'other' (P < .001). In univariable logistic regression, ALD (OR 1.53, 95% CI 1.12-2.09), NAFLD (OR 1.64, 95% CI 1.18-2.29) and 'other' (OR 1.58, 95% CI 1.06-2.36) were associated with frailty. In multivariable logistic regression, only ALD (OR 1.40; 95% 1.01-1.94) and 'other' (OR 1.59; 95% 1.05-2.40) remained associated with frailty. A total of 281 (17%) patients died/were delisted for sickness. In multivariable competing risk regression, LFI was associated with waitlist mortality (sHR 1.05, 95% CI 1.03-1.06), but aetiology was not (P > .05 for each). No interaction between frailty and aetiology on the association with waitlist mortality was found (P > .05 for each interaction term). CONCLUSIONS:Frailty is more common in patients with ALD, NAFLD and 'other' aetiologies. However, frailty was associated with waitlist mortality independent of cirrhosis aetiology, supporting the applicability of frailty across all cirrhosis aetiologies.
10.1111/liv.15006
A Prospective Study of Prevalence and Impact of Sarcopenia on Short-term Mortality in Hospitalized Patients with Liver Cirrhosis.
Journal of clinical and experimental hepatology
Background:Sarcopenia is common in chronic advanced liver disease and is associated with poor prognosis. There is paucity of Indian data regarding sarcopenia in chronic advanced liver disease & its impact on prognosis. The aim of this study was to study the prevalence of sarcopenia in Indian patients with chronic advanced liver disease and its impact on morbidity and short-term mortality. Methods:Patients with chronic advanced liver disease were prospectively evaluated for the presence of sarcopenia using computerized tomography (CT) abdomen. The cross-sectional area of the right psoas muscle was measured at the third lumbar vertebra (L3) and the Psoas muscle index (PMI) was calculated. Sarcopenia was defined as PMI <295 mm/m for females and <356 mm/m for males. The normative values of PMI were obtained from patients undergoing CT scan for non-specific abdominal pain who had no confounding factor which could result in sarcopenia. All patients were followed up for 6 months or until death, whichever was earlier. The impact of sarcopenia on mortality and rate of readmission has been assessed at the end of 6 months. Results:Of the 156 patients with chronic advanced liver disease, 74 (47.4%) patients had sarcopenia. Sarcopenia was more commonly seen in males (M: F = 61:13) and in patients with alcohol-related liver disease. There was a linear correlation (negative) between the PMI and severity of liver disease as assessed by Child-Pugh and model for end-stage liver disease (MELD) scores (r = -0.591 and -0.465, respectively). Patients with encephalopathy, ascites, and coagulopathy had higher prevalence of sarcopenia. On six months follow-up, sarcopenic patients had higher readmission rates (74.3% vs. 22%; = 0.0001) and higher mortality (24.3% vs. 3.7%; = 0.002). MELD score and PMI were independent predictors of mortality. The cut-off value of PMI 305.9 mm/m predicted mortality with a sensitivity of 76.2% and a false positivity of 22.2% (area under curve was 0.805; 95% confidence interval: 0.69-0.91, = 0.001). Conclusion:Sarcopenia is seen in about half of the patients with chronic advanced liver disease. It is commoner in males, patients with alcoholic liver disease, and those with advanced liver disease. Patients with sarcopenia have worse prognosis, require more frequent hospitalization and it negatively impacts short-term survival.
10.1016/j.jceh.2023.05.001
Predictors of Frailty in Patients With Liver Cirrhosis.
Cureus
Introduction Frailty is noticed in a large number of cirrhotic patients with advanced liver disease. Frailty not only disposes cirrhotic patients to increased rates of decompensation and hospitalization but also leads to prolonged hospital stay and increased psychological and social impact, resulting in the delisting of these patients from the transplant list. Therefore, our aim was to identify the factors that are independent predictors of frailty in patients with liver cirrhosis. Methods This cross-sectional study was carried out at the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, from March 1, 2022, to August 31, 2022. All the patients diagnosed with liver cirrhosis and aged 18-70 years were included in the study. The excluded patients comprised those with disorders that over-estimate frailty such as cardiopulmonary disease and hepatocellular carcinoma. The measurement of the Liver Frailty Index (LFI) was done using the hand grip strength method, timed chair stands, and balance testing. Patients with LFI >4.5 were considered frail. All data was entered and analyzed using IBM SPSS Statistics for Windows, Version 22.0 (Released 2013; IBM Corp., Armonk, New York, United States). Continuous variables were analyzed using the student-t test while categorical variables were analyzed using the chi-square test. Variables with significance on univariate analysis then underwent multivariate analysis to identify the independent predictors of frailty in cirrhotic patients. A p-value < 0.05 was considered statistically significant. Results A total of 132 patients were included in the study. Out of them, 89 (67.4%) were males. On assessment, 51 (38.6%) patients were frail on presentation. On univariate analysis, female gender, advanced age, raised total leucocyte count, increased percentage of neutrophils on peripheral smear, raised serum creatinine, raised total bilirubin, raised prothrombin time, high Child Turcotte Pugh (CTP) score, and high model for end-stage liver disease along with low hemoglobin and low serum albumin levels were statistically significantly associated with frailty in cirrhosis. On multivariate analysis, female gender, age >40 years, CTP>B7, Hemoglobin <10g/dl, and neutrophils >60% on peripheral smear were independent predictors of liver frailty in cirrhotic patients. Conclusion Female gender, advanced age, increased neutrophils on peripheral smear, decreased hemoglobin along with increased degree of liver dysfunction were independent predictors of increased frailty in patients with chronic liver disease.
10.7759/cureus.61626
Applicability and prognostic value of frailty assessment tools among hospitalized patients with advanced chronic liver disease.
Skladany Lubomir,Drotarova Zuzana,Vnencakova Janka,Jancekova Daniela,Molcan Pavol,Koller Tomas
Croatian medical journal
AIM:To assess and compare the feasibility and prognostic value of various frailty assessment tools among decompensated cirrhosis inpatients. METHODS:Our prospective observational registry included consecutive patients admitted for cirrhosis between June 2017 and July 2018. Exclusion criteria were intensive-care unit admission, hepatocellular carcinoma outside of the Milan criteria, and other malignancies. Frailty at baseline was assessed with the Liver Frailty Index (LFI), Clinical Frailty Scale (CFS), Fried Frailty Score (FFS), and Short Physical Performance Battery test (SPPB). The follow-up lasted for at least 180 days. RESULTS:The study enrolled 168 patients (35.1% women, median age 57.9 years). The most frequent primary etiology was alcohol-related liver disease (78.6%). The Median Model for End-Stage Liver Disease (MELD) was 16. The 80th percentile of frailty scores was LFI>5.4, CFS>4, FFS>3, and SPPB<5, and it identified patients with higher mortality. LFI and CFS had the highest numerical prognostic value for in-hospital, and 90- and 180-day mortality. In a bivariate analysis of the risk of death or liver transplantation, the combination of MELD and LFI had the highest concordance (0.771±0.04). In a multivariate model, MELD score (HR 1.17, 95% CI 1.12-1.22), overt encephalopathy (2.39, 1.27-4.48), infection at baseline (2.32, 1.23-4.34), and numerical LFI (1.41, 1.02-1.95) were independent predictors of overall mortality. CONCLUSION:Frailty assessment using the evaluated tools is feasible among hospitalized cirrhotic patients, identifying those with worse prognosis. CFS had the highest applicability and accuracy for the initial assessment and LFI for the initial and follow-up assessments.
Frailty and Sleep Disorder in Chronic Liver Diseases.
Nishikawa Hiroki,Yoh Kazunori,Enomoto Hirayuki,Iwata Yoshinori,Nishimura Takashi,Nishiguchi Shuhei,Iijima Hiroko
Life (Basel, Switzerland)
We aimed to investigate the association in frailty and sleep disorder as assessed by the Japanese version of Pittsburgh Sleep Quality Index (PSQI-J) in patients with chronic liver diseases (CLDs, = 317, 141 males). Frailty was determined using the following five phenotypes: unintentional body weight loss, self-reported exhaustion, muscle weakness, slow walking speed, and low physical activity. Sleep disorder was defined as patients with PSQI-J score 6 or greater. Robust (phenotype, 0), prefrail (1 or 2 phenotypes) and frailty (3 phenotypes or greater) were observed in 101 (31.9%), 174 (54.9%) and 42 (13.2%), respectively. The median (interquartile range (IQR)) PSQI-J score was 4 (3, 7). Sleep disorder was found in 115 patients (36.3%). The median (IQR) PSQI-J scores in patients of the robust, prefrail, and frail groups were 3 (2, 5), 5 (3, 7), and 8 (4.75, 10.25), respectively ( < 0.0001 between any two groups and overall < 0.0001). The ratios of sleep disorder in patients with robust, prefrail and frailty were 15.8% (16/101), 39.1% (68/174), and 73.8% (31/42), respectively (overall < 0.0001). In conclusion, CLD patients with frailty can involve poorer sleep quality. As sleep disorder in CLDs is potentially remediable, future frailty-preventive strategies must take sleep complaints into account.
