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Wang H, Lin P. Association between sarcopenia and hemoglobin level: a systematic review and meta-analysis. Front Med (Lausanne) 2024; 11:1424227. [PMID: 39118670 PMCID: PMC11306085 DOI: 10.3389/fmed.2024.1424227] [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: 04/27/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
Background Sarcopenia is a disease characterized by decreased skeletal muscle mass and function in elderly individuals. Decreased hemoglobin levels is a marker of anemia. According to reports, there may be an association between anemia and sarcopenia, but research is inconsistent. Therefore, this meta-analysis aims to explore the association between sarcopenia and low hemoglobin levels. Methods We searched PubMed, Embase, the Cochrane Library, Web of Science, Ovid, China National Knowledge Infrastructure (CNKI), and Wan Fang databases until September 2022. The present study included cross-sectional and case-control studies regarding low hemoglobin levels and sarcopenia. The studies were selected using inclusion and exclusion criteria. Studies were meta-analyzed by Review Manager 5.4 and Stata 16.0. We performed the heterogeneity test using the I 2 test. Subgroup analysis was carried out to explore the cause of heterogeneity. Egger test was used to evaluate publication bias. Results Out of 1,550 initial studies, 16 studies were meta-analyzed. Sarcopenia participants had significantly lower levels of hemoglobin than controls (MD = -0.53, 95% CI: -0.68 to -0.37, p < 0.001). Subgroup analysis, performed in China population reported lower hemoglobin levels in the sarcopenia population (MD = -0.49, 95% CI: -0.65 to -0.33, p < 0.001). And sarcopenia based on AWGS criteria reported lower hemoglobin levels (MD = -0.49, 95% CI: -0.65 to -0.33, p < 0.001). Among the population from hospitals and communities, patients with sarcopenia have lower hemoglobin levels. Conclusion Our meta-analysis found evidence that sarcopenia is associated with low hemoglobin levels. However, further large-scale prospective studies should be conducted in the future to further confirm our conclusions. Systematic review registration PROSPERO, CDR42024532252.
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Affiliation(s)
| | - Ping Lin
- Department of Geriatrics, Hangzhou Third People’s Hospital, Hangzhou, China
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Luong R, Ribeiro R, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Le Couteur DG, Seibel MJ, Hirani V. Empirically derived dietary patterns are associated with major adverse cardiovascular events, all-cause mortality, and congestive cardiac failure in older men: The Concord Health and Ageing in Men Project. J Nutr Health Aging 2024; 28:100020. [PMID: 38388114 DOI: 10.1016/j.jnha.2023.100020] [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: 07/31/2023] [Accepted: 10/10/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Diet is associated with major adverse cardiovascular events (MACE). OBJECTIVE We evaluated the associations between empirically derived dietary patterns and MACE. DESIGN Prospective cohort study. SETTING The Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS 539 community-dwelling older Australian men aged 75 years and older. METHODS Men underwent dietary assessment using a validated dietitian-administered diet history questionnaire. Cox regression analyses were conducted between MACE and the three dietary patterns identified from factor analysis. Five-point MACE comprised of all-cause mortality, myocardial infarction (MI), congestive cardiac failure (CCF), coronary revascularisation, and/or ischaemic stroke. Four-point MACE included the four endpoints of MI, CCF, coronary revascularisation, and/or ischaemic stroke, and excluded all-cause mortality. RESULTS At a median of 5.3 (IQR 4.6-6.3) years of follow-up, the incidences were: five-point MACE 31.2% (n = 168); four-point MACE excluding all-cause mortality 17.8% (n = 96); all-cause mortality 20.1% (n = 111); CCF 11.3% (n = 61); MI 3.7% (n = 20); stroke 3.2% (n = 17); and coronary revascularisation 3.1% (n = 15). In fully adjusted analyses, compared to the bottom tertile, the middle tertile of 'vegetables-legumes-seafood' dietary pattern was associated with reduced five-point MACE (HR 0.67 [95% CI: 0.45, 0.99, P = .047]), and CCF (HR 0.31 [95% CI: 0.15, 0.65, P = .002]), whilst the middle tertile of 'wholegrains-milk-other fruits' dietary pattern was associated with increased five-point MACE (HR 1.78 [95% CI: 1.17, 2.70, P = .007]), four-point MACE (HR 1.92 [95% CI: 1.12, 3.30, P = .018]), and CCF (HR 2.33 [95% CI: 1.17, 4.65, P = .016]). For the 'discretionary-starchy vegetables-processed meats' dietary pattern, a higher score was associated with increased five-point MACE (HR 1.33 [95% CI: 1.09, 1.62, P = .004]), and all-cause mortality (HR 1.63 [95% CI: 1.26, 2.12, P < .001]), and compared to the bottom tertile, the top tertile was associated with increased all-cause mortality (HR 2.26 [95% CI: 1.27, 4.00, P = .005]). CONCLUSION Older men may benefit from consuming a 'vegetables-legumes-seafood' dietary pattern rather than 'discretionary-starchy vegetables-processed meats' and 'wholegrains-milk-other fruits' dietary patterns for the prevention of MACE.
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Affiliation(s)
- Rebecca Luong
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
| | - Rosilene Ribeiro
- Charles Perkins Centre, The University of Sydney, NSW, Australia; School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - Fiona Blyth
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia; Andrology Department, Concord Hospital, Concord, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, The University of Sydney, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Markus J Seibel
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Vasant Hirani
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
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3
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Luong R, Ribeiro R, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Le Couteur DG, Seibel MJ, Hirani V. Cross-sectional and longitudinal associations between empirically derived dietary patterns and frailty among older men: The Concord Health and Ageing in Men Project. J Nutr Health Aging 2024; 28:100021. [PMID: 38267155 DOI: 10.1016/j.jnha.2023.100021] [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: 07/31/2023] [Accepted: 11/30/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Diet may be associated with frailty. OBJECTIVE We aimed to evaluate the associations between empirically derived dietary patterns and frailty in older men. DESIGN Prospective cohort study. SETTING The Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS 785 community-dwelling older Australian men aged 75 years and older. METHODS Men underwent dietary assessment using a validated dietitian-administered diet history questionnaire. Factor analysis identified three dietary patterns. Multinomial logistic regression was conducted between frailty and dietary patterns for cross-sectional analyses and longitudinal analyses over a 3-year follow-up. Frailty was defined by the Fried frailty phenotype. RESULTS Of the 785 men, pre-frailty was prevalent in 47.1% (n = 370), and frailty in 8.3% (n = 65). In fully adjusted cross-sectional analyses, the top tertile and a higher 'vegetables-legumes-seafood' dietary pattern score were associated with reduced prevalence of frailty (OR 0.34 [95% CI: 0.12, 0.93, P = .036]) and OR 0.50 [95% CI: 0.30, 0.83, P = .007] respectively). The top tertile of the 'discretionary-starchy vegetables-processed meats' dietary pattern was also associated cross-sectionally with increased prevalence of pre-frailty (OR 1.75 [95% CI: 1.08, 2.83, P = .022]). Of the 296 robust men in fully adjusted longitudinal analyses, the incidence of pre-frailty was 52.4% (n = 155), and frailty was 5.4% (n = 16) over a 3-year follow-up. The middle tertile of the 'vegetables-legumes-seafood' dietary pattern had a non-significant trend towards reduced incident pre-frailty (OR 0.52 [95% CI: 0.27, 1.00, P = .050]). CONCLUSION Consumption of a 'vegetables-legumes-seafood' dietary pattern appears to be less favoured by frail older men.
