福州成年人群体成分与高血压风险评估

目的 分析福州地区成年人群体成分特点并建立估测体脂含量(%BF)的回归方程,评估%BF对高血压患病风险的预测价值.方法 抽样人群602人(男性310人,女性292人),各年龄层人数比符合福州地区常住(5年及以上)居民年龄构成比.测量人选人群的血压、身高、体重、腰围、体重指数(BMI)等,应用双能X线骨密度仪(DEXA)检测体成分指标(总体脂肪、瘦组织质量).分析抽样人群的腰围、BMI和体成分特征,X2检验分析与BMI≥25 kg/m2诊断一致性的腰围和%BF切点,多元回归分析建立估测人群%BF的回归方程,logistic回归分析%BF对高血压患病风险的预测.结果 成年男、女性人群的%BF、脂肪质量/瘦组织质量随年龄增长而增加,女性%BF明显高于男性.与BMI≥325 kg/m2诊断一致性最高的腰围和%BF切点分别为85 cm、25%(男)和80 cm、35%(女).Logistic回归分析显示,年龄每增加一个等级的高血压患病比数比为1.49(男)和1.75(女),%BF每增加一个等级的高血压患病比数比为1.57(男)和1.65(女),BMI和腰围未能进入回归方程.结论 与BMI 25 kg/m2作为肥胖判定切点一致的%BF切点为25%(男)和35%(女),体成分分析能更好地预测高血压的患病风险.     

Measuring frailty in Dutch community-dwelling older people: Reference values of the Tilburg Frailty Indicator (TFI)

ObjectivesThe objectives of this study were to provide reference values of the Tilburg Frailty Indicator (TFI) for community-dwelling older people by age, sex, marital status, ethnicity, education, income, and residence, and examine the effects of these seven socio-demographic variables on frailty.Methods47,768 individuals aged 65 years and older living in the Netherlands completed a health questionnaire (58.5% response rate), including the TFI. The TFI is a self-report questionnaire for measuring frailty, developed from an integral approach of frailty, including physical, psychological, and social domains.ResultsReference values were provided for men and women separately, as a function of age. We found associations of all socio-demographic variables with frailty, also after controlling for the effects of age. These associations held for both sexes and for big cities as wells as more rural areas. For instance, the effect of age was large for total and physical frailty, women were more frail than men, and some very large average frailty differences between the ethnic groups were found, with autochthon people having the lowest frailty score.ConclusionsIn conclusion, this study offers reference values of the TFI by socio-demographic characteristics and explains frailty using these characteristics. This information will support researchers, policymakers and health care professionals in interpreting scores of the TFI, which may guide their efforts to reduce frailty and its adverse outcomes.     

Frailty and Chronic Kidney Disease: The Third National Health and Nutrition Evaluation Survey

Background

Frailty is common in the elderly and in persons with chronic diseases. Few studies have examined the association of frailty with chronic kidney disease.

Methods

We used data from the Third National Health and Nutrition Examination Survey to estimate the prevalence of frailty among persons with chronic kidney disease. We created a definition of frailty based on established validated criteria, modified to accommodate available data. We used logistic regression to determine whether and to what degree stages of chronic kidney disease were associated with frailty. We also examined factors that might mediate the association between frailty and chronic kidney disease.

Results

The overall prevalence of frailty was 2.8%. However, among persons with moderate to severe chronic kidney disease (estimated glomerular filtration rate < 45 mL/min/1.73 m²), 20.9% were frail. The odds of frailty were significantly increased among all stages of chronic kidney disease, even after adjustment for the residual effects of age, sex, race, and prevalent chronic diseases. The odds of frailty associated with chronic kidney disease were only marginally attenuated with additional adjustment for sarcopenia, anemia, acidosis, inflammation, vitamin D deficiency, hypertension, and cardiovascular disease. Frailty and chronic kidney disease were independently associated with mortality.

Conclusion

Frailty is significantly associated with all stages of chronic kidney disease and particularly with moderate to severe chronic kidney disease. Potential mechanisms underlying the chronic kidney disease and frailty connection remain elusive.     