10.3390/life10080137
Branched-chain amino acids supplementation improves liver frailty index in frail compensated cirrhotic patients: a randomized controlled trial.
BMC gastroenterology
BACKGROUND:Physical frailty is related with morbidity and mortality in patients with cirrhosis. Currently, there is no approved treatment of frailty in these patients. Here, we evaluated the efficacy of 16 weeks branched-chain amino acids (BCAA) supplementation on frailty in frail compensated cirrhotic patients. METHODS:After a 4-week run-in period consisted of dietary and exercise counseling, compensated cirrhotic patients with frailty, defined by liver frailty index (LFI)≥4.5, were randomly assigned (1:1) to BCAA or control group. The BCAA group received twice daily BCAAs supplementation (210 kcal, protein 13.5 g, BCAA 2.03 g) for 16 weeks. The primary outcome was frailty reversion. The secondary outcomes were changes in biochemistries, body composition evaluated by bioelectrical impedance analysis, and quality of life (QoL). RESULTS:54 patients were prospectively enrolled (age 65.5 ± 9.9 years, 51.9% female, Child-Pugh A/B 68.5%/31.5%, MELD 10.3 ± 3.1). Baseline characteristics were similar between both groups. At week 16, BCAA group had a significant improvement in LFI (-0.36 ± 0.3 vs. -0.15 ± 0.28, P = 0.01), BMI (+ 0.51 ± 1.19 vs. -0.49 ± 1.89 kg/m, P = 0.03), and serum albumin (+ 0.26 ± 0.27 vs. +0.06 ± 0.3 g/dl, P = 0.01). The proportion of frailty reversion at week 16 was significantly higher in BCAA group (36% vs. 0%, P < 0.001). Compared with baseline, BCAA group had a significant increase in skeletal muscle index (7.5 ± 1.6 to 7.8 ± 1.5 kg/m, P = 0.03). Regarding the QoL, only the BCAA group had a significant improvement in all 4 domains of physical component score of the SF-36 questionnaire. CONCLUSIONS:A 16-week BCAA supplementation improved frailty in frail compensated cirrhotic patients. In addition, this intervention resulted in an improvement of muscle mass and physical domain of QoL in these patients. TRIAL REGISTRATION:This study was registered with Thai Clinical Trial Registry (TCTR20210928001; https://www.thaiclinicaltrials.org/# ).
10.1186/s12876-023-02789-1
Nutritional assessment in patients with liver cirrhosis.
World journal of hepatology
Malnutrition is a liver cirrhosis complication affecting more than 20%-50% of patients. Although the term can refer to either nutrient deficiency or excess, it usually relates to undernutrition in cirrhosis settings. Frailty is defined as limited physical function due to muscle weakness, whereas sarcopenia is defined as muscle mass loss and an advanced malnutrition stage. The pathogenesis of malnutrition in liver cirrhosis is multifactorial, including decreased oral intake, maldigestion/malabsorption, physical inactivity, hyperammonemia, hypermetabolism, altered macronutrient metabolism and gut microbiome dysbiosis. Patients with chronic liver disease with a Body Mass Index of < 18.5 kg/m and/or decompensated cirrhosis or Child-Pugh class C are at the highest risk of malnutrition. For patients at risk of malnutrition, a detailed nutritional assessment is required, typically including a history and physical examination, laboratory testing, global assessment tools and body composition testing. The latter can be done using anthropometry, cross-sectional imaging including computed tomography or magnetic resonance, bioelectrical impedance analysis and dual-energy X-ray absorptiometry. A multidisciplinary team should screen for and treat malnutrition in patients with cirrhosis. Malnutrition and sarcopenia are associated with an increased risk of complications and a poor prognosis in patients with liver cirrhosis; thus, it is critical to diagnose these conditions early and initiate the appropriate nutritional therapy. In this review, we describe the prevalence and pathogenesis of malnutrition in liver cirrhosis patients and discuss the best diagnostic approach to nutritional assessment for them.
10.4254/wjh.v14.i9.1694
Associations of metabolic heterogeneity of obesity with frailty progression: Results from two prospective cohorts.
Journal of cachexia, sarcopenia and muscle
BACKGROUND:Previous studies indicated that obesity would accelerate frailty progression. However, obesity is heterogeneous by different metabolic status. The associations of metabolic heterogeneity of obesity with frailty progression remain unclear. METHODS:A total of 6730 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 4713 from the English Longitudinal Study of Ageing (ELSA) were included at baseline. Metabolic heterogeneity of obesity was evaluated based on four obesity and metabolic phenotypes as metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHOO), and metabolically unhealthy overweight/obesity (MUOO). Frailty status was assessed by the frailty index (FI) ranging from 0 to 100 and frailty was defined as FI ≥ 25. Linear mixed-effect models were used to analyse the associations of metabolic heterogeneity of obesity with frailty progression. RESULTS:In the CHARLS, MUOO and MUNW presented the accelerated FI progression with additional annual increases of 0.284 (95% CI: 0.155 to 0.413, P < 0.001) and 0.169 (95% CI: 0.035 to 0.303, P = 0.013) as compared with MHNW. MHOO presented no accelerated FI progression (β: -0.011, 95% CI: -0.196 to 0.173, P = 0.904) as compared with MHNW. In the ELSA, the accelerated FI progression was marginally significant for MUOO (β: 0.103, 95% CI: -0.005 to 0.210, P = 0.061) and MUNW (β: 0.157, 95% CI: -0.011 to 0.324, P = 0.066), but not for MHOO (β: -0.047, 95% CI: -0.157 to 0.062, P = 0.396) in comparison with MHNW. The associations of MUOO and MUNW with the accelerated FI progression were stronger after excluding the baseline frail participants in both cohorts. The metabolic status changed over time. When compared with stable MHNW, participants who changed from MHNW to MUNW presented the accelerated FI progression with additional annual increases of 0.356 (95% CI: 0.113 to 0.599, P = 0.004) and 0.255 (95% CI: 0.033 to 0.477, P = 0.024) in the CHARLS and ELSA, respectively. The accelerated FI progression was also found in MHOO participants who transitioned to MUOO (CHARLS, β: 0.358, 95% CI: 0.053 to 0.663, P = 0.022; ELSA, β: 0.210, 95% CI: 0.049 to 0.370, P = 0.011). CONCLUSIONS:Metabolically unhealthy overweight/obesity and normal weight, but not metabolically healthy overweight/obesity, accelerated frailty progression as compared with metabolically healthy normal weight. Regardless of obesity status, transitions from healthy metabolic status to unhealthy metabolic status accelerated frailty progression as compared with stable metabolically healthy normal weight. Our findings highlight the important role of metabolic status in frailty progression and recommend the stratified management of obesity based on metabolic status.
10.1002/jcsm.13169
Association of Cystatin C Kidney Function Measures With Long-term Deficit-Accumulation Frailty Trajectories and Physical Function Decline.
JAMA network open
Importance:It remains unclear whether cystatin C and cystatin C-based kidney function measures are associated with frailty trajectories and physical function decline. Objective:To examine the associations of cystatin C level, cystatin C estimated glomerular filtration rate (eGFRcys), and the difference between eGFRs (eGFRdiff) using cystatin C and creatinine levels with long-term deficit-accumulation frailty trajectories and physical function decline. Design, Setting, and Participants:This prospective cohort study used data from 15 949 participants in the China Health and Retirement Longitudinal Study (CHARLS) and the US Health and Retirement Study (HRS), 2 ongoing nationally representative cohort studies enrolling community-dwelling older people. Biennial surveys, known as waves, are conducted in both the CHARLS and the HRS. Seven-year data from wave 1 (May 2011 to March 2012) to wave 4 (July to September 2018) in the CHARLS and 12-year data from wave 8 (March 2006 to February 2007) to wave 14 (April 2018 to June 2019) in the HRS were assessed, with wave 1 in the CHARLS and wave 8 in the HRS serving as baseline waves. Data were analyzed from February 12 to May 20, 2022. Exposures:Baseline serum cystatin C and creatinine levels. Cystatin C eGFR and creatinine estimated GFR (eGFRcr) were calculated using the 2021 race-free equations developed by the Chronic Kidney Disease Epidemiology Collaboration. The difference between eGFRcys and eGFRcr was calculated by subtracting eGFRcr from eGFRcys. Main Outcomes and Measures:Based on 12-year follow-up data from the HRS and 7-year follow-up data from the CHARLS, a 29-item deficit-accumulation frailty index (FI) was constructed to assess frailty trajectories at each visit. Physical function decline was evaluated using repeated objective physical function measurements (grip strength and gait speed). Linear mixed models were used to examine longitudinal associations. Results:Among 15 949 older adults included in the analysis, 9114 participants were from the HRS (mean [SD] age, 66.2 [10.1] years; 5244 women [57.5%]), and 6835 were from the CHARLS (mean [SD] age, 58.4 [9.8] years; 3477 women [50.9%]). With regard to race and ethnicity, the HRS cohort included 7755 White individuals (85.1%) and 1359 individuals (14.9%) of other races and/or ethnicities (including American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Pacific Islander, and other); all participants in the CHARLS cohort were of Chinese ethnicity. Each SD increment in serum cystatin C was associated with a faster increase in FI in both the HRS cohort (β = 0.050 SD/y; 95% CI, 0.045-0.055 SD/y; P = .001) and the CHARLS cohort (β = 0.051 SD/y; 95% CI, 0.042-0.060 SD/y; P = .001). An inverse association was observed for eGFRCys (HRS cohort: β = -0.058 SD/y; 95% CI, -0.062 to -0.053 SD/y; P = .001; CHARLS cohort: β = -0.056 SD/y; 95% CI, -0.064 to -0.047 SD/y; P = .001). These associations remained after controlling for serum creatinine (β = 0.051 SD/y; 95% CI, 0.042-0.060 SD/y; P = .001) and eGFRcr (β = -0.056 SD/y; 95% CI, -0.064 to -0.047 SD/y; P = .001) in the CHARLS cohort. Similar to the results observed for eGFRcys, each SD increment in the eGFRdiff was associated with a slower increase in FI (β = -0.027 SD/y; 95% CI, -0.035 to -0.018 SD/y; P = .001) in the CHARLS cohort. Similar findings were observed for physical function decline. For example, each SD increment in serum cystatin C was associated with faster decreases in both grip strength (β = -0.006 SD/y; 95% CI, -0.008 to -0.003 SD/y; P = .001) and gait speed (β = -0.007 SD/y; 95% CI, -0.011 to -0.003 SD/y; P = .001) in the HRS cohort and faster decreases in gait speed (β = -0.017 SD/y; 95% CI, -0.027 to -0.006 SD/y; P = .002) in the CHARLS cohort. Conclusions and Relevance:In this cohort study, cystatin C, eGFRcys, and eGFRdiff were associated with long-term frailty trajectories and physical function decline among community-dwelling older people without frailty. Monitoring kidney function using cystatin C could have clinical utility in identifying the risk of accelerated frailty progression.