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Affiliation(s)
- Rebecca Luong
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
| | - Rosilene Ribeiro
- Charles Perkins Centre, The University of Sydney, NSW, Australia; School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - Fiona Blyth
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; School of Public Health, The University of Sydney, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia; Andrology Department, Concord Hospital, Concord, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, The University of Sydney, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Markus J Seibel
- Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
| | - Vasant Hirani
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia; ANZAC Research Institute, The University of Sydney, Concord, NSW, Australia
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Luong R, Ribeiro RV, Rangan A, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Le Couteur DG, Seibel MJ, Hirani V. Haem Iron Intake Is Associated with Increased Major Adverse Cardiovascular Events, All-Cause Mortality, Congestive Cardiac Failure, and Coronary Revascularisation in Older Men: The Concord Health and Ageing in Men Project. J Nutr Health Aging 2023; 27:559-570. [PMID: 37498103 DOI: 10.1007/s12603-023-1945-6] [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: 02/27/2023] [Accepted: 06/22/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Nutritional intake can influence major adverse cardiovascular events (MACE). Dietary iron is found in two forms: haem-iron (HI) only found in animal sources and non-haem iron (NHI) present mostly in plant sources. OBJECTIVE We evaluated the associations between dietary iron intakes with MACE and iron status biomarkers. DESIGN Prospective cohort study. SETTING The Concord Health and Ageing in Men Project, Sydney, Australia. PARTICIPANTS 539 community-dwelling older Australian men aged 75 years and older. METHODS Men underwent nutritional assessment using a validated diet history questionnaire. Entries were converted to food groups and nutrients. The dietary calculation was used to derive HI and NHI intakes from total iron intakes. Analyses of iron intakes with iron status biomarkers were conducted using linear regression, and with MACE and individual endpoints were conducted using Cox regression. Five-point MACE comprised of all-cause mortality, myocardial infarction (MI), congestive cardiac failure (CCF), coronary revascularisation, and/or ischaemic stroke. Four-point MACE included the four endpoints of MI, CCF, coronary revascularisation, and/or ischaemic stroke, and excluded all-cause mortality. RESULTS At a median of 5.3 (4.6 - 6.3) years follow-up, the incidences were: 31.2% (n = 168) five-point MACE, 17.8% (n = 96) four-point MACE excluding all-cause mortality, 20.1% (n = 111) all-cause mortality, 11.3% (n = 61) CCF, and 3.1% (n = 15) coronary revascularisation. In adjusted analyses, higher HI intake (per 1mg increment) was associated with increased five-point MACE (HR: 1.45 [95% CI: 1.16, 1.80, P = .001]), four-point MACE excluding all-cause mortality (HR: 1.64 [95% CI: 1.26, 2.15, P <.001]), all-cause mortality (HR: 1.51 [95% CI: 1.15, 1.99, P = .003]), CCF (HR: 2.08 [95% CI: 1.45, 2.98, P <.001]), and coronary revascularisation (HR: 1.89 [95% CI: 1.15, 3.10, P = .012]). Compared with the bottom tertile of NHI intake, the middle tertile of NHI intake was associated with reduced risk of all-cause mortality (HR: 0.56 [95% CI: 0.33, 0.96, P = .035]). Total iron intake was not associated with MACE and individual endpoints. Dietary iron intakes were not associated with serum iron and haemoglobin. CONCLUSION Higher haem iron intake was independently associated with increased risks of five-point MACE, four-point MACE excluding all-cause mortality, all-cause mortality, CCF, and coronary revascularisation in older men over 5 years.
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Affiliation(s)
- R Luong
- Rebecca Luong, Level 4, Charles Perkins Centre D17, University of Sydney, NSW 2006, Australia,
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Brożonowicz J, Ćwirlej-Sozańska A, Sozański B, Orzech-Janusz E, Garus A, Grzesik M, Wilmowska-Pietruszyńska A, Wiśniowska-Szurlej A. Relationship between Selected Functional Performance Parameters and the Occurrence of Anaemia in Hospitalized Females and Males Aged 80 and More. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13179. [PMID: 36293764 PMCID: PMC9603316 DOI: 10.3390/ijerph192013179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
Anaemia is considered a factor that significantly increases the risk of disability and mortality in the elderly. Among the hospitalized elderly, the incidence of anaemia is higher than in the general population, which necessitates extensive diagnostics for anaemia in this group. The aim was to assess the relationship between the occurrence of anaemia in hospitalized females and males, aged 80 years and more, and selected determinants of motor fitness. The analysis covered 91 females and 57 males aged 80 and more. The study implemented haemoglobin level, handgrip strength, a lower limb strength, mobility and balance measurement. The analysis used the logistic regression model and the cut-off point was determined by ROC curve. A 1 kg increase in muscle strength reduced the risk of anaemia in a group of males by 12%. The value of handgrip strength from which anaemia can be predicted in a group of males is 24.4 kg. In the female group, no statistically significant correlations were found. There is a need to continue research in this area with the participation of a larger group of respondents to look for potential factors that may be related to anaemia, in order to find non-invasive diagnostic tools useful for elderly people.
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Affiliation(s)
- Justyna Brożonowicz
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland
| | - Agnieszka Ćwirlej-Sozańska
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland
| | - Bernard Sozański
- Institute of Medicine, College of Medical Sciences, University of Rzeszow, 35-310 Rzeszow, Poland
| | - Ewa Orzech-Janusz
- Geriatric Department at the District Hospital Named by Henryk Jankowski in Przeworsk, 37-200 Przeworsk, Poland
| | - Anna Garus
- Geriatric Department at the District Hospital Named by Henryk Jankowski in Przeworsk, 37-200 Przeworsk, Poland
| | - Magdalena Grzesik
- Geriatric Department at the District Hospital Named by Henryk Jankowski in Przeworsk, 37-200 Przeworsk, Poland
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6
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Luong R, Ribeiro RV, Rangan A, Naganathan V, Blyth F, Waite LM, Handelsman DJ, Cumming RG, Le Couteur DG, Hirani V. Changes in dietary total and non-haem iron intake is associated with incident frailty in older men: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2022; 77:1853-1865. [PMID: 35352124 PMCID: PMC9434472 DOI: 10.1093/gerona/glac077] [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: 10/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Nutritional intake could influence the development of frailty. The aim was to evaluate the associations between dietary iron intakes and changes in dietary iron intakes with frailty. Methods Cross-sectional analyses involved 785 men with Fried frailty phenotype (FP) and 758 men with Rockwood frailty index (FI) data aged 75 years and older at nutrition assessment from the Concord Health and Ageing in Men Project prospective cohort study. Of these, 563 men who were FP robust or prefrail, and 432 men who were FI nonfrail were included in the longitudinal analyses for more than 3 years. Dietary intake was assessed at both timepoints using a validated diet history questionnaire. The dietary calculation was used to derive heme iron and nonheme iron intakes from total iron intakes. The associations were evaluated through binary logistic regression. Results Incidence of FP frailty was 15.3% (n = 86). In longitudinal analyses, maintaining total iron intakes (medium tertile −2.61–0.81 mg/d), increases in total iron and nonheme iron intakes (high tertiles ≥0.82 mg/d and ≥0.80 mg/d), and changes in nonheme iron intake (1 mg increment) were associated with reduced risks of incident FP frailty (OR: 0.47 [95% confindence interval (CI): 0.24, 0.93, p = .031], OR 0.48 [95% CI: 0.23, 0.99, p = .048], OR 0.41 [95% CI: 0.20, 0.88, p = .022], and OR 0.89 [95% CI: 0.82, 0.98, p = .017]). Conclusion Maintaining or increases in total dietary iron and increases or changes in dietary nonheme iron intakes more than 3 years were associated with reduced incidence of FP frailty in older men.
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Affiliation(s)
- Rebecca Luong
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia
| | - Rosilene V Ribeiro
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,School of Life and Environmental Sciences, Faculty of Science, The University of Sydney, NSW, Australia
| | - Anna Rangan
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - Fiona Blyth
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia.,School of Public Health, The University of Sydney, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
| | - Robert G Cumming
- ARC Centre of Excellence in Population Ageing Research (CEPAR), The University of Sydney, NSW, Australia.,School of Public Health, The University of Sydney, NSW, Australia
| | - David G Le Couteur
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
| | - Vasant Hirani
- Charles Perkins Centre, The University of Sydney, NSW, Australia.,Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia.,Centre for Education and Research on Ageing, Concord Hospital, The University of Sydney, Concord, NSW, Australia.,ANZAC Research Institute, The University of Sydney and Concord Hospital, Concord, NSW, Australia
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Vlot EA, Vernooij LM, Loer SA, van Dongen EP, Noordzij PG. External validation of the ACTA-PORT transfusion risk score in elderly cardiac surgery patients at risk of frailty. J Cardiothorac Vasc Anesth 2022; 36:2983-2990. [DOI: 10.1053/j.jvca.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/11/2022]
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Covino M, Salini S, Russo A, De Matteis G, Simeoni B, Maccauro G, Sganga G, Landi F, Gasbarrini A, Franceschi F. Frailty Assessment in the Emergency Department for Patients ≥80 Years Undergoing Urgent Major Surgical Procedures. J Am Med Dir Assoc 2022; 23:581-588. [DOI: 10.1016/j.jamda.2021.12.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/13/2021] [Accepted: 12/19/2021] [Indexed: 01/07/2023]
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9
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Gnanenthiran S, Ng AC, Cumming RG, Brieger DB, Le Couteur DG, Waite LM, Seibel M, Handelsman DJ, Naganathan V, Kritharides L, Blyth FM. Hemoglobin, Frailty and Long-Term Cardiovascular Events in Community-Dwelling Older Men Aged ≥70 years. Can J Cardiol 2022; 38:745-753. [DOI: 10.1016/j.cjca.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 12/11/2022] Open
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Seko Y, Kato T, Morimoto T, Yaku H, Inuzuka Y, Tamaki Y, Ozasa N, Shiba M, Yamamoto E, Yoshikawa Y, Yamashita Y, Kitai T, Taniguchi R, Iguchi M, Nagao K, Jinnai T, Komasa A, Nishikawa R, Kawase Y, Morinaga T, Toyofuku M, Furukawa Y, Ando K, Kadota K, Sato Y, Kuwahara K, Kimura T. Newly Diagnosed Infection After Admission for Acute Heart Failure: From the KCHF Registry. J Am Heart Assoc 2021; 10:e023256. [PMID: 34730004 PMCID: PMC8751959 DOI: 10.1161/jaha.121.023256] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background No studies have explored the association between newly diagnosed infections after admission and clinical outcomes in patients with acute heart failure. We aimed to explore the factors associated with newly diagnosed infection after admission for acute heart failure, and its association with in‐hospital and post‐discharge clinical outcomes. Methods and Results Among 4056 patients enrolled in the Kyoto Congestive Heart Failure registry, 2399 patients without any obvious infectious disease upon admission were analyzed. The major in‐hospital and post‐discharge outcome measures were all‐cause deaths. There were 215 patients (9.0%) with newly diagnosed infections during hospitalization, and 2184 patients (91.0%) without infection during hospitalization. The factors independently associated with a newly diagnosed infection were age ≥80 years, acute coronary syndrome, non‐ambulatory status, hyponatremia, anemia, intubation, and patients who were not on loop diuretics as outpatients. The newly diagnosed infection group was associated with a higher incidence of in‐hospital mortality (16.3% and 3.2%, P<0.001) and excess adjusted risk of in‐hospital mortality (odds ratio, 6.07 [95% CI, 3.61–10.19], P<0.001) compared with the non‐infection group. The newly diagnosed infection group was also associated with a higher 1‐year incidence of post‐discharge mortality (19.3% in the newly diagnosed infection group and 13.6% in the non‐infection group, P<0.001) and excess adjusted risk of post‐discharge mortality (hazard ratio, 1.49 [95% CI, 1.08–2.07], P=0.02) compared with the non‐infection group. Conclusions Elderly patients with multiple comorbidities were associated with the development of newly diagnosed infections after admission for acute heart failure. Newly diagnosed infections after admission were associated with higher in‐hospital and post‐discharge mortality in patients with acute heart failure. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT02334891.
