Circulating Micronutrient Biomarkers Are Associated With 3 Measures of Frailty: Evidence From the Irish Longitudinal Study on Ageing

Abstract

Keywords:Micronutrients biomarkers frailty aging a b s t r a c t Objectives: To examine the associations between 3 frailty instruments and circulating micronutrients in a large representative sample of older adults. Design: Cross-sectional data from a nationally representative cohort study conducted between October 2009 and July 2011. Participants and setting: Adults age !50 years (n ¼ 4068) living in the community in Ireland. Measurements: Circulating micronutrients (lutein, zeaxanthin, folate, vitamin B-12, and vitamin D) were measured, transformed, and standardized. Frailty was assessed using the Frailty Phenotype, the Frailty Index, and the FRAIL Scale (fatigue, resistance, ambulation, illnesses, and loss of weight), instruments. Multinomial logistic regression determined associations between micronutrients and prefrailty or frailty. Models were adjusted for sociodemographic, lifestyle, health, and seasonal factors. Results: Adjusting for age, sex, and educational attainment, all 3 measures of frailty were associated with lower levels of lutein [relative risk ratios (RRRs): 0.43-0.63], zeaxanthin (RRRs: 0.49-0.63), and vitamin D (RRRs: 0.51-0.75), and with the accumulation of micronutrient insufficiencies (RRRs: 1.42-1.90). Attenuated but significant associations were also observed with all measures of prefrailty for lutein, vitamin D, and number of micronutrient insufficiencies. The associations with frailty persisted following additional adjustment for social, lifestyle, and health and seasonal factors, and following multiple test correction. Conclusions and implications:We have presented the most consistent evidence in the largest study to date that micronutrient concentrations are associated with prefrailty and frailty in older adults. Our data suggest that low micronutrient status has potential as an easily modifiable marker and intervention target for frailty and supports further investigation into micronutrient supplementation and fortification to prevent frailty and disability among older adults.

Role of Dietary Carotenoids in Frailty Syndrome: A Systematic Review

“…Figure 2 depicts a graph representation of the findings. We found moderate (n = 3) [36,38,40] to high (n = 8) methodological quality among the studies (Table 4). An overview of quality ratings within and across studies is provided in Figure 3 (panel A and B), highlighting areas with higher or lower ratings.…”

“…Then, 16 were excluded due to not meeting the characteristics of the approach or the review goal. After reviewing the full text of the remaining 36 records, only 11 met the inclusion criterion of age and were included in the final qualitative analysis [33][34][35][36][37][38][39][40][41][42][43]. Figure 1 illustrates the number of studies at each level of the review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow chart.…”

“…As regards the assessment tool used to evaluate physical frailty, the majority of studies used the CHS phenotype by Fried (n = 9), while one study applied two other additional constructs, i.e., the Frailty Index (FI) and the FRAIL Scale, and a minority (n = 2) used surrogate measures such as grip/hip/knee strength or gait speed. Among the investigated carotenoids, lutein/zeaxanthin (seven studies [34,37,[39][40][41][42][43]), α-carotene (seven studies [33,34,[37][38][39]41,43]), and β-carotene (seven studies [33,34,[37][38][39]41,43]) presented a higher burden of evidence, followed by total carotenoids (five studies [33][34][35][36]43]), β-cryptoxanthin (five studies [33,[37][38][39]41]), and lycopene (four studies [37,39,41,43]). Studies investigating plasma concentrations of lutein/zeaxanthin against the presence of physical frailty, in some instances assessing different levels of exposure (tertiles [39] or quartiles [34]), found an inverse relationship; only one study evaluated dietary intake as exposure [43] and found the same direction of the association.…”

Frail by different measures: a comparison of 8-year mortality in The Irish Longitudinal Study on Ageing (TILDA)

“… Morley’s FRAIL scale (frail if ≥ 3 among fatigue, resistance, ambulation, illnesses, and loss of weight). This was operationalised in TILDA as previously described [ 11 ]. A 32-item Frailty Index (FI ≥ 0.25), the description of which has been detailed elsewhere [ 12 ], and the Clinical Frailty Scale classification tree (CFS ≥ 5), as detailed elsewhere [ 13 ].…”

“…Morley’s FRAIL scale (frail if ≥ 3 among fatigue, resistance, ambulation, illnesses, and loss of weight). This was operationalised in TILDA as previously described [ 11 ].…”