10.1001/jamanetworkopen.2022.34208
Aging metrics incorporating cognitive and physical function capture mortality risk: results from two prospective cohort studies.
BMC geriatrics
BACKGROUND:Aging metrics incorporating cognitive and physical function are not fully understood, hampering their utility in research and clinical practice. This study aimed to determine the proportions of vulnerable persons identified by three existing aging metrics that incorporate cognitive and physical function and the associations of the three metrics with mortality. METHODS:We considered three existing aging metrics including the combined presence of cognitive impairment and physical frailty (CI-PF), the frailty index (FI), and the motoric cognitive risk syndrome (MCR). We operationalized them using data from the China Health and Retirement Longitudinal Study (CHARLS) and the US National Health and Nutrition Examination Survey (NHANES). Logistic regression models or Cox proportional hazards regression models, and receiver operating characteristic curves were used to examine the associations of the three metrics with mortality. RESULTS:In CHARLS, the proportions of vulnerable persons identified by CI-PF, FI, and MCR were 2.2, 16.6, and 19.6%, respectively. Each metric predicted mortality after adjustment for age and sex, with some variations in the strength of the associations (CI-PF, odds ratio (OR) (95% confidence interval (CI)) 2.87 (1.74-4.74); FI, OR (95% CI) 1.94 (1.50-2.50); MCR, OR (95% CI) 1.27 (1.00-1.62)). CI-PF and FI had additional predictive utility beyond age and sex, as demonstrated by integrated discrimination improvement and continuous net reclassification improvement (all P < 0.001). These results were replicated in NHANES. CONCLUSIONS:Despite the inherent differences in the aging metrics incorporating cognitive and physical function, they consistently capture mortality risk. The findings support the incorporation of cognitive and physical function for risk stratification in both Chinese and US persons, but call for caution when applying them in specific study settings.
10.1186/s12877-022-02913-y
Frailty is associated with the progression of prediabetes to diabetes and elevated risks of cardiovascular disease and all-cause mortality in individuals with prediabetes and diabetes: Evidence from two prospective cohorts.
Diabetes research and clinical practice
AIMS:To investigate the impacts of frailty on the progression of prediabetes to diabetes, cardiovascular disease (CVD) and all-cause mortality in individuals with prediabetes and diabetes. METHODS:7,933 subjects with prediabetes and diabetes were included from the China Health and Retirement Longitudinal Study (CHARLS) and English Longitudinal Study of Ageing (ELSA). Frailty status was assessed by frailty index and classified as robust, pre-frail, and frail. Logistic regression was used to calculate risks of progression to diabetes. Cox regression was used to calculate risks of CVD and all-cause mortality. RESULTS:In prediabetes, frail subjects had significantly increased risks of progression to diabetes (CHARLS, OR = 1.55, 95 %CI: 1.09-2.20; ELSA, OR = 1.86, 95 %CI: 1.02-3.37) compared with robust subjects. Frail subjects with prediabetes also presented significantly increased risks of CVD (CHARLS: HR = 1.90, 95 %CI: 1.45-2.48; ELSA: HR = 1.94, 95 %CI: 1.31-2.88) and all-cause mortality (CHARLS: HR = 2.45, 95 %CI: 1.79-3.36; ELSA: HR = 2.13, 95 %CI: 1.46-3.10) than robust subjects with prediabetes. In diabetes, frailty still increased risks of CVD (CHARLS, HR = 2.72, 95 %CI: 1.97-3.77; ELSA, HR = 2.41, 95 %CI: 1.43-4.06) and all-cause mortality (CHARLS, HR = 2.28, 95 %CI: 1.56-3.33; ELSA, HR = 2.28, 95 %CI: 1.47-3.53). CONCLUSIONS:Frailty is associated with the progression of prediabetes to diabetes and elevated risks of CVD and all-cause mortality in individuals with prediabetes and diabetes.
10.1016/j.diabres.2022.110145
Associations of Dynapenic Abdominal Obesity and Frailty Progression: Evidence from Two Nationwide Cohorts.
Nutrients
The associations of dynapenic abdominal obesity and transitions with frailty progression remain unclear among middle-aged and older adults. We included 6937 participants from the China Health and Retirement Longitudinal Study (CHARLS) and 3735 from the English Longitudinal Study of Aging (ELSA). Participants were divided into non-dynapenia and non-abdominal obesity (ND/NAO), abdominal obesity alone (AO), dynapenia alone (D), and dynapenic abdominal obesity (D/AO). Frailty status was assessed by the frailty index (FI), and a linear mixed-effect model was employed to analyze the associations of D, AO, D/AO, and transitions with frailty progression. Participants with AO, D, and D/AO had increased FI progression compared with ND/NAO in both cohorts. D/AO possessed the greatest additional annual FI increase of 0.383 (95% CI: 0.152 to 0.614), followed by D and AO in the CHARLS. Participants with D in the ELSA had the greatest magnitude of accelerated FI progression. Participants who transitioned from ND/NAO to D and from AO to D/AO presented accelerated FI progression in the CHARLS and ELSA. In conclusion, dynapenic abdominal obesity, especially for D/AO and D, presented accelerated frailty progression. Our findings highlighted the essential intervention targets of dynapenia and abdominal obesity for the prevention of frailty progression.
10.3390/nu16040518
Unraveling the relationship between high-sensitivity C-reactive protein and frailty: evidence from longitudinal cohort study and genetic analysis.
BMC geriatrics
BACKGROUND:This study aimed to investigate the association of high-sensitivity C-reactive protein (hs-CRP) with incident frailty as well as its effects on pre-frailty progression and regression among middle-aged and older adults. METHODS:Based on the frailty index (FI) calculated with 41 items, 6890 eligible participants without frailty at baseline from China Health and Retirement Longitudinal Study (CHARLS) were categorized into health, pre-frailty, and frailty groups. Logistic regression models were used to estimate the longitudinal association between baseline hs-CRP and incident frailty. Furthermore, a series of genetic approaches were conducted to confirm the causal relationship between CRP and frailty, including Linkage disequilibrium score regression (LDSC), pleiotropic analysis, and Mendelian randomization (MR). Finally, we evaluated the association of hs-CRP with pre-frailty progression and regression. RESULTS:The risk of developing frailty was 1.18 times (95% CI: 1.03-1.34) higher in participants with high levels of hs-CRP at baseline than low levels of hs-CRP participants during the 3-year follow-up. MR analysis suggested that genetically determined hs-CRP was potentially positively associated with the risk of frailty (OR: 1.06, 95% CI: 1.03-1.08). Among 5241 participants with pre-frailty at baseline, we found pre-frailty participants with high levels of hs-CRP exhibit increased odds of progression to frailty (OR: 1.39, 95% CI: 1.09-1.79) and decreased odds of regression to health (OR: 0.84, 95% CI: 0.72-0.98) when compared with participants with low levels of hs-CRP. CONCLUSIONS:Our results suggest that reducing systemic inflammation is significant for developing strategies for frailty prevention and pre-frailty reversion in the middle-aged and elderly population.