Frailty prevalence using Frailty Index,associated factors and level of agreement among frailty tools in a cohort of Japanese older adults

Frailty prevalence defined by the deficit accumulation model (Frailty Index) has limited exploration in a Japanese population. The objective of this paper is to investigate the prevalence of frailty by Frailty Index among a cohort of healthy Japanese older adults, define risk factors associated with pre-frailty and frailty status and evaluate Frailty Index's agreement with Frailty Phenotype and Kihon checklist.MethodsData from 673 participants of the 2014 wave of the Nagoya Longitudinal Study - Healthy Elderly were used. Annual assessments include investigation of mood, memory, health status, nutrition, physical performance and oral health. The Frailty Index was compared to Frailty Phenotype and Kihon Checklist, and factors associated to Frailty Index were investigated through univariate and multivariate logistic regression.ResultsFrailty prevalence was 13.5% (n = 91) by Frailty Index, 1.5% (n = 10) by Frailty Phenotype and 4% (n = 27) by Kihon Checklist. Although the correlations between the three scales were moderate to high, the agreement between the scales was poor. In terms of risk factors, age, polypharmacy and physical activity level were associated with being pre-frail and frail. Having a higher waist circumference was associated with being pre-frail, and lower handgrip strength and lower walking speed were associated with being frail.ConclusionsThe Frailty Index showed similar metrics and agreement comparable to findings of previous studies, and was able to identify a higher number of individuals who were pre-frail and frail. Age, polypharmacy, physical activity, waking speed and waist circumference were associated with pre-frailty and frailty by frailty index.     

Cross-sectional and Longitudinal Associations of Environmental Factors with Frailty and Disability in Older People

PurposeTo determine cross-sectional and longitudinal associations of environmental factors with frailty and disability.MethodsThis study was conducted in a sample of Dutch citizens. At baseline the sample consisted of 429 subjects (aged ≥ 65 years); a subset of this sample participated again two and half years later (N = 355). The participants completed a web-based questionnaire, “the Senioren Barometer”, comprising seven scales for assessing environmental factors, and the Tilburg Frailty Indicator (TFI) and the Groningen Activity Restriction Scale (GARS), for assessing frailty and disability, respectively. Environmental factors of interest were: nuisance; housing; facilities; residents; neighborhood; stench/noise; and traffic.ResultsSequential regression analyses demonstrated that all environmental factors together explained a significant part of the variance of physical and social frailty and disability in performing activities of daily living (ADL) and instrumental activities of daily living (IADL), measured at Time 1 (T1) and Time 2 (T2). These analyses also showed that four of the environmental factors were associated with at least one of the outcome measures: housing, nuisance, residents, and neighborhood. Housing was the only environmental factor associated with three different outcome measures (social frailty, ADL disability, IADL disability), assessed at T1 and T2.ConclusionThe findings offer health-care and welfare professionals and also policymakers starting points for interventions. These interventions should focus, in particular, on housing, nuisance, residents, and neighborhood, because their impact on frailty and/or disability was the largest.     

Fitness but not weight status is associated with projected physical independence in older adults

Obesity and fitness have been associated with older adults’ physical independence. We aimed to investigate the independent and combined associations of physical fitness and adiposity, assessed by body mass index (BMI) and waist circumference (WC) with the projected ability for physical independence. A total of 3496 non-institutionalized older adults aged 65 and older (1167 male) were included in the analysis. BMI and WC were assessed and categorized according to established criteria. Physical fitness was evaluated with the Senior Fitness Test and individual test results were expressed as Z-scores. Projected ability for physical independence was assessed with the 12-item composite physical function scale. Logistic regression was used to estimate the odds ratio (OR) for being physically dependent. A total of 30.1 % of participants were classified as at risk for losing physical independence at age 90 years. Combined fitness and fatness analysis demonstrated that unfit older adults had increased odds ratio for being physically dependent in all BMI categories (normal: OR = 9.5, 95 %CI = 6.5–13.8; overweight: OR = 6.0, 95 %CI = 4.3–8.3; obese: OR = 6.7, 95 %CI = 4.6–10.0) and all WC categories (normal: OR = 10.4, 95%CI = 6.5–16.8; middle: OR = 6.2, 95 %CI = 4.1–9.3; upper: OR = 7.0, 95 %CI = 4.8–10.0) compared to fit participants that were of normal weight and fit participants with normal WC, respectively. No increased odds ratio was observed for fit participants that had increased BMI or WC. In conclusion, projected physical independence may be enhanced by a normal weight, a normal WC, or an increased physical fitness. Adiposity measures were not associated with physical independence, whereas fitness is independently related to physical independence. Independent of their weight and WC status, unfit older adults are at increased risk for losing physical independence.     