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Affiliation(s)
- Yuta Seko
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Takao Kato
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Takeshi Morimoto
- Clinical Epidemiology Hyogo College of Medicine Nishinomiya Japan
| | - Hidenori Yaku
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | | | - Yodo Tamaki
- Division of Cardiology Tenri Hospital Tenri Japan
| | - Neiko Ozasa
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Masayuki Shiba
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Erika Yamamoto
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yusuke Yoshikawa
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Yugo Yamashita
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center Suita Japan
| | - Ryoji Taniguchi
- Department of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan
| | - Moritake Iguchi
- Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kazuya Nagao
- Department of Cardiology Osaka Red Cross Hospital Osaka Japan
| | - Toshikazu Jinnai
- Department of Cardiology Japanese Red Cross Otsu Hospital Otsu Japan
| | - Akihiro Komasa
- Department of Cardiology Kansai Electric Power Hospital Osaka Japan
| | | | - Yuichi Kawase
- Department of Cardiology Kurashiki Central Hospital Kurashiki Japan
| | - Takashi Morinaga
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Mamoru Toyofuku
- Department of Cardiology Japanese Red Cross Wakayama Medical Center Wakayama Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine Kobe City Medical Center General Hospital Kobe Japan
| | - Kenji Ando
- Department of Cardiology Kokura Memorial Hospital Kitakyushu Japan
| | - Kazushige Kadota
- Department of Cardiology Kurashiki Central Hospital Kurashiki Japan
| | - Yukihito Sato
- Department of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine Shinshu University Graduate School of Medicine Matsumoto Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan
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11
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Cheng CW, Liu MH, Wang CH. Predictors of infection-related rehospitalization in heart failure patients and its impact on long-term survival. J Cardiovasc Med (Hagerstown) 2021; 21:889-896. [PMID: 32576750 PMCID: PMC7752229 DOI: 10.2459/jcm.0000000000001025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infection is the most common non-cardiovascular cause of re-hospitalizations for heart failure patients. We therefore investigated the predictors of infection-related re-hospitalization (IRRH) in heart failure patients and its impact on long-term survival. METHODS AND RESULTS We prospectively recruited 622 patients after the index hospitalization for decompensated heart fail with primary endpoints of IRRH and all-cause mortality. During follow-up of 3.9 ± 2.7 years, IRRHs occurred in 104 (16.7%) patients. Of the 104 patients who experienced IRRHs, the time from the index hospitalization to IRRH was 1.0 (interquartile range: 0.4-2.6) years. Independent predictors of IRRH were age (hazard ratio: 1.02, 95% confidence interval: 1.01-1.04), diabetes mellitus (2.12, 1.42-3.17), not taking angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (1.67, 1.01-2.78), needing maintenance therapy with a loop diuretic (2.10, 1.36-3.26), hemoglobin levels (0.87, 0.79-0.96), and estimated glomerular filtration rates (eGFRs) (0.99, 0.98-0.99). IRRH independently predicted all-cause mortality (1.99, 1.32-2.98) after adjusting for age, body mass index, New York Heart Association functional class, chronic obstructive pulmonary disease, brain natriuretic peptide, hemoglobin, and eGFR. The increased risk of death associated with IRRHs was predominantly for lower respiratory tract infections (3.71, 2.28-6.04), urogenital tract infections (2.83, 1.32-6.10), and sepsis (3.26, 1.20-8.85). CONCLUSION IRRHs in patients discharged for acute decompensated heart fail independently predicted worse long-term survival. We further identified independent predictors of IRRHs. These findings warrant future studies for tackling IRRH.
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Affiliation(s)
- Chi-Wen Cheng
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City.,Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
| | - Min-Hui Liu
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City
| | - Chao-Hung Wang
- Division of Cardiology, Department of Internal Medicine, Heart Failure Research Center, Chang Gung Memorial Hospital, Keelung City.,Chang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C
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12
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Marzban M, Nabipour I, Farhadi A, Ostovar A, Larijani B, Darabi AH, Shabankari E, Gholizade M. Association between anemia, physical performance and cognitive function in Iranian elderly people: evidence from Bushehr Elderly Health (BEH) program. BMC Geriatr 2021; 21:329. [PMID: 34030664 PMCID: PMC8142505 DOI: 10.1186/s12877-021-02285-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/11/2021] [Indexed: 12/19/2022] Open
Abstract
Background and objectives The present study aimed to investigate the relation between anemia and hemoglobin (Hgb) concentration, physical performance, and cognitive function in a large sample of Iranian elderly population. Methods Data were collected from Bushehr elderly health (BEH) program. A total of 3000 persons aged ≥60 years were selected through multistage random sampling. Hemoglobin values lower than 12 and 13 g/dL were considered as anemia for women and men, respectively. The cognitive function was measured using the Mini-cog test and Category fluency test (CFT), and the physical function was measured using handgrip strength (muscle strength), Relative handgrip strength (RHGS), and 4.57-m usual gait speed. Univariate and adjusted multivariate logistic regression and linear regression with Stata MP (version 15) were run, and a p-value of < 0.05 was used as statistically significant for all analyses. Results Among participants, 7.43% were anemic, and 115 (51.57%) simultaneously had anemia and cognitive disorder. There were significant associations between red blood cell count (RBC), hemoglobin (Hgb), platelet count (PLT), and hematocrit percentage (HCT) with cognitive impairment. Additionally, Hgb concentration was significantly associated with all physical measures (Mean handgrip, Relative handgrip, and usual gait speed) and late recall (mini-cog) among the whole participants. This association remained statistically significant after considering multi-cofounders. In contrast, after stratifying the participants by gender, the association between Hgb concentration and usual gait speed was decreased in both men and women; moreover, Hgb association with cognitive measures (category fluency test and late recall) was no longer significant (all p-values > 0.05). Conclusion There was a cross-sectional and significant association between anemia and functional variables (e.g., Relative and mean handgrip) in Iranian elderly population, whereas Semantic memory, Late recall, and walking were more affected by gender.
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Affiliation(s)
- Maryam Marzban
- Clinical Research Development Center, The Persian Gulf Martyrs, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Iraj Nabipour
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Akram Farhadi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran. .,The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Afshin Ostovar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Darabi
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Elnaz Shabankari
- Department of Nutrition Science, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Mohamad Gholizade
- The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.,The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran
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13
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Le Couteur DG, Handelsman DJ, Stanaway F, Waite LM, Blyth FM, Naganathan V, Cumming RG, Hirani V. Sarcopenic Obesity and Amino Acids: Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2021; 76:1000-1004. [PMID: 33709116 DOI: 10.1093/gerona/glab076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 11/14/2022] Open
Abstract
Although characteristic changes in amino acid concentrations occur in obesity and sarcopenia, amino acids concentrations have not been reported in sarcopenic obesity. We studied n = 831 men aged 75 years and older from the 5-year follow-up of the Concord Health and Ageing in Men Project. Sarcopenia was defined using the Foundation of the National Institutes of Health criteria and obesity was defined as >30% fat mass. There were 31 men (3.7%) who had sarcopenic obesity. Branched chain amino acids were elevated in the obese (but not sarcopenic) group (n = 348) but reduced in both the sarcopenic (but not obese) (n = 44) and the sarcopenic obese groups. Apart from this, most of the amino acid concentrations were between those for the obese and the sarcopenic groups. Yet despite low concentrations of branched chain amino acids, the sarcopenic obese group had indications of insulin resistance and diabetes mellitus (fasting glucose and insulin concentrations, homeostatic model assessment, and percentage of participants taking diabetes medications) that were similar to the obese group. In summary, sarcopenic obese participants did not have a unique amino acid signature. In obesity, elevated branched chain amino acids are not a prerequisite for insulin resistance and diabetes if obesity is associated with sarcopenia.
