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Sun Y, Li W, Zhou Y, Wang B, Tan X, Lu Y, Zhu J, Shi W, Wang N. Long-term changes in frailty and incident type 2 diabetes: A prospective cohort study based on the UK Biobank. Diabetes Obes Metab 2024; 26:3352-3360. [PMID: 38783818 DOI: 10.1111/dom.15676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024]
Abstract
AIMS To estimate the association between long-term changes in frailty and the risk of incident type 2 diabetes (T2DM) and to evaluate the effect of preventing the worsening of frailty on the risk of T2DM. METHODS We included 348 205 participants free of baseline T2DM and with frailty phenotype (FP) data from the UK Biobank; among them, 36 175 had at least one follow-up assessment. According to their FP score, participants were grouped into nonfrailty, prefrailty and frailty groups. Frailty assessed at baseline and at follow-up was used to derive the trajectory of frailty (ΔFP). Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Compared with those in the nonfrailty group at baseline, the HRs of T2DM for the prefrailty and frailty groups were 1.38 (95% CI 1.33-1.43) and 1.69 (95% CI 1.59-1.79), respectively (both p < 0.001), in the multivariable-adjusted model. During a median follow-up of 5.4 years after the final assessment, data for 472 T2DM patients were recorded. A 1-point increase in the final FP was associated with a 25% (95% CI 1.14-1.38; p < 0.001) increased risk of T2DM. For the trajectory of frailty, each 0.5-point/year increase in ΔFP was associated with a 52% (95% CI 1.18-1.97; p < 0.001) greater risk of T2DM, independent of the FP score at baseline. Compared with those that remained in the nonfrailty group, the greatest risk of T2DM over time was prefrailty aggravation (HR 3.03, 95% CI 2.00-4.58; p < 0.001). Using the frailty index did not materially change the results. CONCLUSIONS Long-term changes in frailty were associated with the risk of incident T2DM, irrespective of baseline frailty status. Preventing the worsening of frailty may reduce T2DM risk.
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Affiliation(s)
- Ying Sun
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weihao Li
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yinuo Zhou
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Xiao Tan
- Department of Big Data in Health Science, Zhejiang University, Hangzhou, China
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jingjing Zhu
- Clinical Research Center, School of Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai, China
| | - Wentao Shi
- Clinical Research Center, School of Medicine, Shanghai Ninth People's Hospital Affiliated to Shanghai JiaoTong University, Shanghai, China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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Williams-Farrelly MM, Ferraro KF. Early Origins of Frailty: Do Later-Life Social Relationships Alter Trajectories of Decline? J Aging Health 2024; 36:275-285. [PMID: 37358912 PMCID: PMC10749989 DOI: 10.1177/08982643231185426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Objectives: Social relationships are widely regarded as salubrious, but do they mediate the influence of childhood experiences on frailty in later life? Drawing from cumulative inequality theory, we assess the influence of childhood experiences and adult relationships on frailty trajectories. Methods: We analyzed data from the Health and Retirement Study to examine the influence of six domains of childhood experiences and social relationships on frailty trajectories over 8 years. Mediation analyses were completed with structural equation models. Results: Risky adolescent behavior, chronic disease, and impairments during childhood are associated directly with higher risk of initial frailty, but not over time. More social roles and higher social support mediate the relationship between childhood experiences and frailty, and the effect of more social roles continues over time. Discussion: This study provides compelling evidence that supportive social relationships mediate the risk and severity of frailty in later life associated with noxious childhood experiences.
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Affiliation(s)
- Monica M. Williams-Farrelly
- Department of General Internal Medicine and Geriatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Aging Research, Indianapolis, IN, USA
- Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Kenneth F. Ferraro
- Department of Sociology, Purdue University, West Lafayette, IN, USA
- Center on Aging and the Life Course, Purdue University, West Lafayette, IN, USA
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Gobbens RJJ, Kuiper S, Dijkshoorn H, van Assen MALM. Associations of individual chronic diseases and multimorbidity with multidimensional frailty. Arch Gerontol Geriatr 2024; 117:105259. [PMID: 37952423 DOI: 10.1016/j.archger.2023.105259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty. METHODS Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases. RESULTS The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease. CONCLUSIONS Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.