10.1186/s12877-024-04836-2
The effects of cognitive leisure activities on frailty transitions in older adults in China: a CHARLS-Based longitudinal study.
BMC public health
BACKGROUND:In an effort to identify factors associated with frailty transitions that trigger a significant difference in preventing and postponing the progression of frailty, questions regarding the role of cognitive leisure activities on various aspects of older adults' health were raised. However, the relationship between cognitive leisure activities and frailty transitions has rarely been studied. METHODS:A total of 5367 older Chinese adults aged over 60 years from the China Health and Retirement Longitudinal Study (CHARLS) were selected as participants. The 2nd wave of the CHARLS in 2013 was selected as the baseline, and sociodemographic and health-related status baseline data were collected. The FRAIL Scale was used to measure frailty, while cognitive leisure activities were measured by the Cognitive Leisure Activity Index (CLAI) scores, which consisted of playing mahjong or cards, stock investment, and using the internet. After two years of follow-up, frailty transition from baseline was assessed at the 3rd wave of the CHARLS in 2015. Ordinal logistic regression analysis was used to examine the relationship between cognitive leisure activities and frailty transitions. RESULTS:During the two-year follow-up of 5367 participants, the prevalence of frailty that improved, remained the same and worsened was 17.8% (957/5367), 57.5% (3084/5367) and 24.7% (1326/5367), respectively. Among all participants, 79.7% (4276/5367), 19.6% (1054/5367), and 0.7% (37/5367) had CLAI scores of 0, 1, and 2 to 3, respectively. In the univariate analysis, there was a statistically significant association between a score of 2 to 3 on the Cognitive Leisure Activity Index and frailty transitions (odds ratio [OR] = 1.93, 95% CI 0.03 to 1.29, p = .04), while all other covariates were not significantly different across the three groups. After adjusting for covariates, participants with more cognitive leisure activities had a higher risk of frailty improvement than those without cognitive leisure activities (odds ratio [OR] = 1.99, 95% CI 1.05 to 3.76, p = .04). CONCLUSIONS:Cognitive leisure activities were positively associated with the risk of frailty improvement in older adults, mainly when participating in multiple such activities. Older adults may be encouraged to participate in a wide variety of cognitive leisure activities to promote healthy aging.
10.1186/s12889-024-18889-w
Concurrent and lagged associations of social participation and frailty among older adults.
Health & social care in the community
Frailty is a pervasive symptom among the older population, and social participation is a beneficial factor of late-life well-being. However, studies on the bidirectional association between social participation and frailty are limited. This study examined the cross-sectional and lagged associations of social participation and frailty. The analytic sample contained 6865 community-dwelling older adults, with 21,141 observations, from the first four waves (2011-2018) China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by the Frailty Index (FI). Social participation was measured by the accumulation of the frequencies of six social activities. Random intercept two-level models were used to analyse the concurrent and lagged association between social participation and frailty. The results showed significantly cross-sectional associations between higher levels of frailty and lower levels of social participation in the same wave. Moreover, there was a lagged association of social participation in the prior wave with the current frailty (b = -0.001, SE = 0.001, p = 0.028), and frailty in the prior wave with the current social participation (b = -0.634, SE = 0.088, p < 0.001) even after adjusting for sociodemographic characteristics, and frailty or social participation in the prior wave. The bidirectional associations between social participation and frailty imply the necessity of enhancing social participation to prevent or slow the frailty progression, and improving the physical and social environment to reduce social participation restrictions imposed by frailty status.
10.1111/hsc.13888
Bidirectional Longitudinal Study of Frailty and Depressive Symptoms Among Older Chinese Adults.
Frontiers in aging neuroscience
OBJECTIVE:Frailty and depression, as two common conditions among older adults in China, have been shown to be closely related to each other. The aim of this study was to investigate the bidirectional effects between frailty and depressive symptoms in Chinese population. METHODS:The bidirectional effect of frailty with depressive symptoms was analyzed among 5,303 adults ≥ 60 years of age from the China Health and Retirement Longitudinal Study (CHARLS). Phenotype and a frailty index were used to measure frailty. Depressive symptoms were evaluated using the Epidemiological Studies Depression Scale (CES-D). Logistic regression and Cox proportional hazard regression models were used to determine the bidirectional effects of frailty and depressive symptoms in cross-sectional and cohort studies, respectively. Subgroup and sensitivity analyses were further used to further verify the associations. RESULTS:In the cross-sectional study, the multivariate-adjusted ORs (95% CIs) for depressive symptoms among pre-frail and frail adults, as defined by the frailty index and phenotype, were 3.05 (2.68-3.49), and 9.78 (8.02-12.03), respectively. Depressed participants showed higher risks of pre-frailty and frailty [frailty index, 3.07 (2.69-3.50); and phenotypic frailty, 9.95 (8.15-12.24)]. During follow-up, the multivariate-adjusted HRs (95% CIs) for depressive symptoms among pre-frail and frail participants, as defined by the frailty index and phenotype, were 1.38 (1.22-1.57), and 1.30 (1.14-1.48), respectively. No significant relationship existed between baseline depressive symptoms and the incidence of frailty. Moreover, the results from subgroup and sensitivity analyses were consistent with the main results. CONCLUSION:Although a cross-sectional bidirectional association between depressive symptom and frailty has been observed in older (≥60 years old) Chinese adults, frailty may be an independent predictor for subsequent depression. Moreover, no effect of depressive symptoms on subsequent frailty was detected. Additional bidirectional studies are warranted in China.
10.3389/fnagi.2022.791971
How long can Chinese women work after retirement based on health level: Evidence from the CHARLS.
Frontiers in public health
Objective:To further enhance the understanding of factors impacting female participation in the workforce based on health levels and to measure the excess work capacity of middle-aged and older female groups by residence and educational level. Methods:Data of women aged 45-74 were accessed from the China Health and Retirement Longitudinal Study (CHARLS) from 2011, 2013, 2015, to 2018. The health status of women was comprehensively evaluated by single health variables and frailty index. A Probit model was used to measure the excess working capacity of women by region (rural/urban) and educational level, taking all women aged 45-49, rural women aged 45-49, and rural (illiterate) women in all age groups as the benchmark, respectively. Results:The excess capacity of all Chinese women aged 50-64 is 1.9 years, and that of women aged 50-74 is 5.1 years. The excess work capacity of women in urban and rural areas and with different educational levels is heterogeneous. The excess working capacity of urban women aged 50-64 is 6.1-7.8 years, and that of urban women aged 50-74 is 9.8-14.9 years. The excess working capacity of urban women aged 50-64 is about 6 times that of rural women. The excess work capacity of highly educated women was 3 times higher than that of illiterate women. Conclusion:The potential work capacity of Chinese women remains to be exploited, especially for urban and highly educated middle-aged and older women with better conditions of health, whose potential is more significant. A rational retirement policy for women and the progressive implementation of an equal retirement age for men and women will contribute to further advancement of gender equality and healthy aging in the workplace in China.
10.3389/fpubh.2023.987362
Frailty Index and Cardiovascular Disease among Middle-Aged and Older Chinese Adults: A Nationally Representative Cross-Sectional and Follow-Up Study.
Journal of cardiovascular development and disease
Evidence for the association between the frailty index and cardiovascular disease (CVD) is inconclusive, and this association has not been evaluated in Chinese adults. We aim to examine the association between the frailty index and CVD among middle-aged and older Chinese adults. We conducted cross-sectional and cohort analyses using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS). From 2011 to 2018, 17,708 participants aged 45 years and older were included in the CHARLS. The primary outcome was CVD events (composite of heart disease and stroke). Multivariable adjusted logistic regression and Cox proportional hazards models were used to estimate the association between the frailty index and CVD in cross-sectional and follow-up studies, respectively. A restricted cubic spline model was used to characterize dose−response relationships. A total of 16,293 and 13,580 participants aged 45 years and older were included in the cross-sectional and cohort analyses, respectively. In the cross-sectional study, the prevalence of CVD in robust, pre-frailty and frailty was 7.83%, 18.70% and 32.39%, respectively. After multivariable adjustment, pre-frailty and frailty were associated with CVD; ORs were 2.54 (95% confidence interval [CI], 2.28−2.84) and 4.76 (95% CI, 4.10−5.52), respectively. During the 7 years of follow-up, 2122 participants without previous CVD developed incident CVD; pre-frailty and frailty were associated with increased risk of CVD events; HRs were 1.53 (95% CI, 1.39−1.68) and 2.17 (95% CI, 1.88−2.50), respectively. Furthermore, a stronger association of the frailty index with CVD was observed in participants aged <55, men, rural community-dwellers, BMI ≥ 25, without hypertension, diabetes or dyslipidemia. A clear nonlinear dose−response pattern between the frailty index and CVD was widely observed (p < 0.001 for nonlinearity), the frailty index was above 0.08, and the hazard ratio per standard deviation was 1.18 (95% CI 1.13−1.25). We observed the association between the frailty index and CVD among middle-aged and elderly adults in China, independent of chronological age and other CVD risk factors. Our findings are important for prevention strategies aimed at reducing the growing burden of CVD in older adults.