Associations between multidimensional frailty and quality of life among Dutch older people

PurposeTo examine the associations between components of physical, psychological and social frailty with quality of life among older people.MethodsThis cross-sectional study was carried out in a sample of Dutch citizens. A total of 671 people aged 70 years or older completed a web-based questionnaire (‘the Senioren Barometer’). This questionnaire contained the Tilburg Frailty Indicator (TFI) for measuring physical, psychological and social frailty, and the WHOQOL-OLD for measuring six quality of life facets (sensory abilities, autonomy, past, present and future activities, social participation, death and dying, intimacy) and quality of life total.ResultsNine of fifteen individual frailty components had an effect on at least one facet of quality of life and quality of life total, after controlling for socio-demographic factors, multimorbidity and the other frailty components. Of these nine components five, two and two refer to physical, psychological and social frailty, respectively. Feeling down was the only frailty component associated with all quality of life facets and quality of life total. Both physical inactivity and lack of social relations were associated with four quality of life facets and quality of life total.ConclusionThis study showed that quality of life in older people is associated with physical, psychological and social frailty components, emphasizing the importance of a multidimensional assessment of frailty. Health care and welfare professionals should in particular pay attention to feeling down, physical inactivity and lack of social relations among older people, because their relation with quality of life seems to be the strongest.     

Frailty in NHANES: Comparing the frailty index and phenotype

The two most commonly employed frailty measures are the frailty phenotype and the frailty index. We compared them to examine whether they demonstrated common characteristics of frailty scales, and to examine their association with adverse health measures including disability, self-reported health, and healthcare utilization. The study examined adults aged 50+ (n = 4096) from a sequential, cross-sectional sample (2003–2004; 2005–2006), National Health and Nutrition Examination Survey. The frailty phenotype was modified from a previously adapted version and a 46-item frailty index was created following a standard protocol. Both measures demonstrated a right-skewed distribution, higher levels of frailty in women, exponential increase with age and associations with high healthcare utilization and poor self-reported health. More people classified as frail by the modified phenotype had ADL disability (97.8%) compared with the frailty index (56.6%) and similarly for IADL disability (95% vs. 85.6%). The prevalence of frailty was 3.6% using the modified frailty phenotype and 34% using the frailty index. Frailty index scores in those who were classified as robust by the modified phenotype were still significantly associated with poor self-reported health and high healthcare utilization. The frailty index and the modified frailty phenotype each confirmed previously established characteristics of frailty scales. The agreement between frailty and disability was high with each measure, suggesting that frailty is not simply a pre-disability stage. Overall, the frailty index classified more people as frail, and suggested that it may have the ability to discriminate better at the lower to middle end of the frailty continuum.     

Predicting metabolic syndrome by anthropometric measures among adults 35–65 years in the west of Iran; a cross sectional study from an Iranian RaNCD cohort data

AimsAnthropometric indices have been proposed for the early detection of metabolic syndrome (MetS) and its risk factors. The present study aimed to determine optimal cutoff points for the Body Mass Index (BMI), Waist Circumference (WC), and Waist Hip Ratio (WHR) in the prediction of MetS.MethodsThis cross-sectional study was performed on 9746 adults 35–65 years, recruited in Ravansar Non-Communicable Diseases (RaNCD) cohort. The receiver operating characteristic (ROC) curve analysis was used to compare the predictive validity and determine optimal cutoff values.ResultsThe optimal cutoff points for BMI, WC and WHR were 27.3 kg/m² (AUC: 78.6; 95%CI 77.1, 80.1), 97 cm (AUC: 63.8; 95%CI 60.4, 67.2) and 0.95 (AUC: 75.5; 95% CI 73.9, 77.1), respectively in men for the prediction of MetS. But in women the optimal cutoff points for BMI, WC and WHR were 28.6 kg/m² (AUC: 65.7; 95%CI 62.1, 69.4), 98.1 cm (AUC: 65.6; 95%CI 62.4,68.8) and 0.95 (AUC:62.39; 95%CI 60.9,63.9). The risk of MetS in men and women with a BMI higher than the optimal cutoff point was respectively 2.23 and 2.30 times higher than that in those with a WC lower than the cutoff point.ConclusionsBMI is a better predictor of MetS than WC and WHR in adults 35–65 years. We recommend that the optimal cut off point be set for men 27.3 kg/m² and for women 28.6 kg/m².     