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Affiliation(s)
- Robbert J J Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Tranzo, Tilburg University, Tilburg, the Netherlands.
| | - Sandra Kuiper
- Tranzo, Tilburg University, Tilburg, the Netherlands; Department of Research, Public Health Service of West-Brabant, Breda, the Netherlands
| | - Henriëtte Dijkshoorn
- Department of Healthy Living, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Marcel A L M van Assen
- Faculty of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands; Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, the Netherlands
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Sinclair AJ, Abdelhafiz AH. Metabolic Impact of Frailty Changes Diabetes Trajectory. Metabolites 2023; 13:metabo13020295. [PMID: 36837914 PMCID: PMC9960364 DOI: 10.3390/metabo13020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Diabetes mellitus prevalence increases with increasing age. In older people with diabetes, frailty is a newly emerging and significant complication. Frailty induces body composition changes that influence the metabolic state and affect diabetes trajectory. Frailty appears to have a wide metabolic spectrum, which can present with an anorexic malnourished phenotype and a sarcopenic obese phenotype. The sarcopenic obese phenotype individuals have significant loss of muscle mass and increased visceral fat. This phenotype is characterised by increased insulin resistance and a synergistic increase in the cardiovascular risk more than that induced by obesity or sarcopenia alone. Therefore, in this phenotype, the trajectory of diabetes is accelerated, which needs further intensification of hypoglycaemic therapy and a focus on cardiovascular risk reduction. Anorexic malnourished individuals have significant weight loss and reduced insulin resistance. In this phenotype, the trajectory of diabetes is decelerated, which needs deintensification of hypoglycaemic therapy and a focus on symptom control and quality of life. In the sarcopenic obese phenotype, the early use of sodium-glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists is reasonable due to their weight loss and cardio-renal protection properties. In the malnourished anorexic phenotype, the early use of long-acting insulin analogues is reasonable due to their weight gain and anabolic properties, regimen simplicity and the convenience of once-daily administration.
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Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
| | - Ahmed H. Abdelhafiz
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Department of Geriatric Medicine Rotherham General Hospital, Rotherham S60 2UD, UK
- Correspondence:
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Abdelhafiz AH. Effects of hypoglycaemic therapy on frailty: a multi-dimensional perspective. Expert Rev Endocrinol Metab 2023; 18:53-65. [PMID: 36650694 DOI: 10.1080/17446651.2023.2168644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The prevalence of diabetes is increasing in older people. With increasing age, frailty emerges as a new complication leading to disability. Frailty does not only include physical dysfunction but also involves negative impact on cognition and mood. Triad of impairments (TOI) is a new concept that includes physical frailty, dementia and depression to reflect the wider spectrum of frailty. AREAS COVERED Little is known about effects of hypoglycaemic agents on frailty syndrome. A literature search was performed on studies, which reported effects of hypoglycaemic agents on the component of the TOI. EXPERT OPINION It appears that most hypoglycaemic agents have some effects on frailty, although the results of clinical studies are inconsistent. Metformin seems to have a consistent and a positive effect on physical frailty. Its effects on cognitive function, however, are inconclusive but tend to be positive. Metformin appeared to improve depressive symptoms. Other agents such as incretins, thiazolidinediones, and sodium glucose transporter-2 inhibitors have some positive effects on cognition and depression. Sulfonylureas, glinides, or insulin have either negative or neutral effects on TOI components. The negative effects of insulin could be partially explained by the negative psychological factors and the frequent episodes of hypoglycemia associated with such therapy.
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Affiliation(s)
- Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, UK
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Iriarte E, Cianelli R, De Santis JP, Baeza MJ, Alamian A, Castro JG, Matsuda Y, Araya AX. Frailty among older Hispanics living in the United States: A scoping review. Geriatr Nurs 2022; 48:287-295. [PMID: 36335855 DOI: 10.1016/j.gerinurse.2022.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
A scoping review was conducted to identify the available evidence about frailty among older Hispanics living in the U.S. using the Integral Model of Frailty. A not time-limited search was conducted in five peer-reviewed databases. Identified factors associated with frailty among older Hispanics are presented in four categories: (1) Characteristics and prevalence of frailty, (2) Life course determinants of frailty, (3) Comorbidities associated with frailty, and (4) Adverse outcomes of frailty. A total of 1030 articles were identified, and 37 articles were included in the scoping review. Most studies measured frailty based on the Fried Frailty Phenotype (59.5%, n= 22) and had a longitudinal design (64.9%, n= 24). The overall prevalence of frailty among Hispanics ranged from 4.3% to 37.1% (n= 20 studies). Further research is needed that targets Hispanics from different backgrounds in the U.S., particularly those that are high in number (i.e., Mexicans, Puerto Ricans, and Central Americans).