10.3390/jcdd9070228
Long-term impact of PM exposure on frailty, chronic diseases, and multimorbidity among middle-aged and older adults: insights from a national population-based longitudinal study.
Environmental science and pollution research international
Particulate Matter 2.5 (PM) is a significant risk factor for frailty and chronic diseases. Studies on the associations between PM and frailty, chronic diseases, and multimorbidity are scarce, especially from large cohort studies. We aimed to explore the potential association between PM exposure and the risk of frailty, chronic diseases, and multimorbidity. We collected data from a national cohort (CHARLS) with a follow-up period of 11-18 years, totaling 13,366 participants. We obtained PM concentration data from the Atmospheric Composition Analysis Group at Dalhousie University. PM exposure is based on the average annual concentration in the prefecture-level city where residents live. We define frailty as the comprehensive manifestation of declining various body functions, characterized by a frailty index of 0.25 or greater, and multimorbidity as the presence of at least two or more chronic conditions. Cox proportional hazards regression was used to estimate the hazard ratio (HR) with its 95% confidence interval (95%CI). A 10-μg/m increase for PM was significantly associated with an increased risk of frailty (HR = 1.289, 95%CI = 1.257-1.322, P < 0.001). A 10-μg/m increase for PM was significantly associated with the elevated risk for most chronic diseases. Compared to those with no morbidity or only single morbidity, a 10-μg/m increase for PM was significantly associated with the elevated risk for multimorbidity (HR = 1.220, 95%CI = 1.181-1.260, P < 0.001). Ambient PM exposure is a significant risk factor for frailty, chronic diseases, and multimorbidity, and some measures need to be taken to reduce PM concentration and prevent frailty and chronic diseases.
10.1007/s11356-023-31505-5
The visceral adiposity index and risk of type 2 diabetes mellitus in China: A national cohort analysis.
Yu Jinyue,Yi Qian,Chen Ge,Hou Leying,Liu Qing,Xu Yunhan,Qiu Yiwen,Song Peige
Diabetes/metabolism research and reviews
AIMS:Visceral Adiposity Index (VAI) is a sex-specific index of visceral adiposity based on body mass index, waist circumference, triglycerides and high-density lipoprotein cholesterol. This study aims to demonstrate the association of VAI and its longitudinal transition patterns with type 2 diabetes mellitus (T2DM) in middle-aged and older Chinese. MATERIALS AND METHODS:Data from the China Health and Retirement Longitudinal Study (2011, 2013, 2015, and 2018) were analysed. Participants were classified into high- and low-VAI groups at baseline, and subsequently into four transition patterns during follow-up (2011-2015): maintained-high, maintained-low, high-to-low, and low-to-high VAI. Multivariable Cox frailty models with random effects were used to assess the associations of VAI and its transitions with T2DM. RESULTS:A total of 7245 participants were analysed, among which 818 developed T2DM by 2018. A positive association between baseline high-VAI levels and T2DM was observed (HR = 1.49, 95% CI: 1.27-1.75). Compared with people with maintained low-VAI pattern during follow-up, those with transition patterns of maintained-high VAI, high-to-low VAI, and low-to-high VAI were at higher risk of T2DM (HR = 1.97, 1.52, and 1.56, respectively, all p < 0.05). The risk of T2DM decreased significantly in the high-to-low VAI group as compared to the maintained-high VAI group (HR = 0.77, 95% CI: 0.60-0.99). CONCLUSIONS:This study demonstrated the significant associations of baseline VAI and its transitions with the risk of new-onset T2DM. Early prevention efforts are needed to control the development of T2DM in Chinese with high-VAI levels.
10.1002/dmrr.3507
Association between frailty and risk of fall among diabetic patients.
Wang Xiaojie,Chen Zhiyuan,Li Ziyi,Chen Bo,Qi Yong,Li Guowei,Adachi Jonathan D
Endocrine connections
Background:Several epidemiological studies have demonstrated the risk factors for fall, while few studies investigated the association between frailty and risk of fall in diabetic patients aged ≥45 years. Methods:In this multicity observational study, participants with type 2 diabetes aged ≥45 years were enrolled. Frailty status was measured by a frailty index (FI) of deficit accumulation. We used multivariable regression models to examine the relationship between frailty and fall in diabetic patients, and further investigated the associations between frailty and fall in varied subgroups. Results:A total of 2049 participants with type 2 diabetes were identified in our study. Our results showed a per-s.d. and a per-0.01 increment of FI were associated with an increased risk of fall, with a fully adjusted OR of 1.89 (95% CI: 1.50, 2.38), 1.06 (95% CI: 1.04, 1.09), respectively. The effects were magnified when frailty was considered as dichotomous, with an OR of 3.08 (95% CI: 2.18, 4.34). In further subgroup analyses, we found that the females, the older, rural residents, individuals with no sitting toilet, people with poor balance performance and those in poor health status were susceptible to fall. Especially, for the risk of fall in the older, a per-s.d. increase of FI corresponded to an OR of 2.46 (95% CI: 1.68, 3.62). When frailty was regarded as a binary variable, the effect increased to 4.62 (95% CI: 2.54, 8.38) in the older subgroup. Conclusion:Frailty was associated with a higher risk of fall in people with type 2 diabetes, and the effects were higher in vulnerable groups. This evidence suggested that more attention should be paid to vulnerable groups for fall prevention.
10.1530/EC-20-0405
Medical insurance benefits and health inequality: evidence from rural China.
Frontiers in public health
Alleviating health inequality among different income groups has become a significant policy goal in China to promote common prosperity. Based on the data from the China Health and Retirement Longitudinal Study (CHARLS) covering the period from 2013 to 2018, this study empirically examines the impact of Integrated Medical Insurance System (URRBMI) on the health and health inequality of older adult rural residents. The following conclusions are drawn: First, URRBMI have elevated the level of medical security, reduced the frailty index of rural residents, and improved the health status of rural residents. Second, China exhibits "pro-rich" health inequality, and URRBMI exacerbates health inequality among rural residents with different incomes. This result remains robust when replacing the frailty index with different health modules. Third, the analysis of influencing mechanisms indicates that the URRBMI exacerbate inequality in the utilization of medical services among rural residents, resulting in a phenomenon of "subsidizing the rich by the poor" and intensifying health inequality. Fourth, in terms of heterogeneity, URRBMI have significantly widened health inequality among the older adult and in regions with a higher proportion of multiple-tiered medical insurance schemes. Finally, it is suggested that China consider establishing a medical financing and benefit assurance system that is related to income and age and separately construct a unified public medical insurance system for the older adult population.
10.3389/fpubh.2024.1363764
[Study on the status of frailty and related determinants among the elderly in China].
Yin J H,Zeng Y B,Zhou Z,Fang Y
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi
To investigate the frailty status and related determinants among the elderly in China. Frailty index (FI) was applied to evaluate the frailty status of the elderly. Data used in this study was from the China Health and Retirement Longitudinal Study (CHARLS) in 2011-2015. Binary logistic regression analysis was carried out to identify the determinants related to the status on frailty. The prevalence rates of frailty in the elderly were 18.7, 20.6 and 28.4 in 2011, 2013 and 2015, respectively. Being female or elderly under advanced age, were both associated with the higher level of FI. Factors as hip fracture, falls, alcohol intake more than once a month, and less participation in social activities ., might serve as the risk factors for frailty. Chinese elderly showed relatively high prevalence on frailty and with annual increasing trend. The status of frailty was related to factors as adverse events and unhealthy lifestyles. Comprehensive intervention strategies should be adopted in early life of the elderly to delay the development process of frailty.
10.3760/cma.j.issn.0254-6450.2018.09.019
Does social participation decrease the risk of frailty? Impacts of diversity in frequency and types of social participation on frailty in middle-aged and older populations.
BMC geriatrics
BACKGROUND:Social participation (SP) may be an effective measure for decreasing frailty risks. This study investigated whether frequency and type of SP is associated with decreased frailty risk among Chinese middle-aged and older populations. METHODS:Data were derived from the China Health and Retirement Longitudinal Study (CHARLS). Frailty was assessed using the Rockwood's Cumulative Deficit Frailty Index. SP was measured according to frequency (none, occasional, weekly and daily) and type (interacting with friends [IWF]; playing mah-jong, chess, and cards or visiting community clubs [MCCC], going to community-organized dancing, fitness, qigong and so on [DFQ]; participating in community-related organizations [CRO]; voluntary or charitable work [VOC]; using the Internet [INT]). Smooth curves were used to describe the trend for frailty scores across survey waves. The fixed-effect model (N = 9,422) was applied to explore the association between the frequency/type of SP and frailty level. For baseline non-frail respondents (N = 6,073), the time-varying Cox regression model was used to calculate relative risk of frailty in different SP groups. RESULTS:Weekly (β = - 0.006; 95%CI: [- 0.009, - 0.003]) and daily (β = - 0.009; 95% CI: [- 0.012, - 0.007]) SP is associated with lower frailty scores using the fixed-effect models. Time-varying Cox regressions present lower risks of frailty in daily SP group (HR = 0.76; 95% CI: [0.69, 0.84]). SP types that can significantly decrease frailty risk include IWF, MCCC and DFQ. Daily IWF and daily DFQ decreases frailty risk in those aged < 65 years, female and urban respondents, but not in those aged ≥ 65 years, male and rural respondents. The impact of daily MCCC is significant in all subgroups, whereas that of lower-frequent MCCC is not significant in those aged ≥ 65 years, male and rural respondents. CONCLUSION:This study demonstrated that enhancing participation in social activities could decrease frailty risk among middle-aged and older populations, especially communicative activities, intellectually demanding/engaging activities and community-organized physical activities. The results suggested very accurate, operable, and valuable intervening measures for promoting healthy ageing.