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Affiliation(s)
- David G Le Couteur
- Centre of Education and Research on Ageing, Ageing and Alzheimers Institute, University of Sydney and Concord Hospital, New South Wales, Australia.,ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales, Australia
| | - Fiona Stanaway
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre of Education and Research on Ageing, Ageing and Alzheimers Institute, University of Sydney and Concord Hospital, New South Wales, Australia
| | - Fiona M Blyth
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre of Education and Research on Ageing, Ageing and Alzheimers Institute, University of Sydney and Concord Hospital, New South Wales, Australia.,ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, New South Wales, Australia
| | - Vasant Hirani
- School of Life and Environmental Sciences, University of Sydney, New South Wales, Australia
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14
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Esquinas-Requena JL, García-Nogueras I, Hernández-Zegarra P, Atienzar-Núñez P, Sánchez-Jurado PM, Abizanda P. [Anemia and frailty in older adults from Spain. The FRADEA Study]. Rev Esp Geriatr Gerontol 2021; 56:129-135. [PMID: 33771359 DOI: 10.1016/j.regg.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/26/2020] [Accepted: 01/25/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The objective was to examine the prevalence of anemia according to the state of frailty and to analyze the relationship between anemia, hemoglobin concentration and frailty in a cohort of Spanish older adults. MATERIAL AND METHODS Cross-sectional substudy of the FRADEA (Frailty and Dependency in Albacete) cohort, a population-based concurrent cohort study conducted in people older than 69 years of Albacete (Spain). Of the 993 participants included in the first wave, 790 were selected with valid data on anemia and frailty. Anemia was defined according to the criteria of the World Health Organization (hemoglobin less than 13 g/dL in men and 12 g/dL in women). Frailty was assessed using the Fried's phenotype. The association between anemia, hemoglobin concentration and frailty was determined by binary logistic regression adjusted for age, sex, educational level, institutionalization, comorbidity, cognitive status, body mass index, polypharmacy, creatinine, glucose and total white blood cell count. RESULTS The mean age was 79 years. The prevalence of anemia was 19.6%. The prevalence of anemia was significantly higher in frail subjects (29.6%) compared to prefrail (16.6%) and robust ones (6%), p<0.001. The average hemoglobin concentrations were significantly lower in frail (12.7 g/dL), compared to the prefrail (13.5 g/dL) and robust participants (14.4 g/dL), p < 0.001. In the fully adjusted regression model, anemia was associated with frailty (OR 1.95; 95% CI: 1.02-3.73, p<0.05), and similarly, the average hemoglobin concentrations showed a significant association with frailty (OR 0.79; 95% CI: 0.66-0.96, p < 0.05). CONCLUSION Anemia in older adults, defined according to WHO criteria, is independently associated with frailty.
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Affiliation(s)
| | | | - Pablo Hernández-Zegarra
- Servicio de Medicina Interna, Hospital General La Mancha Centro, Alcázar de San Juan, España
| | - Pilar Atienzar-Núñez
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Pedro Manuel Sánchez-Jurado
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
| | - Pedro Abizanda
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
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15
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Le Couteur DG, Ribeiro R, Senior A, Hsu B, Hirani V, Blyth FM, Waite LM, Simpson SJ, Naganathan V, Cumming RG, Handelsman DJ. Branched Chain Amino Acids, Cardiometabolic Risk Factors and Outcomes in Older Men: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2021; 75:1805-1810. [PMID: 31428789 DOI: 10.1093/gerona/glz192] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Indexed: 11/12/2022] Open
Abstract
Increased blood levels of branched chain amino acids (BCAAs) have been associated with cardiometabolic risk factors. Here, we studied 918 community-dwelling older men to determine the relationship between BCAAs and other amino acids with cardiometabolic risk factors, major cardiovascular endpoints (MACE), and mortality. BCAAs had robust associations with many adverse metabolic risk factors (increased glucose, insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), triglycerides; decreased high-density lipoprotein cholesterol). However, paradoxically, participants with lower levels of BCAAs had greater mortality and MACE possibly because increasing age and frailty, both of which were associated with lower BCAA levels, are powerful risk factors for these outcomes in older people. Overall, amino acids that were lowest in frail subjects (BCAAs, α-aminobutyric acid [AABA], histidine, lysine, methionine, threonine, tyrosine) were inversely associated with mortality and MACE. In conclusion, BCAAs are biomarkers for important outcomes in older people including cardiometabolic risk factors, frailty, and mortality. In old age, frailty becomes a dominant risk factor for MACE and mortality.
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Affiliation(s)
- David G Le Couteur
- Ageing and Alzheimers Institute and Centre for Education and Research on Ageing, Concord Hospital, Australia.,ANZAC Research Institute, Concord, Australia.,Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Rosilene Ribeiro
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Alistair Senior
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Benjumin Hsu
- Centre for Big Data Research in Health, University of New South Wales, Kensington, Australia
| | - Vasant Hirani
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Fiona M Blyth
- Ageing and Alzheimers Institute and Centre for Education and Research on Ageing, Concord Hospital, Australia.,School of Public Health, University of Sydney, Camperdown, Australia
| | - Louise M Waite
- Ageing and Alzheimers Institute and Centre for Education and Research on Ageing, Concord Hospital, Australia
| | - Stephen J Simpson
- Charles Perkins Centre, The University of Sydney, Camperdown, Australia
| | - Vasikaran Naganathan
- Ageing and Alzheimers Institute and Centre for Education and Research on Ageing, Concord Hospital, Australia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Camperdown, Australia
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16
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Lee CT, Chen MZ, Yip CYC, Yap ES, Lee SY, Merchant RA. Prevalence of Anemia and Its Association with Frailty, Physical Function and Cognition in Community-Dwelling Older Adults: Findings from the HOPE Study. J Nutr Health Aging 2021; 25:679-687. [PMID: 33949637 DOI: 10.1007/s12603-021-1625-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The prevalence of anemia and its impact on frailty and physical function amongst the multiethnic older populations in the Southeast Asian (SEA) countries are often not well studied. Singapore, a nation comprised of multiethnic communities, is one of the most rapidly aging population globally. We aim to evaluate the prevalence of anemia and its impact on frailty, and physical function in Healthy Older People Everyday (HOPE)- an epidemiologic population-based study on community-dwelling older adults in Singapore. DESIGN Cross-sectional study. SETTING Community. PARTICIPANTS 480 adults ≥ 65 years old. MEASUREMENTS Data were collected from interviewers-administered questionnaires on socio-demographics, FRAIL scale, Mini-Mental State Examination, EQ-5D, Barthel Index, and Lawton index. Hemoglobin concentration and physical assessments, including anthropometry, grip strength, timed up-and-go (TUG) were measured. RESULTS The overall prevalence of anemia was 15.2% (73 out of 480). The Indian ethnic group had the highest prevalence of anemia (32%, OR=3.02; 95%CI= 1.23-7.41) with the lowest hemoglobin concentration compared to the overall population (13.0±1.3g/L and 13.5±1.4g/L, p=0.02). Hemoglobin levels and anemia were significantly associated with frailty (OR=2.28; 95% CI=1.02-5.10), low grip strength (OR=1.79; 95% CI=1.01-3.03), ≥ one IADL impairment (OR=2.35; 95% CI=1.39-3.97). Each 1 g/dL increase in hemoglobin was associated with a 6% decrease in frailty odds after adjusting for potential covariates (OR = 0.94, 95% CI: 0.90-0.99). There was a significant difference in the mean TUG between the non-anemic (11.0±3.4 seconds) and anemic (12.3±6.0 seconds, p=0.01) counterparts, but no difference in the number of falls. CONCLUSION In our multiethnic Asian population, anemia was adversely associated with frailty, decreased muscle strength, and IADL impairment. Health policies on anemia screening should be employed to avoid or potentially delay or reverse these adverse outcomes associated with anemia. Recognition, evaluation, and treatment of anemia amongst this vulnerable population is warranted.
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Affiliation(s)
- C-T Lee
- Chun-Tsu Lee, MBBS(Mal.), M.Med (S'pore), MRCP(UK), FRCPath (UK), FAMS, Fast and Chronic Program, Alexandra Hospital, National University Health System, 378 Alexandra Road, Singapore 159964. Telephone: +65 64722000.