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Affiliation(s)
- E Iriarte
- CU College of Nursing, University of Colorado, 13120 E 19th Ave, Aurora, CO 80045, USA; Pontificia Universidad Católica de Chile, School of Nursing. Vicuña Mackenna 4680, Macul, Santiago, Chile; Millennium Institute for Care Research, MICARE. Chile.
| | - R Cianelli
- Pontificia Universidad Católica de Chile, School of Nursing. Vicuña Mackenna 4680, Macul, Santiago, Chile; School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - J P De Santis
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - M J Baeza
- Pontificia Universidad Católica de Chile, School of Nursing. Vicuña Mackenna 4680, Macul, Santiago, Chile; School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - A Alamian
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - J G Castro
- Leonard M. Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL 33136, USA
| | - Y Matsuda
- School of Nursing and Health Studies, University of Miami, 5030 Brunson Dr, Coral Gables, FL, 33146, USA
| | - A X Araya
- Millennium Institute for Care Research, MICARE. Chile; School of Nursing, Universidad Andrés Bello, República 498, Santiago, Chile
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Lee SF, Li CP, Chen YL, Pei D. Predictors associated with prefrailty in older Taiwanese individuals with type 2 diabetes. Medicine (Baltimore) 2022; 101:e30432. [PMID: 36197245 PMCID: PMC9509158 DOI: 10.1097/md.0000000000030432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Type 2 diabetes (T2DM) is one of the most well-studied and important factors that increase the risk of prefrailty in older people in Taiwan. This study was conducted to examine whether metabolic biomarkers, lifestyle behaviors, body composition, and chronic diseases are associated with frailty in older people with T2DM. We also observed how people manage their T2DM related to prefrailty. This study investigated a total of 201 participants diagnosed with T2DM who received care in our hospital from September 2018 to February 2019. Patients were divided into 3 groups (not frail, prefrail, and frail), and frailty was measured with the 5-item FRAIL scale. Socioeconomic characteristics, metabolic biomarkers, lifestyle behaviors, body composition, and chronic diseases were assessed at enrollment. No participants who we tested met the criteria for frailty. Based on the results of chi-square tests, prefrailty was associated with female sex, middle school education, unemployment, alcohol use, high body fat percentage, above-normal waist circumference, obesity, cardiovascular disease, and hypertension. Logistic regression analyses identified a significant correlation of prefrailty with the type of job from which they retired, cardiovascular disease, and hypertension. An important and surprising finding of this study was that the unemployed group was at high risk for prefrailty, which was not observed in previous research. The groups engaged in manual and professional jobs had better hand grip strength, a slower walking speed, and less risk of prefrailty than the unemployed group.
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Affiliation(s)
- Shu-Fen Lee
- Department of Nursing, Cardinal Tien College of Healthcare and Management, New Taipei City, Taiwan
- *Correspondence: Shu-Fen Lee, Department of Nursing, Cardinal Tien College of Healthcare and Management, No. 112, Minzu Road, Sindian District, New Taipei City 23143, Taiwan (e-mail: )
| | - Chih-Ping Li
- Department of Health Industry Management, Kainan University, Taoyuan City, Taiwan
| | - Yen-Lin Chen
- Department of Pathology, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Dee Pei
- Department of Internal Medicine, Catholic Fu-Jen University, New Taipei City, Taiwan
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Rutherford M, Downer B, Li CY, Chou LN, Al Snih S. Body mass index and physical frailty among older Mexican Americans: Findings from an 18-year follow up. PLoS One 2022; 17:e0274290. [PMID: 36084053 PMCID: PMC9462817 DOI: 10.1371/journal.pone.0274290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSES The relationship between body mass index (BMI) and frailty in older Mexican Americans has not been previously studied. The objective of this study was to examine the relationship between BMI and frailty among non-frail older Mexican Americans at baseline over 18 years of follow up. METHODS Longitudinal population-based study of 1,648 non-institutionalized Mexican Americans aged ≥ 67 years from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1995/96-2012/13). Frailty phenotype was defined as meeting three or more of the following: unintentional weight loss of >10 pounds, weakness, self-reported exhaustion, low physical activity, and slow walking speed. BMI (kg/m2) was classified as underweight (<18.5), normal weight (18.5-<25), overweight (25-< 30), obesity category I (30-<35), and obesity category II/morbid obesity (≥35). Covariates included socio-demographics, comorbidities, cognitive function, and depressive symptoms. Generalized Estimating Equation models were performed to estimate the odds ratio (OR) and 95% confidence interval (CI) of frailty as a function of BMI category. RESULTS Participants with underweight or obesity category II/ morbid obesity had greater odds of frailty over time compared to those with normal weight (OR = 2.39, 95% CI = 1.29-4.44 and OR = 1.62, 95% CI = 1.07-2.44, respectively) after controlling for all covariates. Participants with BMIs in the overweight or category I obesity were at lower odds of frailty over time. CONCLUSIONS Mexican American older adults with BMIs in the underweight or obesity category II/morbid obesity were at higher odds of frailty over time. This indicates that maintaining a healthy weight in this population may prevent future frailty.