Sex differences in sarcopenia and frailty among community-dwelling Korean older adults with diabetes: The Korean Frailty and Aging Cohort Study

Aims/IntroductionWe aimed to examine the prevalence of sarcopenia and frailty in Korean older adults with diabetes compared with individuals without diabetes.Materials and MethodsWe analyzed the data of 2,403 participants aged 70–84 years enrolled in the Korean Frailty and Aging Cohort Study. Sarcopenia was defined using the Asian Working Group for Sarcopenia and the Foundation for the National Institutes of Health. Frailty was assessed by the Cardiovascular Health Study frailty phenotype criteria.ResultsThe mean age of the participants was 76.0 ± 3.9 years, and 47.2% were men. The prevalence of diabetes was 30.2% in men and 25.8% in women. Adults with diabetes showed a lower muscle mass index (appendicular skeletal muscle mass/body mass index) and handgrip strength in both sexes, but only the women showed decreased physical performance. Women with diabetes presented a higher prevalence of sarcopenia diagnosed by the Foundation for the National Institutes of Health criteria, and frailty compared with participants without diabetes (sarcopenia 14.7% vs 8.5%, P = 0.001; frailty 9.5% vs 4.9%, P = 0.003). Men in the high and middle tertiles for homeostatic model assessment of insulin resistance presented a significantly higher prevalence of sarcopenia, compared with men in the low tertile homeostatic model assessment of insulin resistance (high tertile 16.6%, middle tertile 13.3%, low tertile 8.6%).ConclusionsIn older adults with diabetes, muscle mass index and muscle strength were lower than in those without diabetes. However, the prevalence of sarcopenia and frailty was higher and physical performance was lower only in women with diabetes.     

Frailty and chronic diseases in older adults

There are two hallmarks of aging that must be considered primary concerns when trying to improve health for older adults: frailty and chronic diseases. Some pathologic mechanisms related to diseases may help to explain frailty. This article describes known associations among frailty and chronic diseases and introduces punished inefficiency as an explanatory framework for frailty. Punished inefficiency proposes that having several physiologic impairments leads to physiologic inefficiencies. These inefficiencies may become manifest as frailty, often in the presence of disease. Therefore, frail older adults perform less external work because they must spend more on an absolute scale out of a smaller pool of internal resources. Stress imposed on frail older adults strengthens this negative feedback to activity, leading to disuse. This article discusses how people with frailty and chronic diseases may experience a malignant course and thereby intends to improve the ability to identify beneficial biologic and health care delivery strategies for older adults with, or at risk of, frailty.     

Body mass index,waist circumference,body fat mass,and risk of developing hypertension in normal-weight children and adolescents

Background and aims

We prospectively examined the association between three adiposity indices, including body mass index (BMI), waist circumference (WC), and percentage of body fat (PBF), and risk of hypertension in normal-weight Chinese children.