10.1186/s12877-022-03219-9
Associations Between Intellectual and Social Activities With Frailty Among Community-Dwelling Older Adults in China: A Prospective Cohort Study.
Huang Yafang,Guo Xiangyu,Du Juan,Liu Yanli
Frontiers in medicine
Frailty is one of the most important global health challenges. We aimed to examine the associations between frequency of intellectual and social activities and frailty among community-dwelling older adults in China. This is a prospective analysis of older adults (aged ≥60 years) who had intellectual and social activity data and were free of frailty from the national representative China Health and Retirement Longitudinal Study (CHARLS). The exposure was frequency of intellectual and social activities. Frailty was measured by the frailty index (FI) and defined as FI ≥ 0.25. Frailty incidents were followed up for 2 years. We estimated the relative risks (RRs) with 95% confidence intervals (CIs) using log-linear binominal regression adjusting for potential confounders. We documented 655 frailty cases over the past 2 years. Participants who had frequent intellectual activities had a lower frailty risk compared with participants who did not have intellectual activity (adjusted RR = 0.65, 95%CI = 0.47-0.90). The adjusted RRs were 0.51 (95%CI = 0.33-0.77) for participants who did not have a slip or a fall accident and 1.06 (95%CI = 0.65-1.75) for participants who had experienced slip and fall accidents ( = 0.01 for interaction). Having frequent social activities was not associated with a significant decrease in frailty risk compared with participants who did not have social activity (adjusted RR = 0.93, 95%CI = 0.78-1.12). This observational study showed that having frequent intellectual activities was associated with a decreased frailty risk. The association was likely to be stronger in participants without a slip or a fall accident. Randomized controlled trials are needed to confirm this observational finding.
10.3389/fmed.2021.693818
Effects of (pre)frailty and cognitive reserve on mild cognitive impairment among community-dwelling older adults.
Archives of gerontology and geriatrics
OBJECTIVE:We aimed to identify the effect of lifespan cognitive reserve and (pre)frailty on mild cognitive impairment (MCI) among older adults. MATERIALS AND METHODS:A total of 4420 older adults aged above 60 with intact cognition recruited in 2011/2012 were followed up in 2015 from the China Health and Retirement Longitudinal Study (CHARLS). The assessment of MCI was based on executive function, episodic memory, and visual-spatial ability. (Pre)frailty was assessed by the validated version of the Fried physical frailty phenotype scale. The lifespan cognitive reserve consisted of the highest educational level, occupational complexity, and participation in leisure activities. Modified Poisson regression models were used to identify the risk of MCI in relation to (pre)frailty and lifespan cognitive reserve index. We examined the interactions of (pre)frailty and lifespan cognitive reserve index on both additive and multiplicative scales. RESULTS:Baseline (pre)frailty significantly increased the risk of MCI after 3-4 years of follow-up, and high cognitive reserve protected individuals from the risk of MCI. There was an additive interaction between (pre)frailty and the low lifespan cognitive reserve (the relative excess interaction risk=1.08, 95 % CI= 0.25-1,91), but no multiplicative interaction (RR=0.95, 95 % CI= 0.67-1.37). The risk of MCI was larger among older adults with comorbid (pre)frailty and low cognitive reserve than those with each condition alone. CONCLUSION:Cognitive reserve attenuates the risk of MCI associated with (pre)frailty. This finding implicates the urgency for identifying and managing MCI among frail older adults who accumulate low cognitive reserve in the life course.
10.1016/j.archger.2024.105533
Transition of Hypertriglyceridemic-Waist Phenotypes and the Risk of Type 2 Diabetes Mellitus among Middle-Aged and Older Chinese: A National Cohort Study.
Chen Ge,Yi Qian,Hou Leying,Peng Shenghan,Fan Mengya,Song Peige,Zhu Yimin
International journal of environmental research and public health
The rapid economic growth and nutritional changes in China have brought an increased burden of type 2 diabetes mellitus (T2DM). This study aimed to assess the effects of hypertriglyceridemic-waist (HTW) and its dynamic transitions on incident T2DM among middle-aged and older Chinese. Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS). Participants were classified into three HTW phenotypes, namely NTNW (normal triglyceride (TG) and waist circumference (WC)), NTEW/ETNW (normal TG and enlarged WC, or elevated TG and normal WC) and ETEW (elevated TG and enlarged WC). Multivariable Cox frailty models were used to assess the associations of HTW phenotypes and their transitions over time with the risk of T2DM. A total of 7397 subjects without T2DM were included, of which 849 developed T2DM during 2011-2018. Compared with individuals with NTNW, people in the NTEW/ETNW group and ETEW group were at a significantly higher risk of T2DM (HR = 1.28, 95% CI: 1.06-1.54 and HR = 1.61, 95% CI: 1.26-2.06). For subjects with NTNW at baseline, the risk of developing T2DM increased by 38% and 83% if their metabolic status changed to NTEW/ETNW and ETEW, respectively. For subjects with NTEW/ETNW, the risk of T2DM decreased by 33% when their metabolic status changed to normal (NTNW); but the risk increased by 49% if the status became more serious (ETEW). NTEW/ETNW, ETEW and their transitions to adverse states were risk factors for T2DM.
10.3390/ijerph18073664
The association between physical activity intensity and frailty risk among older adults across different age groups and genders: Evidence from four waves of the China Health and Retirement Longitudinal Survey.
PloS one
"Exercise is the best medicine" is well known, but the optimal dose of physical activity (PA) for males and females across different age groups is still unknown. This study, using data from the four waves of CHARLS, aimed to determine the optimal PA dose that reduces frailty risks among older adults across various age groups and both sexes. We created a frailty index score using 63 health-related variables and used 0.21 as the frailty cut point. Binary logistic regression was used to compare the effect of vigorous, moderate, and light intensity PA under IPAQ criteria on frailty risk. The study found that regardless of whether males or females, the optimal effect of vigorous-intensity PA in reducing the risk of frailty is consistently observed throughout the entire old age career. Moreover, the age groups at which moderate-intensity PA reduces the risk of frailty were from age 70 for males and from age 80 for females. And light-intensity PA had no effect on reducing the risk of frailty. Moderate and vigorous intensity of PA in older adults should be promoted, but guidelines and recommendations must account for optimal associations with PA dose across genders and age groups.
10.1371/journal.pone.0305346
Exploring the association between Frailty Index and low back pain in middle-aged and older Chinese adults: a cross-sectional analysis of data from the China Health and Retirement Longitudinal Study (CHARLS).
BMJ open
OBJECTIVES:This study explored the association between the Frailty Index (FI) and low back pain (LBP) in middle-aged and older Chinese adults. We hypothesised that a higher FI correlates with increased LBP prevalence. DESIGN:Cross-sectional analysis. SETTING:The study used data from the China Health and Retirement Longitudinal Study (CHARLS) across various regions of China. PARTICIPANTS:The analysis included 6375 participants aged 45 and above with complete LBP and FI data from the CHARLS for 2011, 2013 and 2015. We excluded individuals under 45, those with incomplete LBP data, participants with fewer than 30 health deficit items and those missing covariate data. OUTCOME MEASURES:We constructed an FI consisting of 35 health deficits. Logistic multivariable regression examined the relationship between FI and LBP, using threshold analysis to identify inflection points. Sensitivity analyses were performed to ensure the robustness of the findings. RESULTS:Of the participants, 27.2% reported LBP. A U-shaped association was observed between FI and LBP, with the highest quartile (Q4, FI ≥0.23) showing more than a twofold increased risk of LBP (OR=2.90, 95% CI: 2.45-3.42, p<0.001). Stratified analysis showed a significant association in participants under 60, particularly in the lowest FI quartile (OR=1.43, 95% CI: 1.14 to 1.79). Sensitivity analysis upheld the robustness of the primary results. CONCLUSIONS:The findings suggest a complex relationship between frailty and LBP, highlighting the need for early screening and tailored interventions to manage LBP in this demographic. Further research is necessary to understand the mechanisms of this association and to validate the findings through longitudinal studies.
10.1136/bmjopen-2024-085645
Frailty, cognitive impairment, and depressive symptoms in Chinese older adults: an eight-year multi-trajectory analysis.