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Affiliation(s)
- Megan Rutherford
- School of Medicine, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Brian Downer
- Department of Population Health and Health Disparities/School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Chih-Ying Li
- Department of Occupational Therapy/School of Health Professions, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Lin-Na Chou
- Department of Biostatistics and Data Science/School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Soham Al Snih
- Department of Population Health and Health Disparities/School of Public and Population Health, University of Texas Medical Branch, Galveston, TX, United States of America
- Division of Geriatrics & Palliative Medicine/Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States of America
- Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, United States of America
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Hypoglycaemic therapy in frail older people with type 2 diabetes mellitus-a choice determined by metabolic phenotype. Aging Clin Exp Res 2022; 34:1949-1967. [PMID: 35723859 PMCID: PMC9208348 DOI: 10.1007/s40520-022-02142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/21/2022] [Indexed: 11/01/2022]
Abstract
Frailty is a newly emerging complication of diabetes in older people and increasingly recognised in national and international clinical guidelines. However, frailty remains less clearly defined and frail older people with diabetes are rarely characterised. The general recommendation of clinical guidelines is to aim for a relaxed glycaemic control, mainly to avoid hypoglycaemia, in this often-vulnerable group of patients. With increasing age and development of frailty, body composition changes are characterised by an increase in visceral adipose tissue and a decrease in body muscle mass. Depending on the overall body weight, differential loss of muscle fibre types and body adipose/muscle tissue ratio, the presence of any associated frailty can be seen as a spectrum of metabolic phenotypes that vary in insulin resistance of which we have defined two specific phenotypes. The sarcopenic obese (SO) frail phenotype with increased visceral fat and increased insulin resistance on one side of spectrum and the anorexic malnourished (AM) frail phenotype with significant muscle loss and reduced insulin resistance on the other. In view of these varying metabolic phenotypes, the choice of hypoglycaemic therapy, glycaemic targets and overall goals of therapy are likely to be different. In the SO phenotype, weight-limiting hypoglycaemic agents, especially the new agents of GLP-1RA and SGLT-2 inhibitors, should be considered early on in therapy due to their benefits on weight reduction and ability to achieve tight glycaemic control where the focus will be on the reduction of cardiovascular risk. In the AM phenotype, weight-neutral agents or insulin therapy should be considered early on due to their benefits of limiting further weight loss and the possible anabolic effects of insulin. Here, the goals of therapy will be a combination of relaxed glycaemic control and avoidance of hypoglycaemia; and the focus will be on maintenance of a good quality of life. Future research is still required to develop novel hypoglycaemic agents with a positive effect on body composition in frailty and improvements in clinical outcomes.