The effects of physical activity, body mass index (BMI) and waist circumference (WC) on glucose intolerance in older people: A nationwide study from Taiwan

We investigated the gender-specific effects of physical activity, BMI and WC on glucose intolerance in an elderly Taiwanese population (n = 1344) aged 65 and above, who participated in the Elderly Nutrition and Health Survey in Taiwan in 1999-2000. In this cross-sectional study, physical activity was assessed using the Modified Baecke Questionnaire for Older Adults (MBQOA). Categories of physical activity level were defined by tertiles of MBQOA scores. Glucose intolerance in subjects not previously diagnosed with diabetes was categorized according to 2003 American Diabetes Association criteria. After adjustment for potential confounders, physical activity was significantly inversely associated with the presence of undiagnosed type 2 diabetes and impaired fasting glucose (IFG) in older women. In older men, the association was less clear. BMI and WC were significantly positively associated with the presence of undiagnosed diabetes in men and were significantly associated with IFG in both sexes. In older women, undiagnosed diabetes was strongly associated with increased WC, but not with BMI. Our findings highlight that older women with low physical activity or high WC, and older men with high BMI or WC are important target populations for interventions to prevent glucose intolerance.     

A comparison between physical and biopsychosocial measures of frailty: Prevalence and associated factors in Brazilian older adults

PurposeTo estimate the prevalence of frailty, according to Tilburg Frailty Indicator (TFI) and CHS index, to investigate the correlation between both instruments and to identify the factors associated with this condition in older users of primary health care.MethodsThis is a sectional study with 302 individuals aged 60 years or more of Rio de Janeiro/Brazil. Sociodemographic, health, functional dependence and lifestyle variables were collected. Frailty was evaluated by the TFI (biopsychosocial frailty) and the CHS index (physical frailty).ResultsThe prevalence of frailty estimated by the TFI was 35.8% and by the CHS index was 23.5%, while 19.2% were considered frail by both instruments. Significant correlations were observed between the two measures (r = 0.675, p < 0.001) and between the CHS index and the physical (r = 0.744, p < 0.001) and psychological domains (r = 0.322, p < 0.001) of the TFI. Considering the TFI, sex, age, healthy lifestyle, osteoarticular diseases, stroke/ischemia and functional dependence in IADL were associated with frailty. By the CHS index, marital status, satisfaction with housing environment, osteoarticular diseases, medication, functional dependence in ADL and IADL were associated with frailty.ConclusionOur study demonstrates that the CHS index and the TFI identify different groups of frail older adults, and the factors associated with physical frailty and biopsychosocial frailty, also differ. Both instruments seem suitable to be used by primary health care professionals in Brazil. Nevertheless, we believe that a fully self-rated assessment is more practical to be applied routinely in this level of attention in the country.     

Influences of body mass index and waist circumference on physical function in older persons with heart failure

BACKGROUND:

In older persons with heart failure (HF), body composition may influence physical function and treatment effectiveness. There is a lack of research concerning the associations between waist circumference (WC) or body mass index (BMI) and physical function in this population.

OBJECTIVE:

To determine whether BMI and WC are associated with physical function in older men and women with HF.

METHODS:

Seventy-one men and 36 women 65 years of age and older living with HF completed two surveys spaced three months apart. Height, weight, WC, time since diagnosis, edema, comorbidities and physical function were self-reported at baseline and follow-up. Physical function was determined using the physical component score of the Short Form-12 and the physical limitation domain (PLD) of the Kansas City Cardiomyopathy Questionnaire. Multivariate linear regression and analysis of covariance were used to evaluate the relationships between WC and BMI, as well as cross-classifications of WC and BMI with physical function, after adjusting for confounders and interactions.

RESULTS:

The cross-sectional and short-term follow-up analyses did not detect an association between WC or BMI and physical function, with the exception of changes in the PLD, which were significantly different across WC categories. Persons with a moderate WC experienced the greatest improvement in function. The physical component and PLD scores were lower than those reported by Canadians 75 years of age and older and stable HF patients, respectively. Women reported lower physical function scores than men.

CONCLUSION:

Findings from the present study indicate that older persons with HF, especially women, have poor physical functioning regardless of their WC or BMI.     