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17
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Tanaka S, Kamiya K, Saito H, Saito K, Ogasahara Y, Maekawa E, Konishi M, Kitai T, Iwata K, Jujo K, Wada H, Kasai T, Hamazaki N, Nozaki K, Nagamatsu H, Ozawa T, Izawa K, Yamamoto S, Aizawa N, Wakaume K, Oka K, Momomura SI, Kagiyama N, Matsue Y. Prevalence and prognostic value of the coexistence of anaemia and frailty in older patients with heart failure. ESC Heart Fail 2020; 8:625-633. [PMID: 33295134 PMCID: PMC7835564 DOI: 10.1002/ehf2.13140] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/01/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022] Open
Abstract
Aims There have been no investigations of the prevalence and clinical implications of coexistence of anaemia and frailty in older patients hospitalized with heart failure (HF) despite their association with adverse health outcomes. The present study was performed to determine the prevalence and prognostic value of the coexistence of anaemia and frailty in hospitalized older patients with HF. Methods and results We performed post hoc analysis of consecutive hospitalized HF patients ≥65 years old enrolled in the FRAGILE‐HF, which was the prospective, multicentre, observational study. Anaemia was defined as haemoglobin < 13 g/dL in men and <12 g/dL in women, and frailty was evaluated according to the Fried phenotype model. The study endpoint was all‐cause mortality. Of the total of 1332 patients, 1217 (median age, 81 years; 57.4% male) were included in the present study. The rates of anaemia and frailty in the study population were 65.7% and 57.0%, respectively. The patients were classified into the non‐anaemia/non‐frail group (16.6%), anaemia/non‐frail group (26.4%), non‐anaemia/frail group (17.7%), and anaemia/frail group (39.3%). A total of 144 patients died during 1 year of follow‐up. In multivariate analyses, only the anaemia/frail group showed a significant association with elevated mortality rate (adjusted hazard ratio, 1.94; 95% confidence interval, 1.02–3.70; P = 0.043), compared with the non‐anaemia/non‐frail group after adjusting for other covariates. Conclusions Coexistence of anaemia and frailty are prevalent in hospitalized older patients with HF, and it has a negative impact on mortality.
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Affiliation(s)
- Shinya Tanaka
- Department of Rehabilitation, Nagoya University Hospital, Aichi, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Science, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0373, Japan
| | - Hiroshi Saito
- Department of Rehabilitation, Kameda Medical Center, Chiba, Japan.,Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuya Saito
- Department of Rehabilitation, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yuki Ogasahara
- Department of Nursing, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Emi Maekawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masaaki Konishi
- Division of Cardiology, Yokohama City University Medical Center, Kanagawa, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kentaro Iwata
- Department of Rehabilitation, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kentaro Jujo
- Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuaki Hamazaki
- Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan
| | - Kohei Nozaki
- Department of Rehabilitation, Kitasato University Hospital, Kanagawa, Japan
| | - Hirofumi Nagamatsu
- Department of Cardiology, Tokai University School of Medicine, Tokyo, Japan
| | - Tetsuya Ozawa
- Department of Rehabilitation, Odawara Municipal Hospital, Kanagawa, Japan
| | - Katsuya Izawa
- Department of Rehabilitation, Kasukabe Chuo General Hospital, Saitama, Japan
| | - Shuhei Yamamoto
- Department of Rehabilitation, Shinshu University Hospital, Nagano, Japan
| | - Naoki Aizawa
- Department of Cardiovascular Medicine, Nephrology and Neurology, University of Ryukyus, Okinawa, Japan
| | - Kazuki Wakaume
- Department of Rehabilitation, Kitasato University Medical Center, Saitama, Japan
| | - Kazuhiro Oka
- Department of Rehabilitation, Saitama Citizens Medical Center, Saitama, Japan
| | | | - Nobuyuki Kagiyama
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.,West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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18
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Kito A, Imai E. The Association with Dietary Patterns and Risk of Anemia in Japanese Elderly. J Nutr Sci Vitaminol (Tokyo) 2020; 66:32-40. [PMID: 32115451 DOI: 10.3177/jnsv.66.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anemia is a risk factor for frailty. Although various factors can reduce the risk of anemia, information on dietary contributions is limited. This study aimed to evaluate the association between anemia and eating patterns in Japanese elderly. Our study included 6,864 elderly individuals, aged ≥65 y, whose data were obtained from the 2010-2015 National Health and Nutritional Survey, Japan. Anemia was defined as whole blood hemoglobin concentrations <13 g/dL in men, and <12 g/dL in women. We classified eating patterns into 33 food groups, using food items obtained from dietary records, and identified three dietary patterns using principal component analysis method. Participants were assigned and divided into quartiles according to pattern-specific factor scores. We calculated adjusted odds ratios (ORs) for anemia using multivariate logistic regression, and assigned the first quartile (minimum) as the reference. The overall prevalence of anemia was 17.1%. The meats and vegetables eating pattern was characterized by red meat and other vegetables, the Japanese eating pattern by rice and salted or pickled vegetables, and the fruits and vegetables eating pattern by fruits and green-yellow vegetables. Participants in the highest meats and vegetables eating pattern quartile had a 20% lower risk of anemia than those in the lowest quartile (OR 0.81; 95% confidence interval (CI) 0.66-1.00); the Japanese eating pattern participants had a 20% higher risk of anemia (OR 1.28; 95% CI 1.06-1.53). The fruits and vegetables eating pattern participants had no significant change in their risk of anemia. This study may indicate that consuming a high red meat diet prevents anemia in elderly Japanese individuals.
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Affiliation(s)
- Aya Kito
- Department of Nutrition, School of Human Cultures, The University of Shiga Prefecture
| | - Eri Imai
- Department of Nutrition, School of Human Cultures, The University of Shiga Prefecture
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19
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Das A, Cumming RG, Naganathan V, Blyth F, Ribeiro RV, Le Couteur DG, Handelsman DJ, Waite LM, Simpson SJ, Hirani V. Prospective Associations Between Dietary Antioxidant Intake and Frailty in Older Australian Men: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2020; 75:348-356. [PMID: 30955034 DOI: 10.1093/gerona/glz054] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The objective of the study is to evaluate the prospective associations between antioxidant intake and incident frailty among older Australian men aged ≥75 years. METHODS Seven hundred and ninety-four men participated in a detailed diet history interview at the Concord Health and Ageing in Men Project (CHAMP) study third wave (considered baseline nutrition here) and 781 men participated at the fourth wave (considered 3-year follow-up here). The main outcome measurement was incident frailty at 3-year follow-up, using the Cardiovascular Health Study definition. Dietary adequacy of antioxidant intake was assessed by comparing participants' median intakes of four dietary antioxidants (vitamin A, E, C, and zinc) to the nutrient reference values (NRVs). Attainment of the NRVs was incorporated into a dichotomized variable "poor" (meeting ≤2 antioxidants) or "good" (meeting ≥3 antioxidants) as the independent variable using the cut-point method. Also, intakes of each individual dietary antioxidant at baseline nutrition were categorized into quartiles. Analyses were performed using multinomial logistic regression. RESULTS Incidence of pre-frailty was 53.0% and frailty was 6.4% at 3-year follow-up. Poor dietary antioxidant intake (meeting ≤2) at baseline nutrition was associated with incident frailty at 3-year follow-up in unadjusted (OR: 2.59 [95% CI: 1.47, 4.59, p = .001]) and adjusted (OR: 2.46 [95% CI: 1.10, 5.51, p = .03]) analyses. The lowest quartile of vitamin E intake (<7.08 mg/d) was significantly associated with incident frailty (OR: 2.46 [95% CI: 1.01, 6.00, p = .05]). CONCLUSIONS Poor antioxidant intake, particularly vitamin E, is a plausible factor associated with incident frailty among older men. This supports the need for clinical trials of diets rich in antioxidants or possibly low-dose antioxidant supplements, for prevention of frailty.
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Affiliation(s)
- Arpita Das
- School of Life and Environmental Science Charles Perkins Centre, University of Sydney, New South Wales.,ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales
| | - Robert G Cumming
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales.,ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales.,Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales.,School of Public Health, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales
| | - Fiona Blyth
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales
| | - Rosilene V Ribeiro
- School of Life and Environmental Science Charles Perkins Centre, University of Sydney, New South Wales
| | - David G Le Couteur
- ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales.,Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales
| | - Stephen J Simpson
- School of Life and Environmental Science Charles Perkins Centre, University of Sydney, New South Wales
| | - Vasant Hirani
- School of Life and Environmental Science Charles Perkins Centre, University of Sydney, New South Wales.,ANZAC Research Institute, University of Sydney and Concord Hospital, New South Wales.,Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, New South Wales
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20
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Esquinas-Requena JL, Lozoya-Moreno S, García-Nogueras I, Atienzar-Núñez P, Sánchez-Jurado PM, Abizanda P. [Anemia increases mortality risk associated with frailty or disability in older adults. The FRADEA Study]. Aten Primaria 2020; 52:452-461. [PMID: 31506204 PMCID: PMC8054287 DOI: 10.1016/j.aprim.2019.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/17/2019] [Accepted: 07/09/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To analyze if anemia increases 10-year mortality risk associated to frailty and disability in older adults. DESIGN Substudy of the FRADEA population-based concurrent cohort study (Frailty and dependence in Albacete), with a 10-year follow-up (2007-2017) in people older than 69years. SETTING Albacete city, Spain. PARTICIPANTS Of the 993 participants included in the first wave, 790 were selected with valid data on function (frailty and disability), anemia and vital status at 10years. MAIN MEASUREMENTS Anemia was defined according to the criteria of the World Health Organization (hemoglobin <13g/dL in men and <12g/dL in women). A functional classification variable was created, including frailty and disability, identifying four progressive functional levels: robust, prefrail, frail and disabled in basic activities of daily life, using frailty phenotype and Barthel index respectively. A new eight categories variable was constructed combining the four functional groups with the presence or absence of anemia. The association with mortality was determined by Kaplan-Meier and Cox proportional hazards analysis adjusted for age, sex, comorbidity, polypharmacy, institutionalization and creatinine. RESULTS Mean age was 79years and 59.6% were women. 393 participants (49.7%) died during the follow-up period. The median survival was 98.4months (interquartile range 61). The risk of mortality increased from the levels with better functionality to those with worse functionality, and for each subgroup it was higher in the participants with anemia. Prefrail without anemia HR [hazard ratio] 1.59 (95%CI 1.07-2.36) and with anemia HR 2.37 (95%CI 1.38-4.05). Frail without anemia HR 3.18 (95%CI 1.68-6.02) and with anemia HR 4.42 (95%CI 1.99-9.84). Disabled without anemia HR 3.81 (95%CI 2.45-5.84) and with anemia HR 5.48 (95%CI 3.43-8.76). CONCLUSION Anemia increases the risk of mortality associated with frailty and disability in older adults.