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Abdelhafiz AH, Peters S, Sinclair AJ. Low glycaemic state increases risk of frailty and functional decline in older people with type 2 diabetes mellitus - Evidence from a systematic review. Diabetes Res Clin Pract 2021; 181:109085. [PMID: 34634389 DOI: 10.1016/j.diabres.2021.109085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
AIMS To explore risk of frailty and functional decline associated with low glycaemia in older people with type 2 diabetes. METHODS Systematic review. RESULTS 11 studies included. Six studies investigated risk of frailty or physical decline with hypoglycaemia. Hypoglycaemia increased risk of incident frailty (HR 1.60, 95% CI 1.14 to 2.42) in one study and risk of fractures in four studies (2.24, 1.56 to 3.21, 1.24, 1.13 to 1.37, 1.94, 1.67 to 2.24 and 1.71, 1.35 to 2.16 respectively). In sixth study, hypoglycaemia associated with dependency (P < 0.001). Five studies explored association of low blood glucose/HbA1c with frailty. One study showed that mean blood glucose decreased with increasing frailty (p = 0.003). Two studies reported that HbA1c inversely correlated with clinical frailty scale (r = -0.31, p < 0.01) and HbA1c < 6.9% increased risk of frailty (HR, 1.41 95% CI 1.12 to 1.78) respectively. Last two studies showed that HbA1c < 6.5% associated with risk of any fracture (HR 1.08, 95% CI 1.06 to 1.11) and HbA1c < 6.0% associated with increased risk of care need (3.45, 1.02 to 11.6) respectively. CONCLUSIONS Low glycaemia increases risk of frailty and functional decline in older people with type 2 diabetes. Management should minimise incidence of low glycaemia in these patients.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, United Kingdom
| | - S Peters
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, United Kingdom
| | - A J Sinclair
- King's College, London, United Kingdom; Foundation for Diabetes Research in Older People (fDROP), Droitwich Spa WR9 0QH, UK.
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Vieira ER, Cavalcanti FADC, Civitella F, Hollifield M, Caceres S, Carreno J, Gaillard T, Huffman FG, Mora JC, Queiroga MR. Effects of Exercise and Diet on Body Composition and Physical Function in Older Hispanics with Type 2 Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158019. [PMID: 34360312 PMCID: PMC8345658 DOI: 10.3390/ijerph18158019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 12/20/2022]
Abstract
Type 2 Diabetes mellitus (DM2) affects 9.3% of the U.S. population. Health disparities are evident in DM2; twice as many Hispanics as non-Hispanic Whites have DM2. The objective of this study was to pilot test the feasibility of implementing and evaluating trends of nutrition and exercise interventions to improve diabetes management and physical function in 29 disadvantaged older Hispanics with DM2. We delivered combined diet and exercise (n = 8) and diet-only (n = 6) interventions and compared the results to a control/no intervention group (n = 15). We cluster-randomized the participants into the three arms based on the senior center they attended. The interventions were delivered twice a week for 3 months (24 sessions) and assessments were conducted pre and post intervention. The results indicate the feasibility of implementing the interventions and slight improvements in both intervention groups compared to the control group. The diet-only group tended to have larger improvements on body composition measures (especially in muscle mass), while the diet + exercise group tended to have larger improvements on physical function (especially in chair stands). There was a high rate of attrition, especially in the diet + exercise group, but those who completed the intervention tended to have improvements in body composition and physical function.
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Affiliation(s)
- Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
- Correspondence:
| | | | - Fernanda Civitella
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Monica Hollifield
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33179, USA; (M.H.); (F.G.H.)
| | - Stephanie Caceres
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Jorge Carreno
- Department of Physical Therapy, Florida International University, Miami, FL 33179, USA; (F.C.); (S.C.); (J.C.)
| | - Trudy Gaillard
- Department of Undergraduate Nursing, Florida International University, Miami, FL 33179, USA;
| | - Fatma G. Huffman
- Department of Dietetics and Nutrition, Florida International University, Miami, FL 33179, USA; (M.H.); (F.G.H.)
| | - Jorge Camilo Mora
- Department of Humanities, Health and Society, Florida International University, Miami, FL 33179, USA;
| | - Marcos Roberto Queiroga
- Department of Physical Education, Midwestern Parana State University, Guarapuava 85040-167, PR, Brazil;
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Abdelhafiz AH, Emmerton D, Sinclair AJ. Impact of frailty metabolic phenotypes on the management of older people with type 2 diabetes mellitus. Geriatr Gerontol Int 2021; 21:614-622. [PMID: 34151494 DOI: 10.1111/ggi.14214] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 12/25/2022]
Abstract
AIMS To provide a pathophysiological basis for distinguishing metabolic variants of the frailty phenotype in older adults with type 2 diabetes. METHODS We have made an in-depth review of the possible mechanisms in diabetes, ageing and frailty that will alter allow us to describe phenotypic changes which might assist in predicting responses to particular glucose-lowering therapy. RESULTS Our review has enable us to describe with some confidence a sarcopenic obese phenotype and an anorexic malnourished phenotype. CONCLUSIONS By identifying these two phenotypes we can predict which would be most responsive to certain classes of therapy and where therapies may be ill-advised. This represents the first novel approach in this area. Further work is being planned to develop this hypothesis. Geriatr Gerontol Int 2021; 21: 614-622.