BMC geriatrics
BACKGROUND:Frailty, cognitive impairment, and depressive symptoms are closely interrelated conditions in the aging population. However, limited research has longitudinally analyzed the concurrent trajectories of these three prominent conditions in older adults in China. This study aimed to explore the eight-year trajectories of frailty, cognitive impairment, and depressive symptoms, and to identify individual-level and structural-level factors associated with the trajectories. METHODS:Four waves of data from the China Health and Retirement Longitudinal Study (2011-2018) were used to identify 6,106 eligible older adults. The main measures included frailty by the frailty index constructed using 30 indicators, cognitive impairment by the summary score of immediate and delayed word recall, figure drawing, serial subtraction, and orientation, and depressive symptoms by the Center for Epidemiologic Studies Depression Scale. Multi-trajectory models identified the trajectories of frailty, cognitive impairment, and depressive symptoms over time. Multinomial logistic regression was employed to estimate the associations between individual-level capital factors and one structural factor (hukou and geographic residency) with the identified trajectories, adjusting for demographic characteristics. RESULTS:Four trajectories emerged: (1) worsening frailty, worsening cognitive impairment, depression (14.0%); (2) declining pre-frailty, declining cognition, borderline depression (20.0%); (3) pre-frailty, worsening cognitive impairment, no depression (29.3%); and (4) physically robust, declining cognition, no depression (36.7%). Using the "physically robust, declining cognition, no depression" as the reference, not working, no social activity participant, worse childhood family financial situation, and poorer adult health were most strongly associated with the "worsening frailty, worsening cognitive impairment, depression" trajectory; worse health during childhood had the highest association with the "declining pre-frailty, declining cognition, borderline depression" trajectory; less education, lower household consumption, and rural hukou had the greatest association with the increased likelihood of the "pre-frailty, worsening cognitive impairment, no depression" trajectory. CONCLUSIONS:Findings could inform the understanding of the interrelationship of frailty, cognitive impairment, and depressive symptoms in older adults in China and may help practitioners detect adults at risk for adverse trajectories to implement strategies for proper care.
10.1186/s12877-023-04554-1
Causal association of NAFLD with osteoporosis, fracture and falling risk: a bidirectional Mendelian randomization study.
Frontiers in endocrinology
Introduction:The causal association between non-alcoholic fatty liver disease (NAFLD) and osteoporosis remains controversial in previous epidemiological studies. We employed a bidirectional two-sample Mendelian analysis to explore the causal relationship between NAFLD and osteoporosis. Method:The NAFLD instrumental variables (IVs) were obtained from a large Genome-wide association study (GWAS) meta-analysis dataset of European descent. Two-sample Mendelian randomization (MR) analyses were used to estimate the causal effect of NAFLD on osteoporosis, fracture, and fall. Reverse Mendelian randomization analysis was conducted to estimate the causal effect of osteoporosis on NAFLD. The inverse-variance weighted (IVW) method was the primary analysis in this analysis. We used the MR-Egger method to determine horizontal pleiotropic. The heterogeneity effect of IVs was detected by MR-Egger and IVW analyses. Results:Five SNPs (rs2980854, rs429358, rs1040196, rs738409, and rs5764430) were chosen as IVs for NAFLD. In forward MR analysis, the IVW-random effect indicated the causal effect of NAFLD on osteoporosis (OR= 1.0021, 95% CI: 1.0006-1.0037, = 0.007) but not on fracture (OR= 1.0016, 95% CI: 0.998-1.0053, = 0.389) and fall (OR= 0.9912, 95% CI: 0.9412-1.0440, = 0.740). Furthermore, the reverse Mendelian randomization did not support a causal effect of osteoporosis on NAFLD (OR= 1.0002, 95% CI: 0.9997-1.0007, = 0.231). No horizontal pleiotropic was detected in all MR analyses. Conclusions:The results of this study indicate a causal association between NAFLD and osteoporosis. NAFLD patients have a higher risk of osteoporosis but not fracture and falling risk. In addition, our results do not support a causal effect of osteoporosis on NAFLD.
10.3389/fendo.2023.1215790
Anti-osteoporotic treatments in the era of non-alcoholic fatty liver disease: friend or foe.
Frontiers in endocrinology
Over the last years non-alcoholic fatty liver disease (NAFLD) has grown into the most common chronic liver disease globally, affecting 17-38% of the general population and 50-75% of patients with obesity and/or type 2 diabetes mellitus (T2DM). NAFLD encompasses a spectrum of chronic liver diseases, ranging from simple steatosis (non-alcoholic fatty liver, NAFL) and non-alcoholic steatohepatitis (NASH; or metabolic dysfunction-associated steatohepatitis, MASH) to fibrosis and cirrhosis with liver failure or/and hepatocellular carcinoma. Due to its increasing prevalence and associated morbidity and mortality, the disease-related and broader socioeconomic burden of NAFLD is substantial. Of note, currently there is no globally approved pharmacotherapy for NAFLD. Similar to NAFLD, osteoporosis constitutes also a silent disease, until an osteoporotic fracture occurs, which poses a markedly significant disease and socioeconomic burden. Increasing emerging data have recently highlighted links between NAFLD and osteoporosis, linking the pathogenesis of NAFLD with the process of bone remodeling. However, clinical studies are still limited demonstrating this associative relationship, while more evidence is needed towards discovering potential causative links. Since these two chronic diseases frequently co-exist, there are data suggesting that anti-osteoporosis treatments may affect NAFLD progression by impacting on its pathogenetic mechanisms. In the present review, we present on overview of the current understanding of the liver-bone cross talk and summarize the experimental and clinical evidence correlating NAFLD and osteoporosis, focusing on the possible effects of anti-osteoporotic drugs on NAFLD.
10.3389/fendo.2024.1344376
Comparison of Clinical Characteristics Between Obese and Non-Obese Patients with Nonalcoholic Fatty Liver Disease (NAFLD).
Diabetes, metabolic syndrome and obesity : targets and therapy
OBJECTIVE:Non-alcoholic fatty liver disease (NAFLD), previously thought to predominantly affect obese individuals, has also been shown to occur in subjects who have a relatively normal body mass index (BMI). Due to the normal BMI, non-obese NAFLD are easily to be ignored and eventually lead to potential liver injuries. METHODS:A population-based cross-sectional study was conducted on 1608 cases with normal serum alanine aminotransferase (ALT) levels who were divided into an obese group (BMI ≥25 kg/m) and a non-obese group (BMI <25 kg/m). NAFLD was diagnosed by ultrasound and Fibro Scan examination. Non-obese populations were divided into NAFLD group (CAP ≥240 db/m) and non-NAFLD group (CAP <240 db/m). The incidence of NAFLD in the obese and non-obese populations and constituent ratios of genders, age, and serum levels of triglycerides (TG), cholesterol (CHOL), and blood glucose were compared. Risk factors of NAFLD in non-obese people were analyzed by multivariate logistics regression. RESULTS:The occurrence of NAFLD was higher in the obese group than in the non-obese group, regardless of gender (P <0.001). In the non-obese group, the occurrence of NAFLD in female patients was lower than that in male (P=0.001). The occurrence of NAFLD increased with age, with 50-59 years being the peak age of incidence in both male and female. The peak age of NAFLD occurrence in non-obese male patients was more delayed than that in obese male patients. BMI (OR=1.311, P=0.000) and TG (OR=2.545, P=0.000) were risk factors for NAFLD in the non-obese population. CONCLUSION:Compared with obese population, the incidence of NAFLD in non-obese population was relatively low and more frequently in male than in female, the peak age of NAFLD occurrence in non-obese male patients was also delayed. BMI and TG should still be controlled to avoid the occurrence of NAFLD although the BMI of such patients is normal.
10.2147/DMSO.S304634
DEXA Scan Body Fat Mass Distribution in Obese and Non-Obese Individuals and Risk of NAFLD-Analysis of 10,865 Individuals.
Journal of clinical medicine
Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide yet predicting non-obese NAFLD is challenging. Thus, this study investigates the potential of regional fat percentages obtained by dual-energy X-ray absorptiometry (DXA) in accurately assessing NAFLD risk. Using the United States National Health and Nutrition Examination Survey (NHANES) 2011−2018, multivariate logistic regression and marginal analysis were conducted according to quartiles of regional fat percentages, stratified by gender. A total of 23,752 individuals were analysed. Males generally showed a larger increase in marginal probabilities of NAFLD development than females, except in head fat, which had the highest predictive probabilities of non-obese NAFLD in females (13.81%, 95%CI: 10.82−16.79) but the lowest in males (21.89%, 95%CI: 20.12−23.60). Increased percent of trunk fat was the strongest predictor of both non-obese (OR: 46.61, 95%CI: 33.55−64.76, p < 0.001) and obese NAFLD (OR: 2.93, 95%CI: 2.07−4.15, p < 0.001), whereas raised percent gynoid and leg fat were the weakest predictors. Ectopic fat deposits are increased in patients with non-obese NAFLD, with greater increases in truncal fat over gynoid fat. As increased fat deposits in all body regions can increase odds of NAFLD, therapeutic intervention to decrease ectopic fat, particularly truncal fat, may decrease NAFLD risk.