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Affiliation(s)
| | - Silvia Lozoya-Moreno
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | | | - Pilar Atienzar-Núñez
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España
| | - Pedro Manuel Sánchez-Jurado
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España
| | - Pedro Abizanda
- Servicio de Geriatría, Complejo Hospitalario Universitario de Albacete, Albacete, España; CIBERFES, Instituto de Salud Carlos III, Madrid, España.
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21
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Ruan Y, Guo Y, Kowal P, Lu Y, Liu C, Sun S, Huang Z, Zheng Y, Wang W, Li G, Shi Y, Wu F. Association between anemia and frailty in 13,175 community-dwelling adults aged 50 years and older in China. BMC Geriatr 2019; 19:327. [PMID: 31796000 PMCID: PMC6891965 DOI: 10.1186/s12877-019-1342-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anemia and frailty contribute to poor health outcomes in older adults; however, most current research in lower income countries has concentrated on anemia or frailty alone rather than in combination. The aim of the present study was to investigate the association between anemia and frailty in community-dwelling adults aged 50 years and older in China. METHODS The study population was sourced from the 2007/10 SAGE China Wave 1. Anemia was defined as hemoglobin less than 13 g/dL for men and less than 12 g/dL for women. A Frailty Index (FI) was compiled to assess frailty. The association between anemia and frailty was evaluated using a 2-level hierarchical logistic model. RESULTS The prevalence of anemia was 31.0% (95%CI: 28.4, 33.8%) and frailty 14.7% (95%CI: 13.5, 16.0%). In the univariate regression model, presence of anemia was significantly associated with frailty (OR = 1.62, 95% CI: 1.39, 1.90) and the effect remained consistent after adjusting for various potential confounding factors including age, gender, residence, education, household wealth, fruit and vegetable intake, tobacco use, alcohol comsumption and physical activity (adjusted OR = 1.31, 95% CI:1.09, 1.57). Each 1 g/dL increase in hemoglobin concentration was associated with 4% decrease in the odds of frailty after adjusting for several confounding variables (adjusted OR = 0.96, 95% CI: 0.93, 0.99). CONCLUSION Anemia and low hemoglobin concentrations were significantly associated with frailty. Therefore, health care professionals caring for older adults should increase screening, assessment of causes and treatment of anemia as one method of avoiding, delaying or even reversing frailty.
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Affiliation(s)
- Ye Ruan
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Yanfei Guo
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Paul Kowal
- World Health Organization, Geneva, Switzerland
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Ye Lu
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Chazhen Liu
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Shuangyuan Sun
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Zhezhou Huang
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Yang Zheng
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Wenjing Wang
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Gan Li
- School of public health, Shanghai Jiaotong university, Shanghai, People’s Republic of China
| | - Yan Shi
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
| | - Fan Wu
- Shanghai Municipal Centre for Disease Control and Prevention (Shanghai CDC), Shanghai, People’s Republic of China
- Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
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22
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Meybohm P, Neef V, Westphal S, Schnitzbauer A, Röder D, Schlegel N, Zacharowski K. Präoperativer Eisenmangel mit/ohne Anämie – ein unterschätzter Risikofaktor? Chirurg 2019; 91:109-114. [DOI: 10.1007/s00104-019-01037-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Yeoh HL, Cheng A, Palmer C, Crowe SM, Hoy JF. Frailty in men living with HIV: a cross-sectional comparison of three frailty instruments. Antivir Ther 2019; 23:117-127. [PMID: 28731422 DOI: 10.3851/imp3185] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Potent antiretroviral treatment has resulted in near normal life expectancy for people living with HIV. Consequently, there is an increased focus on comorbidities, frailty and quality of life. METHODS We assessed and compared the prevalence of frailty, associated factors and relationship with quality of life in older Australian men living with HIV in a cross-sectional study using three frailty measurements. The Frailty Phenotype, Frailty Index and Edmonton Frail Scale were applied to 93 HIV-infected men aged over 50 years, on antiretroviral therapy. Multivariable ordinal logistic regression was used to analyse the associations of frailty with covariates and quality of life. RESULTS The prevalence of frailty was 10.8% (n=10) using the Frailty Phenotype; 22.6% (n=21) using the Frailty Index and 15.1% (n=14) using the Edmonton Frail Scale. Frailty Phenotype-defined pre-frailty/frailty was associated with pre-1996 ART initiation (OR, 3.56; CI, 1.23, 10.36; P=0.020) and depression (OR, 3.74; CI, 1.24, 11.27; P=0.019). Osteoporosis, serious non-AIDS events and AIDS were associated with Frailty Index-defined frailty (OR, 4.84, CI, 1.27, 18.43, P=0.021; OR, 4.27, CI, 1.25, 14.58, P=0.020; OR, 4.62, CI, 1.30, 16.45, P=0.018, respectively) and Edmonton Frail Scale-defined frailty (OR, 7.51; CI, 1.55, 36.42; P=0.012; OR, 7.71; CI, 1.62, 36.75; P=0.010; OR, 8.53; CI, 1.70, 42.73; P=0.009, respectively), independent of age and current CD4+ T-cell count. Frailty, defined by any of the instruments, was significantly associated with poorer quality of life (P<0.001). CONCLUSIONS Identifying frailty is an increasingly important contemporary consideration of HIV care related to ageing and quality of life.
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Affiliation(s)
- Hui-Ling Yeoh
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Allen Cheng
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Clovis Palmer
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Suzanne M Crowe
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia.,Burnet Institute, Melbourne, Australia
| | - Jennifer F Hoy
- Department of Infectious Diseases, The Alfred Hospital, Melbourne, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Australia
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24
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Abstract
Anemia is a common, yet often overlooked, geriatric syndrome characterized by reduced hemoglobin levels and associated with adverse health outcomes and early mortality. Evidence suggests that anemia is an independent risk factor for frailty in older adults. In this article, the authors review the evidence for the role of chronic inflammation in the pathogenesis of anemia in the frail elderly. Understanding the relationships between anemia, frailty, and chronic inflammation will pave the way for the development of novel interventional strategies for the treatment and prevention of anemia and, likely, also frailty in older adults.
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Affiliation(s)
- Juliette Tavenier
- Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, Hvidovre 2650, Denmark
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle - Room 1A.38A, Baltimore, MD 21224, USA.
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25
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Ahmad NS, Hairi NN, Said MA, Kamaruzzaman SB, Choo WY, Hairi F, Othman S, Ismail N, Peramalah D, Kandiben S, Mohd Ali Z, Ahmad SN, Abdul Razak I, Bulgiba A. Prevalence, transitions and factors predicting transition between frailty states among rural community-dwelling older adults in Malaysia. PLoS One 2018; 13:e0206445. [PMID: 30395649 PMCID: PMC6218037 DOI: 10.1371/journal.pone.0206445] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 10/13/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study aims to describe the prevalence and transitions of frailty among rural-community dwelling older adults in Malaysia and to analyse factors associated with different states of frailty transition. Frailty was conceptualized using modified Fried phenotype from the Cardiovascular Health Study. DESIGN This is a prospective longitudinal study with 12-months follow up among older adults in Malaysia. SETTING Kuala Pilah, a district in Negeri Sembilan, which is one of the fourteen states in Malaysia. PARTICIPANTS 2,324 community-dwelling older Malaysians aged 60 years and older. RESULTS The overall prevalence of frailty in this study was 9.4% (95% CI 7.8-11.2). The prevalence increased at least three-fold with every 10 years of age. This increase was seen higher in women compared to men. Being frail was significantly associated with older age, women, and respondents with a higher number of chronic diseases, poor cognitive function and low socioeconomic status (p<0.05). During the 12-months follow-up, our study showed that the transition towards greater frailty states were more likely (22.9%) than transition toward lesser frailty states (19.9%) while majority (57.2%) remained unchanged. Multivariate logistic regression analysis showed that presence of low physical activity increased the likelihood of worsening transition towards greater frailty states by three times (OR 2.9, 95% CI 2.2-3.7) and lowered the likelihood of transition towards lesser frailty states (OR 0.3, 95% CI 0.2-0.4). CONCLUSION Frailty is reported among one in every eleven older adults in this study. The prevalence increased across age groups and was higher among women than men. Frailty possesses a dynamic status due to its potential reversibility. This reversibility makes it a cornerstone to delay frailty progression. Our study noted that physical activity conferred the greatest benefit as a modifiable factor in frailty prevention.