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Affiliation(s)
- Ahmed H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Demelza Emmerton
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, UK
| | - Alan J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, UK
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Makino K, Lee S, Bae S, Chiba I, Harada K, Katayama O, Shinkai Y, Makizako H, Shimada H. Prospective Associations of Physical Frailty With Future Falls and Fear of Falling: A 48-Month Cohort Study. Phys Ther 2021; 101:6131766. [PMID: 33561290 DOI: 10.1093/ptj/pzab059] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 10/06/2020] [Accepted: 01/03/2021] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The present study aimed to examine the prospective associations of physical frailty with future falls and fear of falling (FOF) among community-dwelling older adults. METHODS A prospective cohort study with a 48-month follow-up was conducted in a Japanese community. Participants were 2469 community-dwelling older adults aged 65 years or older who completed baseline and follow-up assessments at intervals of 48 ± 2 months. Primary outcomes were recent falls (defined as at least one fall within the past year) and FOF (determined by response to "Are you afraid of falling?") at follow-up survey. Physical frailty, operationalized by the frailty phenotype (slowness, weakness, exhaustion, weight loss, and low activity) based on the criteria of the Japanese version of the Cardiovascular Health Study (J-CHS), was also assessed as a predictor of future falls and FOF. RESULTS Multivariable logistic regression showed that prefrailty or frailty increase the risk of not only future falls (odds ratio [OR]: 1.57; 95% CI = 1.20-2.05) but also FOF (OR: 1.33; 95%CI = 1.05-1.69). In addition, the relationship between baseline frailty status and future falls remained significant after adjusting for baseline FOF (OR: 1.55; 95% CI = 1.19-2.02), and the relationship between baseline frailty status and future FOF also remained significant after adjusting for baseline falls (OR: 1.32; 95% CI = 1.04-1.68). CONCLUSIONS Frailty status may predict future falls and FOF among community-dwelling older adults. Strategies to prevent frailty may be beneficial to prevent not only future falls but also future FOF in a community setting. IMPACT Falls and FOF have a close relationship but a different clinical meaning. Older adults with physical frailty may require monitoring as high risk not only for falls but also for FOF.
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Affiliation(s)
- Keitaro Makino
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Ippei Chiba
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Osamu Katayama
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Yohei Shinkai
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hyuma Makizako
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.,Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
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Emmerton D, Abdelhafiz A. Newer anti-diabetic therapies with low hypoglycemic risk-potential advantages for frail older people. Hosp Pract (1995) 2021; 49:164-175. [PMID: 33729898 DOI: 10.1080/21548331.2021.1905414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The prevalence of diabetes is increasing due to increasing aging of the population. Hypoglycemia is a common diabetes-related complication in old age especially in patients with multiple comorbidities and frailty. Hypoglycemia and frailty appear to have a bidirectional relationship reenforcing each other in a negative downhill spiral that leads to an increased risk of adverse events including disability and mortality. The incidence of hypoglycemia in this age group is usually underestimated due to its atypical clinical presentation and difficult recognition by health care professionals. Guidelines generally recommend a relaxed glycemic control in frail older people with diabetes mainly due to the fear of anti-diabetic medications-induced hypoglycemia. The new anti-diabetic therapies of sodium-glucose co-transporter-2 (SGLT-2) inhibitors and glucagon like peptide-1 receptor agonists (GLP-1RA) have consistently shown a cardio-renal protective effect independent of their glycemic control. Contrary to the traditional hypoglycemic agents that either increase insulin stimulation or insulin sensitization with a potential hypoglycemic risk especially sulfonylureas, the new therapies have a novel anti-diabetic mechanisms of action that have a negligible risk of hypoglycemia. The new therapies appear to be both effective and well tolerated in old age. With appropriate patients' selection, most older people will be eligible for the new therapies if well tolerated and no contraindications. In frail older people, we suggest a pragmatic approach of the use of the new therapies based on the concept of the weight status rather than the frailty status. Frail patients with normal or excess weight are likely to gain most from the new therapies due to its favorable metabolic properties in this group, while the use in the underweight frail patients should be largely avoided especially in those with persistent anorexia and weight loss.
