Frailty, nutrition-related parameters, and mortality across the adult age spectrum

Abstract

BackgroundNutritional status and individual nutrients have been associated with frailty in older adults. The extent to which these associations hold in younger people, by type of malnutrition or grades of frailty, is unclear. Our objectives were to (1) evaluate the relationship between individual nutrition-related parameters and frailty, (2) investigate the association between individual nutrition-related parameters and mortality across frailty levels, and (3) examine whether combining nutrition-related parameters in an index predicts mortality risk across frailty levels.MethodsThis observational study assembled 9030 participants aged ≥ 20 years from the 2003–2006 cohorts of the National Health and Nutrition Examination Survey who had complete frailty data. A 36-item frailty index (FI) was constructed excluding items related to nutritional status. We examined 62 nutrition-related parameters with established cut points: 34 nutrient intake items, 5 anthropometric measurements, and 23 relevant blood tests. The 41 nutrition-related parameters which were associated with frailty were combined into a nutrition index (NI). All-cause mortality data until 2011 were identified from death certificates.ResultsAll 5 anthropometric measurements, 21/23 blood tests, and 19/34 nutrient intake items were significantly related to frailty. Although most nutrition-related parameters were directly related to frailty, high alcohol consumption and high levels of serum alpha-carotene, beta-carotene, beta-cryptoxanthin, total cholesterol, and LDL-c were associated with lower frailty scores. Only low vitamin D was associated with increased mortality risk across all frailty levels. Seventeen nutrition-related parameters were associated with mortality in the 0.1–0.2 FI group, 11 in the 0.2–0.3 group, and 16 in the > 0.3 group. Overall, 393 (5.8%) of the participants had an NI score less than 0.1 (abnormality in ≤ 4 of the 41 parameters examined). Higher levels of NI were associated with higher mortality risk after adjusting for frailty and other covariates (HR per 0.1: 1.19 [95%CI 1.133–1.257]).ConclusionsMost nutrition-related parameters were correlated to frailty, but only low vitamin D was associated with higher risk for mortality across levels of frailty. As has been observed with other age-related phenomena, even though many nutrition-related parameters were not significantly associated with mortality individually, when combined in an index, they strongly predicted mortality risk.

Genetically-predicted life-long lowering of low-density lipoprotein cholesterol is associated with decreased frailty: A Mendelian randomization study in UK biobank

“…To our knowledge, this is the first study to use MR to quantify the effect of lipid lowering on frailty. Some observational studies—results of which are prone to confounding—observed a null or an opposite association between the two [29,30]. Hypercholesterolaemia may influence frailty via several underlying mechanisms, including the promotion of endothelial dysfunction and inflammation [31,32].…”

What Enables Individuals to Be More Physically Active across Levels of Frailty?

“…There is also a stronger relationship between frailty with physical inactivity and high sedentary levels, therefore individual frailty deficits may influence physical inactivity and sedentary behavior in meaningful ways beyond investigation of movement behaviors (sedentary time and physical activity) in isolation [24,25]. The effect of health deficits on other health behaviors such as nutrition is also a worthwhile area of inquiry [26,27].…”

The Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess Frailty

“…In this study, we propose scoring one point for every additional level of the PFFS for a total score 0–43; however, future testing will determine at what score of the PFFS various frailty levels can be operationalized. Currently, the 0.1, 0.2, 0.3, and 0.45 (20,21) cut points to capture vulnerability, and mild, moderate, and severe frailty correspond to 4, 9, 13, and 19 on the raw PFFS score.…”