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Affiliation(s)
- Nur Sakinah Ahmad
- Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noran Naqiah Hairi
- Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mas Ayu Said
- Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- Division of Geriatrics, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Yuen Choo
- Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Farizah Hairi
- Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sajaratulnisah Othman
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norliana Ismail
- Tobacco Control Unit, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Devi Peramalah
- Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shathanapriya Kandiben
- Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zainudin Mohd Ali
- Negeri Sembilan State Health Department (JKNNS), Negeri Sembilan, Malaysia
| | - Sharifah Nor Ahmad
- Negeri Sembilan State Health Department (JKNNS), Negeri Sembilan, Malaysia
| | - Inayah Abdul Razak
- Negeri Sembilan State Health Department (JKNNS), Negeri Sembilan, Malaysia
| | - Awang Bulgiba
- Centre for Epidemiology and Evidence Based Practice, Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
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26
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Falutz J. Frailty: is thy name…..universal? Evolving challenges of managing effectively treated older people living with HIV. Antivir Ther 2017; 23:101-104. [PMID: 29171838 DOI: 10.3851/imp3211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
The increased survival of treated people living with HIV (PLWH) represents a tremendous accomplishment. However, this has not been accompanied by uniform improvements in quality of life. Many PLWH prematurely develop age-related complications and traditional geriatric syndromes, including frailty. This is a potentially reversible state of vulnerability to adverse outcomes. Its operationalization remains challenging. The most commonly used tools, the frailty phenotype and the frailty index, have their advantages and limitations, but predict similar poor outcomes. Yeoh et al. applied both metrics, and a simpler construct, the Edmonton Frail Scale, to a population of Australian PLWH. Although the prevalence of frailty was generally similar to that in other settings, distinct differences occurred between the tools. This paper adds to the literature on this serious condition in this already vulnerable population. Further research is needed before consensus is reached on how to reliably and simply diagnose frailty in PLWH.
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Affiliation(s)
- Julian Falutz
- Division of Geriatrics and Chronic Viral Illness Service, McGill University Health Center, Montreal, QC, Canada
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27
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Miaskowski C, Wong ML, Cooper BA, Mastick J, Paul SM, Possin K, Steinman M, Cataldo J, Dunn LB, Ritchie C. Distinct Physical Function Profiles in Older Adults Receiving Cancer Chemotherapy. J Pain Symptom Manage 2017; 54:263-272. [PMID: 28716620 PMCID: PMC5610084 DOI: 10.1016/j.jpainsymman.2017.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/01/2017] [Accepted: 07/07/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT Although physical function is an important patient outcome, little is known about changes in physical function in older adults receiving chemotherapy (CTX). OBJECTIVES Identify subgroups of older patients based on changes in their level of physical function; determine which demographic and clinical characteristics were associated with subgroup membership; and determine if these subgroups differed on quality-of-life (QOL) outcomes. METHODS Latent profile analysis was used to identify groups of older oncology patients (n = 363) with distinct physical function profiles. Patients were assessed six times over two cycles of CTX using the Physical Component Summary score from the Short Form 12. Differences, among the groups, in demographic and clinical characteristics and QOL outcomes were evaluated using parametric and nonparametric tests. RESULTS Three groups of older oncology patients with distinct functional profiles were identified: Well Below (20.4%), Below (43.8%), and Above (35.8%) normative Physical Component Summary scores. Characteristics associated with membership in the Well Below class included the following: lower annual income, a higher level of comorbidity, being diagnosed with depression and back pain, and lack of regular exercise. Compared with the Above class, patients in the other two classes had significantly poorer QOL outcomes. CONCLUSION Almost 65% of older oncology patients reported significant decrements in physical function that persisted over two cycles of CTX. Clinicians can assess for those characteristics associated with poorer functional status to identify high-risk patients and initiate appropriate interventions.
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Affiliation(s)
| | - Melisa L Wong
- School of Medicine, University of California, San Francisco, California, USA
| | - Bruce A Cooper
- School of Nursing, University of California, San Francisco, California, USA
| | - Judy Mastick
- School of Nursing, University of California, San Francisco, California, USA
| | - Steven M Paul
- School of Nursing, University of California, San Francisco, California, USA
| | - Katherine Possin
- School of Medicine, University of California, San Francisco, California, USA
| | - Michael Steinman
- School of Medicine, University of California, San Francisco, California, USA
| | - Janine Cataldo
- School of Nursing, University of California, San Francisco, California, USA
| | - Laura B Dunn
- School of Medicine, Stanford University, Palo Alto, California, USA
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California, USA
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28
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Shen Z, Ruan Q, Yu Z, Sun Z. Chronic kidney disease-related physical frailty and cognitive impairment: a systemic review. Geriatr Gerontol Int 2017; 17:529-544. [PMID: 27240548 DOI: 10.1111/ggi.12758] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/12/2016] [Indexed: 11/28/2022]
Abstract
AIM The objective of this review was to assess chronic kidney disease-related frailty and cognitive impairment, as well as their probable causes, mechanisms and the interventions. METHODS Studies from 1990 to 2015 were reviewed to evaluate the relationship between chronic kidney disease and physical frailty and cognitive impairment. Of the 1694 studies from the initial search, longitudinal studies (n = 22) with the keywords "Cognitive and CKD" and longitudinal or cross-sectional studies (n = 5) with the keywords "Frailty and CKD" were included in final analysis. RESULTS By pooling current research, we show clear evidence for a relationship between chronic kidney disease and frailty and cognitive impairment in major studies. Vascular disease is likely an important mediator, particularly for cognitive impairment. However, non-vascular factors also play an important role. Many of the other mechanisms that contribute to impaired cognitive function and increased frailty in CKD remain to be elucidated. In limited studies, medication therapy did not obtain the ideal effect. There are limited data on treatment strategies, but addressing the vascular disease risk factors earlier in life might decrease the subsequent burden of frailty and cognitive impairment in this population. Multidimensional interventions, which address both microvascular health and other factors, may have substantial benefits for both the cognitive impairments and physical frailty in this vulnerable population. CONCLUSIONS Chronic kidney disease is a potential cause of frailty and cognitive impairment. Vascular and non-vascular factors are the possible causes. The mechanism of chronic kidney disease-induced physical frailty and cognitive impairment suggests that multidimensional interventions may be effective therapeutic strategies in the early stage of chronic kidney disease. Geriatr Gerontol Int 2017; 17: 529-544.
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Affiliation(s)
- Zhiyuan Shen
- Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
| | - Qingwei Ruan
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhuowei Yu
- Shanghai Institute of Geriatrics and Gerontology, Shanghai Key Laboratory of Clinical Geriatrics, Department of Geriatrics, Huadong Hospital, and Research Center of Aging and Medicine, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhongquan Sun
- Department of Urology, Huadong Hospital, Fudan University, 221 West Yan'an Road, Shanghai, China
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29
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Zulfiqar AA, Sui Seng X, Gillibert A, Kadri N, Doucet J. Anemia and frailty in the elderly hospitalized in an acute unit: Preliminary results. Eur J Intern Med 2017; 38:e8-e9. [PMID: 27829532 DOI: 10.1016/j.ejim.2016.10.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
Anemia is a frequent reason for hospitalization in acute geriatric units. The elderly are particularly susceptible and can condition the prognosis in cases of poor tolerance. The main objective is to research the link between anemia and weakness according to FRIED.
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Affiliation(s)
| | - Xavier Sui Seng
- Geriatric Department, University Hospital of Rouen, 76000 Rouen, France.
| | - André Gillibert
- Pharmacovigilance Unit, University Hospital of Rouen, France.
| | - Nadir Kadri
- Geriatric Department, University Hospital of Rouen, 76000 Rouen, France.
| | - Jean Doucet
- Geriatric Department, University Hospital of Rouen, 76000 Rouen, France.
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30
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Lekan DA, Wallace DC, McCoy TP, Hu J, Silva SG, Whitson HE. Frailty Assessment in Hospitalized Older Adults Using the Electronic Health Record. Biol Res Nurs 2017; 19:213-228. [PMID: 27913742 DOI: 10.1177/1099800416679730] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Frailty, a clinical syndrome of decreased physiologic reserve and dysregulation in multiple physiologic systems, is associated with increased risk for adverse outcomes. PURPOSE The aim of this retrospective, cross-sectional, correlational study was to characterize frailty in older adults admitted to a tertiary-care hospital using a biopsychosocial frailty assessment and to determine associations between frailty and time to in-hospital mortality and 30-day rehospitalization. METHODS The sample included 278 patients ≥55 years old admitted to medicine units. Frailty was determined using clinical data from the electronic health record (EHR) for symptoms, syndromes, and conditions and laboratory data for four serum biomarkers. A frailty risk score (FRS) was created from 16 risk factors, and relationships between the FRS and outcomes were examined. RESULTS The mean age of the sample was 70.2 years and mean FRS was 9.4 ( SD, 2.2). Increased FRS was significantly associated with increased risk of death (hazard ratio = 1.77-2.27 for 3 days ≤ length of stay (LOS) ≤7 days), but depended upon LOS ( p < .001). Frailty was marginally associated with rehospitalization for those who did not die in hospital (adjusted odds ratio = 1.18, p = .086, area under the curve [AUC] = 0.66, 95% confidence interval for AUC = [0.57, 0.76]). DISCUSSION Clinical data in the EHR can be used for frailty assessment. Informatics may facilitate data aggregation and decision support. Because frailty is potentially preventable and treatable, early detection is crucial to delivery of tailored interventions and optimal patient outcomes.