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Affiliation(s)
- Demelza Emmerton
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, United Kingdom of Great Britain and Northern Ireland
| | - Ahmed Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Rotherham, United Kingdom of Great Britain and Northern Ireland
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Abdelhafiz AH, Emmerton D, Sinclair AJ. New hypoglycaemic therapy in frail older people with diabetes mellitus-phenotypic status likely to be more important than functional status. Diabetes Res Clin Pract 2020; 169:108438. [PMID: 32920102 DOI: 10.1016/j.diabres.2020.108438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/20/2020] [Accepted: 09/08/2020] [Indexed: 12/21/2022]
Abstract
Frail older people are largely excluded from clinical trials and therefore glycaemic targets and optimum hypoglycaemic therapy in this group has not been fully investigated. Guidelines generally recommend tight glycaemic control in functionally fit individuals and relaxed targets in frail ones mainly due to the fear of hypoglycaemia. The newly introduced sodium glucose cotransporter-2 inhibitors and the glucagon like peptide-1 receptor agonists have shown benefit that is independent of glycaemic control and a minimal risk of hypoglycaemia. However, guidelines still express caution about its use in frail older people due to fear of other side effects such as weight loss, hypotension and falls. Some frail older people will miss out on the benefits of this new therapy if frailty is considered as a one entity with a blanket application of guidelines. We propose that frailty should be viewed as two distinct metabolically different phenotypes, the sarcopenic-obese, in which new therapy will improve their metabolic profile and should be liberally used if no contraindications, and the anorexic-malnourished phenotype in which the new therapy should be cautiously considered. In other words, glycaemic targets should be driven by individual's overall function but the use of new therapy should be driven by frailty phenotype.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
| | - D Emmerton
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK
| | - A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK
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Pandit V, Nelson P, Kempe K, Gage K, Zeeshan M, Kim H, Khan M, Trinidad B, Zhou W, Tan TW. Racial and ethnic disparities in lower extremity amputation: Assessing the role of frailty in older adults. Surgery 2020; 168:1075-1078. [PMID: 32917429 DOI: 10.1016/j.surg.2020.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Frailty is a state of decreased physiologic reserve contributing to functional decline and is associated with adverse surgical outcomes, particularly in the elderly. Racial disparities have been reported previously both in frail individuals and in limb-salvage patients. Our goal was to assess whether race and ethnicity are disproportionately linked to frailty status in geriatric patients undergoing lower-limb amputation, leading to an increased risk of complications. METHODS A 3-year analysis was conducted of the National Surgical Quality Improvement Program database and included all geriatric (age ≥65 years) patients who underwent amputation of the lower limb. The frailty index was calculated using the 11-factor modified frailty index with a cutoff limit of 0.27 defined for frail status. Outcomes were 30-day complications, mortality, and readmissions. Multivariate regression analysis was performed. RESULTS A total of 4,218 geriatric patients underwent surgical amputation of a lower extremity (above knee: 41%; below knee: 59%). Of these patients, 29% were frail, 26% were African American, and 9% were Hispanic. Being African American (odds ratio: 1.6 [1.3-1.9]) and Hispanic (odds ratio: 1.1 [1.05-2.5]) was independently associated with frail status. Frail African Americans had a higher likelihood of 30-day complications (odds ratio: 3.2 [1.9-4.4]) and 30-day readmissions (odds ratio: 2.9 [1.8-3.6]) when compared with nonfrail individuals. Similarly, frail Hispanics had higher 30-day complications (odds ratio: 2.6 [1.9-3.1]) and 30-day readmissions (odds ratio: 1.4 [1.1-2.7]) compared with nonfrail Hispanics/Latinos. CONCLUSION African American and Hispanic geriatric patients undergoing lower-limb amputation are at increased risk for frailty status and, as a result, increased associated operative complications. These disparities exist regardless of age, sex, comorbid conditions, and location of amputation. Further studies are needed to highlight disparities by race and ethnicity to identify potentially modifiable risk factors, decrease frailty, and improve outcomes.