Frailty phenotype,frailty index and risk of mortality in Chinese elderly population- Rugao longevity and ageing study

Background: To explore the associations of frailty phenotype and frailty index (FI) defined frailty and pre-frailty with mortality in a Chinese elderly population.Methods: Data of 1788 community-dwelling elders aged 70–84 years from the ageing arm of Rugao Longevity and Ageing Study, a prospective cohort study, were used. Frailty phenotype was defined using modified Fried’s phenotype (FP) criteria and FI was constructed using 45 health deficits. Mortality was ascertained using the Death Registry of Rugao's Civil Affairs Bureau.Results: During 3-year follow-up, 149 (8.3%) of the 1788 elderly subjects died. For frailty phenotype, about 9.5% of the elderly were frail and 43% were pre-frail. For FI, frail (FI > 0.21) was approximately 27.5%, and pre-frail (FI: 0.1–0.21) was approximately 51.3%. Highest mortality was observed among frail participants defined by both FP and FI criteria (all Log Rank P < 0.05). Frailty defined by the frailty index was associated with a 2.31 fold (95% CI 1.16–4.6) risk of all-cause death compared with robust elderly. Compared with the robust elderly, not only frailty (HR 2.24, 95% CI 1.31–3.83) defined by frailty phenotype but also pre-frailty (HR 1.51, 95% CI 1.03–2.21) was associated with risk of all-cause mortality.Conclusions: Frailty, defined by either phenotype or index, is associated with increased risks of mortality in elderly Chinese community population.     

Body composition and hip fracture type in elderly women

Many observations support the view that there are significant differences between patients sustaining trochanteric fractures and those sustaining cervical fractures of the hip. Our aim was to evaluate the association between soft tissue composition (fat and lean compartments) and the type of hip fracture sustained. Of 120 consecutive women affected by their first hip fracture admitted to our rehabilitation hospital 102 were included in this cross-sectional study. Body composition was assessed by DXA. Body fat mass was lower in the women with trochanteric fracture than in those with cervical fracture (difference between groups: 2.86 kg; 95% CI 0.10–5.61 kg; p=0.042). The percentage of fat was 30.75±8.77 (mean±SD) versus 34.75±7.29 (difference between groups: 4.00; 95% CI 0.84–7.16; p=0.014). In contrast, no meaningful differences in body lean mass were shown between the two groups. Logistic multiple regression showed that fat mass was associated with the type of fracture independently of age, height, weight, time between fracture occurrence and DEXA assessment, comorbidity, number of drugs in use, lean mass and bone mineral content. The logistic regression results were similar when fat percentage was substituted for fat mass. The data show that fat but not lean body mass is associated with the type of hip fracture, contributing to the definition of the differences between patients sustaining cervical or trochanteric fractures. We stress the importance of distinguishing the two types of fracture when clinical or epidemiological studies related to body composition, including those regarding nutrition or physical exercise, are performed.Abbreviations BMD Bone mineral density - DEXA Dual-energy X-ray absorptiometry - BMC Bone mineral content     

Predictive validity of the Brazilian version of the Tilburg Frailty Indicator for adverse health outcomes in older adults

PurposeThis study aimed to determine the predictive value of the Brazilian Tilburg Frailty Indicator (TFI) for adverse health outcomes (falls, hospitalization, disability and death), in a follow-up period of twelve months.MethodsThis longitudinal study was carried out with a sample of people using primary health care services in Rio de Janeiro, Brazil. At baseline the sample consisted of 963 people aged 60 years and older. A subset of all respondents participated again one year later (n = 640, 66.6% response rate). We used the TFI, the Katz’s scale for assessing ADL disability and the Lawton Scale for assessing IADL disability. Falls, hospitalization and death were also assessed using a questionnaire.ResultsThe prevalence of frailty was 44.2% and the mean score of the TFI was 4.4 (SD = 3.0). There was a higher risk of loss in functional capacity in ADL (OR = 3.03, CI95% 1.45–6.29) and in IADL (OR = 1.51, CI95% 1.05–2.17), falls (OR = 2.08, CI95% 1.21–3.58), hospitalization (OR = 1.83, CI95% 1.10–3.06), and death (HR = 2.73, CI95% 1.04–7.19) for frail when compared to non-frail elderly, in the bivariate analyses. Controlling for the sociodemographic variables, the frailty domains together improved the prediction of hospitalization, falls and loss in functional capacity in ADL, but not loss in functional capacity in IADL.ConclusionThe TFI is a good predictor of adverse health outcomes among elderly users of primary care services in Brazil and appears an adequate and easy to administer tool for monitoring their health conditions.