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Affiliation(s)
- Deborah A Lekan
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Debra C Wallace
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Thomas P McCoy
- 1 School of Nursing, University of North Carolina at Greensboro, Greensboro, NC, USA
| | - Jie Hu
- 2 College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Susan G Silva
- 3 School of Nursing, Duke University, Durham, NC, USA
| | - Heather E Whitson
- 4 Departments of Medicine and Opthalmology, School of Medicine, Duke University, Durham, NC, USA.,5 Durham VA Geriatrics Research Education and Clinical Center (GRECC), Durham, NC, USA
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31
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Röhrig G, Rücker Y, Becker I, Schulz RJ, Lenzen-Großimlinghaus R, Willschrei P, Gebauer S, Modreker M, Jäger M, Wirth R. Association of anemia with functional and nutritional status in the German multicenter study "GeriAnaemie2013". Z Gerontol Geriatr 2016; 50:532-537. [PMID: 27364876 DOI: 10.1007/s00391-016-1092-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/25/2016] [Accepted: 05/19/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Anemia and malnutrition are risk factors for frailty in older people but data from multicenter studies among German geriatric inpatients are lacking. This analysis evaluated data from the multicenter study "GerAnaemie2013" commissioned by the German Geriatric Society. PATIENTS AND METHODS The study involved an analysis of the 579 geriatric inpatients recruited in the context of the German multicenter study "GeriAnaemie2013". Study parameters: Barthel index (BI), handgrip strength, nutritional data (e.g. loss of appetite, loss of weight and decreased food intake). INCLUSION CRITERIA in-patient age ≥70 years, exclusion criteria: current cancer disease or cancer-associated treatment. Anemia was defined according to the World Health Organization (WHO) criteria. RESULTS The mean age of patients was 81.9 years, overall prevalence of anemia 55.1 %, mean hemoglobin (Hb) level 11.9 g/dl, average BI 50.8 points and 30.3 % of all patients were at risk of malnutrition. While univariate analysis revealed a significantly lower BI in anemic patients, this association was no longer seen in multivariate analysis. Regression analysis revealed that a drug intake of > 5 drugs/day doubles the chance of suffering from anemia with an adjusted odds ratio (OR) of 2.17 (confidence interval (CI) 1.28-3.68, p = 0.004) as well as a serum albumin level below 3.5 g/dl with an adjusted OR of 2.11 (range 1.40-3.19, p < 0.001). CONCLUSION Polymedication and low serum albumin were independent risk factors for anemia in geriatric patients, probably reflecting disease severity.
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Affiliation(s)
- Gabriele Röhrig
- Ageing Clinical Research, Department II of Internal Medicine, University Hospital Cologne, Herderstrasse 52, 50937, Cologne, Germany.
- Department of Geriatrics, St. Marien-Hospital, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Ymkje Rücker
- Ageing Clinical Research, Department II of Internal Medicine, University Hospital Cologne, Herderstrasse 52, 50937, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, Cologne, Germany
| | | | | | - Peter Willschrei
- Clinic for Geriatric Medicine, Kliniken Essen Mitte, Essen, Germany
| | | | - Mirja Modreker
- Clinic for Geriatric Medicine and Geriatric Rehabilitation, Helios Kliniken Schwerin, Schwerin, Germany
| | - Martin Jäger
- Clinic for Geriatric Medicine, St. Vinzenz-Hospital Dinslaken, Dinslaken, Germany
| | - Rainer Wirth
- St. Marien-Hospital Borken, Department for Geriatric Medicine, Borken, Germany
- Institute for Biomedicine of Aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Germany
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Abrahamsen JF, Monsen ALB, Landi F, Haugland C, Nilsen RM, Ranhoff AH. Readmission and mortality one year after acute hospitalization in older patients with explained and unexplained anemia - a prospective observational cohort study. BMC Geriatr 2016; 16:109. [PMID: 27221100 PMCID: PMC4879736 DOI: 10.1186/s12877-016-0284-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/16/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Few studies have examined whether specific subtypes of anemia in older persons are more related to adverse outcomes such as hospital readmissions and death after acute hospitalization and post-acute care. METHODS An observational prospective cohort study was conducted between 2011 and 2014. A total of 884 community-dwelling patients, ≥70 years of age were transferred from acute medical and orthopaedic hospital departments to a skilled nursing home where they were examined by comprehensive geriatric assessment and had laboratory tests taken for the investigation of anemia. They were divided into three major groups and compared; 1) no anemia (reference group), 2) explained anemia (renal insufficiency, iron deficiency, vitaminB12/folate deficiency or multifactorial anemia) and 3) unexplained anemia. The groups were compared, and association of anemia with hospital readmission and death was estimated by logistic regression analyses. RESULTS Compared to the patients with unexplained anemia (n=135), patients with explained anemia (n=275) had more often died (22 % vs. 14 %, p=0.05) and had more frequenlty been readmitted to hospital (39 % vs. 27 %, p=0.03). Compared to the patients without anemia (n=474), the patients with explained anemia had increased odds of hospital readmissions (OR = 1.54 (95 % CI: 1.05-2.25), p=0.03), while patients with unexplained anemia, (n=135), had neither increased odds of hospital readmissions, (OR=0.83, 95 % CI: 0.51-1.34, p=0.44) nor death (OR = 0.74, 95 % CI: 0.41-1.31, p=0.30), in adjusted regression analysis. CONCLUSION Since no increased risk of hospital readmissions or death was seen in older patients with unexplained anemia in the first year after acute hospitalization, no further invasive investigations might be necessary to investigate the cause of anemia in these patients. A close clinical follow up might be the best way to care for older patients with a mild and unexplained anemia.
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Affiliation(s)
- Jenny Foss Abrahamsen
- Kavli Research Centre for Geriatrics and Dementia, Haraldsplass Deaconess Hospital, Ulriksdal 8, Bergen, 5009, Norway. .,Department of Nursing Home Medicine, Municipality of Bergen, Norway.
| | | | - Francesco Landi
- Facoltà di Medicina e chirurgia, Universita Cattoloca del Sacro Cuore, Rome, Italy
| | | | - Roy Miodini Nilsen
- Centre for Clinical Research, Haukeland -University Hospital, Bergen, Norway
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Hirani V, Naganathan V, Blyth F, Le Couteur DG, Seibel MJ, Waite LM, Handelsman DJ, Hsu B, Cumming RG. Low Hemoglobin Concentrations Are Associated With Sarcopenia, Physical Performance, and Disability in Older Australian Men in Cross-sectional and Longitudinal Analysis: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2016; 71:1667-1675. [PMID: 26994391 DOI: 10.1093/gerona/glw055] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 03/01/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this study is to examine associations between Hb levels and sarcopenia, low muscle strength, functional measures, and activities of daily living (ADL) and instrumental ADL (IADL) disabilities in older Australian men. METHODS Men aged 70 years and older (2005-2007) from the Concord Health and Ageing in Men Project were assessed at baseline (n = 1,705), 2 years (n = 1,367), and 5 years (n = 958). The main outcome measurements were walking speed, muscle strength, ADL and IADL disabilities, and sarcopenia using the Foundation for the National Institutes of Health criteria (low appendicular lean mass adjusted for body mass index < 0.789 and poor grip strength < 26kg). Analysis was performed using Hb levels as a continuous measure, unadjusted and adjusted by age, income, body mass index, measures of health, estimated glomerular function, inflammatory markers, and medication use. Receiver operating characteristic curve analysis was performed to determine a threshold of Hb for each outcome. RESULTS In cross-sectional and longitudinal analysis, for every 1g/dL increase in Hb, there was a significant reduction in risk of sarcopenia, slow walking speed, poor grip strength, inability to perform chair stands, and ADL and IADL disabilities in unadjusted, age-adjusted, and multivariate-adjusted analysis. The highest value of the Youden Index for Hb was 14.2g/dL for sarcopenia and grip strength, 14.5g/dL for walking speed, and 14.4g/dL for all other outcomes. CONCLUSION Declines in Hb levels over time are associated with poor functional outcomes. The risks and benefits of interventions to increase Hb among older men warrant further investigation to differentiate whether this is an active contributor to age-related debility or a passive biomarker of it.
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Affiliation(s)
- Vasant Hirani
- School of Life and Environmental Sciences Charles Perkins Centre, .,Centre for Education and Research on Ageing, Concord Hospital.,The ARC Centre of Excellence in Population Ageing Research
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Hospital
| | - Fiona Blyth
- Centre for Education and Research on Ageing, Concord Hospital
| | | | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, Department of Endocrinology and Metabolism, Concord Hospital
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Hospital
| | - David J Handelsman
- Department of Andrology, ANZAC Research Institute, Concord Hospital, and
| | - Ben Hsu
- Department of Andrology, ANZAC Research Institute, Concord Hospital, and
| | - Robert G Cumming
- Centre for Education and Research on Ageing, Concord Hospital.,The ARC Centre of Excellence in Population Ageing Research.,School of Public Health, University of Sydney, New South Wales, Australia
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