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Affiliation(s)
- Viraj Pandit
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK.
| | - Peter Nelson
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Kelly Kempe
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Karli Gage
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | | | - Hyein Kim
- Division of Vascular Surgery, Department of Surgery, University of Oklahoma School of Community Medicine, Tulsa, OK
| | - Muhammad Khan
- Department of Surgery, Westchester Medical Center, New York, NY
| | - Bradley Trinidad
- Department of Vascular Surgery, University of Arizona, Tucson, AZ
| | - Wei Zhou
- Department of Vascular Surgery, University of Arizona, Tucson, AZ
| | - Tze-Woei Tan
- Department of Vascular Surgery, University of Arizona, Tucson, AZ
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Abdelhafiz AH, Davies PC, Sinclair AJ. Triad of impairment in older people with diabetes-reciprocal relations and clinical implications. Diabetes Res Clin Pract 2020; 161:108065. [PMID: 32044347 DOI: 10.1016/j.diabres.2020.108065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/28/2020] [Accepted: 02/06/2020] [Indexed: 12/25/2022]
Abstract
Frailty is emerging as a new category complication of diabetes in older people. Clinically, frailty is still not well defined and mostly viewed as a decline in solely the physical domain. However, frailty is a multidimensional syndrome and the newly introduced concept of "triad of impairment" (physical, cognitive and emotional) may be a more representative of the broad nature of frailty. The components of the triad of impairment (TOI) commonly coexist and demonstrate a reciprocal relation. Diabetes in old age appears to increase the risk of the triad of impairment, which may eventually progress to disability. Therefore, older people with diabetes should be regularly assessed for the presence of these three key components. Adequate nutrition and regular resistance exercise training have been shown to have a positive impact on the long-term outcome in this population. However, the role of good glycaemic control and the use of current hypoglycaemic medications in reducing the incidence of this triad are less clear. Future research is needed to develop novel hypoglycaemic medications that not only focus on glycaemic control and cardiovascular safety but also on reducing the risk of the triad of impairment.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK.
| | - P C Davies
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK
| | - A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa WR9 0QH, UK; Kings College, London SE1 9NH, UK
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Hou P, Xue HP, Mao XE, Li YN, Wu LF, Liu YB. Inflammation markers are associated with frailty in elderly patients with coronary heart disease. Aging (Albany NY) 2019; 10:2636-2645. [PMID: 30325739 PMCID: PMC6224228 DOI: 10.18632/aging.101575] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/24/2018] [Indexed: 12/24/2022]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) are important indicators of adverse outcomes and have predictive value for many diseases; however, the relationships between frailty, and the NLR and RDW in patients with coronary heart disease (CHD) have not been determined. In this cross-sectional study, we investigated the association between frailty, and the NLR and RDW in elderly CHD patients ≥ 60 years of age. Frailty was defined according to frailty phenotype. Of 345 patients enrolled in the study, 22.6%, 58.3%, and 19.1% were characterized as robust, pre-frail, and frail, respectively. A significant positive correlation was observed between frailty and the NLR (r = 0.169) and RDW (r = 0.196). After adjusting for confounders, linear regression analyses showed that participants in the 4th quartile of the NLR or RDW were more likely to have a higher frailty phenotype score. Based on multivariable logistic regression, patients in the 4th quartile of the NLR and RDW, the fully-adjusted odds ratios for incident frailty were 2.894 (p = 0.011) and 2.494 (p = 0.040), respectively. Our findings indicate that frailty is associated with the NLR and RDW in elderly patients with CHD.
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Affiliation(s)
- Ping Hou
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Hui-Ping Xue
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Xin-E Mao
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Yong-Nan Li
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Lin-Feng Wu
- School of Nursing, Yangzhou University, Yangzhou 225000, China
| | - Yong-Bing Liu
- School of Nursing, Yangzhou University, Yangzhou 225000, China
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Bustamante-Ara N, Villarroel L, Paredes F, Huidobro A, Ferreccio C. Frailty and health risks in an agricultural population, Chile 2014–2017. Arch Gerontol Geriatr 2019; 82:114-119. [DOI: 10.1016/j.archger.2019.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 01/20/2023]
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