10.3390/jcm11206205
Association of grip strength with non-alcoholic fatty liver disease: investigation of the roles of insulin resistance and inflammation as mediators.
Park Seung Ha,Kim Dong Joon,Plank Lindsay D
European journal of clinical nutrition
BACKGROUND/OBJECTIVES:The purpose of this study was to examine the association between muscle weakness and non-alcoholic fatty liver disease (NAFLD), and whether the association is partly explained by insulin resistance or inflammation. SUBJECTS/METHODS:Subjects were 3922 adults who participated in the 2015 Korea National Health and Nutrition Examination Survey. Relative grip strength (rGS; calculated as maximal grip strength divided by BMI) was used to predict NAFLD defined by NAFLD liver fat score. Participants were classified into four groups according to the quartiles of rGS distribution (Q1-Q4). Insulin resistance was assessed by triglycerides and glucose (TyG) index. Inflammation was measured with C-reactive protein (CRP). Fibrosis was assessed by the Fibrosis-4 index (FIB-4) and the NAFLD fibrosis score. RESULTS:rGS had significant negative associations with TyG index and CRP (all p < 0.001). rGS was a significant predictor of NAFLD (OR, 0.54-0.19 in Q2-Q4 men; OR, 0.54-0.08 in Q2-Q4 women, all p < 0.001). Adjustment for other participant factors did not substantially affect the results. Addition of TyG index changed the estimates for NAFLD slightly and addition of CRP increased the ORs by 10-20% in Q3-Q4 women. In the subpopulation with NAFLD (n = 946), rGS showed strong inverse relationships with FIB-4 and NAFLD fibrosis score (all p < 0.001). CONCLUSIONS:Grip strength was inversely associated not only with the risk of NAFLD but also with its severity. Insulin resistance and inflammation explained only a small portion of the association between grip strength and NAFLD risk.
10.1038/s41430-020-0591-x
Association between grip strength and non-alcoholic fatty liver disease: A systematic review and meta-analysis.
Frontiers in medicine
Background:The association between grip strength (GS) and non-alcoholic fatty liver disease (NAFLD) has been reported by recent epidemiological studies, however, the results of these studies are inconsistent. This meta-analysis was conducted to collect all available data and estimate the risk of NAFLD among people with low GS, as well as the risk of low GS among patients with NAFLD. Methods:We systematically searched several literature databases including PubMed, Web of Science, Cochrane Library, and Embase from inception to March 2022. These observational studies reported the risk of NAFLD among people with low GS and/or the risk of low GS among patients with NAFLD. Qualitative and quantitative information was extracted, statistical heterogeneity was assessed using the test, and potential for publication bias was assessed qualitatively by a visual estimate of a funnel plot and quantitatively by calculation of the Begg's test and the Egger's test. Results:Of the citations, 10 eligible studies involving 76,676 participants met inclusion criteria. The meta-analysis of seven cross-section studies (69,757 participants) showed that people with low GS had increased risk of NAFLD than those with normal GS (summary OR = 3.32, 95% CI: 1.91-5.75). In addition, the meta-analysis of four studies (14,920 participants) reported that the risk of low GS patients with NAFLD was higher than those in normal people (summary OR = 3.31, 95% CI: 2.45-4.47). Conclusion:In this meta-analysis, we demonstrated a strong relationship between low GS and NAFLD. We found an increased risk of NAFLD among people with low GS, and an increased risk of lower GS among NAFLD patients. Systematic review registration:[www.crd.york.ac.uk/prospero], identifier [CRD42022334687].
10.3389/fmed.2022.988566
Longitudinal Associations Between Hand Grip Strength and Non-Alcoholic Fatty Liver Disease in Adults: A Prospective Cohort Study.
Xia Yang,Cao Limin,Liu Yashu,Wang Xuena,Zhang Shunming,Meng Ge,Zhang Qing,Liu Li,Wu Hongmei,Gu Yeqing,Wang Yawen,Zhang Tingjing,Wang Xing,Sun Shaomei,Zhou Ming,Jia Qiyu,Song Kun,Niu Kaijun,Zhao Yuhong
Frontiers in medicine
This study aimed to determine the longitudinal association between hand grip strength (HGS) and the development of non-alcoholic fatty liver disease (NAFLD) in adults. A cohort study. This study was conducted in a general Chinese population ( = 14,154) from 2013-2018. NAFLD was diagnosed by liver ultrasonography during evaluating alcohol consumption. The associations between the HGS and NAFLD were assessed using a multivariable Cox proportional hazards regression model. During the study period with a mean follow-up duration of 3.20 years, 2,452 participants developed NAFLD. The risk of NAFLD decreased progressively with increasing HGS in both men and women ( for trend <0.0001). The multivariate-adjusted hazard ratios (95% ) for NAFLD incidence across the quartiles of HGS were 1 (reference), 0.90 (0.79, 1.02), 0.69 (0.60, 0.79), and 0.44 (0.37, 0.52) for men and 1 (reference), 0.82 (0.69, 0.96), 0.54 (0.45, 0.66), and 0.41 (0.33, 0.52) for women, respectively. The interaction terms for body mass index (BMI)-HGS and waist-HGS were significant in men and women (all < 0.0001). The participants with normal BMIs and waist circumferences had the lowest hazard ratios on the subgroup analyses. The sensitivity analysis that defined NAFLD using the hepatic steatosis and fatty liver indices revealed results that were similar to the main analyses. The present study indicates that the HGS is inversely associated with the incidence of NAFLD.
10.3389/fmed.2021.752999
Sarcopenia assessed by DXA and hand-grip dynamometer: a potential marker of damage, disability and myokines imbalance in inflammatory myopathies.
Rheumatology (Oxford, England)
OBJECTIVES:To assess the ability of dual-energy X-ray absorptiometry (DXA) and hand-grip dynamometer to measure damage in inflammatory myopathies (IM). METHODS:Forty adult IM patients with a disease duration ≥12 months, low or no disease activity for ≥6 months, were prospectively enrolled. Thirty healthy age and sex-matched volunteers were enrolled as controls. Whole-body DXA and hand-grip dynamometer were used to measure muscle mass, grip strength and diagnose sarcopenia (EWGSOP2 criteria). Relationships between the results of strength in 12 muscles, functional tests, patient-reported disability, IMACS damage score, and history of the disease were assessed. The serum levels of potential molecular actors in the damage were measured. RESULTS:DXA and grip strength measurements took ≤20 min. Both muscle mass and grip strength were decreased in IM patients vs volunteers (-10% and -30%, respectively) with a dispersion that varied widely (interquartile range -24.3% to +7.8% and -51.3% to -18.9%, respectively). Muscle mass and grip strength were non-redundantly correlated (r up to 0.6, P = 0.0001) with strength in 14 muscles (manual muscle test and hand-held dynamometer), functions (of limbs, respiratory and deglutition muscles), patient-reported disability, damage (extension and severity in muscular and extra-muscular domains) and blood levels of several myokines. Seven IM patients (17.5%) were sarcopenic. They had the worst damage, impaired functions, disability and history of severe myopathy. Decreased irisin and osteonectin levels were associated with sarcopenia (area under the curve 0.71 and 0.80, respectively). CONCLUSION:DXA and hand-grip dynamometer are useful tools to assess damage in IM. Irisin and osteonectin may play a role in IM damage pathogenesis.
10.1093/rheumatology/keae207
Association of phenotypic frailty and hand grip strength with telomere length in SLE.
Lupus science & medicine
OBJECTIVE:Frailty and objective hand grip strength (one of the components of the frailty phenotype) are both risk factors for worse health outcomes in SLE. Whether telomere length, an established cellular senescence marker, is a biologic correlate of the frailty phenotype and hand grip strength in patients with SLE is not clear. First, we aimed to evaluate differences in telomere length between frail and non-frail women with SLE and then assessed whether frailty or hand grip strength is differentially associated with telomere length after adjusting for relevant confounders. METHODS:Women ≥18 years of age with validated SLE enrolled at a single medical centre. Fried frailty status (which includes hand grip strength), clinical characteristics and telomere length were assessed cross-sectionally. Differences between frail and non-frail participants were evaluated using Fisher's exact or Wilcoxon rank-sum tests. The associations between frailty and hand grip strength and telomere length were determined using linear regression. RESULTS:Of the 150 enrolled participants, 131 had sufficient data for determination of frailty classification; 26% were frail with a median age of 45 years. There was a non-significant trend towards shorter telomere length in frail versus non-frail participants (p=0.07). Hand grip strength was significantly associated with telomere length (beta coefficient 0.02, 95% CI 0.004, 0.04), including after adjustment for age, SLE disease activity and organ damage, and comorbidity (beta coefficient 0.02, 95% CI 0.002, 0.04). CONCLUSIONS:Decreased hand grip strength, but not frailty, was independently associated with shortened telomere length in a cohort of non-elderly women with SLE. Frailty in this middle-aged cohort may be multifactorial rather than strictly a manifestation of accelerated ageing.
10.1136/lupus-2023-001008